Quality Management & Quality Improvement
Western Wisconsin Cares's Quality program identifies areas for improvement and supports members in the most beneficial, cost-effective manner possible.
- An overview of the program’s scope, organization, administration and broad goals.
- A quality work plan that lists in detail objectives and projects, including timelines and responsible persons.
- A quality program organizational chart.
- One performance improvement project approved by the Wisconsin Department of Health Services.
Broad Quality Goals
- Promote an organization-wide commitment to quality of care and service and leadership involvement in improving quality.
- Educate and involve all staff in the quality improvement activities, providing consistent feedback and supporting their understanding of the program, including member rights and appeals and grievances.
- Engage members, community members and other stakeholders in a commitment to quality and an increased understanding of WWC.
- Support consistent process for policy development, formatting, tracking and implementation and ensure staff has efficient access to the most recent versions of policies, procedures and training materials.
- Monitor to ensure processes are followed to minimize member risk of critical incidents and adverse events.
- Improve and enhance the quality of member services provided through ongoing, objective and systematic measurement, analysis and improvement of performance.
- Monitor internal processes to ensure protection of member rights.
- Complete annual quality program evaluation to assist in mapping a work plan specific to WWC
- Use performance data to drive quality improvement process, identify areas for improvement and help facilitate the most appropriate allocation of resources.
- Work with provider network to ensure authorized services are monitored, evaluated and improved through collaboration and oversight, using quality standards required by contract, regulation, industry and community standards and this quality program.
- WWC’s quality efforts will monitor member satisfaction and incorporate member feedback into program planning and development.
- Develop and/or enhance utilization management process to ensure that member outcomes are being supported in a beneficial, cost-effective manner and help determine any point at which quality may be compromised.
Scope of Activity
The scope of activity for the WWC Quality Program encompasses
- Outcomes experienced by members as a result of services provided by WWC or its contracted providers
- Quality of assessments and member-centered care plans
- Completeness and accuracy of completed functional screenings
- Staff expertise and understanding of member outcomes and supports
- Relationships with members and members’ informal support systems
- The services in the Family Care benefit package provided to our members either directly by WWC or by the providers under contract with the WWC
- The internal WWC and external provider processes by which services are delivered to members
- Response to incidents impacting members
- Investigation of program integrity events
- Quality standards for providers under contract with WWC
- Utilization review
- Member satisfaction with services
- Member records and confidentiality
- Document management
- Contract compliance