Magellan Healthcare
Provider Focus Newsletter
News & information for Magellan network providers

region/plan-specific news : Commercial Health Plans - excluding California

QI program evaluation reflects accomplishments and opportunities

The Magellan center serving commercial health plans in states other than California conducted a comprehensive evaluation of its quality improvement (QI) program covering the full year 2023.

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. Consider these positive results and how you may have contributed to them!

  • Member Telephone Accessibility met or exceeded all goals, including a member call abandonment rate of 1.1% (goal is ≤ 3%) and an average speed of answer of 7 seconds (goal is ≤ 30 seconds).
  • Appeal Decision and Notification timeliness met all goals.
  • Inpatient hospitalization metrics, including average length of stay (ALOS) and inpatient days per 1,000 members, met goals for Commercial, Medicare, and Medicaid.
  • Overall readmission rates for Commercial, Exchange and Medicaid members met goals.
  • Geographic Availability and Penetration Rates met all goals at 100%.
  • Member Notification of Provider Terminations met timeliness at 100%.
  • The center continued to refine the care delivery model which incorporates variable intensity levels based on members’ risk for re-admission.
  • There was increased identification of members, engagement and engaged length of time for members in Complex Care Management.
  • Rates of readmissions for members engaged in care management decreased from the 2022 rates.
  • The center sustained a positive result (100% pass rate) for the Inter-Rater Reliability activity. This annual activity measures consistency of application of medical necessity criteria by clinical care management staff and physician reviewers.
  • Out-of-network approved service requests per 1,000 members decreased, indicating network providers are meeting member needs at higher rates.
  • Within annual treatment record reviews, Assessment and Treatment of Patients for Suicidal Risk met goals for all five  measures.
  • All internal audits on calls with members or providers met goals and indicated improvement over 2022.
  • Internal audits on UM approvals and denials met goals.
  • The center successfully maintained accreditation through NCQA MBHO and URAC HUM (June 2022-June 2025).
Magellan values your efforts to continually improve the member experience and clinical quality!

2021 MarCom Gold Award Winner 2020 MarCom Gold Award Winner
2019 MarCom Gold Award Winner 2018 MarCom Gold Award Winner

About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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