Molina Healthcare of New Mexico (MHNM) is committed to promoting and fostering an environment that ensures quality and safety of care and services provided to our members.
MHNM has implemented a Member (Patient) Safety Initiative to promote safe health practices through education and dissemination of information for decision-making. MHNM does this in several different ways such as:
- Distribute information to members for the purpose of helping them improve their knowledge of clinical safety in their own care.
- Collaborate with Network Providers and Practitioners to support safe clinical practices.
- Monitor and review codes specific to safety issues in the complaint system to capture, track and trend member safety concerns.
- Develop and maintain drug usage criteria, assess the efficacy of new drugs or a new use for an existing drug
- Collaborate with the Molina Healthcare of New Mexico Pharmacy Benefits Manager, to ensure that polypharmacy and drug interaction information is incorporated into routine and counseling information provided to members and providers.
- Monitor indicators relating to polypharmacy and misuse of medication.
- Monitor member complaint, appeal and quality of care review and reporting processes for issues regarding poor care or potentially unsafe practices.
- Ensure review and action, through the Expedited Appeal process, on an appeal of a medical necessity denial based on the urgency of the request.
- Promote continuity and coordination of care between Behavioral Health and primary care providers.
- Monitor processes to ensure that care is continued if a provider is terminated from or leaves the Molina Healthcare Network.
- Verify the credentials of providers joining the Molina Healthcare of NM Network of Providers and Practitioners to assure that they meet the requirements for providing quality care.
- Ensure that credentialing and recredentialing processes include practice site assessment data, medical record review data, utilization and complaint information.
- Evaluate provider offices during site visits for initial credentialing or follow-up visits for other indications.
- Review practitioner and provider appeal and Health and Human Services Department, Office of Inspector General (OIG) sanctioning information.
The following are links to key information that will:
- Provide easy access to information regarding how to determine accreditation/certification status and if survey findings are available for New Mexico facilities. This information assists members and providers to make informed decisions about how to find high quality programs and services.
- Make available information to members and practitioners about national initiatives that are either a broad approach to decreasing medical errors or are focused studies and interventions such as reducing rates of central line infections in the ICU.
Accreditation findings for hospitals:Joint Commission on Accreditation of Healthcare Organizations – Quality Check Section ( http://jointcommission.org/AccreditationPrograms/Hospitals/)
Accreditation information regarding health plans, medical centers, and clinical programs. http://www.healthchoices.org/
Miscellaneous other types of certifications and Accreditation Organizations. www.hospitalconnect.com/aha/key_issues/patient_safety/accreditation/index.html
One broad activity that has been widely reviewed and discussed is the Leapfrog Initiative. There is an increased focus on patient safety in hospital systems throughout the US, primarily through the Leapfrog Group, a coalition composed of more than 150 public and private organizations that provide health care benefits. The Leapfrog Group works with medical experts throughout the U.S. to identify problems and propose solutions that it believes will improve hospital systems that could break down and harm patients. Representing more than 34 million health care consumers in all 50 states, Leapfrog provides important information and solutions for consumers and health care providers.
http://www.leapfroggroup.org/ This group worked with medical experts and has identified three key processes within hospitals that if implemented,are believed to reduce medical errors and negative outcomes. These processes are:
- Computer Physician Order Entry - Reduces prescribing errors and delays in care.
- Evidence-Based Hospital Referral - Identified hospitals with extensive experience with certain high-risk surgeries and conditions and encourages patients to use this information in making decisions and providers in making referrals.
- ICU Physician Staffing- Requires ICU trained specialists for the management of patients who are admitted to Intensive and Coronary Care units.
Other national organizations such as the Agency for Healthcare Research and Quality (AHRQ) and the National Patient Safety Foundation (NPSF) are working toward decreasing errors through other approaches. The AHRQ website http://www.ahcpr.gov offers information about other safety studies and activities from various healthcare delivery settings on how to reduce errors. The NPSF website http://www.npsf.org/html/resources.html offers various printable resources, a safety bibliography and a speaker's bureau.
The following printable resources may be of interest to practitioners and health delivery organizations:
Provide one location where providers and members can find links to websites that offer printable member safety information and tools for medical practices that have been shown to decrease error potential.
Communicate information about significant quality improvement activities undertaken by facilities, medical groups and clinics. This includes activities such as the New Mexico Health Care Takes on Diabetes Collaborative as well as provider certifications programs for diabetes and cardiovascular disease.
Provide information on how Molina Healthcare continues to support safe home practices for our members through our bicycle helmet and infant car seat safety programs
If your organization has implemented programs that have improved access to services or clinical outcomes, we would like to highlight your accomplishments on our website.
Please describe your program or initiative and describe your improvements and email it to, Sharon Huerta, LISW, Quality Improvement Manager.
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