The Molina Healthcare Quality Improvement (QI) Program provides 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 member's health. The QI Program assists the organization 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 key quality processes include but are not limited to:
- Implementation of programs and processes to improve members' outcomes and health status.
- Collaboration with our contracted provider network to identify relevant care processes, develop tools and design meaningful measurement methodologies for the provided care and service.
- Evaluation of the effectiveness of programs, interventions and process improvements and determine further actions.
- Designing effective and value-added interventions.
- Continuously monitoring performance parameters and comparing to Molina standards, national and regional benchmarks, as well as regulatory requirements.
- Analysis of information and data to identify trends and opportunities, and the appropriateness of care and services.
- Oversight and improvement of delegated functions; Claims, UM and Credentialing.
- Ensuring a quality and adequate provider and Health Delivery Organization network through appropriate contracting, studies and Credentialing processes.
- Evaluating member satisfaction with their experience of care through the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey.
- Conducting provider satisfaction surveys with specific questions about the UM process, such as determining the level of satisfaction with getting a service approved, obtaining a referral and case management.
The QI Program promotes and fosters accountability of employees and network and affiliated health personnel for the quality and safety of care and services provided to Molina members.
If you would like more information about our QI Program, initiatives, and/or the progress toward meeting our quality goals, please contact Customer Care.
*Printed copies of information posted on our website are available upon request.
- Standards for Medical Record Documentation
- Access and Availability
- HEDIS Measures of Focus
Each year Molina sets goals to improve our services to members. Annually we measure member satisfaction using the Consumer Assessment of Healthcare Providers and Systems survey (CAHPS®). The survey looks at key satisfaction drivers through the continuum of care, including health plan performance and the member's experiences in the physician office. Survey instruments are sent to adult members and parents of child members. Results are collected and analyzed to track member satisfaction with health plan performance and to identify opportunities for improvement. Molina's goal is to be better than 75 percent of other Medicaid health plans in the nation who report their results to the National Committee for Quality Assurance (NCQA).
Detailed results can be found by clicking below:
CAHPS® Annual Trends
If you have any questions, would like additional information about CAHPS®, or have suggestions for our Quality Improvement Program, please contact Customer Care.
• CCC Plus: (800) 424-4524
• Medallion 4.0: (800) 424-4518
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).