QUALITY IMPROVEMENT. Molina has defined key goals for the Quality Improvement Program. Through the Quality Improvement Program, Molina:

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 and service. The identified goals are based on an evaluation of programs and services; regulatory, contractual and accreditation requirements; and strategic planning initiatives. Contracted Providers and Facilities must allow Molina Healthcare to use its performance data collected in accordance with the provider s or facility s contract. The use of performance data may include, but is not limited to, the following: (1) development of quality improvement activities; (2) public reporting to consumers; (3) preferred status designation in the network; (4) and/or reduced member cost sharing. Additional information on the Quality Improvement Program (QIP) and activities is available on our website at www.molinhealthcare.com. Upon request in writing, Molina Healthcare will provide information on these or other QIP activities in writing, including a description of the QIP and an update on Molina Healthcare s progress in meeting the QIP goals. Please contact the Quality Department at (800) 869-7175 Ext. 147181. Quality Improvement Program Goals Molina has defined key goals for the Quality Improvement Program. Through the Quality Improvement Program, Molina: Defines, demonstrates, and discusses Molina s commitment and involvement in achieving improvements in quality of care and health results, member safety and quality of service; Plans and maintains programs that describe the health and health outcome needs of health plan members with the aim of improving clinical care and service outcomes within identified member populations; Ensures the relevance of the program through understanding health plan s member demographics and epidemiological data; Helps make sure that health care and services and interventions talk to the varied cultural, racial and ethnic, linguistic and added unique needs of Molina s membership; Improves the quality, safety, appropriateness, availability, accessibility, coordination and continuity of health care and services delivered to members; Conducts ongoing and systematic examination to design effective interventions that mitigate barriers to improve Molina s structure, processes, and outcomes; Develops the structure and processes to measure and improve member and provider satisfaction with the medical and behavioral health care delivered by providers and practitioners and health plan services; Section 7-Page 1

Uses a multidisciplinary committee structure to further the achievement of Quality Improvement Program goals; Encourages and supports a collaborative relationship between members, providers and regulators to promote effective health management, health promotion and wellness education; Applies sound approaches and methods to develop indicators and performance measures that are objective and clearly defined using systematic collection of valid and reliable data; Provides data on quality program and outcomes to health plan members and prospective members to allow individuals to compare and select from among health coverage options; Designs and carries out programs for network providers that are focused on topics, such as improving health outcomes, reducing hospital readmissions, improving member safety and reducing medical errors, and reducing health and health care disparities for network providers that use increased reimbursement or other market-based incentives to stimulate achievement of Quality Improvement goals; Aligns activities to meet external voluntary accreditation requirements; Fosters a shared organization-wide approach to protect the privacy and security of private member and provider information in line with Federal and State requirements and accreditation standards; Facilitates health plan efforts to maintain Federal and State regulatory compliance, including distribution of validated information and data in a form, manner, and reporting frequency as determined by regulatory agencies to support evaluation of Quality Improvement strategies; and Oversees and organizes health plan efforts to achieve and maintain NCQA accreditation. Molina implements Quality Improvement Program activities to identify and evaluate the health care and services given to the health plan s most vulnerable members in order to meet the unique needs of health plan members. Molina accomplishes this objective using systematic methods and analysis to identify vital subpopulations, such as members who are frail/disabled, and/or members who have many chronic medical and/or behavioral health conditions and/or members who have End Stage Renal Disease (ESRD) and/or members who are nearing the end of life through these methods and data analysis. Molina identifies, stratifies and checks the high priority needs of health plan members through data and information gathered through: Health risk assessments; Home visits; Predictive modeling; Medical, behavioral health, laboratory and pharmacy claims and encounters data review/analysis, as applicable; Care/case/Health (e.g., disease) management activities; Self-referrals by members/caregivers; Member self-referrals through Member Services and Nurse Advice Line; and/or Section 7-Page 2

