Quality Improvement Program

Quality Improvement at MHS  

Managed Health Services (MHS) wants all members to get safe, quality care. Our Quality Improvement (QI) Program helps us make care and services better. It also helps us support the health of our members.   

The QI Program looks at the care members get. This may include medical care, mental health care, dental care, and vision care, when covered by a member’s benefits. We use feedback and other facts to find ways to make care safer and easier to get.  

Our goal is to help members get the care they need, when they need it.  

Goals and Objectives  

The QI Program works to help members stay healthy. It also helps make care and services better. We work with members, doctors, and community groups to find ways to improve care.  

The program works to:  

• Help members stay healthy.  
• Help members get the care they need.  
• Make care safe. 
• Support checkups, shots, and healthy habits. 
• Improve member experience. 
• Reduce barriers to care. 
• Partner with doctors to improve care. 
• Review results and make changes when needed.  

Members help shape these goals by sharing their experiences through surveys, complaints, appeals, Member Services calls, and the Member Advisory Committee. MHS reviews this feedback when planning and evaluating quality improvement activities. 

How We Measure Quality 

MHS uses quality measures to see how well we serve our members. These measures also show us where we can do better.  

Examples include: 

• Health screenings and shots. 
• Care for diabetes, asthma, and high blood pressure.  
• Access to doctors and mental health care.  
• Member survey results.  
• Member complaints and appeals.  
• Patient safety concerns.  
• Follow-up care after a doctor visit or hospital stay.   

Member feedback is an important part of how MHS measures quality. Survey responses, complaints, appeals, and Member Advisory Committee input help us understand member experiences and identify areas for improvement. Members may contact Member Services at 1-877-647-4848 to share feedback or learn about additional ways to participate. 

We review these measures during the year. We use the results to improve care and services for our members.  

Member Participation  

We want to hear from our members. Your feedback helps us understand what we do well and what we can do better.   

Members can share ideas, ask questions, file a complaint or appeal, or learn how to participate in the MHS Member Advisory Committee by: 

• Calling MHS Member Services at 1-877-647-4848. TTY/TDD users may call 1-800-743-3333.
• Completing member surveys when you receive them.
• Asking Member Services how to join or provide input to the Member Advisory Committee. 

Member feedback is reviewed and used to identify opportunities to improve care, services, access, and the member experience. 

Resources  

The Centers for Medicare & Medicaid Services (CMS) has streamlined their original compare tools into a one-click site on Care Compare It gives patients, and caregivers one user-friendly place to find cost, quality of care, service volume, and other CMS quality data to help make informed health care decisions.  

Indiana Hospital Association (IHA) uses data reported to the Centers for Medicare & Medicaid Services and the Indiana State Department of Health. The data on this website includes important hospital quality measures including patient satisfaction, readmissions, infection, death, birthing outcomes and hospital charges.  All hospitals report data in the same way, making it easy to compare among hospitals and even between states. 

Healthgrades is an online resource for information about physicians, hospitals and health care providers that includes ratings based clinical and quality outcomes.  

The Leapfrog Hospital Safety Grade uses national performance measures from the Centers for Medicare & Medicaid Services (CMS), the Leapfrog Hospital Survey and other supplemental data sources. Taken together, those performance measures produce a single letter grade representing a hospital’s overall performance in keeping patients safe from preventable harm and medical errors.