Quality Improvement Program (QIP)

 

University of Maryland Health Partners (UMHP) is committed to providing the best possible health care to all of its members.  UMHP has an active Quality Improvement Program that monitors the quality of care and service provided to its members.  The Quality Improvement Program is integrated throughout the health plan and is governed by a committee structure composed of doctors, nurses and other non-clinicians.   These committees regularly measure performance and recommend improvements for all health plan functions.

UMHP continuously evaluates its Quality Improvement Program using nationally recognized measures such as The Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers & Systems (CAHPS).  These measures help UMHP determine if members are receiving the care they need and are satisfied with that care.  These measures allow UMHP to assess the overall health status of its members to ensure all members remain healthy and well.

Using the results of these measures UMHP annually sets goals and objectives for its Quality Improvement Program.  At the end of every year, UMHP reviews its Quality Improvement Program to identify both achievements as well as opportunities for improvement from the previous year.

Examples of 2018 Achievements:

  • UMHP is committed to helping our members achieve health and wellness.  UMHP is furthering this commitment through our development of a Population Health Management Strategy.  Population Health measures the combined health and needs of all our members.  Through a population health model, we are expanding condition-specific programs to meet the needs of our members.  Specific programs are custom designed to provide quality care, wellness education and community resources in a way that best serves you.  
  • UMHP improved access to care for women.  In 2018 more of our female members we able to access the following important preventive services for women: 
    • Breast cancer screening 
    • Cervical cancer screening 
    • Prenatal care 
    • Postpartum care 
  • UMHP added new ways for you to tell us how we are doing.  Every time you call us you can give us your feedback.  Stay on the line after the call to take a quality survey to provide your opinions about the care and service you need.  We use your feedback develop new programs and resources that are available to you. 
  

Examples of 2019 Goals & Objectives:

  • Ensure that health education resources available to our members are specifically target to their needs.  It is UMHP’s goal to ensure its members have the information you need to, along with your doctor, make the best decisions about care that is right for you and your families. 
  • Focus on population health management:  UMHP understands the burdens faced by members with chronic conditions such as diabetes, high blood pressure and asthma.  UMHP is improving its population health programs to help you manage your chronic conditions.  UMHP’s goal is to increase resources available to its members with chronic conditions to help them manage their health. 
  • UMHP is committed to improving health care outcomes for its members through a population health approach which includes a focus on improving the individual member experience of care (both quality and satisfaction) while also working to improve the overall health of its total member population.  This approach focuses on removing the barriers that members face that prevent them from achieving health and wellness while focusing on providing comprehensive care that is right for members at every stage of life. 
  • Expand access to care:  UMHP is constantly evaluating the adequacy of our network in providing care that meets the physical, mental, social and cultural needs of our members.  In 2019 UMHP is focusing on removing as many barriers as we can the prevent you from getting the care that you need.  UMHP wants to help you make and keep your appointments and ensure that those appointments are effective one you arrive.
  

Click on the below drop down buttons to find out more about specific sections of our Quality Improvement Program.

State and National Quality Program Recognition

NCQA Accreditation: UMHP has been certified by the National Committee for Quality Assurance (NCQA).  This organization sets high quality standards for Health Plans across the nation.Qlarant Quality Review: UMHP undergoes an annual on-site review by a Quality Review Organization selected by the Maryland Department of Health (MDH).  In addition to the annual review, Qlarant provides ongoing monitoring and feedback about the quality of care provided by UMHP.

Satisfaction Survey

University of Maryland Health Partners analyzes feedback from members who respond to the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) member survey. This survey is organized by the Maryland Department of Health (MDH) every year.  Surveys may be mailed to your home or conducted over the phoneUMHP uses your feedback to improve our customer service and your overall healthcare experience. UMHP also conducts satisfaction surveys of its own throughout the year. Below please see our 2018 scores for the CAHPS survey of adult and child members.  The ratings indicate the percentage of members who responded positively to each question.

Based on your feedback, in 2019 UMHP is focusing on improving your access to care as well the quality and accuracy of information available to you over the phone and on our website.

Health Education Program:

The goal of the Health Education Program is to empower its members with information on how to take control of their health. The information we gather in our Quality Improvement Program helps us to understand the members we serve, and allows UMHP to take action to provide up-to-date, easy-to-use health education services to our members. Examples of Health Education services provided by UMHP include the regular mailings, newsletters, web-site postings, a 24-hour nurse advice line, community events and population health programs including case management.

Member Outreach Program:

The goal of the Outreach Program is to help members get the care and services they need at the right time and the right location. UMHP outreaches to you to let you know which wellness services would be beneficial to you and helps you access those services.  Outreach always comes with education on how to stay healthy.  UMHP reaches out to members in different ways such as by phone, letter, text messages and personal contact.

Cultural Competency Program:

UMHP strives to build health care systems that consider members’ ethnic backgrounds, age, gender, lifestyles, language, disabilities, reading levels, religion and areas where they live. UMHP believes that members experience better health outcomes and results when care is delivered in their own language and their cultural background is considered. Providing interpreter services free of charge and building a diverse network of participating providers are two examples of how UMHP takes actions to provide culturally competent care.  All UMHP staff are experienced and trained in recognizing cultural differences and their impact on health care.

Patient Safety:

Providing safe medical care and preventing complications is a priority.  Our Quality Program includes multiple methods to ensure safe and effective medical care is provided to our members.  UMHP only contracts with well-qualified providers that meet high quality standards.  Once providers are contracted their performance is monitored to promote safety and reduce complications.  This includes reviewing certain high risk medical procedures or medications to confirm they are necessary, tracking health outcomes and investigating quality of care complaints from members.

For more information on UMHP’s Quality Improvement Program please contact Member Services and ask to speak with the Quality Improvement Department about our Quality Improvement Program or email quality@umhealthpartners.com.