Quality Improvement Program (QIP)
CareFirst Medicare Advantage is committed to providing the best possible health care to all of our members. We have an active Quality Improvement Program that monitors the quality of care and service provided to our members. The Quality Improvement Program is integrated throughout the health plan and is governed by a committee structure composed of doctors and nurses. These committees regularly measure performance and recommend improvements for all health plan functions.
CareFirst Medicare Advantage continuously evaluates its Quality Improvement Program using nationally recognized measures such as The Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers & Systems (CAHPS), the Centers for Medicare and Medicaid Services (CMS) STARS Measures, and Health Outcomes Surveys (HOS). These measures help CareFirst Medicare Advantage determine if members are receiving the care they need and are satisfied with that care. Certain measures also allow CareFirst Medicare Advantage to assess the overall health status of our members to ensure all members remain healthy and well.
Using the results of these measures CareFirst Medicare Advantage annually sets goals and objectives for its Quality Improvement Program. At the end of every year CareFirst Medicare Advantage reviews its Quality Improvement Program to identify both achievements as well as opportunities for improvement from the previous year.
Satisfaction survey
CareFirst Medicare Advantage analyzes feedback from members who respond to the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) member survey. This survey is organized by the Centers for Medicare and Medicaid Services (CMS) every year. We use your feedback to improve our customer service and your overall healthcare experience. CareFirst Medicare Advantage also conducts satisfaction surveys of its own throughout the year. Below please see our 2019 scores for the CAHPS survey of Medicare members. The ratings indicate the percentage of our members who responded positively to each question.2019 CAHPS Score
| Survey Question | CareFirst Medicare Advantage Score |
|---|---|
| Getting Needed Care | 83 |
| Getting Appointments and Care Quickly | 75 |
| Customer Service | 92 |
| Getting Needed Prescription Drugs | 92 |
| Care Coordination | 84 |
| Rating of Health Care Quality | 78 |
| Rating of Health Plan | 88 |
| Rating of Drug Plan | 86 |
| Annual Flu Vaccine | 70 |
CareFirst Medicare Advantage is dedicated to improving these ratings to provide you with the best care possible.
Health education program
The goal of the Health Education Program is to empower members with information on how to take control of their health. The information we gather in our Quality Improvement Program assists us to understand the members we serve, and allows CareFirst Medicare Advantage to take action to provide up-to-date, easy-to-understand health education services to its members. Examples of Health Education services provided by CareFirst Medicare Advantage are mailings, newsletters, our web-site, disease management and case management services.Cultural competency program
CareFirst Medicare Advantage strives to build health care systems that consider members’ ethnic backgrounds, age, gender, lifestyles, language, disabilities, reading levels, religion and areas where they live. CareFirst Medicare Advantage believes that members experience better health outcomes and results when care is delivered in their own language and their cultural background is taken into account. Making interpreter services available free of charge and building a diverse network of participating providers are two examples of how CareFirst Medicare Advantage takes actions to provide culturally competent care.Patient safety
Providing safe medical care and preventing complications is a priority. Our Quality Program includes several methods to ensure safe and effective medical care is provided to our members. First, CareFirst Medicare Advantage contracts with well-qualified providers that meet high standards. Other measures to promote safety and reduce complications include reviewing certain high risk medical procedures or medications to confirm these are necessary, tracking health outcomes and investigating quality of care complaints from members.For more information on CareFirst Medicare Advantage’s Quality Improvement Program please contact Member Services 410-779-9932 or toll-free at 1-844-386-6762 (TTY: 711), 8 AM to 8 PM EST, 7 days a week from October 1 – March 31; and, 8 AM to 8 PM EST, Monday through Friday from April 1 – September 30 and ask to speak with the Quality Improvement Department about our Quality Improvement Program or email QualityMD@CareFirst.com.