Quality Program
Premera's
purpose is to improve customers' lives by making healthcare work better. We are
focused on improving the health of, and increasing the value to, our customers,
or members, by driving positive change in the healthcare space. To achieve
this, we focus on addressing the four member problems of appropriateness,
underuse, experience, and cost.
Solving
these problems for our members requires innovation and a structured approach.
We use data and analytics to build programs that lead to lower costs, better
care, and improved member experience. We align our resources and structure to
operate as efficiently as possible and always remain open to new ideas that
will solve for appropriateness, underuse, experience, and cost. We constantly
scan the market for innovations developed outside of our walls and work to
implement these when they are better than our own. We believe in breaking down
barriers and moving from innovation to implementation with oversight and
monitoring to ensure programs achieve their intended objectives.
Premera
views quality standards as a starting point. We conduct uniform quality
assessments through consistent national measures aligned with
industry-recognized standards and market-specific measures that address local
care gaps. Key areas addressed include appropriateness to reduce harm and
waste, best practice adherence to support guideline-based treatment, health
management to promote preventive care, and outcomes to measure effective care
delivery. We use quality criteria and measurements to continually evolve and
influence better care delivery for our members.
The
Clinical Quality program covers all
commercial plans. quality programs, projects, and initiatives that may address
all markets or focus on a particular population, product, process, or customer
group.