Quality Improvement Strategy

Troy Medicare (HMO)

Quality Improvement and Management Strategy


TroyMedicare (HMO) leadership take it seriously to put the coordination of care back into the hands of the local providers that our members trust to arrange and provide health care services to our members. By eliminating unnecessary authorization requirements and lowering the cost of medications, Troy Medicare(HMO) will increase the quality of health care delivery and improve health outcomes for our members. The purpose of a Quality Improvement and ManagementProgram is to ensure Troy has the necessary infrastructure to coordinate care, promote quality, performance, and efficiency on an ongoing basis.

TroyMedicare HMO is committed to the following goals:

     I.        Making sure our members get the right care at the right time with the right provider.

    II.        Continuously monitor and improve our health care delivery to ensure quality and safety measures are met and improved.

  III.        Making sure our members have access to medically necessary health care by setting minimal authorization requirements and allowing our providers to take care of our members.

  IV.        Increasing the adherence to medications by driving down the cost of medications for our members.

We will we meet these goals by:

     I.        Monitoring utilization, reviewing claims trends, and tracking medication costs.

    II.        Conducting annual consumer surveys and monitoring member experience and satisfaction.

  III.        Monitoring patterns of care to ensure providers and members are not experiencing roadblocks to providing medically necessary care to our members.

  IV.        Lowering the administration costs of medications, therefore allowing Troy Medicare (HMO) to provide medications to our members at a lower cost.

TroyMedicare (HMO) will adhere to the requirements as set by CMS in the development and ongoing management of a quality improvement program.