Quality Improvement Plan

MedStar Family Choice (MFC) 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 (Healthcare Effectiveness and Data and Information Set), CAHPS (Consumer Assessment of Healthcare Providers and Systems), 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 and practitioner community.
  2. Identify and remove barriers to health care services and resources including, but not limited to, cultural and linguistic barriers.
  3. Include participating network practitioners in the Quality Improvement Plan, policy decisions, and quality improvement process.
  4. Provide support and education to practitioners and providers to improve the safety of their practices.
  5. Ensure compliance with EPSDT (Early and Periodic Screening, Diagnostic and Treatment) screening rates and the completion of all components according to the EPSDT and MDH (Maryland Department of Health) screening criteria.
  6. Provide integration, coordination, and continuity of medical and behavioral health.
  7. Perform a comprehensive population assessment of the member population to improve the quality of healthcare received by members, identify SDOH (social determinants of health), reduce health care disparities, and ensure members receive culturally and linguistically appropriate health care services.
  8. Identify opportunities for improvement and implement activities designed to address quality indicators, measurements, and goals.
  9. Assess quality of care and service using benchmarks representing best outcomes of practice.
  10. Develop, implement, and monitor CAPs (corrective action plans) based on identified deficiencies.
  11. Coordinate monitoring of MFC’s performance with internal and external parties.
  12. Align the organization with the goals established by VBP (value-based purchasing).
  13. Integrate improvement strategies across departments and coordinate collection of data to identify, analyze, and trend opportunities for improvement.
  14. Advance the use of quality management principles through education, resource sharing, and analysis.
  15. Incorporate Federal, State, and local public health organizations goals and coordinate activities with the development of the Quality Improvement Plan.
  16. 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.
  17. Improve oversight of activities of delegated entities and the quality of care they provide.
  18. Prevent fraud, waste, and abuse and ensure compliance with all associated Federal and State laws and regulations.
  19. Meet the standards for the Maryland SPR (systems performance review).
  20. Align the organization with NCQA (National Committee for Quality Assurance) accreditation standards.
  21. Promote a culture of quality beginning with senior leadership.
  22. Support the MSH (MedStar Health) effort to become a high reliability organization by applying the principles of preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to experience.

Overall Plan for 2021:

  1. Successful submission of documents, reports, and analyses for NCQA renewal survey.
  2. Develop and implement an annual NCQA-compliant population health management strategy for meeting the care needs of members, which will include provider reporting tools and incentives to assist in the achievement of population health management goals.
  3. Continue quality assurance reviews for any reports submitted to the EQRO (External Quality Review Organization).
  4. Complete the SPR interim desktop review with the EQRO successfully and on-schedule.
  5. Expand existing practitioner incentive programs where efficacy is demonstrated.
  6. Improve provider reporting to deliver meaningful and interactive gap in care reports to practitioners and providers.
  7. Implement a program to establish relationships with provider offices, deliver gaps in care reports, and help close gaps in care using a Population Health Coordinator.
  8. Improve training and education for MFC staff regarding HEDIS requirements and processes.
  9. Submit HEDIS rates according to the NCQA schedule and have no rates reported with bias.
  10. Educate practitioners on EPSDT guidelines, HEDIS requirements, MFC pharmacy benefits, HEDIS results, CAHPS survey results, provider satisfaction survey results, and other initiatives as appropriate.
  11. Establish additional connections to member data in provider EHRs, HIEs, and vendor data.
  12. Implement skip trace solutions for improved member demographics.
  13. Implement a redesigned hypertension quality program to improve blood pressure results and follow-up rates for members with hypertension.
  14. Identify additional opportunities for improvement and implement cross-departmental interventions to improve quality of care and quality scores.
  15. Implement PIPs and improve quality of care in areas outlined by MDH.
  16. Increase utilization and access to mobile and community-based services to improve member access to care.
  17. Increase utilization of 90-day pharmacy benefits for chronic medications.
  18. Develop standard operating procedures on all new and existing quality initiatives.
  19. Develop standardized reporting of efforts and outcomes for quality initiatives.
  20. Optimize processes and workflows to maximize productivity and efficient use of resources.
  21. Continue participation in the MSH Quality Leaders Coordinating Council.
  22. Continue participation with the Cerner Optimization Population Health Subcommittee.
  23. Participate in MSH POD meetings to educate and support practitioners and providers in achieving population health management goals.

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

Information current as of: 02/04/21