WellCare Patient Care Advocate Millie Hurtado has been working to help the group improve its Quality scores since March 2016. She worked closely with the Director of Patient Quality and HEDIS® to implement new processes and to close care gaps.
Millie helped organize the immunization schedule to make sure members received all required shots before their second birthday. She also worked to ensure the group met the 90th percentile for Blood Lead Test by having members tested at 12, 18 and 24 months. She also addressed coding issues and abstract records to help close gaps in care.
Another of major focuses was continually working to remove members who had aged out of the practice. She reviewed memberships every month and worked closely with Provider Relations to reassign those members.
WellCare’s Patient Care Advocacy Program embeds an associate into large IPA and group practices to help providers identify members with care gaps.
The program’s goals are to:
• Improve the health care quality and access of care for members
• Improve the Healthcare Effectiveness Data and Information Set (HEDIS®) rates
• Improve the Consumer Assessment of Health Plan Providers and Systems (CAHPS®) scores
• Improve the Health Outcomes of Seniors (HOS®) survey results
• Improve STAR scores
• Improve the overall member and provider experience