Quality Improvement Program
Molina Healthcare of Michigan serves Michigan members in counties throughout Michigan. Molina Healthcare of Michigan 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.
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.
The following QI Program Description includes discussion of program philosophy, scope, structure, and methodology.
- The QIP provides a structure for promoting and achieving excellence in all areas through continuous improvement.
- Improvements are based on industry "best practice" or on standards set by regulators or accrediting organizations.
- The QIP is applicable to all disciplines comprising the organization, at all levels of the organization.
- Teams and teamwork are essential to the improvement of care and services.
- Data collection and analysis is critical to problem-solving and process improvement.
- Each employee is highly valued as a contributor to quality processes and outcomes.
- Compliance with National Committee for Quality Assurance (NCQA) Standards and achievement of accreditation demonstrates Molina Healthcare's commitment to quality improvement.
- Information about the QIP is available for members and providers upon request.
- Internal and external feedback about Molina Healthcare's programs and processes is integrated into the improvement efforts.
Quality Improvement Program Goals
- 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.
- Define, demonstrate, and communicate the organization-wide commitment to and involvement in achieving improvement in the quality of care, member safety and service.
- 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.
- 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.
- Facilitate organizational efforts which achieved and maintain regulatory compliance and NCQA Accreditation-Commendable in 2011.