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Quality Improvement Plan

MedStar Family Choice is committed to devoting its best effort to providing safe, high quality care to every member of MedStar Family Choice. Results and analyses of major Quality Improvement initiatives such as HEDIS, CAHPS, and Value Based Purchasing will be written in language understandable to the broad audience of MedStar Family Choice members and posted on the MedStar Family Choice website. They will also be communicated through the MedStar Family Choice Member and Provider Newsletters. Other studies may be made available at the discretion of MedStar Family Choice.

OBJECTIVES:

  1. To establish and maintain high standards for health care.
  2. To create a review process that is consistent throughout the MedStar Family Choice provider community and to provide a systematic approach for monitoring the quality, safety and appropriateness and effectiveness of patient care and services.
  3. To ensure the integration of information into the Quality Improvement Plan.
  4. To ensure and support efforts to remove any barriers to health care services and resources, including but not limited to language barriers.
  5. To include all participating practitioners in the MedStar Family Choice network as appropriate in the Quality Improvement Plan and Quality Improvement process.
  6. To provide support and education to practitioners and providers to improve the safety of their practices.
  7. To monitor the Early and Periodic Screening, Diagnosis, and Treatment screenings rates and ensure the completion of all components of the EPSDT screenings according to the Maryland Department of Health.
  8. To provide integration, coordination and continuity of the medical and the substance abuse aspects of behavioral health.
  9. To recommend policy decisions with practitioner input.
  10. To identify meaningful and relevant issues for assessment based on patient populations, demographics, care settings, types of services and case mix.
  11. To define quality indicators, measurements, and goals.
  12. To compare the quality of care and service against available benchmarks for standards of practice.
  13. To develop, implement, and monitor corrective action plans (CAPs).
  14. To centralize and coordinate performance monitoring information.
  15. To implement integrated improvement strategies and ensure follow up as appropriate by using collected data to identify, analyze, and trend problems.
  16. To advance the use of quality management principles through education, resource sharing, and analysis.
  17. To incorporate Federal, State, and local public health goals in the development of the Quality Improvement Plan.
  18. To comply with specific quality of care, access to care, documentation and performance standards adopted by the Federal and State agencies for the treatment of enrollees especially those with special needs.
  19. To provide oversight of continuous and ongoing activities of delegated entities.
  20. To comply with all applicable Federal and State laws and regulations with an emphasis on preventing fraud and abuse.
  21. To strive for highest quality of care compared to State and national benchmarks.
  22. To meet the standards for the Maryland System Performance Review.
  23. To maintain accreditation from the National Committee for Quality Assurance.

Overall Plan for 2016:

  1. To maintain an active Board of Directors and Executive Management Team to ensure the necessary resources are made available.
  2. To hold appropriate Committee meetings throughout the year including: Quality Improvement/ Utilization Management, Peer Review, Clinical Practice Guidelines/Ambulatory Best Practices, Credentialing, Pharmacy & Therapeutics, Utilization Management, Compliance /Privacy Committee, and other ad hoc groups as needed.
  3. To provide vigorous oversight of our partners and vendors who provide care and services to our members.
  4. To evaluate network adequacy and access to services.
  5. To maintain a network of qualified practitioners and monitor their satisfaction with MedStar Family Choice on an annual basis.
  6. To monitor member satisfaction by responding and monitoring complaints, appeals, inquiries, through the annual analysis of the Consumer Assessment of Health Plans Survey (CAHPS) and by supporting a Consumer Advisory Board.
  7. To support patient safety initiatives.
  8. To provide age appropriate Preventive Services and support this with a strong and sustained outreach effort designed to engage and educate our members about taking charge of their health and well being.
  9. To report audited Health Effectiveness Data Information Set (HEDIS®*) scores to the Maryland Department of Health annually covering preventive care, access to services, and effectiveness of care for chronic illnesses like asthma and diabetes.
  10. To maintain systems operations under the State guidelines as measured through the External Quality Review Organization, the Delmarva Foundation.
  11. To participate in the Maryland Department of Health sponsored Performance Improvement Projects for Substance Abuse.
  12. To remain committed to the principles of Patient First: Caring For You, Caring About You.
  13. Increase collaboration between the Maryland and DC MedStar Family Choice plans in order to maintain a cohesive work environment. Promote a good working relationship, shared responsibility, and excellent communication.
  14. Continue in 2016 with the new model of work that has been executed in the new MedStar Family Choice location during calendar year 2016.

*HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Information current as of: 07/25/17