Referrals from network providers. Molina carries out and evaluates a comprehensive Model of Care to meet the needs of the most vulnerable populations who are enrolled in the Medicare and Medicare- Medicaid Programs. Molina identifies these members early and places individuals who are identified as a higher priority or in a higher level of stratification in designated Molina Programs. Designated Molina programs include Health Management (e.g. Disease Management), Care Management, and/or Case Management. Molina manages the health care and services for these members more aggressively and more often. Implementing this approach, Molina is able to ensure that the most vulnerable populations receive needed services that are timely and appropriate. Molina Case Managers also put into place care plans before, during and after transitions in health care settings and/or changes in the health status as needed for these members. Scope of Program Activities Molina carries out a broadly defined Quality Improvement Program, with the goal of fully addressing the many and wide-ranging topics within the scope of Quality Improvement. Molina s Quality Improvement Program focuses on activities that encompass the member s entire health care experience. This, therefore, means that Molina s Quality Improvement Program focuses on medical and/or behavioral health care and/or services in any setting of care that are delivered to health plan members. Molina s Quality Improvement Program scope includes, but is not limited to, medical and behavioral health care and services supplied in institutional, outpatient, home care, and or even the member s home. Contracted provider groups, primary care and specialty practitioners and ancillary providers may render these services. Molina s Quality Improvement Program focuses on all types of health care and services, such as preventive health care, acute care, and/or the management of chronic/complex conditions. Molina also routinely assesses the needs of the health plan member population by age, disease categories, risk status and lines of business, with the aim of better meeting the needs of our members. Molina is fully invested in making sure that our members receive timely and appropriate behavioral health care and services in collaboration with network providers. Through Molina s Quality Improvement Program, Molina evaluates how well behavioral health care and services are delivered to health plan members as designated within their assigned benefits. Management of behavioral health care and services is evaluated along with any medical issues that may impact the member s health. Molina takes this holistic approach to ensure that there is effective coordination of all health care between medical and behavioral health providers, case managers and care coordinators in order to meet the needs of our members and to achieve a high level of satisfaction. Important Aspects of Care and Service Molina continuously checks important aspects of health care and services to ensure that health plan members get timely, appropriate, effective, efficient, and safe care in the right setting at the right place. Molina checks key aspects or activities that include, but are not limited to: Access/availability, to include health risk assessments, appointment scheduling, network composition through assessment by volumes and type of providers, and geographic analysis; Section 7-Page 3

Continuity/coordination of care between medical and behavioral health providers, primary care physicians and specialists, case managers, providers and members, within secondary preventive behavioral health programs, and through collaboration between providers; Case and disease management as measured by the use of and compliance with evidencebased guidelines and processes for structured assessment and follow-up; Appropriateness of care as measured by comparison of performance against established benchmarks, review for potential over- and under-utilization, use of and compliance with clinical practice guidelines, grievance and case review processes, and distribution of enrollee rights and responsibilities; Behavioral Health and Chemical Dependency care and services as measured by the use of and compliance with clinical practice guidelines; Long Term Care and Long Term Services and Supports (as applicable) to health plan members; Management of chronic conditions and acute care for individuals; Improvements in member safety/medical error reduction/avoidance; High-risk/high-volume/problem-prone care (activities are also designed to improve member safety, reduce or avoid medical errors and/or prevent hospital readmissions); Preventive care and services as measured by the use of and compliance with clinical practice guidelines (activities are also designed to focus on wellness and health promotion); Activities that focus on members with special health care needs; Activities that focus on members with complex health needs who may need case management and/or care coordination (activities are also designed to improve health results, improve member safety and/or reduce/avoid medical errors and/or prevent hospital readmissions and/or reduce health and health care disparities); Outreach to members to ensure effective coordination of services (i.e., clinical, transportation, support to access care, etc.) (activities are also designed to improve health results, improve member safety and/or reduce/avoid medical errors and/or prevent hospital readmissions and/or reduce health and health care disparities and/or focus on wellness and health promotion); HEDIS measurement/reporting and activities to address performance gaps (activities are also designed to improve health outcomes, and/or reduce health and health care disparities and/or focus on wellness and health promotion); Member and practitioner satisfaction with medical and behavioral health care and services, through measurement such as the Consumer Assessment of Healthcare Providers and Systems survey, the Qualified Health Plan enrollee satisfaction survey, the behavioral health Experience of Care and Health Outcomes Survey, and provider satisfaction survey; Section 7-Page 4

