Quality Management

Maryland Physicians Care focuses on keeping our members healthy. With our Quality Improvement Program, we closely evaluate and monitor the medical care and programs our members receive. We measure their quality and safety to find out what works best. That helps us improve our members’ health and identify the areas we need to improve.

Annually, Maryland Physicians Care will assess our programs’ progress against set goals. All aspects of the Quality Improvement Program are evaluated, including clinical and service activities. Some of these include:

  • Promote safety in healthcare through member and provider education
  • Establish and adopt Preventive Health Guidelines and Clinical Practice Guidelines to help members understand the type of medical services they need and how often they’re needed.
  • Assess provider availability to ensure members have access to qualified health care professionals.
  • Evaluate the quality of care members receive through analysis of measure outcomes, known as, Healthcare Effectiveness Data and Information Set (HEDIS®).
  • Measure outcomes to help us determine whether our members are receiving appropriate preventive care, such as:
    • Annual flu shots
    • Child immunizations (shots)
    • Eye tests
    • Cholesterol tests
    • Prenatal care for pregnant women
  • Evaluate member quality of care concerns and take action whenever necessary
  • Conduct member surveys that assess levels of satisfaction or dissatisfaction with us. For example, we conduct a Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, which:
    • Is mailed to members every year to complete and send back
    • Helps us recognize how happy or unhappy members are with their care and doctors
    • Helps us identify areas in need of improvement for action

For more information about our Quality Improvement Program, please contact member services at 1-800-953-8854.

Listed below are some of our 2014 accomplishments:

  • Achieved a score of 100 percent during the 2014 External Quality Review Organization (EQRO) Audit
  • Improved outcomes in the following HEDIS measures:
    • Immunizations for Adolescents - Combo 1
    • Well Child Visits First 15 Months of Life
    • Well Child Visits for 3-6 Year Olds
    • Adolescent Well Care
    • Child Access 25 mo – 6 yrs.
    • Adult Access 45-64
    • Breast Cancer Screening
    • Cervical Cancer Screening
    • Postpartum Care
    • Frequency of Prenatal Care
    • CDC – HbA1c Testing
    • CDC – HbA1c Adequate Control < 8
    • CDC – Eye Exam
    • CDC – LDL Testing
    • CDC – LDL Control < 100
    • CDC – Nephropathy
    • CDC – Blood Pressure < 140/90
  • Improved member satisfaction in the following CAHPS survey areas:
    • General Child and Chronic Condition Child
      • Shared Decision Making
      • Care Coordination
      • Doctor Communication
      • Getting Needed Care
    • Adults
      • Doctor Communication
      • Getting Care Quickly
      • Customer Service

Listed below are some of our areas of focus and goals for 2015:

  • Continue to identify opportunities to improve access to care for our members
  • Continue to focus on high-volume practitioners for clinical education, assistance in identification of noncompliant members, and assistance in appointment scheduling
  • To focus in-network activities to help reduce hospital readmissions
  • Enhance staff effectiveness through sales training, monitoring outcomes and monitoring productivity

Listed below are some of our 2015 accomplishments:

  • Achieved a preliminary score of 100 percent for the 2015 External Quality Review Organization (EQRO) audit. Final results are due in September.  It is expected this will be the 5th year in a row Maryland Physicians Care receives a perfect score.
  • Achieved a National Committee for Quality Assurance (NCQA) accreditation status of Commendable for service and clinical quality, meeting and exceeding NCQA’s rigorous requirements for consumer protection and quality improvement.
  • Improved outcomes in the following HEDIS measures:
    • Adult BMI assessment
    • Weight assessment and counseling for children
    • Childhood immunizations - Combo 4 through Combo 10
    • Immunizations for Adolescents – Combo 1
    • Breast Cancer Screening
    • Chlamydia Screening in Women – total (16-24) years
    • Medication management of COPD worsening – Bronchodilator Rate
    • Use of Appropriate Medications for people with Asthma – total ages 5-64
    • Medication management for people with Asthma
    • Appropriate testing for children with a sore throat
    • Controlling High Blood Pressure
    • Appropriate treatment with medicine after a heart attack
    • Comprehensive Diabetes Care: HbA1c testing
    • Comprehensive Diabetes Care: HbA1c control (<8%)
    • Comprehensive Diabetes Care: medical attention for kidney disease
    • Comprehensive Diabetes Care: controlling blood pressure
    • Child and Adolescents’ Access to a Primary Care Provider
    • Well Child visits the first 15 months of life
  • Improved member satisfaction in the following Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey areas:
    • Adults
      • How Well Doctors Communicate
      • Getting Needed Care
      • Getting Care Quickly
      • Health Promotion and Education
      • Coordination of Care
    • Child
      • Health Promotion and Education
    • Child with Chronic Conditions
      • Doctor Communication
      • Getting Care Quickly
      • Customer Service
      • Health Promotion and Education
  • Improved satisfaction rates in all six of the Provider Satisfaction Survey composite measures:
    • Overall satisfaction
    • No-Show Appointments
    • Finance Issues
    • Customer Service/Provider Relations
    • Coordination of Care/Case Management
    • Utilization Management
  • MPC achieved success in the 2 state mandated Performance Improvement Projects (PIPs)
    • Adolescent Well Care -- MPC was able to sustain a rate above the national benchmark for a second year in a row.
    • Controlling High Blood Pressure -- MPC exceeded our goal and saw an improvement of 14.6 percentage points above last year.
  • MPC performed well in the annual Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program evaluation. MPC met or exceeded the rate required for all 5 components of the review. 

