Leadership drives quality


Inspired leadership plants UPMC Health Plan among the highest-ranked in the  nation. “Our senior team is very engaged in our quality initiatives,” Senior Director of Quality Improvement Colleen Walsh says.

This year, Pittsburgh, Pa.-based UPMC earned the eleventh spot nationwide for commercial plans, progress from fifty-ninth in 2007, according to the National Committee for Quality Assurance (NCQA) Health Insurance Plan Rankings. Its Medicaid program ranks consistently in the mid-teens.

The NCQA rankings reflect initiatives between UPMC and its providers that promote high-quality care at lower costs. “We believe here that our providers drive this,” Walsh says. UPMC is currently reforming its physician incentive program for primary care. Within the next two or three years, the plan will expand shared and fixed savings models as it reduces reimbursements for fee-for-service payments.

UPMC is able to pursue goals like payment reform because of strong relationships with its mixed network of physicians. “Our approach to our network is supportive,” Walsh says. UPMC’s physician account executives (PAEs) serve as direct liaisons, and meet providers where they are. Some large practices have thoroughly integrated electronic health record (EHR) systems, for example. Smaller ones have EHRs that are not yet integrated with UPMC, and some others still prefer paper records. “Providers tell us what they want and we support them in that need,” she says.

The same flow of communication enables population health management, which Walsh also credits for UPMC’s high quality ranking. UPMC offers tools and programs for weight loss, smoking cessation and encouraging other healthy habits that help members prevent chronic conditions down the line. “We make sure our physicians understand what programs are available to their patients,” she says.

UPMC leaders consider the health plan a facilitator of top-quality care, and the quality rankings follow. “We try to pull these two parties together to have care rendered. If HEDIS® went away tomorrow primary care providers would still be treating diabetics,” Walsh says.

There’s no down time to this – ever.”

-Sophie Schwadron
ACHP Intern

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