Commitment to Quality Care | Healthy Indiana Plan

Commitment to Quality Care

MDwise is always looking for new ways to help you improve your health. All MDwise members deserve health services that are high quality, safe and culturally appropriate. To make sure this happens, the MDwise quality program reviews care and services members get throughout the year.

The quality program reviews:

  • Members getting services they need.
  • Members getting service when they need it.
  • Responses from our member satisfaction surveys.

These reviews help us to work closely with our doctors to make any changes that are needed. These reviews also help us know what information our members need from us.

MDwise Has Special Recognition

MDwise Hoosier Healthwise and Healthy Indiana Plan are accredited as a health plan by the NCQA (National Committee for Quality Assurance). This means that the NCQA reviewed the care and services that MDwise offers. NCQA has very high standards for quality. The NCQA evaluation is well-known throughout the country.

We want to give our members the best care. NCQA recognition shows that MDwise is committed to quality care. It also shows that we protect our member’s rights. You will see a special seal on many MDwise materials you receive. Only health plans that have passed the NCQA review can use this seal.

MDwise Annual Review of Care

MDwise wants to make sure you receive the care and services that you need. Every spring we conduct a review of medical claims and records called HEDIS (Healthcare Effectiveness Data and Information Set). This monitors how well we are doing. This is part of NCQA accreditation.

Some examples of the type of care we review include:

  • Well-care visits for children.
  • Pregnancy care.
  • Care for specific conditions like diabetes.

HEDIS results help MDwise know where we are doing well. It also lets MDwise know where we need to improve.

Member Surveys and Outreach

Your opinions are very important to us. MDwise sends out a member satisfaction survey every year. This survey is called CAHPS (Consumer Assessment of Healthcare Providers and Systems). These surveys are first sent by mail. A follow-up call is made if we do not get a response in the mail. This survey lets us know how MDwise members feel about the care they are getting. It helps us know what we are doing well and where we need to improve.

Members may also get phone calls from MDwise. One type of call might be to check on your health needs. Your answers help us know which programs might be right for you. Another type of call might remind you about important preventive care. Any MDwise caller will tell you right away who they are and why they are calling.

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Culturally and Linguistically Appropriate Services (CLAS)

MDwise wants to be sure that you get services that are right for you based on your culture. We want to be sure that you can speak to providers in your own language. We also want members to understand their health care. It is important that you have things explained in a way that you can understand.

MDwise uses the CLAS standards as a guide. These are national standards from the Office of Minority Health. They were created for health care providers and organizations. We ask members and providers for information about their race, ethnicity and language to help meet culture and language needs. We work on finding providers with different backgrounds in order to offer a diverse provider network. We have bilingual staff and phone interpreters to help us talk to members in their own language. We offer training to staff and providers on a regular basis to help meet your needs.