2017 Quality Management overview

Size: px
Start display at page:

Download "2017 Quality Management overview"

Transcription

1 Quality Management overview Amerigroup Community Care wants to make sure our members get and stay healthy at a low cost. We do this by: Offering quality programs Working with doctors and/or facilities Educating our community Quality Management looks at services members receive, finds ways to make programs better and creates new programs. National and state quality programs National Committee for Quality Assurance (NCQA) Amerigroup maintains national accreditation through the NCQA. NCQA uses surveys and HEDIS scores to look at our: Policy and procedures Quality programs Customer satisfaction Quality and access to care Healthcare Effectiveness Data and Information Sets (HEDIS ) HEDIS is a set of measures collected by all accredited health plans using the same specifications. The results are publically reported every year and allow a fair comparison of each health plan. We use the results to make our programs better and create new ones. HEDIS looks at seven areas: Effectiveness of care Access/availability of care Experience of care Utilization and risk adjusted utilization Relative resource use Health plan descriptive information Measures collected using electronic clinical data systems Our HEDIS scores improved in 30 measures in Preventive services like assessing BMI, nutritional counseling and physical activity counseling increased an average of 10 percentage points from WEBMMD

2 Measure BMI Nutritional counseling Physical activity counseling Our quality programs Medical records review for documentation standards Complete and accurate medical records improve quality and help us coordinate care. Our Quality Management team reviews medical records from primary care providers (PCPs). We give providers the results and use them to improve medical record documentation. Continuity and coordination of care PCPs, specialists, hospitals and urgent care centers need to communicate to improve quality of care. Surveys and medical record reviews look at communication between PCPs, specialists and/or facilities. We give providers and facilities the results along with ways they can improve. Patient safety Amerigroup helps providers make sure members receive the right medication in the right dosage and avoid negative drug interactions. Some of our pharmacy-related programs that help do this are: Polypharmacy: We tell providers about members with multiple medications and prescribers. Age appropriateness: We tell providers when a medication is not recommended because of a person s age. Health promotion Amerigroup health promotion includes health risk assessments, member outreach and community events. We do targeted outreach with members to: Learn about problems they have getting care. Educate them about the importance of a healthy lifestyle. We use claims history to choose members and make sure they received recommended preventive and routine health care.

3 Our health program representative participates in community events and tells people about: Women s health Prenatal care Children s wellness visits Case Management programs Case Management programs help members with health concerns take control of their care by: Coordinating quality health care services. Making sure members know how to manage their condition. Case managers work with members, their families and caregivers. They develop individual care plans and provide education and health care resources. This helps improve members health outcomes. Members may be referred to a case management program by providers, other internal programs and self-referral. Disease Management program Disease Management helps members meet health care goals. We encourage member education and self-care by working with members and/or family members and caregivers. Disease managers may: Coordinate health care services. Support relationships between members and providers. Provide interventions to help members be as healthy as they can be. Refer members to Beacon Health Options to help with behavioral health conditions. The Disease Management program includes seven NCQA accredited programs: Asthma Coronary health disease (CAD) Congestive heart failure (CHF) Diabetes Disease Management also offers programs for: Bipolar disorder Hypertension Substance use disorder HIV/AIDS Major depressive disorder Schizophrenia We use claims data to identify members for the Disease Management program.

4 Customer satisfaction Amerigroup is committed to keeping our members happy. Our plan uses member surveys, member complaint and appeals data, and provider feedback to improve member experience and satisfaction. The annual Customer Assessment of Healthcare Providers and Systems (CAHPS ) survey lets our members give feedback on: The health plan Providers Their experience getting the care they need Their experience getting the care their child needs The results tell us how we can better serve our members. Here are some of our 2016 and 2017 CAHPS results for adult members. Our goal is to be at the 50th percentile or above. CAHPS Adult Survey Question 2016 score* 2017 score* 2017 percentile We want to know your rating of the specialist you saw most often in the last 6 months. Using any number from 0-10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you rate that specialist? personal doctor listen carefully to you? personal doctor show respect for what you had to say? Treated with courtesy and respect by the health plan s Customer Services? 81.07% 82.63% 67th 93.15% 94.54% 90th 94.18% 94.18% 75th 73.1% 78.4% 66th * Percentage of members that selected the highest rating

5 Overall, members said they were happy with these key areas: How well doctors talk to them (92.3% Summary Rate Always/Usually) Customer service (88.4% Summary Rate Always/Usually) Coordination of care (82.6% Summary Rate Always/Usually) Customer satisfaction - Child We also asked parents or guardians of child members 17 years of age and younger to share how happy they were with Amerigroup and getting health care for their child. Here are some of our 2016 and 2017 CAHPS results for child members. CAHPS Child Survey Question 2016 score* 2017 score* 2017 percentile child s doctor explain things about your child s health in a way that was easy to understand? child s doctor listen carefully to you? child s doctor show respect for what you had to say? In the last 6 months, how often did customer service at your child s health plan give you the information or help you needed? 78.0% 78.6% 28th 64.1% 82.0% 39th 86.4% 86.9% 22nd 52.4% 56.6% 26th * Percentage of parents that answered Always Overall, members with children said they were happy with these areas: How well doctors talk to them (92.5% Summary Rate Always/Usually) Customer service (86.0% Summary Rate Always/Usually) Getting care quickly (85.7% Summary Rate Always/Usually)

