Quality Improvement Program
Our goal at INTotal is to provide you with the highest quality of care for you and your family. Accountability and achieving excellence is very important to us. We are guided by a number of standards and practices to ensure that you are getting the right care. Here are some examples of how quality informs everything that we do:
- Results-based projects across the health plan led by our Quality Management (QM) program
- Sound advice from internal and external experts
- National standards set by the National Committee for Quality Assurance (NCQA)
- Current research that informs the criteria we use
- First-hand experience of case managers who know our members’ needs
Our QM program is dedicated to excellence in the quality of service and care our members receive, and we are always on the lookout for ways to improve our program. Our comprehensive QM program:
- Holds itself to the NCQA and State Quality Assessment and Performance Improvement program standards
- Routinely monitors and evaluates the care and services provided to members
- Performs studies across all care and service areas to ensure ongoing evaluation and improvement of the program
- Encourages both members and providers to talk to us about recommendations for improvement
- Identifies areas where we can promote and improve patient safety
The INTotal Health governing body oversees the Quality Management committee structure and it includes:
- A quality management committee
- A medical advisory committee
- A credentialing committee
- A utilization management committee
- A pharmacy and therapeutics committee
We measure our clinical performance and service satisfaction using the Medicaid Healthcare Effectiveness Data and Information Set (HEDIS) standards and results from our Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
| Child CAHPS Survey | |||
| Questions | 2015 Score | 2016 Score | # of 2016 Responses |
| Getting Needed Care (% Always and Usually) | 81% | 87% | 234 |
| Getting Care Quickly (% Always/Usually) | 87% | 90% | 255 |
| How Well Doctors Communicate (% Always/Usually) | 90% | 92% | 346 |
| Customer Service (% Always and Usually) | 84% | 88% | 188 |
| Shared Decision Making (% Yes) | 67% | 74% | 103 |
| Health Promotion (% Yes) | 68% | 66% | N/A |
| Coordination of Care | 78% | 81% | 126 |
| Adult CAHPS Survey | |||
| Questions | 2015 Score | 2016 Score | # of 2016 Responses |
| Getting Needed Care (% Always and Usually) | 81% | 83% | 227 |
| Getting Care Quickly (% Always/Usually) | 80% | 89% | 231 |
| How Well Doctors Communicate (% Always/Usually) | 89% | 82% | 267 |
| Customer Service (% Always and Usually) | 81% | 86% | 126 |
| Shared Decision Making (% Yes) | 75% | 81% | 143 |
| Health Promotion | 72% | 72% | N/A |
| Coordination of Care | 82% | 84% | 161 |
| HEDIS Scores | ||
| Measure | Measurement Year 2014 | Measurement Year 2015 |
| Adult BMI Assessment | 77.86% | 72.03% |
| Weight Assessment, Counseling for Nutrition, and Physical Activity for Children/Adolescents (Counseling for Nutrition) | 59.85% | 58.80% |
| Childhood Immunization Status (Combination 3) | 71.78% | 69.91% |
| Lead Screening in Children | 67.40% | 67.79% |
| Breast Cancer Screening | 45.11% | 48.41% |
| Cervical Cancer Screening | 50.85% | 55.94% |
| Medication Management for People With Asthma (Total – Medication Compliance 75%) | 41.12% | 49.22% |
| Controlling High Blood Pressure | 55.50% | 49.11% |
| Comprehensive Diabetes Care (HbA1c Testing) | 85.89% | 87.86% |
| Follow-Up After Hospitalization for Mental Illness (30-Day Follow-Up) | 48.26% | 59.45% |
| Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life | 78.69% | 76.90% |
| Adolescent Well-Care Visits | 46.26% | 50.23% |
If you would like more information about our QI Program, processes, outcomes and goals please contact Member Services at 1.855.323.5588.