Maryland Physicians Care has a Quality Management (QM) Program. The QM Program monitors and assesses the health care services delivered to our members. The goal is to deliver high-quality care and services to all members.
Every year Maryland Physicians Care measures our progress against goals. We measure all parts of the QM Program. That includes clinical and service activities like:
- Promoting health care safety with member and provider education.
- Establishing preventive health guidelines and clinical practice guidelines. These help members understand what kind of services they need and how often they’re needed.
- Making sure members have access to qualified health care professionals.
- Evaluating the quality of care members receive. We look at data known as the Healthcare Effectiveness Data and Information Set® (HEDIS). That info helps us see if members are receiving appropriate preventive care. Examples of preventive care:
- Annual flu shots
- Child immunizations (shots)
- Eye tests
- Cholesterol tests
- Prenatal care for pregnant women
- Evaluating member quality of care concerns and take action if needed
- Conducting surveys to see if members are satisfied. Example: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey:
- The survey is mailed to members every year to complete and send back.
- The survey helps us see how happy or unhappy members are with their care and doctors.
- The survey helps us find areas to improve.
For more information about our Quality Management Program, please contact Member Services at 1-800-953-8854.
Listed below are some of our areas of focus and goals for 2020:
- Meet or exceed member satisfaction results from 2019
- Ensure that the provider network has sufficient numbers and types of primary care and specialty practitioners so that members have access to care as needed
- Improve the rate of members who receive lead tests at one year old
- Continue to work with local organizations to address the Opioid epidemic
- Maintain the low number of members who are readmitted to the hospital
- Increase the number of pregnant members who get their post-partum exam
- Decrease the number of unnecessary Emergency Room Visits
- Increase the number of SSI Adults and Children who have at least one office visit with a network provider
- Continue health promotion activities by
- Placing helpful information and health education on MPC’s website
- Providing a quarterly newsletter
- Using social media (face book) to post health information to promote health
- Sending letters, post-cards and texts to remind members of important due dates of services
- Providing community events to promote health
...and much, much more!
Listed below are some of our 2019 accomplishments:
- Lowered the High Dose Opioid usage rate through the efforts of the Opioid Over-Utilization Quality Improvement Activity Program
- Improved member satisfaction in two Adult Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey areas: Rating of Personal Doctor and Coordination of Care
- Increased the Lead Screening rate (the number of children tested for lead poisoning) through the implementation of the Lead Performance Improvement Project
- Improved results on the overall Early and Periodic Screening and Diagnostic Testing (EPSDT) review. This shows that providers are providing recommended screening and preventive services at well child visits (according to the guidelines of the Maryland Healthy Kids Program)
- Increased the Asthma Controller Medication rates through member and provider education and home visits to members who did not use controller medication as prescribed.
- Revised the Pay for Performance (P4P) Program that resulted in an increased number of members getting preventive services.
Listed below are some of our areas of focus and goals for 2019:
- Increase awareness and promote internal collaboration across all departments to improve our members' satisfaction scores.
- Transition from fee-for-service to value-based arrangements which support incentives to improve quality.
- Collaborate with local organizations to discuss and address the Opioid epidemic.
- Continue to look for and find ways to improve access to care for our members.
- Continue to help coordinate care and assist members with scheduling doctor appointments, especially for preventative care.
- Maintain the low number of members who are readmitted to the hospital.
- Increase the number of children who complete the appropriate testing for lead poisoning within the recommended time frame.
- Increase the number of practitioners who complete and include in the medical record the lab testing and screenings that are recommended by the Maryland Healthy Kids Program. This program establishes preventative care standards for children and young adults 0-21 years old.
- Help improve members understanding of Asthma including its causes, things that can trigger an attack, and the medications that can help treat it and reduce reliance on rescue medications.