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Nuestro programa de mejora de la calidad

En United Healthcare (UHC), nuestra misión es asistir a las personas para que sus vidas sean más saludables y hacer que el sistema de salud funcione mejor para todos. Brindamos servicios a miembros de Medicaid y MinnesotaCare en los condados de Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Washington y St. Louis. In St. Louis county, we also serve members with SNBC, MSHO, and MSC+. Además, en el condado de Scott, también brindamos servicio a miembros con SNBC. United Healthcare siempre está trabajando para mejorar la calidad de la atención médica y los servicios que reciben nuestros miembros. 

Cómo identificamos los problemas y los solucionamos

  • Usamos herramientas como datos y encuestas para encontrar áreas o grupos de personas que necesitan ayuda adicional.
  • Trabajamos con los proveedores y los miembros para asegurarnos de que nuestros miembros reciban la atención que necesitan cuando la necesitan.
  • Compartimos materiales de aprendizaje sobre la atención médica con proveedores y miembros.
  • Ofrecemos recompensas financieras para fomentar una mejor atención.
  • Los miembros con necesidades complejas reciben apoyo adicional de nuestros administradores de casos.
  • Nos reunimos con nuestros miembros en la comunidad.
  • Nos asociamos con grupos locales que apoyan a las comunidades a las que prestamos servicio.

Objetivos de calidad de United Healthcare

  • Promover programas y actividades de gestión de la salud de la población
  • Mejorar la experiencia de miembros y proveedores
  • Cumplir con los requisitos normativos y de acreditación
  • Brindar servicios a diversas poblaciones

Proyectos de mejora de la calidad

Familia y niños

What are we doing to improve pregnancies?

We want to help members have a healthy pregnancy and healthy baby. Healthy First Steps® is a program offered through your health plan. We will work with you and your provider to help you take healthy steps through pregnancy and after delivery. 

Nuestro programa ayuda a las miembros embarazadas antes y después de tener a sus bebés. We help with community resources, medical care, and behavioral health care. We guide you to have a healthy pregnancy, receive a car seat, and offer rewards for visiting the doctor. Ayudamos a las familias a obtener los cuidados y el apoyo que necesitan, cuando más lo necesitan.

What are some of the challenges to improving pregnancies? 

Puede ser difícil comunicarse con las mujeres miembro en la primera etapa de su embarazo si no sabemos que están embarazadas. Tampoco podemos ayudar si no tenemos la dirección o el número de teléfono correctos. Les pedimos a las mujeres miembro que se comuniquen con nosotros y con su condado cuando estén embarazadas o tengan un cambio de dirección o número de teléfono. Cuando nosotros y el condado tengamos esta información, podremos inscribirlas en nuestro programa. Esto asegura que las mujeres miembro embarazadas reciban todos los beneficios que ofrecemos. 

How can we help your baby to stay healthy? 

After the baby is born, it is important for the mom and baby to see the doctor. We can help with scheduling doctor appointments, answering questions, and arranging transportation. El proveedor examinará, por ejemplo, el peso, los ojos, los oídos y el corazón del bebé. As the baby grows older, the well-baby checks will teach parents how to raise a healthy child. Esto podría implicar hablar sobre ejercicio, alimentación saludable y cómo prevenir lesiones.

How do we know we made a difference? 

The goal of the program is to help our pregnant members and their babies be as healthy as possible. We look at data related to care access, health outcomes of our members, and if members are satisfied. Data is reviewed on an ongoing basis. An evaluation of the program also happens each year. In 2023, the nurse case managers helped 87% of our members with a high-risk pregnancy. They did this by helping them engage in care, removing barriers to care, and supporting improved birth outcomes. 

¿Cómo planeamos mejorar para marcar una diferencia saludable?  

We will continue to support our members getting to doctor appointments, access to doulas, food, transportation, car seats, and housing. In 2024, we plan to help educate members on how to have a healthy pregnancy and what resources United Healthcare can offer them.  Our goal is to help members have healthy pregnancies and remove barriers to care.

Seniors and SNBC

 

Why is it important to think about mental and physical health together?

It is important to think about the whole person when helping members. Together, diabetes and mental health can have a big impact on well-being. Studies have shown that people with diabetes are at a higher risk of having mental health challenges like depression and anxiety. Understanding the relationship between diabetes and mental health may lead to better outcomes for members. 

What are we doing to improve the health of those with diabetes and mental health issues?

