Quality Improvement Plan
Medical Associates Health Plans has a comprehensive Quality Improvement program in place to optimize the delivery of safe, quality patient care and services within available resources.
The program is designed to provide a continual monitoring of the quality improvement process and the services provided by our participating health care practitioners, participating hospitals, skilled nursing facilities, home health care agencies, rehabilitation centers, and other health professionals. In addition, we have an established library of preventive health guidelines to promote wellness screenings and disease prevention.
Our Quality Improvement program objectively assesses the important aspects of patient care, safety and service, corrects identified problems, and continuously monitors to assure the success of the continuous Quality Improvement process. The following are specifically monitored:
- Optimum achievable patient outcomes
- Patient and family understanding and satisfaction
- Patient safety
- Cost effectiveness
- Reasonable documentation
- Over- and/or under-utilization of services
- Claims processing and payment
- Membership services
- Case management
- Hospital utilization review
- Marketing
- Contracting
- Finance
- Provider credentialing/credentialing
- Audit results
- Trends of clinical and service delivery
- Incidence of acceptable/unacceptable complications
- Number of active participants in the disease management programs
We make copies of our Quality Improvement Plan available to members and to participating providers, including quarterly reports and preventive health guidelines.
Preventive Health Guidelines.
If you would like a printed version of our Quality Improvement Plan or guidelines, please call 563-556-8070 or 800-747-8900
Availability of Health Plan File (for Members)
Members of Medical Associates Health Plans may view the contents of their health plan file. Please call ahead so that we may schedule an appointed time to have your file conveniently ready for you. We will ask you to sign a consent form when you arrive, and a staff member will remain present as you review your member file. Call 563-556-8070 or toll free 800-747-8900.
NCQA Accreditation
The National Committee for Quality Assurance (NCQA) continues to award Medical Associates Health Plans with accreditation for service and clinical quality that meet NCQA’s rigorous requirements for consumer protection and quality improvement.
NCQA’s rigorous evaluation is a voluntary one. It reviews all aspects of the Plan’s operations including preventive health services, member satisfaction, physician credentialing, and quality improvement. The NCQA team analyzes how well a health plan manages quality and continuous improvement of care. In addition, the health plan’s preventative services are compared with a nationally recognized list of common disease states (HEDIS® Health Plan Employer Data and Information Set).
NCQA is a private, not-for-profit organization dedicated to improving healthcare quality. NCQA accredits and certifies a wide range of healthcare organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing healthcare quality information for consumers, purchasers, healthcare providers, and researchers.
The Quality Improvement Plan
An active quality improvement program is a requirement of the many regulatory organizations that review Medical Associates Clinic and Health Plans.
The purpose of a quality improvement program is to objectively and systematically monitor and evaluate the quality appropriateness of patient care and to pursue opportunities to improve care and resolve identified problems. The Quality Improvement Committee (QIC) is responsible for these activities and makes recommendations for resolution to the Board of Directors of Medical Associates Clinic, PC. The Board assumes ultimate responsibility for establishing, maintaining, and supporting the quality improvement program. QIC activity is also reported to the Board of Directors of the Medical Associates Health Plans (MAHP) on a quarterly basis.
The QIC, comprised of physicians, reviews the practices of their fellow physicians and all other health care practitioners. Active participation of Committee members is encouraged in an effort to provide maximum quality of patient care. Subcommittees also assist the QIC in their quality assurance responsibilities, including the Credentialing Committee and Utilization Management Committee.
