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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 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.