The overarching goal of the Member Quality Management Committee (MQMC) is to enhance the overall healthcare experience and outcomes for Empower Health Plan members. This committee serves as a critical advisory body that assesses various aspects of healthcare delivery and provides recommendations to the Empower Quality and Performance Committee based on the guidelines outlined in the PASSE Provider Manual 253.00.
- Improvement of Healthcare: The primary objective of the MQMC is to drive continuous improvement in the quality of healthcare services provided to Empower members. By reviewing and analyzing a wide range of healthcare indicators and data, the committee identifies areas that require enhancement and devises strategies to address them. This focus on improvement ultimately leads to better health outcomes and increased satisfaction for Empower members.
- Data-Driven Decision Making: The MQMC operates on a data-driven approach, regularly receiving and analyzing relevant information and indicators. These indicators include member and provider utilization, which helps the committee understand how healthcare services are being utilized and identify patterns or areas for improvement. Member and provider satisfaction data provide valuable insights into the level of contentment and experience within the health plan, guiding efforts to optimize the member-provider relationship.
- Clinical Outcome Metrics and Initiatives: The committee delves into clinical outcome metrics, which involve assessing the effectiveness of various treatments and interventions provided to members. By analyzing these metrics, the MQMC can identify areas where clinical outcomes can be enhanced, leading to better health results for members. Additionally, the committee explores and recommends new clinical initiatives that align with best practices and evidence-based medicine.
- Clinical Guidelines and Quality of Care Review: MQMC ensures that the clinical guidelines followed by the Empower Health Plan are up-to-date, evidence-based, and aligned with industry standards. Regularly reviewing and updating these guidelines guarantees that members receive care that adheres to the latest advancements in medical knowledge. The committee also conducts quality of care reviews to assess the delivery of healthcare services and identify any areas that may require improvements.
- Behavioral and Medical Management Initiatives: The MQMC actively participates in the evaluation and enhancement of behavioral and medical management initiatives within the health plan. This includes measures to optimize care coordination, disease management programs, mental health services, and any other initiatives aimed at improving health outcomes for members with specific medical or behavioral health needs.
- Member Safety Issues: The committee places significant emphasis on member safety. By closely monitoring safety-related incidents, analyzing root causes, and recommending preventive measures, the MQMC ensures that members are protected from avoidable risks during their healthcare journey.
The Member Quality Management Committee plays a vital role in enhancing healthcare services for Empower Health Plan members. By reviewing and analyzing a broad range of data, metrics, and indicators related to utilization, satisfaction, clinical outcomes, and safety, the MQMC guides and informs the Empower Quality and Performance Committee on strategies and recommendations to continuously improve the overall quality of care provided to Empower members.