MDwise Commitment to Quality Care
MDwise is committed to pursuing opportunities for improvement of MDwise Hoosier Healthwise and MDwise Healthy Indiana Plan members’ general health, health outcomes and service through ongoing comprehensive assessment and quality improvement activities.
MDwise establishes and maintains the MDwise Quality Improvement (QI) program, which is designed to lead to improvements in the delivery of health care and services, inclusive of both physical and behavioral health, to its members, as well as in all health plan functional areas.
The MDwise quality improvement initiatives strive to achieve significant improvement over time in identified clinical care and non-clinical care/service areas that are expected to have a favorable effect on health outcomes, service received and member and provider satisfaction.
- MDwise develops and implements an annual QI work plan and policies and procedures to guide the implementation of the quality improvement program initiatives in accordance with the National Committee for Quality Assurance (NCQA).
- The MDwise QI program and policies and procedures provide the framework and structure by which the organization can identify aspects of clinical care and service issues relevant to MDwise members.
- The annual MDwise QI work plan prioritizes and defines health and clinical care and service activities to be monitored and evaluated in the calendar year. The QI work plan is specific to the MDwise member population, monitoring activities and interventions for improving both health outcomes and the delivery of health care services across the continuum of services available to MDwise members.
- MDwise utilizes HEDIS measures to monitor quality at the health plan, delivery system and provider level.
- MDwise conducts an annual CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey to determine member satisfaction with the plan and network providers.
- Pay for Outcomes (P4O) is a MDwise program developed to implement health system improvements that promote good health and health outcomes for MDwise members. Pay for Outcomes initiatives are designed to be congruent with federal and state priorities for Medicaid, state focus studies and the MDwise QI work plan.
- MDwise is focused on providing services to members that are culturally and linguistically appropriate. The national CLAS standards that are developed by the Office of Minority Health are used as a guide in ongoing activities and in developing improvement projects.
- The MDwise QI program and work plan are evaluated annually to measure program effectiveness and to revise and/or establish new program improvement goals and initiatives. Click here for a summary of last year's quality activities.
MDwise works collaboratively with the delivery systems in the development, coordination and evaluation of QI activities that promote the quality and safety of clinical care and service to MDwise members.
The QI program and MDwise policies and procedures and contract agreements indicate the dual involvement of MDwise administration and the delivery systems and their providers in identifying and participating in the QI program activities and initiatives.
You can find more details in the MDwise provider manual