MLMSO’s Quality Management department has a comprehensive and integrated Quality Management program. It is designed to objectively and continuously monitor and evaluate the quality, appropriateness and outcome of health care delivered to members of the IPAs. To ensure medically necessary covered services are available and accessible to members taking into consideration the member’s cultural and linguistic needs. To ensure quality standards and consistency is met as required by contract, regulatory agencies and industry and practice guidelines. Quality Management department continuously pursues ways for improvement. The Quality Management Program is reviewed annually. Elements of the program include but are not limited to the following areas:
- Development of clinical practice guidelines
- Provider accessibility and availability
- Provider satisfaction
- Under- and over-utilization
- Adverse outcomes/ sentinel events
- Medical record keeping practices
- Facility site reviews
- Member satisfaction
- Grievance resolution
- High risk and high volume services
- Claims timeliness
- Departmental call center management
- Access and clinical studies
- Quality Management Program is available to providers and members upon requested.