MedStar Family Choice is committed to devoting its best effort to providing safe, high-quality care to every member of MedStar Family Choice. Results and analyses of major Quality Improvement initiatives such as HEDIS®, CAHPS®, and the Population Health Incentive Program will be written in language understandable to the broad audience of MedStar Family Choice members and posted on the MedStar Family Choice website. They will also be communicated through the MedStar Family Choice Member and Provider Newsletters. Other studies may be made available at the discretion of MedStar Family Choice.

OBJECTIVES
Provider Network
1. Provide a systematic approach for monitoring the quality, safety, appropriateness, and effectiveness of member care and services through a consistent review process throughout the MFC provider and practitioner community.
2. Provide support and education to practitioners and providers to improve the safety of their practices and include participating network practitioners in the Quality Improvement Plan, policy decisions, and quality improvement process.

Member Community
3. Perform a comprehensive population assessment of the member population to improve the quality of healthcare received by members, identify SDOH, reduce health care disparities, and ensure members receive culturally and linguistically appropriate health care services and education.
4. Identify and remove barriers to health care services and resources including, but not limited to, cultural and linguistic barriers.

Regulatory/Accreditation
5. Develop, implement, and monitor CAPs and QIAs based on identified deficiencies/opportunities.
6. Incorporate Federal, State, and local public health organizations goals and coordinate activities with the development of the Quality Improvement Plan.
7. Comply with the quality of care, access to care, documentation, and performance standards of Federal and State agencies for the treatment of members, especially those with special needs.
8. Prevent fraud, waste, and abuse and ensure compliance with all associated Federal and State laws and regulations.
9. Meet or exceed the standards for: the Maryland SPR, NCQA accreditation, PHIP, and EPSDT and MDH screening criteria.

MFC Operations
10. Support/enhance a culture of quality at MFC by using benchmarks representing best practice outcomes to trend and analyze data for improvement opportunities, implementing strategies designed to address quality indicators and goals across departments, and coordinating data collection to evaluate opportunities and improvement efforts.
11. Advance the use of quality management principles and evidence-based practice through education, resource sharing, and analysis.
12. Provide integration, coordination, and continuity of medical and behavioral health.
13. Coordinate monitoring of MFC’s performance with internal and external parties.
14. Improve oversight of activities of delegated entities and the quality of care they provide.
15. Support the MSH effort to become a high reliability organization by applying the principles of preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise

 

NEW INITIATIVES FOR 2026

  1. Infuse health equity lens in all programs with a primary goal to ensure that all individuals, regardless of their socioeconomic status, race, ethnicity, gender, or other factors, have fair and equal access to healthcare resources and services.

  1. Enhance member demographic information to increase successful contacts to close gaps in care.

  1. Evaluate member engagement initiatives by HEDIS measure to determine efficacy and fiscal impact while exploring additional evidence-based initiatives that may provide greater ROI.

  1. Explore new interventions to improve provider engagement and satisfaction with MFC.

 
 
INITIATIVES CONTINUED THROUGH 2026

  1. Continue quality assurance reviews for any reports submitted to the EQRO.

  1. Expand existing practitioner incentive programs where efficacy is demonstrated.

  1. Enhance processes that establish relationships with provider offices, deliver gaps in care reports, and help close gaps in care through the collaboration of departments within MFC.

  1. Submit HEDIS rates according to the NCQA schedule and have no rates reported with bias.

  1. Educate practitioners on EPSDT guidelines, HEDIS requirements, MFC pharmacy benefits, HEDIS results, CAHPS survey results, provider satisfaction survey results, and other initiatives as appropriate.

  1. Continue to implement evidence-based PIP initiatives on “Timeliness of Prenatal Care” and “Postpartum Care”.

  1. Increase utilization and access to mobile and community-based services to improve member access to care.

  1. Participate in MSH POD meetings to educate and support practitioners and providers in achieving population health management goals.

  1. Standardize data presentation and educate MFC staff on interpreting/analyzing data to support their ability to evaluate initiatives and efforts. Develop standardized reporting of efforts and outcomes for quality initiatives.

  1. Increase member input into quality initiatives through expanded use of the Consumer Advisory Board and targeted member surveys.

  1. Integrate internal, EPSDT audits to improve the rates for the thresholds for each component and offer provider education in real-time. 

 

2026 Quality Improvement Plan

 

 

Information current as of: