VSP has a comprehensive Quality Management (QM) and Quality Improvement (QI) Program that presents a framework for ensuring quality eye care for members accessing VSP’s doctors. The QM/QI Program Description defines the goals, scope, structure, function and other components for the QM/QI Program at VSP.

Purpose

VSP’s QM/QI Program ensures quality vision and eye health care to members accessing VSP’s doctors. The program is designed to objectively and systematically monitor and evaluate the quality and appropriateness of care and services. We strive to continuously pursue opportunities for improvement and problem resolution.

Policy

It is the policy of the organization to ensure:

• Compliance with VSP approved policies and procedures for the QM/QI process
• Adherence to guidelines, standards and criteria set by government, accrediting agencies, and other regulatory agencies as appropriate
• The QM/QI Program accommodates the contractual requirements and benefit design of each client/health plan

Goals

The goals of the QM/QI program include, but are not limited to, the following:

• To develop, implement and coordinate all activities that are designed to improve the processes by which care and services are delivered
• To provide tools, resources and training for staff involved in quality of care processes with clinician oversight and guidance
• To identify inappropriate practice patterns and opportunities to improve patient care
• To evaluate the effectiveness of implemented changes in order to continuously improve the quality of care and service provided by VSP and doctors to VSP customers (members, clients, and health plans)
• To ensure that there are documented mechanisms to evaluate the effects of the QM/QI Programs utilizing member and doctor satisfaction data
• To ensure that QM/QI policies and procedures are reviewed, revised and approved, as needed, by the QM Committee
• To utilize efficient and appropriate communication channels to deliver QM information to appropriate individuals
• To facilitate documentation, reporting and follow-up of Credentialing and QM/QI activities in order to facilitate excellence in vision care services and outcomes.

Quality Improvement Process

Overview

The QI process includes documented policies and procedures utilized in monitoring, reviewing and improving care and services provided to VSP members by VSP doctors. VSP may use applicable provider data for quality improvement activities.

Policy

The QM/QI policy review occurs annually and is revised as needed. Procedural revisions and revisions with clinical impact are reviewed and approved by the QM Committee. VSP’s clients and regulatory agencies receive material revisions to the policy or procedures, as required.

Patient Safety

Patient safety is reviewed and addressed. Interventions are identified and implemented. Patient safety activities include, but are not limited to:

• Potential Quality of Care Complaints/Grievances
• Credentialing/Recredentialing
• QA Doctor Reviews
• Clinical Practice Guidelines / algorithms
• Member Surveys

QI Work Plan

The QI Work Plan is approved by the Board of Directors annually. Quarterly updates to the work plan reflect progress on QM/QI activities and are evaluated annually. The QM Committee reviews the updates and evaluations before forwarding to the Board of Directors.

Improvement Activities

Development, implementation and review activities include, but are not limited to the following:

Potential Quality of Care Complaints and Grievances

• Doctor Trends
• Complaint type trends
• Credentialing/Recredentialing and Professional Review
• Doctor Improvement Action Plan

Member, Client and VSP Doctor Satisfaction

• QA Report/Evaluations
• QA Doctor Reviews
• Company Satisfaction Survey Results

Risk Management

• Clinical Practice Guidelines and Algorithms
• Assessment of New Technology

Benefit Utilization

• Identification of outlier practice patterns that may identify under or over utilization