Quality Improvement Program
We ensure the quality, accessibility and profitability of providing health services to our members.
Quality Improvement Program
By implementing the Quality Improvement Program (QIP), MMM Healthcare, LLC will assure that the provision of healthcare services to its Medicare members are: accessible, cost effective and of high quality. The scope of this QIP applies to all MMM Healthcare products, including HMO and PPO plans with Medicare Advantage Prescription Drug (MA-PD) and Special Needs Plans (SNPs).
Purpose
Our QIP contains detailed information of all the Quality Improvement Activities (QIAs) that we will conduct during the year to fulfill the Centers for Medicare and Medicaid Services (CMS) regulatory requirements, as well as for those of the National Committee for Quality Assurance (NCQA). All the activities conducted by MMM Healthcare, LLC and its administrative leadership are driven by the adoption of the definition of Quality in Health care of the Institute of Medicine
Objectives
The goal of the QIP is to achieve demonstrable improvement in member’s health, functional status and satisfaction across the broad spectrum of care and services provided. To obtain this goal, the organization will work to improve their processes to ensure desired healthcare outcomes for the benefit of its membership.
The degree to which health services for individuals and populations increase the likelihood of desired health out comes and are consistent with current professional knowledge.
Overall objectives
Develop quality initiatives based on the demographics and individual needs of the members ensuring that such initiatives support, culturally and linguistically, our diverse membership.
Develop a network of qualified providers -practitioners, facilities and other ancillary medical services -through a process of initial credentialing and re-credentialing every three years.
Promote appropriate preventive healthcare and wellness activities to improve the health status of members with serious and complex medical conditions by offering services to assist in managing their condition in collaboration with their primary healthcare team.
Analyze the data gathered, identify barriers that are related to the clinical practice and/or administrative aspects of the delivery system and implement interventions to improve those barriers that are relevant to our membership.
Monitor member and practitioner satisfaction to identify potential concerns and opportunities for improvement, and announce results to the organization’s leadership and stakeholders.
Actively demonstrate a commitment to patient safety by identifying andacting upon opportunities to improve the clinical practices of our network of providers.
Identify and investigate any potential quality of care issues that may adversely affect the healthcare services provided to our membership.
Have access to the medical records of our members to ensure that the documentation is appropriate and to assess if medically necessary services are being provided
Maintain the confidentiality of data relating to individual members and practitioners.
Monitor the quality of care and services delivered by delegated entities with respect to standards established by the organization, regulatory agencies and stakeholders.
Ensure continuity and coordination of care, whether medical or mental health care, between primary care physicians (PCP) and other professionals, during the transition from one level of care to another.
Responsability
The Board of Directors (BOD) has the ultimate accountability for the quality of the care and the quality of the services provided to members. The BOD delegates its authority and responsibility for the Quality Improvement Program (QIP) to the Quality Improvement Committee (QIC) and has established that the Chief Medical Officer (CMO) is responsible for its general oversight.
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