6 Provider satisfaction We also talk to your primary care physicians (PCPs) to see what we can do to improve your care and services. In 2017, we asked your PCPs to rate us on case management, finance issues, customer service for PCPs, timing of approvals for patient services and more. Here are some of the results: 60.00% Provider satisfaction survey results 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Coordination of Care/ Case Management Timing of Claims Processing Timing for Approval of Inpatient Care Fair/Poor Good Excellent/Very Good Eight out of 10 PCPs said they would recommend Amerigroup to their patients (81.6%) and/or to other doctors (80.1%). Based on the PCP feedback, we re working to improve in these areas: Coordination of care and Case Management programs Customer service and provider relations Answering questions and/or fixing problems quickly

Quality Improvement Program

Quality Improvement Program How we measure up At HealthKeepers, Inc., we focus on helping our Anthem HealthKeepers Plus members get healthy and stay healthy. To help us serve you the best we can, each year we look closely at the

More information

QUALITY IMPROVEMENT PROGRAM

QUALITY IMPROVEMENT PROGRAM QUALITY IMPROVEMENT PROGRAM EmblemHealth s mission is to create healthier futures for our customers and communities. We will do this by providing members with a broad range of benefits and conscientious

More information

2012 HEDIS/CAHPS Effectiveness of Care Report for 2011 Measures Oregon Commercial Business

2012 HEDIS/CAHPS Effectiveness of Care Report for 2011 Measures Oregon Commercial Business 2012 HEDIS/CAHPS Effectiveness of Care Report for 2011 Measures Oregon Commercial Business About HEDIS The Healthcare Effectiveness Data and Information Set (HEDIS 1 ) is a widely used set of performance

More information

Guide to Accessing Quality Health Care Spring 2017

Guide to Accessing Quality Health Care Spring 2017 Guide to Accessing Quality Health Care Spring 2017 MolinaHealthcare.com 5771749DM0217 MyMolina MyMolina is a secure web portal that lets you manage your own health from your computer. MyMolina.com is easy

More information

A Guide to Accessing Quality Health Care

A Guide to Accessing Quality Health Care A Guide to Accessing Quality Health Care Spring 2015 MolinaHealthcare.com 37894DM0115 Molina Healthcare s Quality Improvement Plan and Program Your health care is important to us. We want to hear how we

More information

PROVIDER NEWSLETTER. Illinois 2016 Issue II DISEASE MANAGEMENT IMPROVING MEMBERS HEALTH IN THIS ISSUE

PROVIDER NEWSLETTER. Illinois 2016 Issue II DISEASE MANAGEMENT IMPROVING MEMBERS HEALTH IN THIS ISSUE Illinois 2016 Issue II PROVIDER NEWSLETTER DISEASE MANAGEMENT IMPROVING MEMBERS HEALTH Disease Management is a no-cost, voluntary program to assist members with specific chronic conditions. A member is

More information

2017 CAHPS Child Medicaid Survey Summary Report

2017 CAHPS Child Medicaid Survey Summary Report 2017 CAHPS Child Medicaid Survey Summary Report June 2017 Morpace research is completed in compliance with ISO 20252 Table of Contents Executive Highlights........................................ Background,

More information

ProviderReport. Managing complex care. Supporting member health.

ProviderReport. Managing complex care. Supporting member health. ProviderReport Supporting member health Managing complex care Do you have patients whose conditions need complex, coordinated care they may not be able to facilitate on their own? A care manager may be

More information

Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP)

Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP) Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP) Medicare Drug and Health Plan Contract Administration Group Donna Williamson & Brandy Alston December 6, 2016

More information

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services

More information

Medical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14

More information

McLaren Health Plan Quality Improvement Update 2014

McLaren Health Plan Quality Improvement Update 2014 McLaren Health Plan Quality Improvement Update 2014 Since the incorporation of McLaren Health Plan (MHP) in November 1997, the staff has continued to utilize their extensive clinical and administrative

More information

2015 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members

2015 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members 2015 Congestive Heart Failure Program Evaluation Our mission is to improve the health and quality of life of our members 2015 Congestive Heart Failure Program Evaluation Program Title: Congestive Heart

More information

2017 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members

2017 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members 2017 Congestive Heart Failure Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Congestive Heart Failure Program Evaluation Program Title: Congestive Heart

More information

Passport Advantage Provider Manual Section 8.0 Quality Improvement

Passport Advantage Provider Manual Section 8.0 Quality Improvement Passport Advantage Provider Manual Section 8.0 Quality Improvement Table of Contents 8.1 Quality Improvement Program 8.2 Clinical Practice Guidelines 8.3 Star s 8.4 Quality of Care Concerns 8.3 Practitioner

