- Introduction
- The Purpose of the Quality Improvement Initiative
- The Target Population
- The Benefits of the Quality Improvement Initiative
- The Interprofessional Collaboration Needed to Implement the QII
- The Cost of Budget Justification
- The Basis upon which the QII will be Evaluated
- References
- Video Voice-over
Introduction
Molina Healthcare is a company that provides managed health care services under Medicare and Medicaid. The company’s purpose is to deliver high-quality care to those people who receive government assistance. Nowadays, healthcare systems encounter different problems related to members’ outcomes and patients’ health status, and they should develop quality improvement initiatives to address these problems. One of the vital issues needed to be addressed is the growing number of people with diabetes (CDC, 2020). This executive summary will focus on the quality improvement initiative aimed at diabetes, its benefits, interprofessional collaboration, the cost justification, and the initial evaluation criteria.
The Purpose of the Quality Improvement Initiative
The goal of the quality improvement initiative (QII) of the Molina Healthcare company is to improve health outcomes among the enrollees with diabetes. According to Lu et al. (2018), diabetes affects about 8.5% of the adult population (p. 1). Deficiencies in care lead to various complications, premature mortality, and extra expenses on health issues that might have been prevented. Thus, the purpose of the QII is to develop the interventions that will help change provider conduct, develop new systems that will make health care more efficient and error-safe, and implement health promotion activities. Moreover, the QII aims to train healthcare professionals to improve type 2 diabetes mellitus management, working in a patient-oriented and accessible environment.
The Target Population
The target population of this QII is the enrollees with diabetes mellitus. The most significant emphasis will be made on veterans and the older population with diabetes. American Diabetes Association (ADA) recommends that physicians set a target “A1C level of under 7% (8.6 mmol/L)” and control HbA1c levels every three-six months (Edupuganti et al., 2019, p. 2). Those patients whose HbA1c level is higher than 9% require special attention because they are at hazard of blindness, end-stage renal disease, and other adverse health outcomes (Edupuganti et al., 2019). Therefore, these patients should be considered the target population.
The Benefits of the Quality Improvement Initiative
The primary benefits of the quality improvement program are related to patient health outcomes. Thus, if Molina Healthcare improves the healthcare system, it will diminish possible failures and redundancy. Moreover, the health professionals’ performance will also be accelerated. The program is designed to ensure patient safety and engagement, patient-oriented communication, evidence-based support and care, and health education for patients. Another advantage of this initiative is its proactiveness. The upgraded processes will help identify and solve the problems before they occur. The initiative is cost-effective because it is aimed at the prevention of adverse health outcomes. Thus, the costs needed for dealing with failures, errors, and complications of diabetes will be saved. Finally, the QII is efficient because it diminishes unnecessary activities related to equipment, supplies, energy, and ideas.
The Interprofessional Collaboration Needed to Implement the QII
Interprofessional collaboration is essential for the implementation of the QII. Collaborative teams will be created to support patients with type 2 diabetes mellitus. Such teams should include “a chronic disease management nurse or diabetes educator, pharmacist and/or dietitian working in the practices of family physicians” (Szafran et al., 2019, p. 2). The interprofessional collaboration will help improve preventive care and patients’ education and diminish costs associated with health care. On the one hand, it may seem that involving several practitioners will be more expensive. However, collaborative work will result in faster and better outcomes, thus saving time and money for health care.
The Cost of Budget Justification
Patients with diabetes require significant costs associated with drugs and cardiovascular disease. Thus, the cost-effectiveness of the QII should be measured and evaluated further. According to Perelle et al. (2020), “with the cost of about US$19 per patient for the [QII] over 2 years, the cost-effectiveness was reported to be significant” (p. 6). If the patients with diabetes have fewer complications and improve their quality of life, the Molina Healthcare company will save money on treating those complications. The QII will require to calculate the costs for program management and annual cost savings. Thus, recent research showed that the implementation of a similar QII would need US$130 per patient with diabetes in the United States of America (Perelle et al., 2020, p. 6). One can see that the quality improvement program is not cheap, but if it has long-term effects on the patients’ quality of life, it will show cost-effectiveness in the future.
The Basis upon which the QII will be Evaluated
The QII will be evaluated on the basis of the theory of change. The theory of change consists of three main pieces: the “What,” the “Context,” and the “How” (Parry et al., 2018, p. 30). This approach will help evaluate how the new activities will lead to the desired short-term and long-term outcomes, discover the barriers to the program implementation, and assess the availability of resources needed for the initiative. Suppose the stage of improvement is associated with favorable long-term outcomes, and these changes outweigh the costs needed for the QII implementation. In that case, the program will be considered cost-effective and health-effective. On the other hand, if the changes are insignificant and health outcomes are short-term, the program will need to be modified. In conclusion, the quality improvement initiative is crucial for Molina Healthcare because the company has a significant number of patients with diabetes, and it aims to increase this number and improve the quality of life of such patients.
References
Centers for Disease Control and Prevention. National diabetes statistics, report, 2020. CDC. Web.
Edupuganti, S., Bushman, J., Maditz, R., Kaminoulu, P., & Halalau, A. (2019). A quality improvement project to increase compliance with diabetes measures in an academic outpatient setting. Clinical Diabetes and Endocrinology, 5(11), 1-13. Web.
Lu, J.B., Danko, K.J., Elfassy, M.D., Welch, V., Grimshaw, J.M., & Ivers, N.M. (2018). Do quality improvement initiatives for diabetes care address social inequities? Secondary analysis of a systematic review. BMJ Open, 8(2), 1-7. Web.
Parry, G., Coly, A., Goldmann, D., Rowe, A.K., Chattu, V., Logiudice, D., Rabrenovic, M., & Nambiar, B. (2018). Practical recommendations for the evaluation of improvement initiatives. International Journal for Quality in Health Care, 30(1), 29-36. Web.
Perelle, L., Radisic, G., Cations, M., Kaambwa, B., Barbery, G., & Laver, K. (2020). Costs and economic evaluations of Quality Improvement Collaboratives in healthcare: A systematic review. BMC Health Services Research, 20(155), 1-10. Web.
Szafran, O., Kennett, S.L., Bell, N.R., & Torti, J.M. (2019). Interprofessional collaboration in diabetes care: Perceptions of family physicians practicing in or not in a primary health care team. BMC Family Practice, 22(44), 1-10. Web.