Caring Starts with Emphasis on Quality

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Member experience is a top priority at My Choice Wisconsin. The Quality Management (QM) Program monitors the quality of services for members across all programs and continuously improves processes that will lead to enhanced outcomes. The QM Program is expected to meet standards set forth by the Department of Health Services (DHS) for Medicaid programs and by the Centers for Medicare and Medicaid Services (CMS) for Medicare Advantage Plans.

There are many organizations that review the QM Program, its initiatives, and results. Annual Quality Reviews are conducted by Metastar, Inc., an External Quality Review Organization, that examines the overall effectiveness of care management and compliance with the DHS contracts. External entities also audit My Choice Wisconsin’s Health Effectiveness Data and Information Set (HEDIS) and Medicare data.

My Choice Wisconsin’s QM Program regularly surveys members to make sure their needs are being met and to hear if they are satisfied with their care and services. We use these results to improve and provide the highest quality of care and support to our members.  

To find out more about Quality in our different programs please review “Long-Term Care” or “Health Plan” below.

Long Term Care Quality

My Choice Wisconsin works hard to improve long-term care outcomes for our members. Here are some of the current projects and focuses for the Family Care and Partnership programs:

• 2023 Clinical Performance Improvement Project
• 2023 Non-Clinical Performance Improvement Project
• 2023 Quality Plan
• 2022 Quality Plan Results
• 2022 Clinical Performance Improvement Project Results
• 2022 Non-Clinical Performance Improvement Project Results

The external review organization, Metastar, conducts an Annual Quality Review (AQR) of Family Care and Partnership programs. Here are some comments from our previous AQR reports:

• Strongly values staff development and provides a variety of training and other professional growth opportunities for staff at all levels
• Values and supports member rights
• Has a structured quality management system which includes consistent monitoring, collection and analysis of data, and development of strategies to improve the quality of member care and organizational operations
• Supports its Member Advisory Committee that resulted in an active group with regular meetings that provides input and feedback to the organization
• Effectively customizes and uses its member record system to streamline processes and produce data for monitoring
• Provides a variety of internal resources to support member care
• Demonstrates a strong commitment to providing services in a culturally competent manner, including community outreach, training for staff, and contracting with providers who speak a variety of languages

If you would like to provide feedback on My Choice Wisconsin’s Long-Term Care Quality Management Program, email: Quality.Program@mychoicewi.org.

Health Plan Quality

My Choice Wisconsin has four programs that are monitored by the Health Plan Quality team. These programs include Partnership, Medicaid SSI HMO, BadgerCare Plus. and Medicare Dual Advantage HMO SNP. There are many quality initiatives, both state and federal, that aim to ensure quality care, health equity and member satisfaction with their health plans.

Some of the primary activities of the Health Plan Quality team include Performance Improvement Projects, Chronic Care Improvement Programs, Medicaid Pay for Performance, Centers for Medicare and Medicaid Services (CMS) Star Ratings, Healthcare Effectiveness Data Information Set (HEDIS), and member experience surveys.

Medicare Quality Activities:

The CMS Star Rating Program uses a five-star quality rating system to measure the experiences Medicare beneficiaries have with their health plan and health care system. Health plans are rated on a scale of 1 to 5 stars, with 5 being the highest. For the plan year 2023, My Choice Wisconsin Health Plan has been awarded 4 out of 5 stars in the Medicare Star Ratings for our Partnership and Dual Advantage health plans.

HEDIS is the measurement tool used by the nation’s health plans to evaluate their performance in terms of clinical quality and customer service. HEDIS is reported for our Partnership, SSI HMO, BadgerCare Plus, and Dual Advantage programs and the results contribute to the overall CMS Star Ratings and Medicaid Pay for Performance. These results are rigorously audited by CMS-approved vendors for consistency and validity.

The Consumer Assessment of Health Care Providers survey and System & Health Outcome survey are administered annually to members in the Dual Advantage and Partnership programs. These are federally-approved surveys used to help organizations understand the member experience. Results are used to drive improvement locally at My Choice Wisconsin and nationally at CMS.

Medicaid Quality Activities:

SSI HMO and BadgerCare Plus have a set of Pay for Performance measures that the State has identified as the most important for driving improvement across Medicaid programs. The Quality team monitors and organizes improvement initiatives to improve results. HEDIS results are monitored and improvement focuses on Pay for Performance measures and the SSI Core Set of measures which is a set of measures that is reported to CMS. 

 

NCQA HEDIS Compliance Audit™ is a trademark of the National Committee for Quality Assurance (NCQA).