Medical Coverage Guidance documents; Health plan service standards and operational performance thresholds; Activities focused on quality of care/critical incident clinical case review, Serious Reportable Adverse Events, and Hospital Acquired Conditions (activities are also designed to improve health results, improve member safety and/or reduce/avoid medical errors and/or prevent hospital readmissions); Medication management (activities are also designed to improve health outcomes, improve member safety and/or reduce/avoid medical errors and/or prevent hospital readmissions and/or reduce health and health care disparities); Activities that focus on the provision of timely and appropriate health care and services that meet the needs for its culturally and linguistic diverse membership; Activities are also designed to improve health outcomes and/or prevent hospital readmissions and/or reduce health and health care disparities and/or focus on wellness and health promotion); Review and analysis of demographic, health status, and utilization patterns of enrolled populations and communities (activities are also designed to identify information that can be used to improve health outcomes and/or prevent hospital readmissions and/or reduce health and health care disparities and/or focus on wellness and health promotion); Health Management Information Systems performance and data capture; Plan-determined Quality Improvement projects, internal and collaborative projects with other health plans, including but not limited to, Quality Improvement Projects, Performance Improvement Projects, and Chronic Care Improvement Programs designed to meet state and federal regulatory requirements and internal health plan needs; Collection, reporting and analysis of applicable and appropriate measures of health outcomes and indices of quality for the target populations and sub- populations (activities are also designed to identify information that can be used to improve health outcomes and/or prevent hospital readmissions and/or reduce health and health care disparities and/or focus on wellness and health promotion); and Activities that focus on people with co-morbid health problems and complexities linked to concurrent/on-going or unresolved medical and behavioral health issues (activities are also designed to improve health outcomes, improve member safety and/or reduce/avoid medical errors and/or prevent hospital readmissions and/or reduce health and health care disparities and/or focus on wellness and health promotion). Patient Safety Program Molina Healthcare is committed to promoting and fostering an environment that ensures quality and safety of care and services provided to our Members. Molina Healthcare promotes safe health practices through education and dissemination of information for decision-making. Molina Healthcare does this in the following ways: Section 7-Page 5

Distributes information to Members for the purpose of helping him/her improve his/her knowledge of clinical safety in his/her own care; Collaborates with network providers to support safe clinical practices; Monitors and reviews codes specific to safety issues in the complaint system to capture, track and trend member safety concerns; Develops and maintains drug usage criteria, assesses the efficacy of new drugs or a new use for an existing drug; Collaborates with the Molina Healthcare Pharmacy Benefits Manager to ensure that polypharmacy of narcotic controlled substances and drug interaction information is incorporated into routine counseling information provided to Members and practitioners/providers; Monitors indicators relating to polypharmacy of narcotic controlled substances and misuse; Monitors member complaint, appeal, and quality of care review and reporting processes for issues regarding poor care or potentially unsafe practices; Ensure review and action, through the expedited appeal process, on an appeal of a medical necessity denial based on the urgency of the request; Promotes continuity and coordination of care between behavioral health, primary care practitioners (PCPs) and specialists; Monitors processes to ensure that care is continued if a provider is terminated from or leaves the Molina Healthcare network; Verifies the credentials of providers joining the Molina Healthcare s network to assure that they meet the requirements for providing quality care; Ensures that credentialing and recredentialing processes includes practice site assessment data, medical record review data, utilization and complaint information; Evaluates provider offices during site visits for initial credentialing or follow-up visits for other indications; Reviews Department of Health and Human Services Office of Inspector General sanctioning Information. HEALTH MANAGEMENT PROGRAMS Molina Healthcare s Health Management programs provide patient education information to Members and facilitate Provider access to these programs and services. Transitions of Care (ToC) The Molina Healthcare TOC Program is designed to manage member transitions between levels of care to improve quality of care for members, ensure follow-care needs are met, and prevent return to higher levels of care. The program interventions include: improving member and practitioner understanding of roles, expectations and goals; ensure the member is prepared to continue the plan of care from one setting to another; Section 7-Page 6

