Commitment to Quality

Care and Utilization Management

MHC has contracted with the University of Utah Health Plans to both process claims, and oversee our care and utilization management programs.  Through these programs, care and utilization management teams assist members in getting the right care at the right time. Through their work, these teams help our member achieve the best outcome, using nationally-recognized, evidence-based guidelines.

Want to learn more about how the University of Utah Health Plans help our members stay healthier?  Click here to visit their website.

Quality Improvement Strategy

All of us at the MHC want to improve the quality and safety of health care. In order to know if we are improving, we measure how well we, and the professionals we work with, are doing over time. We work with many different health care providers to make your health and health care even better. Our clinical activities and programs are based on guidelines obtained from the best, proven medical best-practices we can find. We work to give you and your health care providers the information and tools needed to make good decisions.

We aim to:

  • Identify and meet the health needs of all of our members
  • Measure, monitor and improve the care that our members get. We look at both quality and safety.
  • Understand and address racial and ethnic differences in health care
  • Come up with ways to do our jobs even better
  • Make sure we obey all the rules, including rules that come from federal and state regulators and accrediting groups
  • Help medical care providers understand the measurements of the care they give and where they are doing well or could do better
  • Make sure providers in our networks meet all of the standards.

Program scope

We work to make your care better by:

  • Providing our members with clear information so they can make good decisions
  • Reviewing the health care services we cover and how care is coordinated
  • Encouraging providers to communicate with one another
  • Developing, carrying out and monitoring patient safety plans
  • Monitoring the effectiveness of our programs
  • Making sure we comply with all the rules on regulation and accreditation
  • Studying the accessibility our network providers
  • Setting standards on keeping all medical records. We also look at ways to audit these records.
  • Monitoring the overuse and underuse of services
  • Performing credentialing and recredentialing activities for our providers
  •  Assessing member and provider satisfaction

Program process and expected outcomes

Medical

Each year we will check to see how close we are to meeting our goals.

  • We collect data on clinical measures called Healthcare Effectiveness Data and Information Set (HEDIS®1). We will share the results with the National Committee for Quality Assurance (NCQA) Quality Compass®.2 The NCQA makes the results public. We use the results to set new goals and improve selected measures each year. As a result, we expect performance to improve on these many measures over time.
  • We ask members how satisfied they are with the MHC and how we can improve with both administrative process and with actual medical care.
  • If medical needs are severe, we involve nurses and other healthcare professionals to directly help members get best care.
  • We look for ways to improve safety through providing information to physicians and members to help them make better decisions about medications.
  • We work with other organizations (University of Utah Health Plans) to bring the latest and best evaluations of current medical care to your providers
  • Are starting education to our members about the benefits and goals of getting appropriate and timely immunizations.

Behavioral health

Each year we monitor the effectiveness of our behavioral health (BH) programs are.

  • We work to bring many behavioral health providers and facilities into our network of Montana clinical care providers
  • We provide information and tools to our members, providers and BH staff to promote the use of medication according to doctors’ instructions.
  • We encourage BH providers to use assessment tools that are based on the best evidence to improve the quality of care they provide.
  • We work closely with providers to make sure that behavioral health care is provided in the best and most effective setting

Accreditation

We take our accreditation by the NCQA seriously. It’s how we show our commitment to:

  • Finding ways to always keep improving
  • Meeting people’s expectations
  • Setting the MHC apart from other health plans
  • You can get more information about our NCQA accreditations on the NCQA website