More information

=======================================================================

======================================================================= ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary

More information

QUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program:

QUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program: QUALITY IMPROVEMENT Molina Healthcare maintains an active Quality Improvement (QI) Program. The QI program provides structure and key processes to carry out our ongoing commitment to improvement of care

More information

New provider orientation. IAPEC December 2015

New provider orientation. IAPEC December 2015 New provider orientation IAPEC-0109-15 December 2015 Welcome 2 Agenda Introduction to Amerigroup Provider resources Preservice processes Member benefits and services Claims and billing Provider responsibilities

More information

Provider Newsletter. Illinois 2017 Issue II. In This Issue. Join the Conversation on Social Media. Join the Conversation on Social Media...

Provider Newsletter. Illinois 2017 Issue II. In This Issue. Join the Conversation on Social Media. Join the Conversation on Social Media... Provider Newsletter Illinois 2017 Issue II New Provider Portal Our portal is getting a whole new look and streamlined tools, including: Comprehensive Member Profile with Eligibility, Benefits & Co-Pays,

More information

Communicator. the JUST A THOUGHT. Ensuring HEDIS-Compliant Preventive Health Services. Provider Portal Features. Peer-to-Peer Review BY DR.

Communicator. the JUST A THOUGHT. Ensuring HEDIS-Compliant Preventive Health Services. Provider Portal Features. Peer-to-Peer Review BY DR. WINTER 2016 MHS NEWSLETTER FOR PHYSICIANS Ensuring HEDIS-Compliant Preventive Health Services Here are a few best practice strategies for raising HEDIS and EPSDT onsite review scores, as demonstrated by

More information

ProviderNews2014 Quarter 3

ProviderNews2014 Quarter 3 TEXAS ProviderNews2014 Quarter 3 Our Quality Improvement program The Amerigroup* Quality Improvement (QI) program is committed to excellence in the quality of service and care our members receive and the

More information

The Heart and Vascular Disease Management Program

The Heart and Vascular Disease Management Program Element A: Program Content The Heart and Vascular Disease Management Program GHC-SCW is committed to helping members, and their practitioners, manage chronic illness by providing tools and resources to

More information

NCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11

NCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11 NCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11 28 PCMH 1: Enhance Access and Continuity PCMH 1: Enhance Access and Continuity 20 points provides access to culturally and linguistically

More information

BlueChoice HealthPlan Medicaid. Provider education 2017

BlueChoice HealthPlan Medicaid. Provider education 2017 BlueChoice HealthPlan Medicaid Provider education 2017 Provider Relations 2 What s new Process for obtaining Makena New website feature Availity Portal Pharmacy reports now available Provider report card

More information

New provider orientation

New provider orientation New provider orientation Welcome 2 Agenda Introduction to Amerigroup Provider resources Contact numbers and questions Provider responsibilities Member benefits and services Claims and billing Preservice

More information

PROVIDER NEWSLETTER. MISSOURI 2017 Issue I ANNUAL PROVIDER SATISFACTION SURVEY IN THIS ISSUE JOIN THE CONVERSATION ON SOCIAL MEDIA

PROVIDER NEWSLETTER. MISSOURI 2017 Issue I ANNUAL PROVIDER SATISFACTION SURVEY IN THIS ISSUE JOIN THE CONVERSATION ON SOCIAL MEDIA MISSOURI 2017 Issue I PROVIDER NEWSLETTER ANNUAL PROVIDER SATISFACTION SURVEY Thank you all who participated in the annual survey process in 2016. Missouri Care continues to focus efforts on the experiences

More information

Care Coordination (CC) assists members and their families with complex needs

Care Coordination (CC) assists members and their families with complex needs Care Coordination (CC) assists members and their families with complex needs Care is member-centered, family-focused, and culturally competent. CC assists in locating services to meet the health and social

More information

CMHC Healthcare Homes. The Natural Next Step

CMHC Healthcare Homes. The Natural Next Step CMHC Healthcare Homes The Natural Next Step Partners in Planning A collaborative effort involving Dept. of Social Services (Mo HealthNet) Dept. of Mental Health Primary Care Association (FQHCs) Coalition

More information

Member Handbook STAR+PLUS Members with Medicare and Medicaid Coverage.

