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 2024.
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 2.3% (goal is ≤ 3%) and an average speed of answer of 25 seconds (goal is ≤ 30 seconds).
- Appeal Decision and Notification timeliness met all goals.
- Inpatient average length of stay (ALOS) met goals for Commercial, Exchange, and Medicaid. Inpatient days/1000 members met targets for Medicare, and Medicaid.
- Overall readmission rates for Commercial and Medicaid members met goals.
- Geographic Availability and Penetration Rates met all goals at 100%.
- Member Notification of Provider Terminations met timeliness at 100%.
- There was increased identification of members, engagement and engaged length of time for members in Complex Care Management.
- The center sustained a positive result (99% 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.
- Appointment accessibility survey data met ≥85% targets for routine appointments offered to new and current patients.
- Assessment of clinical practice guideline adherence met targets for treatment of patients for suicidal risk, major depressive disorder, and ADHD.
- All internal audits on calls with members or providers met goals and indicated improvement throughout the year. Additionally, the QI team implemented Complex Case Management (CCM) documentation audits, measuring compliance with NCQA regulatory standards.
- 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!