coordinate needed services with appropriate practitioners or community resources; and promote member self-management while encouraging empowerment. Goals of the program also include preventing avoidable hospital readmission and emergency room visits, optimal transitioning from one care setting to another and/or identifying an unexpected change in condition requiring further assessment and intervention and confirming/reestablishing the member s connection to their medical home. Transition services are provided telephonically or in-person depending on the level of risk of readmission. Readmission risk is assessed initially by the Inpatient Review team of nurses who manage members admissions from admission notification to discharge. Members are contacted by a ToC coach by phone or in-person while in the facility if possible to assist with coordinating health care needs prior to discharge, then postdischarge by phone or in the member s residence to ensure a smooth transition. For more information about this program, please call Member Services at (800) 869-7165. Asthma Program Asthma Clinical Practice - These guidelines can be reviewed from the Molina Healthcare website at http://www.molinahealthcare.com/providers/wa/medicaid/resource/pages/guide_clinical.aspx Asthma Newsletters Molina Healthcare distributes asthma newsletters to identified Members. You can receive a copy by calling our Quality Improvement Health Education Line at (800) 423-9899, Ext. 141428 or by going to http://www.molinahealthcare.com/members/wa/en- US/mem/medicaid/overvw/resources/news/Pages/mngtnews.aspx Smoking Cessation Molina Healthcare offers smoking cessation to all Washington Medicaid Members over the age of 18 through the Quit-4-Life program at (866) 784-8454. Members can obtain additional information on Asthma on Molina Healthcare s Staying Healthy Webpage: http://www.molinahealthcare.com/members/common/en- US/healthy/hlthcondcare/Pages/carehealth.aspx Healthy Living with Diabetes Molina Healthcare has a diabetes health management program called Healthy Living with Diabetes designed to assist Members in understanding diabetes and self-care. The Healthy Living with Diabetes program includes: Section 7-Page 7

Diabetes Clinical Practice Guidelines These guidelines can be reviewed from the Molina Healthcare website at http://www.molinahealthcare.com/providers/wa/medicaid/resource/pages/guide_clinical.aspx Diabetes Newsletters Molina Healthcare distributes newsletters to diabetic Members. You can receive a copy by calling our Health Education Line at (800) 423-9899, Ext. 141428 or by going to http://www.molinahealthcare.com/members/wa/en- US/mem/medicaid/overvw/resources/news/Pages/mngtnews.aspx Diabetes Education Diabetes education is covered for all Molina Healthcare Members. We encourage Providers to refer patients to these services, especially for newly diagnosed diabetics or those having difficulty managing their disease. Smoking Cessation Molina Healthcare offers smoking cessation to all Washington Medicaid Members over the age of 18 through the Quit-4-Life program at (866) 784-8454. Members can obtain additional information on Diabetes on Molina Healthcare s Staying Healthy Webpage: http://www.molinahealthcare.com/members/common/en- US/healthy/hlthcondcare/Pages/carehealth.aspx Heart Healthy Living Cardiovascular program Molina Healthcare has a Cardiovascular Health Management Program called Heart Healthy Living aimed at assisting Members with their understanding and management of cardiovascular disease (CVD). We have focused on five specific areas: Hyperlipidemia Congestive Heart Failure Hypertension Myocardial Infarction Angina Molina Healthcare believes excellent care starts in your office. Our role is to provide additional services to complement your care. The Heart Healthy Living program includes: Cardiovascular Disease Clinical Practice Guidelines These guidelines can be reviewed from the Molina Healthcare website at http://www.molinahealthcare.com/providers/wa/medicaid/resource/pages/guide_clinical.aspx Smoking Cessation Molina Healthcare offers smoking cessation to all Washington Medicaid Members over the age of 18 through the Quit-4-Life program at (866) 784-8454. We encourage providers to use this service. Section 7-Page 8

