BMC HealthNet Plan’s quality improvement mission is to promote improvement of the health status of our members, as measured by clinical outcomes, performance measures, and member satisfaction.

The objective of the Plan’s quality improvement initiatives is to apply the Continuous Quality Improvement (CQI) approach to identifying, developing, implementing and evaluating all improvement activities. We apply this methodology to the following objectives:

• Foster an organizational culture that delivers customer-focused service
• Make available to members medical and behavioral health services across the care continuum
• Educate members and providers on health management strategies
• Assess the health status of the communities served, and develop and maintain a plan of action to improve the health of our members
• Increase organizational communication and collaboration among stakeholders to enhance the Plan’s ability to meet the needs of our members and providers
• Develop collaborative relationships with community providers, MassHealth, and other state and local health agencies to enhance health service delivery

HEDIS is a national effort, directed by the National Committee for Quality Assurance (NCQA), to standardize the measurement and reporting of health plan and managed care organization performance. The goal is to develop a set of measures that will be consistent over time and that will be specified in sufficient detail to be comparable among plans. MassHealth has adopted this approach, and all participating MCOs are required to participate.

Annually, BMC HealthNet Plan measures its performance according to the indicators chosen by MassHealth. Additionally, the Plan may choose indicators that meet the data requirements of internal quality goals, or that measure the performance of the Plan’s health management programs.

The Plan organizes, collects, analyzes, and submits the measures to MassHealth for review and analysis. MassHealth reports findings and provides peer comparisons to the Plan. The Plan identifies national and local benchmarks and areas for improvement, and collects additional process performance data, if needed The Plan also develops and implements improvement strategies. Success of the strategies is measured through quarterly internal sampling and the following year’s HEDIS results.

These are HEDIS Measures that have been reported in the past:

• Breast Cancer Screening (Ages 51-64)
• Cervical Cancer Screening
• Prenatal and Postpartum Care
• Frequency of Ongoing Prenatal Care
• Weeks of Pregnancy at Time of Enrollment in MCO
• Antidepressant Medication Management
• Follow Up After Hospitalization for Mental Illness
• Mental Health Utilization-Inpatient Discharges and Average Length of Stay
• Mental Health Utilization-Percentage of Members Receiving Inpatient, Day/Night Care and Ambulatory Services
• Chemical Dependency Utilization-Inpatient Discharges and Average Length of Stay
• Chemical Dependency Utilization-Percentage of Members Receiving Inpatient, Day/Night Care and Ambulatory Services

CAHPS is a nationally recognized member satisfaction survey tool used by NCQA and the Centers for Medicare and Medicaid Services to assess member’s experiences in accessing medical and behavioral health care.

MassHealth administers the survey on behalf of all participating MCOs. MassHealth provides each MCO with plan-specific and comparative data from the surveys. All MCOs are required to use these results to develop plan specific improvement initiatives.