Program Summary

Security Health Plan of Wisconsin, Inc. is a health maintenance organization, sponsored by Marshfield Clinic. Security Health Plan serves more than 182,000 members in a 32-county service area of Wisconsin through its commercial plans, Medicare Advantage plans and BadgerCare Plus Managed Care Program. Security Health Plan is the fourth largest health maintenance organization in Wisconsin and has a broad provider network of 43 affiliated hospitals and more than 4,400 affiliated providers.

At Security Health Plan, we take an integrated approach to health care by working with providers and community organizations to make a healthy difference in the lives of our members. With the goal of providing consistent quality care for our members, quality improvement activities are undertaken in collaboration with our affiliated providers. This gives Security Health Plan the ability to tailor our programs to best serve our members.

In 2009, Security Health Plan’s Quality Improvement (QI) program saw great success. To ensure quality for our members, we evaluated performance measures, satisfaction surveys and nationally-recognized quality standards. Security Health Plan measured its performance based on the following:

• Healthcare Effectiveness Data and Information Set (HEDIS®*)

  HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Because so many plans collect HEDIS data and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples" basis.

  HEDIS addresses a broad range of important health issues. Among them are:

  • Effectiveness of care
  • Access/availability of care
  • Satisfaction with the experience of care

  Our HEDIS 2009 results showed that Security Health Plan’s cardiac care for our commercial membership ranked 10th in the nation.

  We use our HEDIS results to determine our direction and focus for quality improvement initiatives.

• Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey

  The CAHPS survey is a comprehensive survey that asks members to evaluate the interpersonal aspects of health care, or how your relationship is with your physician. The survey probes those aspects of care for which consumers and patients are the best source of information, as well as those issues that members have identified as being important. In 2009, Security Health Plan’s CAHPS results showed members’ rating of their personal provider and specialist as well as the rating of the Health Plan increased. Ensuring our members have a positive experience within our health system is an important area of focus for Security Health Plan.

• National Committee for Quality Assurance (NCQA) accreditation

  NCQA is an organization dedicated to improving health care quality. They award a “seal of excellence” to those health plans that have passed a rigorous, comprehensive review of their performance standards. The seal is a reliable indicator that a health plan is well managed and delivers high-quality care and service. Security Health Plan is proud to report that our commercial business has maintained an excellent accreditation status since 2002 and our Medicare Advantage (Advocare) product since 2005.

Accreditation

In 2009, Security Health Plan maintained an ‘Excellent’ NCQA status for both its commercial and Medicare Advantage products. Security Health Plan also achieved or maintained a high level of performance on many of the HEDIS measures, as well as the CAHPS satisfaction survey. Security Health Plan scored above the 90th percentile in 16 of the 22 accreditation clinical scored measures, and four of nine in member satisfaction.

We are also proud to report that Security Health Plan has been ranked by U.S. News & World Report/ NCQA America's Best Health Insurance Plans* for the past several years and is accredited by the National Committee for Quality Assurance (NCQA). This means you will receive some of the best health care and service available in the nation with Security Health Plan.

By implementing quality initiatives in collaboration with our affiliated providers, we are able to see great results in quality, as demonstrated above, and most importantly, make a difference in our members’ quality of care and quality of life.

Clinical quality improvements

Security Health Plan recognizes that keeping members informed empowers them to make educated choices that affect their health and well-being. We promote age -appropriate health services through newsletters, personalized mailings and through health and wellness information. In addition, we provide educational information and telephone coaching/outreach through our disease management programs and wellness initiatives.

We promote the following:

• Preventive screenings
• Breast cancer
• Cervical cancer
• Colorectal cancer
• Annual well-care visits
• Disease management
• Asthma
• Diabetes
• Cardiovascular
• Depression
• Healthy behaviors
• Tobacco cessation
• Physical activity
• Healthy eating
• Health risk assessments

Security Health Plan is continuously working to improve health care services for our members. Through our quality improvement initiatives, we have also identified areas where improvement opportunities exist, such as chlamydia screening, respiratory care and alcohol and drug treatment. We are continuing to evaluate ways to make these services more effective for our members.

Satisfaction

In 2009, Security Health Plan continued to work toward increasing member satisfaction with the Plan and with the health care delivery system.

Security Health Plan monitored its member satisfaction via the following:

• Expressions of satisfaction and dissatisfaction
  Security Health Plan monitored overall satisfaction with the Plan through analysis of positive comments, complaints, appeals and grievance data. In addition, the Plan assessed its member satisfaction with case and disease management programs. New members are also asked to complete a survey to assess their satisfaction with our written materials.
• Service Recovery
  In 2009, Security Health Plan continued to emphasize its service value proposition commitment and expand its service recovery program. Service recovery is a positive approach to complaint resolution. The purpose of this initiative is to improve member and provider satisfaction as demonstrated by fewer appeals and grievances submitted. This initiative proved to be successful in decreasing the number of appeals.
• Nurse Navigator program
  In 2009, Security Health Plan continued the Nurse Navigator program. The navigator is a registered nurse who serves as a resource for members, providers and facilities by providing direction, guidance and promoting access to appropriate health care services. This customer-focused navigator coordinates, responds and researches member, provider and staff questions related to conditions and their care. Member satisfaction with this program remains high.
• CAHPS satisfaction survey
  This survey is used to gain insight into member perceptions of the quality of services provided by a health plan and its providers. The survey is administered by an NCQA-certified CAHPS survey vendor

Security Health Plan also strives to ensure high provider satisfaction with the Plan. Our providers’ satisfaction is assessed via:

• Surveys to assess satisfaction with our:
• Utilization Management program
• Disease Management programs
• Case Management programs
• Surveys to ensure coordination between:
• Primary care providers and specialists
• Primary care providers and behavioral health providers.

Access and availability

Safety is an important component of our QI program. Security Health Plan promotes safety in a variety of ways, such as publishing patient safety information in our provider and member newsletters; promoting bicycle safety by hosting community Bike Rodeos and distributing helmets; monitoring affiliated hospitals for safe practices and providing notifications to members in the event of a drug recall.

Member safety

Overall in 2009, Security Health Plan’s Quality Improvement program saw great success in a dynamic health care environment. Even with difficult economic times and uncertainty in the health care industry, we have noted improvements in areas such as breast cancer screening and colorectal cancer screening. Challenges remain within certain areas. Security Health Plan is dedicated to continuous improvement in an effort to improve the lifestyle and quality of care our members receive and deserve.

** U.S. News/NCQA America’s Best Health Insurance Plans 2009-10. “America’s Best Health Insurance Plans” is a trademark of U.S. News & World Report.