Quality Monitoring Programs

MedStar Family Choice-DC strives to ensure that its enrollees receive high quality health care services. To achieve its quality improvement goals, MedStar Family Choice-DC participates in the following Quality Monitoring Programs:

  1. National Committee for the Quality Assurance (NCQA) Accreditation – NCQA is an organization that develops standards for how health plans should operate and the services and programs they should have for enrollees. Health plans that are accredited by NCQA have met high quality standards. MedStar Family Choice-DC will begin the accreditation process in 2021.
  2. Healthcare Effectiveness Data & Information Set (HEDIS®) – HEDIS is a tool from NCQA that helps health plans score how well their enrollees are doing in areas like preventive care (well visits, Pap smears, mammograms, and immunizations), care of pregnant women, and treatment of chronic diseases like asthma and diabetes. *HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
  3. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) – MedStar Family Choice-DC supports the goals of the EPSDT program to provide comprehensive preventive, dental, mental health, developmental and specialty care services for children under age 21 who are enrolled in Medicaid.
  4. Satisfaction Surveys – MedStar Family Choice-DC conducts annual enrollee and provider satisfaction surveys.
    1. Enrollee Survey – The Consumer Assessment of Healthcare Providers and Systems (CAHPS)
    2. Provider Survey – MedStar Family Choice-DC will survey our primary care providersto obtain information about their experiences with MedStar Family Choice-DC.
  5. Quality of Care Review – The Quality Improvement Department routinely reviews clinical issues to ensure that our enrollees are getting the best possible care. When the quality of care provided to a enrollee is below standards, MedStar Family Choice-DC works with the physician, provider or hospital to correct problems and improve care.
  6. Systems Review Audit – Every year, the Department of Health Care Finance hires a company to perform a complete audit of MedStar Family Choice-DC departments and procedures including utilization and case management; complaints, denials and appeals; provider network; quality; credentialing and enrollee rights.

 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.
Information current as of: 09/17/20