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| 2005 HEDIS® and
CAHPS® Results |
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. |
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| 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. |
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| HEDIS results are important
to Molina Healthcare of Michigan
for several reasons. |
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The scores are a reflection
of the care and services
being provided to our members
by our physicians. |
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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. |
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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. |
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| 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. |
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| External membership in MHM's QIC includes representation
by actively practicing practitioners within MHM. External
members are licensed and board certified. |
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| MHM identified a goal of
reaching or exceeding the NCQA
75th percentile for the following
measures: |
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Childhood Immunization |
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Prenatal and Postpartum
care |
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Well child 0 -15 months |
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Well child 3 - 6 years |
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Breast Cancer Screening |
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Cervical Cancer Screening |
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| MHM put the following interventions
in place to improve the rates
for the identified measures: |
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Quarterly reports to
physicians that identify
the immunization status
and well child visit status
for each child assigned
to that physician. |
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Each month, members receive
reminder letters for immunizations
and well child visits. |
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0 – 6 year olds
receive age specific letters
that include education
on developmental milestones
and age appropriate testing,
as well as immunization
recommendations |
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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. |
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A member incentive was
implemented in April of
2005 for the promotion
of breast and cervical
cancer screenings. |
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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.
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| 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. |
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| In addition to these measures,
MHM demonstrated improvement
in 32 of the 47 measures from
2004 to 2005. |
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| 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. |
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Rating of the health
plan |
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Rating of all health
care |
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| MHM is in the process of
analyzing the survey results
in an effort to improve these
results in the 2006 CAHPS survey. |
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| 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. |
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Click on the link below for a 3 year trending graph
of our 2005
HEDIS 
results. |
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| Additional information about
HEDIS is available through
the Provider
Manual
link, pages 5, 6
and 7 in the Quality Improvement
section. |
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| If you have any questions about HEDIS® or our results, please contact the Quality Improvement Department at 1-866-449-6828, ext. 155595. |
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| HEDIS® is
a registered trademark of
the National Committee for
Quality Assurance (NCQA). |
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- Adobe Acrobat Reader is required to view
the file(s) above. If you do
not have Adobe Reader installed
on your computer, click on
the Adobe Acrobat Reader button
below to download. |
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