Member Handbook STAR+PLUS Members with Medicare and Medicaid Coverage. Member Handbook STAR+PLUS Bexar, El Paso, Harris, Jefferson, Lubbock, Medicaid Rural West, Tarrant, and Travis Service Areas Members with Medicare and Medicaid Coverage TX-MHB-0090-15 06.16 1-800-600-4441

More information

Referrals, Prior Authorizations, Medical Management, and Appeals

Referrals, Prior Authorizations, Medical Management, and Appeals Referrals, Prior Authorizations, Medical Management, and Appeals 1 An Independent Licensee of the Blue Cross Blue Shield Association 044506 (12-21-2017) 2017 Premera. Proprietary and Confidential. Referrals

More information

MEDS TO BEDS AND CARE MANAGEMENT MEDICATION ASSESSMENT TOOLKIT: FOR HOSPITAL TEAM AND PHARMACISTS

MEDS TO BEDS AND CARE MANAGEMENT MEDICATION ASSESSMENT TOOLKIT: FOR HOSPITAL TEAM AND PHARMACISTS MEDS TO BEDS AND CARE MANAGEMENT MEDICATION ASSESSMENT TOOLKIT: FOR HOSPITAL TEAM AND PHARMACISTS Implementation Toolkit Last Updated: 02/2018 OneCity Health Services 199 Water Street, 31st Floor, New

More information

For more information on any of the topics covered, please visit our provider self-service website at

For more information on any of the topics covered, please visit our provider self-service website at Quality improvement summary The results are in We d like to share with you our annual quality improvement summary of clinical performance and service satisfaction. Throughout the year, we evaluate data

More information

2013 Mommy Steps. Program Description. Our mission is to improve the health and quality of life of our members

2013 Mommy Steps. Program Description. Our mission is to improve the health and quality of life of our members 2013 Mommy Steps Program Description Our mission is to improve the health and quality of life of our members I. Purpose Passport Health Plan (PHP) has developed approaches to the management of members

More information

HEDIS 101 for Providers

HEDIS 101 for Providers Quality health plans & benefits Healthier living Financial well-being Intelligent solutions HEDIS 101 for Providers Aetna Better Health of Kentucky 2017 HEDIS 101 for Providers Aetna Better Health 2 HEDIS

More information

Maternity Management. The best part? These are available to you at no additional cost. Intro

Maternity Management. The best part? These are available to you at no additional cost. Intro Telligen provides the following services for Connecticut Carpenters members to help you better manage your health and enjoy a good quality of life. The programs include both Maternity Management and Condition

More information

HHW-HIPP0314 (9/13) MDwise Annual IHCP Seminar. Exclusively serving Indiana families since 1994.

HHW-HIPP0314 (9/13) MDwise Annual IHCP Seminar. Exclusively serving Indiana families since 1994. HHW-HIPP0314 (9/13) MDwise 101 2013 Annual IHCP Seminar Exclusively serving Indiana families since 1994. Agenda Indiana Health Coverage Overview MDwise Overview MDwise Hoosier Healthwise MDwise Healthy

More information

APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS

APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS Appendix 2 NCQA PCMH 2011 and CMS Stage 1 Meaningful Use Requirements 2-1 APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS CMS Meaningful Use Requirements* All Providers Must Meet

More information

MCS Model of Care For Special Needs Plans (SNP) Annual training for delegated entities and facilities

MCS Model of Care For Special Needs Plans (SNP) Annual training for delegated entities and facilities 2018 MCS Model of Care For Special Needs Plans (SNP) Annual training for delegated entities and facilities Quality Department CAN_2790318S CMS Requirements The Centers of Medicare & Medicaid Services (CMS)

More information

2019 Quality Improvement Program Description Overview

2019 Quality Improvement Program Description Overview 2019 Quality Improvement Program Description Overview Introduction Eon/Clear Spring s Quality Improvement (QI) program guides the company s activities to improve care and treatment for the member s we

More information

2012 QUALITY ASSURANCE ANNUAL REPORT Executive Summary

2012 QUALITY ASSURANCE ANNUAL REPORT Executive Summary 2012 QUALITY ASSURANCE ANNUAL REPORT Executive Summary Jai Medical Systems Managed Care Organization, Inc. (JMS) and its providers have closed out their fifteenth full year in the Maryland Medicaid HealthChoice

More information

INFORMATION ABOUT YOUR OXFORD COVERAGE REIMBURSEMENT PART I OXFORD HEALTH PLANS OXFORD HEALTH PLANS (NJ), INC.

INFORMATION ABOUT YOUR OXFORD COVERAGE REIMBURSEMENT PART I OXFORD HEALTH PLANS OXFORD HEALTH PLANS (NJ), INC. OXFORD HEALTH PLANS (NJ), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service

More information

PROVIDER. Newsletter BETTER QUALITY IS OUR GOAL IN THIS ISSUE MEDICARE 2015 ISSUE II

PROVIDER. Newsletter BETTER QUALITY IS OUR GOAL IN THIS ISSUE MEDICARE 2015 ISSUE II MEDICARE 2015 ISSUE II PROVIDER Newsletter BETTER QUALITY IS OUR GOAL Our Quality Improvement (QI) program is dedicated to finding ways to help deliver better care and service to our members, in collaboration

More information

Colorado Choice Health Plans

Colorado Choice Health Plans Quality Overview Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace ) Full Full: Organization demonstrates full compliance

