Quality Management Report 2017 Q4
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1 Quality Management Report 2017 Q4
2 Care Wisconsin Participates in Many Quality Initiatives Across the State and Federal Levels. These activities include: CMS DHS DHS & CMS HEDIS Member Satisfaction (CAHPS & HOS) Model of Care Risk Adjustment STAR Ratings Annual Quality Reviews DHS Quality Indicator Monitoring Member Advisory Committees Member Incident Reporting Member Satisfaction Surveys Pay for Performance Grievances and Appeals Performance Improvement Projects Quality Performance Metrics Utilization Management
3 Current Quality Initiatives Comprehensive Diabetes Management As part of the CMS-required Chronic Care Improvement Project (CCIP) we have various activities in place to improve HbA1C lab values, statin adherence rate, and blood pressure readings for members in the Partnership and Dual Eligible programs. Also, we are committed to ensuring members will have an annual eye exam, HbA1C labs, and visit the clinic to receive a kidney function test Dementia Care Wisconsin Quality Department is focused on improving care management of chronic health conditions. Currently there are many interventions and initiatives focused on our members with dementia. Honoring Choices We are committed to the Honoring Choices Wisconsin initiative which promotes advance care planning for our members. Incident Management System We manage member incidents through internal systems that track appropriate follow up and interventions, to avoid further incident in the future. Internal File Reviews Care Wisconsin monitors the quality of documentation and care management of member through internal file reviews. This allows us to give regular and time sensitive feedback to improve care management of our various members.
4 2018 Medicare Star Rating Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. 4½ Stars Above Average Overall Rating Care Wisconsin Health Plan, Inc. (Contract H5209)
5 STAR One of CMS s strategic goals is to improve the quality of care and general health status for Medicare beneficiaries CMS publishes Part C and D star Ratings each year to measure quality in Medicare Advantage plans Care Wisconsin Highest Rated STAR Measures: Medication Reconciliation Post-Discharge Diabetes Care Eye Exam Medication Adherence for Diabetes Medications MTM Program Completion Rate for CMR
6 Member Satisfaction Survey Family Care (FC) and Partnership (FCP) members are surveyed regarding their experience with key features of the services they received from Care Wisconsin (CW).* *Source:
7 Member Satisfaction Survey Results The Staff listens to your concerns and try and help if they can. They seem to care about the member as a person, not just a client. Partnership Member
8 Member Satisfaction Survey Results I am very thankful for the time and effort put into helping us with our needs and goals. -Family Care Member
9 Medicaid Appeals Care Wisconsin views the grievances and appeals process as important for both members and the organization. Care Wisconsin staff encourages members to utilize the Member Rights Specialists and resources that are available to them that will ensure they get a fair hearing and that their dignity and rights are a priority. A high appeal rate may not be an indication that something is wrong, but that members are exercising their rights.
10 Medicaid Mediation Our goal is to help maintain communication and encourage all Medicaid members to stay engaged in the process throughout their appeal by participating in mediation. In many cases, through mediation we are able to resolve differences without a formal appeal hearing. While not all members choose to participate, we offer mediation to all Medicaid members and work towards our goal of 100% member engagement.
Quality Management Report 2018 Q1
Quality Management Report 2018 Q1 Care Wisconsin Participates in Many Quality Initiatives Across the State and Federal Levels These activities include: Centers for Medicare & Medicaid Services (CMS) Department
Quality Management Report 2017 Q2
Quality Management Report 2017 Q2 Quality Management Program CMS STAR Ratings Member Satisfaction (CAHPS & HOS) HEDIS Risk Adjustment DHS Member Incident Reporting Member Satisfaction Surveys Pay for Performance
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