2005 HEDIS^® and CAHPS^® Results for Michigan

The Quality Improvement (QI) Program is the process that links knowledge, structure, and processes together to assess and improve the quality of care provided by Molina Healthcare of Michigan (MHM). MHM's QI program is designed to monitor and evaluate the quality, appropriateness, and outcomes of care and services, and the processes by which they are delivered to MHM members. One of the methods of measuring the outcomes is the annual HEDIS^® project.

HEDIS^® stands for Health Plan Employer Data and Information Set. It was developed by the National Committee for Quality Assurance (NCQA) as a part of their accreditation process. NCQA Accreditation is a nationally recognized evaluation that purchasers, regulators and consumers can use to assess managed care plans.

• The scores are a reflection of the care and services being provided to our members by our physicians.
• By comparing rates from year to year, and comparing Molina rates to National rates, we can identify what we are doing well, and where we need to focus our quality improvement efforts.
• The Michigan Department of Community Health (MDCH) requires all managed care plans providing care to Medicaid recipients to be NCQA accredited. In order to maintain accreditation, MHM must report HEDIS data.

MHM has a Quality Improvement Committee (QIC) which is responsible for integrating clinical and service activities for inpatient and outpatient services in all settings and involves every area within the health plan. The QIC is responsible for assuring safe, appropriate, and coordinated care is provided to MHM members. They also identify and approve the quality of care programs and goals.

External membership in MHM's QIC includes representation by actively practicing practitioners within MHM. External members are licensed and board certified.

• Childhood Immunization
• Prenatal and Postpartum care
• Well child 0 -15 months
• Well child 3 - 6 years
• Breast Cancer Screening
• Cervical Cancer Screening

• Quarterly reports to physicians that identify the immunization status and well child visit status for each child assigned to that physician.
• Each month, members receive reminder letters for immunizations and well child visits.
• 0 - 6 year olds receive age specific letters that include education on developmental milestones and age appropriate testing, as well as immunization recommendations
• The ongoing implementation of the Mothers of Molina (M.O.M.) program, for pregnant members. A mother-baby nurse was hired to works with physicians in identifying and educating pregnant members early in the pregnancy to promote good outcomes for both mom and baby.
• A member incentive was implemented in April of 2005 for the promotion of breast and cervical cancer screenings.

We continue to see positive results in the childhood and adolescent immunization measures, with improvements seen in each of the last four years. In 2005 we met the NCQA 75th percentile for all our immunization measures! Our prenatal and postpartum rates continue to improve and we hope to reach the 75th percentile in 2006.

We are still struggling with well child visits and preventive women's health. Our breast cancer and cervical cancer rates have stayed level, and we are actively implementing member incentives and education to improve these rates. We are also working with physicians to educate and encourage appropriate billing of well child visits.

In addition to these measures, MHM demonstrated improvement in 32 of the 47 measures from 2004 to 2005.

CAHPS (Consumer Assessment of Health Plans)

Molina Healthcare of Michigan annually measures member satisfaction using the CAHPS survey. This survey looks at key satisfaction drivers throughout the continuum of care, including health plan performance and the members' experience in the physician office. The 2005 CAHPS results indicated an increase in member satisfaction in the majority of categories. There were two identified opportunities for improvement.

• Rating of the health plan
• Rating of all health care

MHM is in the process of analyzing the survey results in an effort to improve these results in the 2006 CAHPS survey.

MHM values the care and education our practitioners provide to our members. Our Quality Improvement program and initiative represent a collaborative effort between the practitioner and MHM to improve the overall health of our members. Together, we can make a difference in the quality of care our members receive.

Click on the link below for a 3 year trending graph of our 2005 HEDIS results.

Additional information about HEDIS is available through the Provider Manual link, pages 5, 6 and 7 in the Quality Improvement section.

If you have any questions about HEDIS^® or our results, please contact the Quality Improvement Department at 1-866-449-6828, ext. 155595.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

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