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| Quality Improvement Program |
| Calendar Year 2007 |
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| Introduction |
| Molina Healthcare of Michigan serves Michigan members in counties throughout
Michigan. Molina Healthcare of Michigan, also referred to as Molina Healthcare,
MH Michigan and “health plan” in this document) has served Medicaid patients
since 2000. For all plan members, Molina Healthcare emphasizes personalized
care that places the physician in the pivotal role of managing healthcare.
Molina Healthcare is responsible for managing the provision of accessible,
appropriate, cost-effective, high quality health care services for its members
throughout the continuum of care. The health plan assists members as they move
through the managed care system, reducing barriers to care, and supporting
members in reaching optimal health. Molina Healthcare credentials and contracts
with individual practitioners, provider organizations, facilities and
institutions to deliver health care and service to members. Molina Healthcare
delegates the authority to perform specified plan functions and services, while
maintaining oversight responsibility for delegated and non-delegated
activities. |
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| The Quality Improvement Program (QIP) is established to provide the structure
and key processes that enable the health plan to carry out its commitment to
ongoing improvement of care and service, and improvement of the health of its
members. The QIP assists Molina Healthcare to achieve these goals. It is an
evolving program that is responsive to the changing needs of the health plan’s
customers and the standards established by the medical community, regulatory
and accrediting bodies. |
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The following QI Program Description includes discussion of program philosophy,
scope, structure, and methodology. |
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| Program Philosophy
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| Molina Healthcare of Michigan maintains the following values, assumptions, and
operating principles for the Quality Improvement Program: |
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The QIP provides a structure for promoting and achieving excellence in all
areas through continuous improvement. |
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Improvements are based on industry “best practice” or on standards set by
regulators or accrediting organizations. |
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The QIP is applicable to all disciplines comprising the organization, at all
levels of the organization. |
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Teams and teamwork are essential to the improvement of care and services. |
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Data collection and analysis is critical to problem-solving and process
improvement. |
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Each employee is highly valued as a contributor to quality processes and
outcomes. |
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Compliance with National Committee for Quality Assurance (NCQA) Standards and
achievement of accreditation demonstrates Molina Healthcare's commitment to
quality improvement. |
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Information about the QIP is available for members and providers upon
request. |
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Internal and external feedback about Molina Healthcare’s programs and processes
is integrated into the improvement efforts.
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Quality Improvement Program Goals
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| Molina Healthcare of Michigan has defined the following goals for the QI
Program: |
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Design and maintain programs that improve the care and service outcomes within
identified member populations, ensuring the relevancy through understanding of
the health plan’s demographics and epidemiological data. |
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Define, demonstrate, and communicate the organization-wide commitment to and
involvement in achieving improvement in the quality of care, member safety and
service. |
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Improve the quality, appropriateness, availability, accessibility, coordination
and continuity of the health care and service provided to members. Through
ongoing and systematic monitoring, interventions and evaluation improve Molina
Healthcare of Michigan (also referred to as MHM) structure, process, and
outcomes. |
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Use a multidisciplinary committee structure to facilitate the achievement of
quality improvement goals and to ensure participation of community providers in
the MH Michigan network. |
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Facilitate organizational efforts which achieved and maintain regulatory
compliance and NCQA Accreditation-Excellent in 2005. |
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