Quality Improvement

TrueCare is committed to providing evidence-based care in a safe, member-centered, timely, efficient and equitable manner. The scope of the Quality Management and Improvement Program (QMIP) is comprehensive, inclusive of both clinical and non-clinical services, and health, safety and welfare concerns. We monitor and evaluate the quality and safety of the care and service delivered to our members, emphasizing:

Member and provider satisfaction and health outcomes are monitored through:

• Quality improvement activities
• Routine health plan reporting
• Annual Health Effectiveness Data and Information Set (HEDIS) – measures the quality of our health plan
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) – measures patient experience with the health care system
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service utilization
• Member surveys
• Review of accessibility and availability standards
• Utilization trends

TrueCare assesses its performance against goals and objectives that are in keeping with industry standards. Annually, we complete an annual evaluation of our QMIP.

TrueCare will pursue National Committee for Quality Assurance (NCQA) accreditations.

The purpose of the Quality Management and Improvement Program (QMIP) is to ensure that Mississippi Medicaid has the necessary infrastructure to:

The QMIP is revised as needed:

• To remain responsive to member needs
• Based on feedback received from our providers and other health partners
• In response to changes in nationally recognized practice standards and evidence-based research
• To meet TrueCare business needs

Program Scope

TrueCare supports an active, ongoing and comprehensive quality improvement program across the organization. Performance goals are developed to measure the components of our program, including performance against national benchmarks.

TrueCare uses HEDIS as one source of performance oversight to determine the quality of care delivered to members. HEDIS is one of the most widely used means of health care measurement in the United States. HEDIS is developed and maintained by NCQA. The HEDIS tool is used by America’s health plans to measure important dimensions of care and service and allows for comparisons across health plans in meeting state and federal performance measures and national HEDIS benchmarks. HEDIS measures are based on evidence-based research and address significant health priorities in the United States.

TrueCare uses the annual member survey, Consumer Assessment of Healthcare Providers and Systems (CAHPS), to capture how a member views the quality of health care received. CAHPS is a program overseen by the United States Department of Health and Human Services―Agency for Healthcare Research and Quality (AHRQ). Potential CAHPS measures include:

• Helpful, courteous customer service
• Getting care quickly
• Ease of access in obtaining needed care
• Provider ability to communicate and show respect to member
• Ratings of all health care, health plan, personal doctor, and specialists

The Quality Management and Improvement Program (QMIP) oversees quality improvement and assessment activities for our MississippiCAN and CHIP members to maintain a robust QMIP Program, our scope includes:

• Ensure regulatory and accrediting agency compliance, including:
  • All federal requirements as outlined by CMS and in 42 CFR Part 438, Managed Care
  • Perform HEDIS^® compliance audit and performance measurement
  • Ensure compliance with NCQA accreditation standards
• Establish safe clinical practices throughout our network of providers
• Provide quality oversight of all clinical services, including addressing all quality-of-care concerns
• Advocate for members across settings, including review and resolution of quality-of-care concerns
• Meet member access and availability needs for physical and behavioral health care
• Determine interventions for HEDIS^® overall rate improvement that increase preventive care rates and facilitate support of member acute and chronic health conditions and other complex health, safety or welfare needs
• Use the annual member CAHPS^® survey to capture member perspectives on health care quality and establishes interventions based on results to enrich member and provider experience and satisfaction. Use the Institute for Healthcare Improvement (IHI) model for improvement methodologies to evaluate initiatives and effect change
• Ensure TrueCare is effectively serving our members with cultural and linguistic needs, as well as identified disparities that may impact member receipt of health care services and achieving positive member outcomes
• Monitor important aspects of care to ensure the health, safety and welfare of members across healthcare settings
• Ensure that TrueCare is effectively serving members with complex health needs
• Ongoing assessment of member population health characteristics
• Regularly assess the geographic availability and accessibility of primary and specialty care providers
• Monitor important aspects of care to ensure the health, safety and welfare of members across health care settings
• Partner collaboratively with network providers, practitioners, regulatory agencies and community agencies

Our commitment to the QMIP is aligned with the Mississippi Division of Medicaid (DOM) expectations for Managed Care Entities (MCEs).

Quality Strategy

TrueCare seeks to advance a culture of quality and safety that begins with our senior leadership and is cultivated throughout the organization. TrueCare utilizes the Institute for Healthcare Improvement (IHI) framework to optimize health system performance, known as the IHI Quadruple Aim.    

The Quintuple Aim focuses on:

1. Improving the health of populations
2. Improving the patient experience of care (including quality and satisfaction)
3. Reducing the per capita cost of health care
4. Improving provider satisfaction
5. Advance health equity

In addition, we utilize Lean Six Sigma tools, when indicated, to focus on improving member experience, member safety and ensuring our processes consistently deliver the desired results.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).