United Healthcare can help members find community resources, medical care and behavioral health care. We give tips for how to manage your health and offer rewards for visiting the doctor. We help individuals get the care and support they need when they need it most.

What were some of the challenges to improving the health of those with diabetes and mental health issues?

It can be hard to help members get the care they need if they don’t know how to treat their medical conditions. Each member has a care coordinator who can help teach them how to care for their health needs. Many of our members live in places where it may be hard to get to the doctor’s office or clinic. To help, we work with members to set up rides to and from their appointments. Having access to the right care at the right time can reduce emergency room visits, hospitalizations, and even early death.

How do know we are making a healthy difference?

Our goal is for our members to be as healthy as possible. We look at data related to access to care, health outcomes of our members, and member satisfaction. Data is reviewed on an ongoing basis. 

¿Cómo planeamos mejorar para marcar una diferencia saludable?

We will continue to support our members by offering benefits such as food, transportation, and a dedicated care coordinator for each member. In 2024, we plan to learn more about our members needs and create resources to better support them. Our goal is to help members be healthy both mentally and physically. 

Quality Programs

The Quality Improvement Program Description provides details about what the health plan will do to make things better for our members. This document explains the steps we will take to review our programs and activities. An update of the program description happens every year. This year:

  • We will reward members for getting care.
  • We are working to reduce members needing to go back to the hospital.
  • We are focusing on health differences. 
  • We will achieve full NCQA Accreditation.
  • We are working to get member feedback.

We reviewed last year’s quality programs and activities to see how well we used our resources to improve our members’ health. We also review the quality and safety of our members’ clinical care. We wanted to know where we did a good job and how we can improve the programs for our members. We used the evaluation to plan for this year. Last year:

  • We made outreach to 93% of our members who were in the hospital for mental health.
  • We offered rewards to our members for prenatal and postnatal visits, immunizations, breast and cervical cancer screenings. 
  • We worked with 87% of our members with high-risk pregnancies.
  • We provided 2,600 meals for members recently leaving the hospital for medical or behavioral health.
  • We provided 16,300 meals for members leaving the hospital after the birth of a baby.
  • We included “bucket” car seats in the car seat benefit for our members.
  • We held 21 dental clinics at a local community center, held a coat give-away, and coordinated a Narcan training for the community. 
  • We assisted in the development of the Fairview Community Health & Wellness Hub.
  • We achieved NCQA Interim Accreditation.

We have a work plan that tracks our health plan goals, monitors quality improvement activities, and plans the services we provide to our members. We track issues and the planned interventions. The plan is reviewed and updated throughout the year. 

Health Equity

At United HealthCare, our mission to help people live healthier lives and to help make the health system work better for everyone. 

Health equity means that everyone has a fair and just opportunity to achieve their full health potential. Some of the things we did at United Healthcare:

  • 95% of our Minnesota staff did training and education on health differences through Health Equity University.
  • Health differences training was offered to all of our providers at no cost.
  • We worked with community organizations to understand how they are experiencing health differences. A few of them:
    • Karen Organization of Minnesota
    • Union Gospel Mission
    • Guiding Star Wakota
    • Hmong Nurses Association
    • Mount Airy Boys and Girls Club
    • Dorothy Day Center
  • Programs to address the health differences in maternal and child health.
    • Healthy First Start
    • Meals for Mom’s from Second Harvest Heartland
    • Boletín informativo para miembros de HealthTalk 
  • Promoting access to safe and affordable housing, nutritious food, and transportation. 
  • Focus on making health information easier to understand for our members.

We’ve set goals for ourselves in 2024 to address health differences.

  • We will work toward Health Equity Accreditation.
  • We will continue to expand our Health Equity Strategy.
  • We will look for ways to reduce health differences and put those plans into action.

Acreditación

The UHC Community Plan of Minnesota is accredited by a group called the National Committee for Quality Assurance (NCQA).  NCQA shares information with us on how to improve the quality of health care we provide to members. It is our goal to meet their standards for accreditation. Being accredited means we have made a promise to meet high quality care standards. To learn more about NCQA, visit their website.

NCQA

Contáctenos

Queremos recibir sus preguntas y comentarios. Comuníquese con nosotros si desea obtener más información o compartir ideas sobre lo que podemos hacer mejor. Comuníquese con UnitedHealthcare al 1-888-269-5410 / TTY: 711 o use su servicio de retransmisión preferido de lunes a viernes de 8 a. m. a 6 p. m. (hora local).

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