Quality Assurance and Monitoring Programs

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

Quality Monitoring Programs

MedStar Family Choice strives to ensure that its members receive high quality health care services. To achieve its quality improvement goals, MedStar Family Choice 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 members. Health plans that are accredited by NCQA have met high quality standards. MedStar Family Choice achieved full accreditation in 2015 and will be resurveyed in 2018.
  2. Healthcare Effectiveness Data & Information Set (HEDIS®): HEDIS is a tool from NCQA that helps health plans score how well their members 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. Highlights of initiatives for improving member health and HEDIS scores in 2015-2016 include:
    1. The Women’s Health Outreach Team to improve prenatal/postpartum care and cervical and breast cancer screening.
    2. Community health screenings and education to improve diabetes, asthma, heart disease, obesity, hypertension and behavioral health.
    3. Pediatric asthma and birth outcome improvement joint projects with the Department of Health Care Finance.
    4. Case management programs for members with diabetes, asthma, HIV, substance abuse, developmental disabilities and congestive heart failure.
    5. School dental education programs.

    *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 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. Highlights of EPSDT program improvements developed in 2013-2014 include:
    1. Additional resources were dedicated to outreaching members in need of EPSDT care.
    2. The Provider Relations Department worked to ensure that all providers seeing children have achieved EPSDT certification and perform the services required under EPSDT.
    3. Outreach home visits were made to members who were behind schedule with physicals, lead testing and immunizations.
    4. A lead testing program to improve testing for children 1 – 2 years of age.
  4. Satisfaction Surveys: MedStar Family Choice conducts annual member and provider satisfaction surveys.
    1. Member Survey – the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey was done in 2015 by WBA Research. Highlights of the results include:
      1. For children, members gave their highest satisfaction ratings to their Personal Doctor at 91% and Health Care at 89%.
      2. For children with chronic conditions, members gave their highest satisfaction ratings to their Personal Doctor at 90% and their Health Care at 83%.
      3. For adults, members gave their highest satisfaction ratings to their Personal Doctor at 82% and equal ratings to their Specialist and Health Plan at 75%.
    2. Provider Survey - A survey was done by WBA Research in 2015 to primary care providers to obtain information about their experiences with MedStar Family Choice. Highlights of the results include:
      1. 75% reported overall satisfaction with MedStar Family Choice
      2. Areas needing improvement were: Case Management and Utilization Management
  5. Quality of Care Review: The Quality Improvement Department routinely reviews clinical issues to ensure that our members are getting the best possible care. When the quality of care provided to a member is below standards, MedStar Family Choice 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 departments and procedures including utilization and case management; complaints, denials and appeals; provider network; quality; credentialing and enrollee rights. The first review occurred in the 3rd quarter of 2014, the only issue identified was a typo in the Member Handbook regarding how much time a member has to request continuation of benefits after a denial of services. The time limit was wrongly printed at 15 days, when the time limit is 10 days. The 2015 review is currently being conducted.
Information current as of: 10/13/17