: Commercial Health Plans in AL, AZ, CO, CT, DE, FL, HI, IL, LA, MD, NC, NJ, OH, OR, PA, SC, TN, TX
Health plan QI program evaluation reflects accomplishments
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 2022.
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.
Some highlights of what Magellan and our network providers achieved in 2022 include:
- Successful reaccreditation through NCQA MBHO and URAC HUM Accreditation processes.
- 30-day readmission rates after acute hospitalization for Commercial/Exchange members were better than established targets.
- Sustained a positive result (100% pass rate) for the Annual Inter-Rater Reliability activity. This activity measures consistency of application of medical necessity criteria by Magellan clinical care management staff.
- Within annual treatment record reviews, Assessment and Treatment of Patients for Suicidal Risk exceeded goals for all five measures.
- Met the monitoring goal for emergent accessibility (non-life threatening emergent appointments within 6 hours) at 100%.
- Telephone Accessibility exceeded all goals, including call abandonment rate of 1.6% (≤ 3% goal) and average speed of answer at 12 seconds (≤30 seconds goal).
- Geographic Availability and Penetration Rate goals were all met at 100%.
- Member Notification of Provider Terminations met timeliness standard at 100%.
- Increased use of screening tools for Co-Occurring Alcohol and Mental Illness by 17% compared to the previous calendar year.
- Implemented Notice of Admission to expedite decision making so that members can quickly access treatment in higher levels of care.
- Continued to refine the Model of Care which incorporates variable intensity levels based on members’ risk for readmission.
- Increased use of screening tools for depression by 27% compared to the previous calendar year.
- Continued promotion and improvement of patient safety activities, including:
- 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.