ABC HealthCare is a national healthcare organization that delivers quality products and services to their members. They offer a broad range of medical and specialty products including PPO’s, HMO’s, and various hybrid and specialty dental and health care services. These services combine the attributes consumers find attractive while also developing and establishing effect cost control techniques. By doing this, they allow their members access to the quality care that is needed. ABC HealthCare has 69 million members that are served by their affiliated companies and 37 million enrolled in its family of health plans making a total of 106 million members served. ABC HealthCare is one of the nation’s leading Health Insurance Plans. ABC HealthCare prides itself in having a framework that yields tangible value for all of their members, employers, healthcare professionals, associates, and shareholders. Along with this framework, ABC HealthCare’s business strategy includes: Creating the best health care value in the industry, excel at day-to-day execution, and capitalize on new opportunities to drive growth. Enterprise clinical quality management is the level of this organization that I represent. The above mentioned business strategies and framework apply to all parts of the company; however, the enterprise clinical quality management department also has their own goals, objectives, and leadership.
The goals of the Enterprise clinical quality management department are to: improve the health of our members, generate revenue through performance guarantees and bonus payments, increase sales through demonstration of quality, decrease the cost of care through improvement of health outcomes, and support business needs by meeting regulatory requirements at the local, state, and national level. Improving population-level health care quality for our members is the top goal and