California quality improvement program achieves success...because of you
Magellan* appreciates your active participation in the provider network and your involvement in quality improvement efforts that benefit all members.
Each year, Magellan conducts an evaluation of our quality and clinical programs. The sampling of results we share below represents QI program initiatives that we undertook during the prior calendar year (2019). But these results don’t merely reflect Magellan’s efforts or successes; they represent your effective collaboration with us to serve the members in your care.
Some highlights include:
- Magellan of California was awarded Full URAC Accreditation effective June 1, 2019 through June 1, 2022 under the Health Utilization Management 7.3 Accreditation Program.
- Five quality improvement activities (QIAs) demonstrated improvement:
- Coordination of care within the behavioral health continuum.
- Treatment outcomes for severe and persistent mentally ill (SPMI) members.
- Coordination of care among medical and behavioral health providers.
- Reduction of member financial and billing grievances.
- Patient safety practices within the provider network.
- Magellan’s Complex Case Management (CCM) program exceeded goals in the following areas:
- 88.6% of contacted eligible members enrolled in the CCM program.
- 97% of members completing outcomes assessments indicated improvement in their ability to self-manage issues.
- 91% of members completing outcomes assessments upon discharge were satisfied with the overall CCM program.
- Magellan’s Behavioral Health Condition Management (BHCM) program exceeded goals in the following areas:
- The member engagement rate was 89%, exceeding the goal of ≥80%.
- 79% of members reported demonstrating clinically significant improvement in mental health, exceeding the goal of ≥65%.
- The Magellan service center exceeded numerous experience/satisfaction goals for the year, one of which is:
- Providers serving Medicare/Medicaid members indicated an overall satisfaction rate of 75.3%, meeting the target of >75%.
- Measures for accessibility of services within the provider network met or exceeded goals:
- Emergent and urgent appointments met timeliness standards at 100%.
- Routine follow-up appointments after initial assessment met or exceeded goals of >70% for prescribers and non-prescribers (70% and 75% respectively).
- Magellan medical and clinical teams maintained focused collaborations with facility providers to improve follow-up after hospitalization, patient safety and discharge planning, and to reduce member readmission rates.
*In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California, Inc. – Employer Services.