: Commercial Health Plans in DC, DE, FL, IL, MD, NJ, OK, PA, TX, VA
QI program evaluation reflects accomplishments and opportunities
The Magellan center serving commercial health plans in the states listed above conducted a comprehensive evaluation of its quality improvement (QI) program covering the full year 2019. For the benefit of members served, the QI program evaluation measures levels of quality service administered through our provider network and clinical care management system.
Highlights from the annual QI evaluation:
In 2019, overall member experience (satisfaction) rates for commercial membership reached 86.3%. Medicare member satisfaction was 85.0%.
- Patient safety survey results for behavioral health providers in the service area showed improvement in several domains:
- The percentage of providers who reported assessing polypharmacy issues if three or more medications are prescribed improved to 95.8% from 84.2% in 2018.
- More than 65% of providers indicated that they coordinate with the patient’s primary care physician (PCP) when medication is prescribed, compared to 62% in 2018.
- Over 65% of prescribing providers reported that they prescribe anti-craving medication to support abstinence, compared to 59% in 2018.
- Forty-four percent of providers reported utilizing technology to improve the coordination of care, compared to 35% in 2018.
- Provider availability standards for geographic distance (i.e., member access) were met at 100% for all practitioner types.
- The rate at which behavioral health practitioners communicated with members’ PCPs after the initial assessment improved from 34.3% to 50.8%.
The service center’s objectives for 2020 pertaining to providers include seeking improvements in:
- Monitoring and follow-up for members seeking behavioral health services, including members with complex health needs.
- Communication between behavioral health providers and PCPs.
- Compliance with treatment record review standards, adherence to clinical practice guidelines, and participation in community case management processes.