|
Quality
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
Our 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, 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.
- Satisfaction Surveys: The DHMH contracts with outside companies to do a satifaction survey on our members and our doctors.
- Systems Review Audit: an annual review of how MedStar Family Choice operates. An independent auditor, hired by the DHMH, reviews how well and how quickly MedStar Family Choice provides plan information to enrollees and provider network adequacy. It also looks at MedStar Family Choice Outreach services, timeliness of claims payment, utilization management procedures and protocols, denials and appeals procedures, committee structures and function, fraud and abuse monitoring and general oversight of our contracted vendors.
- 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.
- Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Program: Preventive services for children are monitored annually by the DHMH. 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.
- 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.
|