More information

Tufts Health Public Plans. Provider Manual

Tufts Health Public Plans. Provider Manual 2017 Tufts Health Public Plans Provider Manual Can t find information you need in this manual? Be sure you ve selected the correct provider manual, or follow one of the links below: Commercial Provider

More information

Provider Manual. Utilization Management Care Management

Provider Manual. Utilization Management Care Management Provider Manual Utilization Management Care Management Utilization Management This section of the Manual was created to help guide you and your staff in working with Kaiser Permanente s Resource Stewardship

More information

2016 Quality Management Annual Evaluation Executive Summary

2016 Quality Management Annual Evaluation Executive Summary 2016 Quality Management Annual Evaluation Executive Summary July 2017 Mission and Vision The purpose of the 2016 Annual Evaluation is to assess IEHP s Quality Program. This assessment reviews the quality

More information

AETNA BETTER HEALTH OF PENNSYLVANIA AETNA BETTER HEALTH KIDS Quality Assessment Performance Improvement Evaluation

AETNA BETTER HEALTH OF PENNSYLVANIA AETNA BETTER HEALTH KIDS Quality Assessment Performance Improvement Evaluation AETNA BETTER HEALTH OF PENNSYLVANIA AETNA BETTER HEALTH KIDS 2016 EXECUTIVE SUMMARY Aetna Better Health, a Medicaid Physical Health-Managed Care Organization in the state of Pennsylvania since 2010 provides

More information

THANK YOU. Health HAPPEN. Quality work yields quality results. Make. for being a member of Amerigroup Community Care! Inside Gettng the care you need

THANK YOU. Health HAPPEN. Quality work yields quality results. Make. for being a member of Amerigroup Community Care! Inside Gettng the care you need Inside Gettng the care you need Make Health HAPPEN Vol. 1, 2017 www.myamerigroup.com/md THANK YOU for being a member of Amerigroup Community Care! Every year, we look at how well we re serving you. Then,

More information

Member Handbook. STAR Kids (TTY 711) Members with Medicare and Medicaid Coverage.

Member Handbook. STAR Kids (TTY 711) Members with Medicare and Medicaid Coverage. Member Handbook STAR Kids Dallas, El Paso, Harris, Lubbock, and Medicaid Rural West Service Areas Members with Medicare and Medicaid Coverage 1-844-756-4600 (TTY 711) www.myamerigroup.com/tx TX-MHB-0109-17

More information

Amerigroup Washington, Inc. January 2015

Amerigroup Washington, Inc. January 2015 Amerigroup Washington, Inc. January 2015 Welcome to our New Medical Directors We are pleased to announce that Dr. Tom Paulson became our new Chief Medical Officer on January 5, 2015. Prior to joining Amerigroup,

More information

Florida Medicaid: Performance Measures (HEDIS)

Florida Medicaid: Performance Measures (HEDIS) Florida Medicaid: Performance Measures (HEDIS) Justin M. Senior Florida Medicaid Director Agency for Health Care Administration Senate Health Policy October 20, 2015 Statewide Medicaid Managed Care (SMMC)

More information

Model of Care. Quality Department 2017

Model of Care. Quality Department 2017 Model of Care Quality Department 2017 1 Objectives Understand the four (4) Model of Care elements, aimed at improving healthcare for D-SNP members. Learn about the Model of Care that MCS offers to their

More information

ATTACHMENT II EXHIBIT II-C Effective Date: February 1, 2018 SERIOUS MENTAL ILLNESS SPECIALTY PLAN

ATTACHMENT II EXHIBIT II-C Effective Date: February 1, 2018 SERIOUS MENTAL ILLNESS SPECIALTY PLAN ATTACHMENT II EXHIBIT II-C Effective Date: February 1, 2018 SERIOUS MENTAL ILLNESS SPECIALTY PLAN The provisions in Attachment II and the MMA Exhibit apply to this Specialty Plan, unless otherwise specified

More information

Dual-eligible SNPs should complete and submit Attachment A and, if serving beneficiaries with end-stage renal disease (ESRD), Attachment D.

Dual-eligible SNPs should complete and submit Attachment A and, if serving beneficiaries with end-stage renal disease (ESRD), Attachment D. Attachment A: Model of Care for Dual-eligible SNPs MA Contract Name: Geisinger Health Plan MA Contract Number: H3954-097 Type of Dual-eligible SNP: Full The model of care describes the MAO's approach to

More information

Provider Guide. Medi-Cal Health Homes Program

Provider Guide. Medi-Cal Health Homes Program Medi-Cal Health Provider Guide This provider guide provides information on the California Medi-Cal Health (HHP) for Community-Based Care Management Entities (CB-CMEs), providers, community-based organizations,

More information

Quality Management (QM) Program AmeriHealth Pennsylvania

Quality Management (QM) Program AmeriHealth Pennsylvania Quality Management (QM) Program AmeriHealth Pennsylvania Goals and Objectives The goals and objectives of the Quality Management (QM) Program are to promote the quality and safety of medical and behavioral

