Northeast
QI Results Reveal Previous Accomplishments and New Focus for 2009
Magellan understands that today’s dynamic health care environment requires a capacity for flexibility that can only be achieved through continual quality improvement. Each year, the Northeast Care Management Center evaluates the effectiveness of our quality improvement (QI) and clinical management programs by reviewing utilization data; examining quality improvement activity outcomes; and analyzing satisfaction survey results from members and providers.
With an emphasis on enhancing the quality of behavioral health care, our prevention programs, and member services—this evaluation serves as the foundation for QI and utilization management activities for the coming year.
Clinical and Service Accomplishments
Key accomplishments noted in the most-recent evaluation are summarized below.
- From 2007 to 2008, intensive care management (ICM) enrollment increased 33 percent.
- The combined commercial business and Medicare ambulatory follow-up care management data indicated a statistically significant improvement in the seven-day measure from baseline (62.97 percent) to the first re-measurement at 63.58 percent, and baseline to the second re-measurement at 65.97 percent.
- Healthcare Effectiveness Data and Information Set (HEDIS®) antidepressant medication management acute phase treatment results (combined commercial and Medicare) increased from 69.52 percent in 2007 to 75.6 percent in 2008. The improvement was statistically significant. The continuation phase treatment results increased from 51.8 percent in 2007 to 62.4 percent in 2008. This improvement also was statistically significant.
- Review of customer service agents results for following procedures to request and place caller on hold—proper hold techniques quality improvement activity (QIA)—improved from the baseline rate at 79.57 percent to the second re-measurement at 84.58 percent. Results were statistically significant.
- Our QIA for increasing use of self-service capabilities showed improvement in three measures. All increases were statistically significant.
- percentage of treatment request forms (TRFs) submitted online
- percentage of initial authorization requests submitted online
- provider satisfaction with training received on the provider website.
- Member satisfaction results averaged 89 percent.
- Provider satisfaction results averaged 89 percent.
Program Focus for 2009
Areas of focus identified during the evaluation process include:
- Improving the seven-day ambulatory follow-up compliance rate
- Maintaining high member and provider satisfaction results
- Demonstrating the effectiveness of the ICM program
- Improving communication between behavioral health providers and primary care physicians
- Maintaining the rate of Acute and Continuation Phase Treatment for the Anti-Depressant Medication Management HEDIS measures.
- Decreasing the rate of readmission to acute inpatient care within 30 days of discharge.
We look forward to continuing to collaborate with you on these efforts. You can obtain additional information regarding the QI program by sending an e-mail to Lori Kastner, manager of QI and accreditation, at LAKastner@MagellanHealth.com.