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QI Program

We are committed to the provision of a well-designed and well-implemented Quality Improvement (QI) program. Our culture, systems and processes are structured around this mission to improve the health of all enrolled members.

Scope

The scope of the QI Program is comprehensive and addresses both the quality and safety of clinical care and quality of services provided to MHS' members including medical, behavioral health, dental and vision care. We incorporate all demographic groups, care settings, and services in QI activities, including preventive care, emergency care, primary care, specialty care, acute care, short-term care, long-term care (depending upon MHS' products), and ancillary services.

Goals & Objectives

Our primary quality improvement goal is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings and aimed at improving quality of care and services delivered.

Credentialing Standards

For consideration to participate in the MHS network, all licensed physicians and other licensed healthcare professionals who have an independent relationship with MHS must complete an application for participation and submit copies of applicable supporting documentation.

Cultural Competency Plan

MHS is committed to establishing multicultural principles and practices throughout its organizational systems of services and programs. That mission is supported by facilitating the process by which MHS can respond to the health care needs of all individuals, regardless of their ethnic, cultural, religious beliefs or language. Our Cultural Competency plan is reviewed and updated annually.

Participation in QI

To improve the quality of care, services and member experience MHS requires providers and practitioners to cooperate with all Quality Improvement activities, including collection evaluation and use of performance data. The MHS QI Program description is on our Provider Guides and Manuals page. If you are interested in learning more about MHS' QI Program, and would like a printed copy, please contact MHS at 1-877-647-4848

Read the MHS QI Program Description on our Provider Guides page.

HEDIS Tips

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.

CareINsite was developed by the Indiana Hospital Association using 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.

Last Updated: 02/25/2021