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Quality Assurance and Monitoring Programs
National Committee for Quality Assurance
The National Committee for Quality Assurance (NCQA) has awarded MedStar Family Choice its highest accreditation status of "Excellent" for service and clinical quality that meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement.
NCQA is committed to providing health care quality information through the web and the media in order to help consumers, employers and others make more informed health care choices. Learn more about NCQA at www.ncqa.org.
Quality Monitoring Programs
The Quality Improvement (QI) Department works closely with the Department of Health and Mental Hygiene (DHMH) to ensure our members receive optimum care.
MedStar Family Choice currently participates in the following Quality Monitoring Programs:
- Healthcare Effectiveness Data & Information Set (HEDIS®*) — an annual review of provider and plan compliance to operational and clinical standards. HEDIS®* studies cover preventive care (adults and children), immunization of children and teens, care of pregnant women, and the care of chronic diseases like asthma and diabetes. Operational standards also review customer service measures. The results are audited and reported to the National Committee for Quality Assurance.
- Satisfaction Surveys - The DHMH contracts with independent organizations to perform both member and provider satisfaction surveys for each MCO.
- Systems Review Audit — To ensure that the services provided to our members meet established regulations, DHMH uses the Delmarva Foundation for Medical Care Inc (Delmarva) as an outside quality review agency to perform a Systems Performance Review (SPR). The purpose of the SPR is to provide an annual assessment of the structure, process, and outcome of each MCO's internal quality improvement program. Delmarva visits each MCO every year to review the following standards: Quality Improvement, Accountability to the Governing Body, Oversight of Delegated Entities, Credentialing and Recredentialing, Enrollee Rights, Availability and Accessibility, Utiization Review, Continuity of Care, Health Education, Outreach, Fraud and Abuse.
- Medical Record Audit — an annual review which measures compliance on medical record content within the MedStar Family Choice provider network. Charts are reviewed to ensure that providers are appropriately documenting the services they provide. Click here to review our Medical Record Audit policies and procedures as well as the documentation standards.
- Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Program — preventive services for children are monitored by the DHMH annually. The QI Department works with providers to ensure that all providers seeing children are EPSDT certified and that they perform the services required under this program.
- Quality of Care Review — MedStar Family Choice QI Department performs an ongoing review of any issues that arise between our providers and members to ensure that our members are receiving optimum care. The Quality Improvement coordinators report their findings to MedStar Family Choice's Medical Director to determine if further action is needed.
- Consumer Report Card — DHMH uses many of the results from the monitoring activities listed above to develop a report card that shows the quality scores for all of the MCOs. New enrollees receive this in their enrollment packet from DHMH. Current enrollees also receive this information when it is time to re-enroll.
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