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. Provide a systematic approach for monitoring the quality, safety, appropriateness, and effectiveness of patient care and services through a consistent review process throughout the MFC provider community.
  2. Identify and remove barriers to health care services and resources, including but not limited to, cultural and linguistic barriers.
  3. Include participating practitioners in the MedStar Family Choice network in the QI Plan, policy decisions, and QI process.
  4. Provide support and education to practitioners and providers to improve the safety of their practices.
  5. Ensure compliance with Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) screening rates, and the completion of all components according to the EPSDT and MDH screening criteria.
  6. Provide integration, coordination, and continuity of the medical and the substance abuse aspects of behavioral health.
  7. Perform a comprehensive population assessment of our member population to improve the quality of healthcare received by our members, identify social determinants of health (SDOH), reduce health care disparities, and ensure our members receive culturally and linguistically appropriate health care services. Identify opportunities for improvement and implement activities designed to encompass quality indicators, measurements, and goals.
  8. Assess quality of care and service using benchmarks representing best outcomes of practice.
  9. Develop, implement, and monitor corrective action plans (CAPs) based on identified deficiencies.
  10. Coordinate performance monitoring information.
  11. Integrate improvement strategies across departments and coordinate collection of data to identify, analyze, and trend problems.
  12. Advance the use of quality management principles through education, resource sharing, and analysis.
  13. Incorporate Federal, State, and local public health organizations goals and coordinate activities within the development of the QI Plan.
  14. Comply with the quality of care, access to care, documentation, and performance standards of Federal and State agencies for the treatment of enrollees, especially those with special needs.
  15. Improve oversight of activities of delegated entities and the quality of care they provide.
  16. Prevent fraud, waste, and abuse and ensure compliance with all associated Federal and State laws and regulations.
  17. Meet the standards for the Maryland System Performance Review.
  18. Align with the accreditation standards from the National Committee for Quality Assurance.
  19. Promote a culture of quality beginning with senior leadership.

Overall Plan for 2019:

  1. Successful implementation of NCQA survey preparation of documents and the cultivation of reports and analyses in real time.
  2. Formalize the MFC Policy Workgroup processes and procedures for the submission of changes to policies in addition to the review and approval of new policies at the QI/UM Committee as a means to continue to meet EQRO and NCQA standards.
  3. Continue to provide training and education to MFC staff regarding HEDIS requirements and processes. Successful completion of HEDIS 2019 audit.
  4. Continue to educate practitioner and MFC staff on EPSDT guidelines, HEDIS requirements, MFC pharmacy benefits, other state driven initiatives as they arise (i.e. HPV), CAHPS/Provider Satisfaction survey results, and VBP targets/results.
  5. Formal development of an NCQA compliant population health management (PHM) strategy for meeting the care needs of our members, along with provider reporting tools to assist in the achievement of PHM goals. The strategy will include the development of a robust and effective practitioner incentive program.
  6. Continue to explore opportunities to gather electronic member data and data sharing with ImmuNet, Federally Funded Health Centers (FQHCs), LabCorp, and MedStar Health’s EMR.
  7. Continue to educate members, practitioner, and MFC staff on MFC’s mail order pharmacy benefits and expand upon the medications offered.
  8. Continue work on PIPs as outlined by MDH.
  9. Continue to expand the use of the Evolent Identifi Case Management platform to optimize reporting functionality and capabilities.
  10. Continue to develop standard operating procedures on all new and existing initiatives to assist with the training of staff and as a resource for anyone working remotely.
  11. Continue to explore ways to streamline current processes and workflows in an effort to maximize productivity.
  12. Continue to participate in MedStar’s Health’s Quality Leaders Coordinating Council.
  13. Explore collaborating with MedStar Health’s new Ambulatory Quality and Safety project as it develops.
  14. Continue to participate with the Cerner Optimization Population Health Subcommittee.
  15. Continue exploring a system wide Credentialing, Quality of Care and Peer Review Process.
  16. Expand existing practitioner incentive programs where efficacy is demonstrated.
  17. Attend MedStar Health Pod meetings, medical offices grouped by geography, to support practitioners and providers in achieving population health management goals through the sharing of data that is meaningful and will assist in the delivery of services, programs, and care to our members.
  18. Continue to develop and implement an effective call monitoring program that evaluates the quality and accuracy of the information provided to our members, recognizes excellent customer service, and identifies any deficiencies that need to be improved upon. 
  19. Continue to perform a formal QA of any reports requiring submission to the EQRO with the QI staff and the responsible parties/subject matter experts who compile the reports.
  20. Collaborate with MedStar Health’s Cerner Optimization Committee to improve EPSDT risk assessments in the EMR.
  21. Explore the use of business intelligence software to deliver meaningful and interactive gap in care reports to our practitioners and providers.

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

Information current as of: 09/18/19