Quality Monitoring Programs
Our Quality Improvement (QI) Department works closely with the Department of Health and Mental Hygiene (DHMH) to ensure our members receive the best possible care. MedStar Family Choice currently participates in the following Quality Monitoring Programs:
- Healthcare Effectiveness Data & Information Set (HEDIS®): An annual review of provider and plan compliance to operational and clinical standards. HEDIS®* studies cover preventive care (well child visits, Pap Smears, Mammograms, check-ups) immunization of children and teens, care of pregnant women, and the care of chronic diseases like asthma and diabetes. Operational standards also review customer service measures.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
- Satisfaction Surveys: The DHMH contracts with outside companies to do a satisfaction survey on our members and our doctors.
- Systems Review Audit: an annual review of how MedStar Family Choice operates. An independent auditor, hired by the DHMH, reviews how well and how quickly MedStar Family Choice provides plan information to enrollees and provider network adequacy. It also looks at MedStar Family Choice Quality Improvement (QI) and Outreach services, timeliness of claims payment, utilization management procedures and protocols, denials and appeals procedures, committee structures and function, fraud and abuse monitoring and general oversight of our contracted vendors.
- Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Program: Preventive services for children (well child visits, immunizations, lead testing) are monitored annually by the DHMH. The QI Department works with providers to ensure that all providers seeing children are EPSDT certified and that they perform the services required under this program.
- Quality of Care Review: MedStar Family Choice QI Department performs an ongoing review of any issues that arise between our providers and members to ensure that our members are receiving the best possible care.
- Consumer Report Card: DHMH uses many of the results from the monitoring activities listed above to develop a report card that shows the quality scores for all of the MCOs. New enrollees receive this in their enrollment packet from DHMH. Current enrollees also receive this information when it is time to re-enroll.