More information

Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans

Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans Welcome to the Agency for Health Care Administration (AHCA) Training Presentation for Managed Medical Assistance Specialty Plans The presentation will begin momentarily. Please dial in to hear audio: 1-888-670-3525

More information

Quality Management Utilization Management

Quality Management Utilization Management Aetna Better Health Aetna Better Health Kids Quality Management Utilization Management 2015 Program Evaluation EXECUTIVE SUMMARY Aetna Better Health, a Medicaid Physical Health-Managed Care Organization

More information

2016 Mommy Steps Program Descriptions

2016 Mommy Steps Program Descriptions 2016 Mommy Steps Program Descriptions Our mission is to improve the health and quality of life of our members Mommy Steps Program Descriptions I. Purpose Passport Health Plan (Passport) has developed approaches

More information

Provider Information Guide Complex Care and Condition Care Overview

Provider Information Guide Complex Care and Condition Care Overview Complex and Overview Introduction Complex and are essential components of Passport Health Plan s (Passport) Coordination services, which are used to support the practitioner-patient relationship and plan

More information

COMPASS Workflow & Core Elements

COMPASS Workflow & Core Elements COMPASS Workflow & Core Elements Care of Mental, Physical, and Substance use Syndromes! The project described was supported by Grant Number 1C1CMS331048-01-00 from the Department of Health and Human Services,

More information

Patient Centered Medical Home 2011

Patient Centered Medical Home 2011 Patient Centered Medical Home 2011 NCQA Standards Rand David, MD, FACP Associate Professor of Medicine Director, Dept. of Ambulatory Care Mount Sinai School of Medicine Elmhurst Hospital Center I have

More information

DENVER HEALTH MEDICAL PLAN, INC. & DENVER HEALTH MEDICAID CHOICE Medicaid Choice & CHP+ Quality Improvement Work Plan

DENVER HEALTH MEDICAL PLAN, INC. & DENVER HEALTH MEDICAID CHOICE Medicaid Choice & CHP+ Quality Improvement Work Plan *2016-2017 QI Program Description-Scope The QI Program Description is reviewed annually and updated according to national and state standards and guidelines. The QI program scope, goals, objectives and

More information

California s Health Homes Program

California s Health Homes Program California s Health Homes Program HPSM Network Webinar 9/05/18 Goals for Today: Health Homes Program overview CB-CME requirements Program readiness and implementation timeline Gather take-away questions

More information

Guide to Accessing Quality Health Care Spring 2017

Guide to Accessing Quality Health Care Spring 2017 Guide to Accessing Quality Health Care Spring 2017 MolinaHealthcare.com 5771753DM0217 MyMolina MyMolina is a secure web portal that lets you manage your own health from your computer. MyMolina.com is easy

More information

2016 Embedded and Rapid Response Care Management

2016 Embedded and Rapid Response Care Management 2016 Embedded and Rapid Response Care Management Program Evaluation Our mission is to improve the health and quality of life of our members 2016 Embedded and Rapid Response Care Management Program Evaluation

More information

DISEASE MANAGEMENT PROGRAMS. Procedural Manual. CMPCN Policy #5710

DISEASE MANAGEMENT PROGRAMS. Procedural Manual. CMPCN Policy #5710 DISEASE MANAGEMENT PROGRAMS Procedural Manual CMPCN Policy #5710 Effective Date: 01/01/2012 Revision Date(s) 11/18/2012; 10/01/13 ; 01/07/14 Approval Date(s) 12/18/2012 ; 10/23/13, 05/27,14 Annotated to

More information

Behavioral Health Care

Behavioral Health Care Provider Communications MHN Behavioral Health Care PCP tools for coordinating care Tina Machi, Health Net We offer tools and resources for improving member health. Managed Health Network (MHN), Health

More information

Provider Newsletter. Missouri 2017 Issue III. Annual Wellness Visit and Additional. In This Issue. Annual Physical

Provider Newsletter. Missouri 2017 Issue III. Annual Wellness Visit and Additional. In This Issue. Annual Physical Provider Newsletter Missouri 2017 Issue III Annual Wellness Visit and Additional Annual Physical Good news! WellCare has improved the way it pays Annual Wellness Exams and Additional Annual Physicals.

More information

Asthma Disease Management Program

Asthma Disease Management Program Asthma Disease Management Program A: Program Content GHC-SCW is committed to helping members, and their practitioners, manage chronic illness by providing tools and resources to empower members to self-manage

More information

EVOLENT HEALTH, LLC Diabetes Program Description 2018

EVOLENT HEALTH, LLC Diabetes Program Description 2018 EVOLENT HEALTH, LLC Diabetes Program Description 2018 1 Evolent Health Diabetes Program Description 2018 Table of Contents Section Page Number I. Introduction... 3 II. Program Scope... 3 III. Program Goals...

