: Commercial Health Plans in AZ, DC, DE, FL, GA, IL, MD, NJ, OH, 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 2021.
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:
- Successfully implemented a new clinical model of care.
- Began migration to a new clinical system used by our clinical and customer service staff.
- Saw statistical improvement in the NCQA Follow Up After Hospitalization measure in 7-day and 30-day follow up; 7-day improved from 22.4% in 2019 to 34.9% in 2021, and 30-day from 41.4% in 2019 to 53.4% in 2021.
- Saw statistical improvement in the NCQA Improving Coordination of Care Between Behavioral Health Practitioners (BHPs) and Primary Care Physicians (PCPs) measures. One measure, percentage of records showing PCP communication after initial assessment/evaluation, had a 13.3 percentage point increase from baseline to the second remeasure.
- Sustained a positive result (99% pass rate) for the Annual Inter-Rater Reliability activity. This annual activity measures consistency of application of medical necessity criteria by clinical care management staff.
- Decreased the number of unauthorized disclosures by 23% from 2020.
- Met goals for the following phone metrics: call abandonment rate 2.6% (<3% goal) and average speed-of-answer 22 seconds (<30 seconds goal).
- Met emergent accessibility monitoring goal at 100%.
- Met provider accessibility goal for follow-up routine care (>70% goal) at 85.6% across all provider types, and initial routine care in 10 days (> 80% goal) by groups/facilities.
- Saw 90% satisfaction in access to quality healthcare among Medicare and Medicaid members who took member experience surveys.
The service center's objectives for 2022 pertaining to providers
include seeking improvements in:
- Promoting and improving patient safety activities.
- Coordination and 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.
- Monitoring and follow-up for members seeking behavioral health services, including members with complex health needs.