Members can obtain additional information on Cardiovascular Disease on Molina s Staying Healthy webpage: http://www.molinahealthcare.com/members/common/en- US/healthy/hlthcondcare/Pages/carehealth.aspx Chronic Obstructive Pulmonary Disease program (COPD) Molina Healthcare has a Chronic Obstructive Pulmonary Disease (COPD) Health Management Program aimed at assisting Members with their understanding and management of COPD. Molina Healthcare believes excellent care starts in your office. Our role is to provide additional services to complement your care. COPD program includes: COPD Clinical Practice Guidelines These guidelines can be reviewed from the Molina Healthcare website at http://www.molinahealthcare.com/providers/wa/medicaid/resource/pages/guide_clinical.aspx Smoking Cessation Molina Healthcare offers smoking cessation to all Washington Medicaid Members over the age of 18 through the Quit-4-Life program at (866) 784-8454. We encourage providers to use this service. Members can obtain additional information on COPD on Molina s Staying Healthy webpage: http://www.molinahealthcare.com/members/common/en- US/healthy/hlthcondcare/Pages/carehealth.aspx ENROLLEES WITH SPECIAL HEALTH CARE NEEDS Molina Healthcare is working toward improving care and service for Enrollees with Special Health Care Needs. Molina Healthcare in collaboration with its providers assist enrollees and families with coordination of care and to provide information regarding available resources. Special health care needs may include but are not limited to: Those who have or are at increased risk of serious and/or chronic physical, developmental, behavioral or emotional conditions, substance use disorder Require health and related services of a type or amount beyond what is generally necessary Inappropriate (over and under) utilization of services including prescription use Specific diagnoses of children with special health care needs include: asthma, diabetes, heart disease, obesity, cancer, autism, cerebral palsy, Down s syndrome, cleft lip and/or palate, attention deficit hyperactivity disorder, prematurity, speech/language delay, sickle cell anemia, diabetes, arthritis, blindness, hearing loss, gross and/or fine motor delay and multiple sclerosis. Section 7-Page 9

Providers who are caring for enrollees with Special Health Care Needs are required to develop an individualized treatment plan and coordinate care with clinical and non-clinical services, such as community resources. The treatment plan should include the following: Short and long term goals Enrollee participation Modified based on enrollee s changing needs Barriers and how they were addressed Case Management services are available for those Enrollees with Special Health Care Needs. Refer to Medical Management section 6 of the Provider Manual. CLINICAL, BEHAVIORAL, PREVENTIVE PRACTICE GUIDELINES Clinical, Behavioral, Preventive Evidence-Based Practice Guidelines Practice guidelines are based on scientific evidence, review of the medical literature, or appropriately established authority, as cited. All recommendations are based on published consensus guidelines and do not favor any particular treatment based solely on cost considerations. The recommendations for care are suggested guides for making clinical decisions. Clinicians and patients must work together to develop individual treatment plans that are tailored to the specific needs and circumstances of each patient. Molina has adopted the following clinical practice guidelines: Asthma Attention-Deficit/Hyperactivity Disorder (ADHD) Bipolar Chlamydia and Gonorrhea Colorectal Cancer Chronic Obstructive Pulmonary Disease (COPD) Depression Diabetes Heart Failure Hypertension Hyperlipidemia Judicious use of Antibiotics Obesity Prescribing Opioids for Pain Preventing Heart Attack and Death in Patients with Cardiovascular Disease Treatment of Substance Related Disorders in Children and Adolescents Treatment of Substance Related Disorders in Adults Section 7-Page 10

Preventive Health Guideline: Infants, Children, and Adolescents (children up to 24 months care for children 2 to 19 years of age, 19 years old, includes Immunization. Preventive Health Guideline: Adults (20-64 years of age and 65 years and older, includes immunization) Preventive Health Guideline: Routine Prenatal Care Additionally, to meet the EPSDT guidelines, Molina uses preventive health guidelines based on U.S. Preventive Services Task Force Recommendations. To evaluate effectiveness, Molina measures performance against important aspects of each clinical practice and preventive guidelines using, but not limited to, the following: Emergency Room visit rates, if applicable Hospitalization Rates, if applicable HEDIS rates Member/family satisfaction with the program for those members receiving active care management. Clinical, Behavioral, and Preventive Practice Guidelines can be reviewed from the Molina Healthcare website at the below links: http://www.molinahealthcare.com/providers/wa/medicaid/resource/pages/guide_clinical.aspx and http://www.molinahealthcare.com/providers/wa/medicaid/resource/pages/guide_prevent.aspx If you would like a printed copy of this information, you may request it by calling our Quality Department at (800) 869-7175 Ext. 147181. MEASUREMENT OF CLINICAL AND SERVICE QUALITY: Healthcare Effectiveness Data and Information Set (HEDIS ) Consumer Assessment of Healthcare Providers and Systems (CAHPS ) Health Outcome Survey (HOS) is conducted for Medicare members Qualified Health Plan (QHP) Marketplace Survey Experience of Care and Health Outcomes (ECHO) Survey Provider Satisfaction Survey Effectiveness of Quality Improvement Initiatives Section 7-Page 11

