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.  Certain 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 2016 Achievements:

  • Achieved accreditation by the National Committee for Quality Assurance (NCQA) for our commitment to quality improvement of health care.
  • Expansion and enhancement of our Disease Management Program to help members with chronic conditions such as diabetes or high blood pressure stay well and active.
  • Increase scores for HEDIS metrics that measure control of blood pressure, control of diabetes, postpartum care, immunizations, breast cancer screenings and wellness visits.

Based on the analysis of our Quality Improvement Program in 2016, we also identified opportunities for improvement.  To measure our improvement in 2017 we have set goals and objectives for the year.

Examples of 2017 Goals & Objectives

  • UMHP is committed to helping our members achieve health and wellness. Through the combined efforts of its OB Case Management, Clinical Outreach Coordinator and Quality teams, UMHP increased its Postpartum Care (PPC) HEDIS Measure by 10% which means that more members received appropriate follow-up care post-delivery. UMHP was also able to assist its vulnerable special needs population (SSI Children) to receive health care services by an increase of over 11%.
  • UMHP expanded its member engagement through partnerships with community-based organizations who assisted UMHP with meeting its members in their homes to help them schedule and keep primary care appointments which improved or maintained their health and wellness.
  • UMHP focused on improving customer services and regularly surveyed its members to learn how it can better serve you. Based on feedback, UMHP is adjusting resources to meet the needs of all members. It remains committed to providing great customer service and it will continue its efforts to ask for your comments on how it can improve its services.

Examples of 2018 Goals & Objectives

  • Increase the health education resources available to its members. It is UMHP’s goal to ensure its members have the information they need to, along with their doctors, make the best decisions about care that is right for them and their families.
  • Focus on chronic condition management: UMHP understands the burdens faced by members with chronic conditions such as diabetes, high blood pressure and asthma. UMHP has ongoing quality improvement efforts focused on several different chronic conditions. UMHP’s goal is to increase resources available to these members 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.
  • UMHP will be focusing on making sure its pediatric population (up to age two) gets tested for Lead exposure through a Performance Improvement Project (PIP) with the Maryland Department of Health (MDH).  UMHP will be developing outreach and education plans to reach our members and their parents/guardians to discuss the importance of lead screening and helping to schedule an appointment to complete the test. 

    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: UM Health Partners has been certified by the National Committee for Quality Assurance (NCQA).  This organization sets high quality standards for Health Plans across the nation.Delmarva Foundation Quality Review: Delmarva Foundation 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, Delmarva Foundation 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.  A survey is mailed to the home but members are also able to call in to take the survey.  UMHP 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 2017 scores for the CAHPS survey of adult and child members.  The ratings indicate the percentage of members who responded positively to each question.

    UMHP’s ratings for all survey questions increased in 2017.  UMHP is dedicated to continuing to improve these ratings to provide you with the best care possible. 

    Health Education Program

    The goal of the Health Education Program is to empower 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, its web-site, its 24-hour Nurse-line, community events, disease management and case management services. 

    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. This includes services to help you stay healthy or prevent illness as well as services to help manage chronic illnesses. 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 taken into account. 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. 

    Patient Safety

     Providing safe medical care and preventing complications is a priority.  Our Quality Program includes several methods to ensure safe and effective medical care is provided to our members.  First, UMHP contracts with well-qualified providers that meet high standards.  Other measures to promote safety and reduce complications include reviewing certain high risk medical procedures or medications to confirm these 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.