Quality & Safety Topics: (click title to go to specific topic)
 Program Description
Program Evaluation
Work Plan
Provider Annual Notices
Safety Matters
Communication & Safety
Electronic Medical Records & Safety
Member Rights & Responsibilities & Safety
Additional Quality & Safety Resources
What is NCQA Accreditation?
MercyCare has continued to receive NCQA (National Committee on Quality Assurance) accreditation since 1999, and passed review again in 2007. NCQA is a not-for-profit organization dedicated to improving health care. The NCQA seal is a recognized symbol of quality and gives consumers the knowledge that their health care provider strives for excellence. You can access information about NCQA at www.ncqa.org.
Below is a brief summary of the standards and activities that are included in NCQA accreditation.
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Quality Management and Improvement (QI): Includes quality improvement program structure and operations. Health services contracting, availability of practitioners, accessibility of services, members satisfaction, disease management, clinical practice guidelines, continuity and coordination of medical care between medical and behavioral health care, quality improvement for clinical care and service, medical record documentation, and if appropriate delegation of QI activities.
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Utilization Management (UM): Includes utilization management structure, clinical criteria for UM decisions, communication services, appropriate professionals, timeliness of UM decisions and notification to members and practitioners, clinical information, denial notices, policies for appeals and the handling of appeals, evaluation of new technology, satisfaction with the UM process, if applicable triage and referral for behavioral health care, and if appropriate delegation of UM.
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Members' Rights and Responsibilities: Includes statement of members' rights and responsibilities, distribution of this statement to members and practitioners, policies for complaints and appeals, subscriber information, physician and hospital directories, privacy and confidentiality, marketing information, and if appropriate delegation of members' rights and responsibilities.
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Credentialing and Recredentialing: Includes credentialing policies and committee, initial credentialing verification, application and attestation, initial sanction information, recredentialing verification, recredentialing cycle length, ongoing monitoring, notification to authorities and practitioner appeal rights, assessment of organizational providers, and if appropriate delegation of credentialing.
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Member Connections (MEM): Includes health risk appraisals, interactive consumer health tools, functionality of claims processing, pharmacy benefit, and personalized information on health plan services, innovations in member services, health information line, encouraging wellness and prevention, and if appropriate delegation of MEM.
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Preventive Health: The process of adopting Clinical Practice Guidelines (CPG's) and educating members and providers relative to encouraging preventable illnesses.
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HEDIS®: Participating in the Healthcare Effectiveness Data Information Set (HEDIS®) annual reporting. Measures that are specifically scored for NCQA and compared to comparable plans. Examples include: Childhood immunizations, antidepressant medication management measure, beta-blocker treatment after a heart attack, comprehensive diabetes care, and cholesterol management.
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CAHPS®: Consumer Assessment of Healthcare Providers and Systems Satisfaction survey participation. Examples include: Getting needed care, claims processing, rating of specialist, rating of health plan, and rating of personal doctor.
The 2008 file is the most current program evaluation. It was written at the end of 2009. This is because HEDIS® results for 2008 were not available until the summer of 2009, and HEDIS® comparisons were not available until fall of 2009.
 Provider Annual Notices
Provider Annual Notices Letter
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Safety
Safety Matters
The safety of our members is of the utmost importance to MercyCare Health Plans. We want all of our members to feel confident in accessing services through any of our network hospitals. One way to identify how effective a hospital is at providing care and the quality and safety of the care provided, is by accessing CheckPoint. All of MercyCare's network hospitals participate in CheckPoint. CheckPoint was developed by the Wisconsin Hospital Association (WHA) and is used to provide reliable data to consumers. Some of the measures reported on CheckPoint are related to:
You can access information from CheckPoint at www.wicheckpoint.org.
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Communication
Good communication is a vital part of patient safety. It is important for members and healthcare providers to effectively communicate with each other. Effective communication reduces the risk of errors and promotes better health outcomes. The Partnership for Clear Health Communications has worked to develop a patient education program to promote communication between healthcare providers and patients. This program consists of the Ask Me 3 questions. These questions are:
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What is my main problem?
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What do I need to do?
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Why is it important for me to do this?
For more information about Ask Me 3 go to www.askme3.org. The Ask Me 3 website also contains a list of words to watch that may be difficult for patients to understand along with appropriate alternatives.
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Electronic Medical Records
Electronic medical records are a timely and patient centered form of communication amongst practitioners. It allows practitioners to communicate and exchange data accurately and effectively, and eliminates the risk of handwritten medical abbreviations. Mercy Health System has made a commitment to implementing electronic medical records throughout its health system.
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Member Rights and Responsibilities
Member rights and responsibilities is also a good tool to promote communication and in turn, safety. MercyCare Health Plans has developed this document to be respectful of member's rights and also to educate members on what is expected of them. Members and providers both should be aware of member's rights and responsibilities. To view MercyCare Health Plans Member Rights and Responsibilities click on the document name at the bottom of this page.
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Additional Quality and Safety Resources
www.leapfroggroup.org
The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America's health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care.
www.wisconsinhealthreports.org
Wisconsin Health Reports is the first Web site to offer a centralized home for health care information for Wisconsin. Today, Wisconsin Health Reports links you to the Wisconsin Collaborative for Healthcare Quality, the Wisconsin Hospital Association's CheckPoint and PricePoint Web Sites. These sites contain current, reliable information about medical clinics and hospitals located throughout Wisconsin.
www.wchq.org
Wisconsin Collaborative for Healthcare Quality is a voluntary consortium of organizations learning and working together to improve the quality and cost-effectiveness of healthcare for the people of Wisconsin.
www.psnet.ahrq.gov
The agency for Healthcare Research and Quality(AHRQ), funds a site that is comprised of a collection of patient safety information and resources titled AHRQ Patient Safety Network. This site offers weekly updates of patient safety literature, news, tools, etc.
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Ask Me 3
 Words to Watch Fact Sheet
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