More information

Patient Experience & Satisfaction

Patient Experience & Satisfaction Patient Experience & Satisfaction Inpatient Satisfaction Inpatient Experience Hancock Regional Hospital conducts phone surveys from patients who have received care from us. Find out what they are saying

More information

Inside This Issue: * Introductory Letter to Premier Blue Providers. * Credentialing. * Office Site Assessments * HEDIS. * Office Medical Record Review

Inside This Issue: * Introductory Letter to Premier Blue Providers. * Credentialing. * Office Site Assessments * HEDIS. * Office Medical Record Review PB-1-99 March 10, 1999 Sent to: PB PCPs, RSs Inside This Issue: * Introductory Letter to Premier Blue Providers * Credentialing * Office Site Assessments * HEDIS * Office Medical Record Review * Member

More information

Special Needs Plan Provider Education

Special Needs Plan Provider Education Special Needs Plan Provider Education Learning Goals What is a Special Needs Plan (SNPs) What differentiates a SNP from other MA plans What SNPs are offered by Freedom Health and Optimum Healthcare 2 Care

More information

Healthcare Effectiveness Data and Information Set (HEDIS)

Healthcare Effectiveness Data and Information Set (HEDIS) Healthcare Effectiveness Data and Information Set (HEDIS) IlliniCare Health is a proud holder of NCQA accreditation as a managed behavioral health organization (MBHO) and prioritizes best in class performance

More information

Behavioral Health Program

Behavioral Health Program Behavioral Health Program Integrated, holistic health care delivered with compassion, respect and integrity for every member. Montana BH Provider Meetings December 2013 John Gorman LPC Sr. Manager of Utilization

More information

FEE FOR SERVICE MEASURES

FEE FOR SERVICE MEASURES FEE FOR SERVICE MEASURES Fee for Service (FFS) Measures provide a single payment incentive to PCP sites in exchange for performing a service or activity. All 2018 measures require providers to submit a

More information

PPS Performance and Outcome Measures: Additional Resources

PPS Performance and Outcome Measures: Additional Resources PPS Performance and Outcome Measures: PPS Performance and Outcome Measures: This document includes supplemental resources to the content on PPS Performance and Outcome Measures presented at the December

More information

Member Satisfaction Survey

Member Satisfaction Survey Member Satisfaction Survey 2016 Results and 2017 Future Plans Presented by Melissa Reagan, M.S.W., L.S.W, Quality Performance Specialist Agenda Review the purpose of the Member Satisfaction Survey and

More information

Quality Management and Improvement 2016 Year-end Report

Quality Management and Improvement 2016 Year-end Report Quality Management and Improvement Table of Contents Introduction... 4 Scope of Activities...5 Patient Safety...6 Utilization Management Quality Activities Clinical Activities... 7 Timeliness of Utilization

More information

Your health comes first

Your health comes first Your health comes first Here are the many ways we re working to ensure the quality of your care At Amerigroup, our focus is on you. We want to help you get and stay healthy. That s why we have many programs

More information

The New Jersey Department of Health and Senior

The New Jersey Department of Health and Senior The New Jersey Department of Health and Senior Services developed this report with the cooperation of the New Jersey health plans. The Department was guided by an advisory group representing health plans,

More information

Pharmacy Quality Measures. Presentation Developed for the Academy of Managed Care Pharmacy Updated: February 2013

Pharmacy Quality Measures. Presentation Developed for the Academy of Managed Care Pharmacy Updated: February 2013 Pharmacy Quality Measures Presentation Developed for the Academy of Managed Care Pharmacy Updated: February 2013 Objectives Explain the purpose of quality measures and how they are developed Identify quality

More information

Introducing. UPMC Community Care. UPMC Community Care. Your choice for wellness and recovery. at a glance

Introducing. UPMC Community Care. UPMC Community Care. Your choice for wellness and recovery. at a glance Introducing UPMC Community Care Your choice for wellness and recovery There are two parts to good health behavioral and physical. You ve already taken a step toward good health by accessing behavioral

More information

EVOLENT HEALTH, LLC. Heart Failure Program Description 2017

EVOLENT HEALTH, LLC. Heart Failure Program Description 2017 EVOLENT HEALTH, LLC Heart Failure Program Description 2017 1 Evolent Health Heart Failure Program Description 2017 Table of Contents Section Page Number I. Introduction. 3 II. Program Scope. 3 III. Program

More information

WHAT IT FEELS LIKE

WHAT IT FEELS LIKE PCMH and PCSP WHAT IT FEELS LIKE Presentation Outline Goals of the Patient Centered Medical Home and the Patient Centered Specialty Practice Identifying the Joint Principles Recognition Programs Standards

More information

CMS Mandated Training

CMS Mandated Training CMS Mandated Training Brand New Day Models of Care PRINT Your Name: SIGN Your Name: Print Today s Date: F:\QM\COMPLIANCE\COMPLIANCE TRAINING\MOC\BRAND NEW DAY MOC TRAINING.docx Brand New Day Medicare Mandated

More information

October Program/Policy Updates

October Program/Policy Updates October 2017 An An Update Update for for Highmark Highmark Health Health Options Options Providers Providers and and Clinicians Clinicians Program/Policy Updates Clinical Practice and Preventive Health

More information

AETNA BETTER HEALTH OF VIRGINIA Provider Newsletter

AETNA BETTER HEALTH OF VIRGINIA Provider Newsletter AETNA BETTER HEALTH OF VIRGINIA Provider Newsletter Winter 2016 Table of Contents 2017 HEDIS Tips...1 Member Rights and Responsibilities..2 Interpreter and Translation Services..2 Practice Guidelines...3

More information

HEDIS 101 for Providers 2018

HEDIS 101 for Providers 2018 HEDIS 101 for Providers 2018 Improving Quality of Care HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Author: Commercial & GBD Communication HEDIS Team Document

More information

Managing Patients with Multiple Chronic Conditions

Managing Patients with Multiple Chronic Conditions Best Practices Managing Patients with Multiple Chronic Conditions Dartmouth-Hitchcock Physicians Case Study Organization Profile Headquartered in Bedford, New Hampshire, Dartmouth-Hitchcock is a large

More information

HEDIS Updates to quality ratings, measures & reporting. Wilhelmina Delostrinos, Director of Quality Improvement & Accreditation

HEDIS Updates to quality ratings, measures & reporting. Wilhelmina Delostrinos, Director of Quality Improvement & Accreditation HEDIS 2018 Updates to quality ratings, measures & reporting Wilhelmina Delostrinos, Director of Quality Improvement & Accreditation Agenda HEDIS Overview HEDIS 2018 Changes to Existing Measures HEDIS 2018

More information

Quality Measures for HMO s: Understanding HEDIS

Quality Measures for HMO s: Understanding HEDIS Quality Measures for HMO s: Understanding HEDIS DANE COUNTY IMMUNIZATION COALITION MEMBERSHIP MEETING November 29, 2011 Elaine Rosenblatt MSN, FNP-BC Director, Quality and Care Management UW Medical Foundation/

More information

Provider Newsletter. Florida 2017 Issue II. In This Issue. Join the Conversation on Social Media. Join the Conversation on Social Media...

Provider Newsletter. Florida 2017 Issue II. In This Issue. Join the Conversation on Social Media. Join the Conversation on Social Media... Provider Newsletter Florida 2017 Issue II New Provider Portal Our portal is getting a whole new look and streamlined tools, including: Comprehensive Member Profile with Eligibility, Benefits & Co-Pays,

More information

Patient Centered Medical Home 2011 Standards

Patient Centered Medical Home 2011 Standards PCMH Standard 6 1 Patient Centered Medical Home 2011 Standards 2 Today s Agenda PCMH 6 PCMH 6 PCMH 6 Elements A-B Elements C-E Elements F-G Standard 6 A MEASURE PERFORMANCE PCMH 6A Measure Performance

More information

GOALS. I. Monitoring the quality of health care for safety, effectiveness and efficiency and seek opportunities for improvement

GOALS. I. Monitoring the quality of health care for safety, effectiveness and efficiency and seek opportunities for improvement MUTUAL OF OMAHA INSURANCE COMPANY UNITED OF OMAHA LIFE INSURANCE COMPANY PPO & MANAGED INDEMNITY MEDICAL & DENTAL PLANS EXCLUSIVE HEALTHCARE, INC. 2005 QUALITY IMPROVEMENT PROGRAM The Quality Improvement

More information

New York State Medicaid Value Based Payment: Data Driven Strategies. Bundled Payment Summit June 27, 2017

New York State Medicaid Value Based Payment: Data Driven Strategies. Bundled Payment Summit June 27, 2017 New York State Medicaid Value Based Payment: Data Driven Strategies Bundled Payment Summit June 27, 2017 Panelists Moderator Paloma Hernandez Anthony Thompson Marc Berg President and CEO Urban Health Plan

More information

Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs

Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs TECHNICAL ASSISTANCE TOOL September 2014 Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs S tates interested in using an accountable care organization (ACO) model

More information

HAWAII REGION R Clinic Administration/Population Management 08/1999 Complex Care 06/01/2000 PAGE NUMBER. 1 of 6 COMPLEX CARE POLICY

HAWAII REGION R Clinic Administration/Population Management 08/1999 Complex Care 06/01/2000 PAGE NUMBER. 1 of 6 COMPLEX CARE POLICY 1 of 6 COMPLEX CARE POLICY 1. Purpose The purpose of this policy to is to assure that patients with complex needs impacting their health status will receive standard services across the continuum of care

More information

AETNA BETTER HEALTH OF ILLINOIS Provider Newsletter June 2017, Vol. 7

AETNA BETTER HEALTH OF ILLINOIS Provider Newsletter June 2017, Vol. 7 AETNA BETTER HEALTH OF ILLINOIS Provider Newsletter June 2017, Vol. 7 www.aetnabetterhealth.com/illinois With questions or concerns, please contact Provider Services at 866-212-2851 Option 2 We heard you!

More information