HEDIS Molina Healthcare utilizes NCQA HEDIS as a measurement tool to provide a fair and accurate assessment of specific aspects of managed care organization performance. HEDIS is conducted annually in the spring. The data comes from on-site medical record review and available administrative data. All reported measures must follow rigorous specifications and are externally audited to assure continuity and comparability of results. The HEDIS measurement set currently includes a variety of health care aspects including immunizations, women s health screening, diabetes care, appropriate use of asthma medications, and prenatal and postpartum care. HEDIS results are used in a variety of ways. They are the measurement standard for many of Molina Healthcare s clinical quality improvement activities and health improvement programs. The standards are based on established clinical guidelines and protocols, providing a firm foundation to measure the success of these programs. Selected HEDIS results are provided to Health Care Authority (HCA) as part of our contract Health plans also submit results directly to NCQA, consistent with the original intent of HEDIS to provide health care purchasers data with which to make informed decisions. The data is also used by NCQA to establish health plan performance benchmarks and are an integral part of the NCQA health plan accreditation process. Your office may be requested to submit documentation from medical files as part of the HEDIS data collection process. The most recent HEDIS results for Molina Healthcare can be found on our website at: http://www.molinahealthcare.com/members/wa/en- US/mem/medicaid/overvw/quality/Pages/hedis.aspx CAHPS CAHPS is the tool used by NCQA to summarize member satisfaction with health care, including providers and health plans. CAHPS examines specific measures, including Getting Needed Care, Getting Care Quickly, How Well Providers Communicate, Courteous and Helpful Office Staff, and Health Plan Customer Service. The CAHPS survey is administered annually in the spring to randomly selected members according to contract. CAHPS survey results are used in much the same way as HEDIS results, only the focus is on the service aspect of care rather than clinical activities. They form the basis for several of Molina Healthcare s quality improvement activities and are used by external agencies and health care purchasers to help ascertain the quality of services being delivered. Molina Healthcare s most recent CAHPS results can be found on our website at: http://www.molinahealthcare.com/members/wa/en- US/mem/medicaid/overvw/quality/Pages/cahps.aspx Section 7-Page 12

HOS The Medicare Health Outcomes Survey (HOS) survey is a patient-reported outcomes measure used in Medicare managed care. The goal of the Medicare HOS is to gather valid, reliable, and clinically meaningful health status data from the Medicare Advantage (MA) program to use in quality improvement activities, pay for performance, program oversight, public reporting, and to improve health. All managed care organizations with Medicare contracts must participate. If you would like to learn more about this survey visit the CMS site below. https://www.cms.gov/research-statistics-data-and-systems/research/hos/index.html QHP The overall objective of the Qualified Health Plan Enrollee Experience Survey is to capture accurate and reliable information about consumer-reported experiences with health care. The survey includes all of the questions in the core CAHPS Health Plan (Adult Medicaid) survey plus additional questions added to collect needed data specific to this population. The Quality Rating System (QRS) Section 1311(c) (4) of the Affordable Care Act (ACA) requires the development of a system to rate QHPs offered through a Marketplace based on quality and price. One significant part of this mandate requires the development and implementation of a survey to assess the consumer experience. The goal of the Quality Rating System is to provide information for consumers to use when they select a health plan in the Marketplace and to facilitate regulatory oversight by states, CMS, and accreditation authorities. Results will be displayed using a 5-star rating scale. The QHP Enrollee Experience Survey supplies data to the QRS regarding patient experiences with their health care. ECHO The Experience of Care and Health Outcomes (ECHO) Survey asks about the experiences of adults and children who have received mental health or substance abuse services through a health plan in the previous 12 months. It is appropriate for patients with a range of service needs, including those with severe mental illness, but does not include questions about inpatient stays or self-help groups. Provider Satisfaction Survey Recognizing that HEDIS and CAHPS both focus on member experience with health care providers and health plans, Molina Healthcare conducts a Provider Satisfaction Survey each year. The results from this survey are very important to Molina Healthcare, as this is one of the primary methods we use to identify improvement areas pertaining to the provider network. The survey results have helped establish improvement activities relating to Molina Healthcare s specialty network, inter-provider communications, and pharmacy authorizations. If your office is selected to participate, please take a few minutes to complete it and send it back. Section 7-Page 13

