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 MFC 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 QI Plan and QI 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 (EPSDT) screening rates and ensure the completion of all components, according to the EPSDT screening criteria.
  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 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 QI 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 2018:

  1. Successful NCQA submission and reaccreditation.
  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 Delmarva and NCQA standards.
  3. Continue to provide training and education to MFC staff regarding HEDIS requirements and processes. Successful completion of HEDIS 2018 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 by July 1, 2018 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 provider 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, provider, 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 assess new analytical software to assist with developing an effective provider incentive program.
  11. Continue to develop desk top procedures on all new and existing initiatives to assist with the training of staff and as a resource for anyone working remotely.
  12. Continue to explore ways to streamline current processes and workflows in an effort to maximize productivity.
  13. Develop a relationship with CSS to improve analytics and the ability to identify opportunities for improvement in member and provider satisfaction.
  14. Continue to participate in MedStar’s Health’s Quality Leaders Coordinating Council.
  15. Explore collaborating with MedStar Health’s new Ambulatory Quality and Safety project as it develops.
  16. Continue to participate with the Cerner Optimization Population Health Subcommittee.
  17. Continue exploring a system wide Credentialing, Quality of Care and Peer Review Process.

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

Information current as of: 08/27/18