Listed below are some of our areas of focus and goals for 2016:

  • Continue to monitor and identify opportunities to improve access to care for our members.
  • Continue to assist members in making and keeping doctor appointments and increase the prevention/wellness education provided to members.
  • Reduce hospital readmission rates.
  • Increase the number of children who complete the appropriate lead testing.
  • Increase the number of our practitioners who care for children and young adults that are EPSDT certified.
  • Continue to work to improve scores in all our HEDIS measures.

Listed below are some of our 2016 accomplishments:

  • The External Quality Review Organizations’ (EQRO) annual review has been changed to every 3 years however MPC received official word of the 100% score for the 5th year in a row for the CY 2015 review in the summer of 2016. The interim review for CY 2016 was positive and a full report is due later this year.
  • Maintained a National Committee for Quality Assurance (NCQA) accreditation status of Commendable for service and clinical quality, continuing to meet and exceed NCQA’s rigorous requirements for consumer protection and quality improvement.
  • Improved outcomes in the following HEDIS measures:
    • Childhood immunizations (CIS)
    • Immunizations for Adolescents – Combo 1 (Meningococcal, Tdap/Td)
    • Human Papillomavirus Vaccine for female Adolescents
    • Lead Screening in Children
    • Pharmacotherapy Management of COPD Exacerbation – both Systemic Corticosteriod and Bronchodilator Rate
    • Use of Appropriate Medications for people with Asthma – total ages 5-64
    • Medication management for people with Asthma
    • Appropriate testing for children with Pharyngitis
    • Adult access to preventative/ambulatory Health Services
    • Child and Adolescents’ Access to a Primary Care Provider
    • Prenatal and Postpartum Care
    • Well Child visits the first 15 months of life
    • Well Child visits in the Third, Fourth, Fifth and Sixth years of life
    • Adolescent Well Care visits
  • Improved member satisfaction in the following Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey areas:
    • Adults
      • Customer Service
      • Shared Decision Making
      • Health Promotion and Education
      • Coordination of Care
    • Child
      • Customer Service
      • Getting Needed Care
    • Child with Chronic Conditions
      • Customer Service
      • Getting Needed Care
      • Coordination of Care
      • Health Promotion and Education
  • Improved satisfaction rates for the “Overall Satisfaction” score in the Provider Satisfaction Survey.
  • Successfully added technology for improved member communication through text messaging and our enhanced Facebook page.
  • MPC remains successful with the 2 state mandated Performance Improvement Projects (PIPs)
    • Adolescent Well Care -- MPC was able to sustain the success of being above the national benchmark for three years in a row and this PIP is now retired.
    • Controlling High Blood Pressure -- MPC continues to work to help improve the care of our members with Hypertension.
  • MPC performed well in the annual Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program evaluation. MPC met or exceeded the rate required for 4 of 5 components of the review.

Listed below are some of our areas of focus and goals for 2017:

  • Continue to monitor and identify opportunities to improve access to care for our members.
  • Continue to assist members in making and keeping doctor appointments and explore new ways to provide prevention/wellness education to members.
  • Maintain the low hospital readmission rate.
  • Increase the number of children who complete the appropriate lead testing within the required time frame.
  • Increase the number of our practitioners who are completing and documenting the EPSDT Lab/At Risk Screening Requirements for children.
  • Improve the Asthma Medication Ratio rate for our members with Asthma.
  • Continue to strive for improved scores in all our HEDIS measures.