Effectiveness of Quality Improvement Initiatives Molina Healthcare monitors the effectiveness of clinical and service activities through metrics selected to demonstrate clinical outcomes and service levels. The plan s performance is compared to that of available national benchmarks indicating a best practice. The Clinical Quality Improvement Committee (CQIC), which includes providers from the provider network, evaluates clinical metrics on an ongoing basis. Results of these measurements guide activities for the successive periods. Additionally, Molina Healthcare has a Member and Provider Satisfaction Committee (MPSC) that oversee all service related activities. Clinical Metrics include but are not limited to the following: Clinical Practice Guideline Compliance measurement: HEDIS measures for asthma and diabetes Use of short-acting beta-agonists for Members with asthma Use of antibiotics for upper respiratory disease Effectiveness of interventions in Healthy Living with Diabetes, Heart Healthy Living, Chronic Obstruct Pulmonary Disease (COPD) programs: Post-hospital follow-up rate with PCP or Specialist Inpatient and emergency department utilization Readmission after primary diagnosis of asthma, diabetes, COPD or a cardiovascular condition Key clinical metrics including but not limited to: annual A1c and eye exams for diabetics and beta-blocker use and cholesterol testing after an acute cardiac event Service Improvement Metrics include but are not limited to: Utilization Management (UM) authorization turn around times (TAT) Pharmacy authorization turn around times Member Services response time Satisfaction with Molina Healthcare specialty network (as measured through CAHPS and Provider Satisfaction Survey) Section 7-Page 14

PREVENTIVE HEALTH, HEALTH EDUCATION AND INCENTIVE PROGRAMS - Molina Healthcare integrates Health Education and Health Management Program goals with HEDIS Effectiveness of Care and Access rate improvement efforts. Molina Healthcare members receive telephonic and mail outreach promoting the importance of the needed preventive visits. Assistance is offered to schedule appointments as well as for needed transportation. Health fairs and provider events offer member education and services in culturally appropriate settings. Additionally, members may be eligible for incentive rewards for completing targeted preventive visits in a timely manner. The following table further details the leading preventive health topics promoted via these programs: HEDIS Measures Pharmacy Reporting 2017 Member Education and Outreach 2017 Member Incentive 2017 Adolescent Well Child (AWC) X X Well Child 15 Months Visit (W15); Six well child visits X X Well Child 3-6 Years Visit (W34) X X Well Child 7-11 Years Visit (W711) X X Childhood Immunization Status (CIS) X X Prenatal and Postpartum Care (PPC) X X Depression; Anti-depressant Medication Management (AMM) X X Comp Diabetes Care; Eye Exam (CDC) X X Comp Diabetes Care; HBA1C (CDC) X X Breast Cancer Screening (BSC) X X Cervical Cancer Screening (CCS) X X QI Incentives Email Box: MHW_QI_Interventions@MolinaHealthcare.com QI Incentives Fax: (800) 461-3234 Apple Health Member Rewards (Incentive forms) can be located at the below link. When updates occur to the forms providers will be notified via fax and/or mail. http://www.molinahealthcare.com/providers/wa/medicaid/forms/pages/fuf.aspx Preventive care guidelines for all ages can be reviewed and downloaded at: http://www.molinahealthcare.com/providers/wa/medicaid/resource/pages/guide_prevent. aspx If you have any questions about this program, please call Quality Improvement Health Education Line at (800) 869-7175 Ext. 141428. Section 7-Page 15