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 the Population Health Incentive Program 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.
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OBJECTIVES:

            Provider Network

  • 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.
  • Provide support and education to practitioners and providers to improve the safety of their practices and include participating network practitioners in the Quality Improvement Plan, policy decisions, and quality improvement process.


Member Community

  • Perform a comprehensive population assessment of the member population to improve the quality of healthcare received by members, identify SDOH, reduce health care disparities, and ensure members receive culturally and linguistically appropriate health care services and education.
  • Identify and remove barriers to health care services and resources including, but not limited to cultural and linguistic barriers.

    Regulatory/Accreditation
  • Develop, implement, and monitor CAPs and QIAs based on identified deficiencies/opportunities.
  • Incorporate Federal, State, and local public health organizations goals and coordinate activities with the development of the Quality Improvement Plan.
  • 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.
  • Prevent fraud, waste, and abuse and ensure compliance with all associated Federal and State laws and regulations.
  • Meet or exceed the standards for: the Maryland SPR, NCQA accreditation, PHIP, and EPSDT and MDH screening criteria.


MFC Operations

  • Support/enhance a culture of quality at MFC by using benchmarks representing best practice outcomes to trend and analyze data for improvement opportunities, implementing strategies designed to address quality indicators and goals across departments, and coordinating data collection to evaluate opportunities and improvement efforts.
  • Advance the use of quality management principles and evidence-based practice through education, resource sharing, and analysis.
  • Provide integration, coordination, and continuity of medical and behavioral health.
  • Coordinate monitoring of MFC’s performance with internal and external parties.
  • Improve oversight of activities of delegated entities and the quality of care they provide.
  • Support the MSH 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 expertise.


New Initiatives for 2024

  1. Redesign the Quality Department to align with new goals, priorities objectives and initiatives to achieve better results and outcomes. 
  1. Infuse health equity lens in all programs with a primary goal to ensure that all individuals, regardless of their socioeconomic status, race, ethnicity, gender, or other factors, have fair and equal access to healthcare resources and services.
  1. Implement a member data management analytic system that can allow member identification for population health, improve member care, enhance operational efficiency, and drive better health outcomes. 
  1. Evaluate current member engagement initiatives to determine efficacy and fiscal impact while exploring additional evidence-based initiatives that may provide greater ROI. 
  1. Increase member input into quality initiatives through expanded use of the Consumer Advisory Board and targeted member surveys. 
  1. Standardize data presentation and educate MFC staff on interpreting/analyzing data to support their ability to evaluate initiatives and efforts. Develop standardized reporting of efforts and outcomes for quality initiatives. 
  1. Improve coordination of efforts with member-facing vendors to ensure quality of services and improve ROI. 
  1. Explore new interventions to improve provider engagement and satisfaction with MFC. 
  1. Work to achieve NCQA Health Equity accreditation by 12/25 as mandated by MDH. 
  1. Continue to implement evidence-based PIP initiatives on “Timeliness of Prenatal Care” and “Postpartum Care”. 

 

            Initiatives Continued through 2024

  • Successful preparation of documents, reports, and analyses for the 2024 NCQA renewal survey during the first, non-lookback year in that renewal cycle. 
  • Continue quality assurance reviews for any reports submitted to the EQRO. 
  • Expand existing practitioner incentive programs where efficacy is demonstrated. 
  • Enhance processes that establish relationships with provider offices, deliver gaps in care reports, and help close gaps in care through the Population Health Coordinator. 
  • Submit HEDIS rates according to the NCQA schedule and have no rates reported with bias. 
  • Educate practitioners on EPSDT guidelines, HEDIS requirements, MFC pharmacy benefits, HEDIS results, CAHPS survey results, provider satisfaction survey results, and other initiatives as appropriate. 
  • Continue to implement PIP initiatives and improve quality of care in areas outlined by MDH. 
  • Increase utilization and access to mobile and community-based services to improve member access to care. 
  • Increase utilization of 90-day pharmacy benefits for chronic medications. 
  • Participate in MSH POD meetings to educate and support practitioners and providers in achieving population health management goals.  

Information current as of: