Medicaid Annual Evaluation Summary 2024
The 2024 Medicaid Quality Improvement (QI) Annual Program Evaluation by Meridian provides a comprehensive review of initiatives, outcomes, and strategic efforts undertaken from January 1 to December 31, 2024. The report evaluates the effectiveness of Meridian’s QI Program in enhancing healthcare delivery, improving member outcomes, and ensuring regulatory compliance across its Medicaid population.
Key Highlights
- Quality Improvement Program (QIP)
- Utilizes a Continuous Quality Improvement methodology.
- Focuses on preventive care, chronic disease management, behavioral health, and member satisfaction.
- Overseen by the Board of Directors and the Quality Improvement Utilization Management Committee (QIUMC).
- Organizational Achievements
- Maintained NCQA Health Plan Ratings score with a 3.5/5.
- Achieved Health Equity Accreditation with a 100% score.
- Expanded Medicaid contracts across multiple regions.
- Recognized for workforce well-being and national leadership in managed care.
- Population Health Management
- Served diverse populations including Healthy Michigan Plan, Children’s Special Health Care Services (CSHCS), and foster care members.
- Addressed disparities in race, ethnicity, and language through targeted interventions.
- Implemented programs like Start Smart for Baby (SSFB), Sickle Cell, and Hepatitis C elimination.
- Performance Measures & Outcomes
- Mixed results in HEDIS® and CAHPS® metrics with notable improvements in lead screening and diabetes care.
- Identified opportunities for improvement in prenatal/postpartum care, immunizations, and provider satisfaction.
- Expanded use of telehealth and community health workers (CHWs) to address access and equity.
- Behavioral Health Integration
- Strengthened collaboration with Prepaid Inpatient Health Plans (PIHPs).
- Focused on reducing disparities in follow-up care after hospitalization and emergency visits.
- Launched digital mental health tools and suicide prevention programs.
- Social Determinants of Health (SDoH)
- Addressed housing, food insecurity, and behavioral health needs.
- Partnered with community organizations and enhanced referral tracking.
- Achieved a 58% success rate in connecting members to social services.
- Dental and Preventive Care
- Transitioned to Delta Dental to improve access and utilization.
- Launched incentive programs and outreach campaigns to reduce non-utilizer rates.
- Integrated dental care into broader health initiatives, especially for pregnant and diabetic members.
- Provider Engagement & Alternative Payment Models
- Promoted Patient-Centered Medical Homes (PCMH) and value-based care.
- Implemented Pay-for-Performance and Quality Bonus Programs.
- PCMH providers consistently outperformed non-PCMH peers in HEDIS® measures.
- Appeals, Grievances & Member Satisfaction
- Appeals and grievances declined significantly from 2023.
- CAHPS® survey results showed areas for improvement in customer service and care ratings.
- Initiated member focus groups and provider summits to enhance experience.
- Compliance & Delegation Oversight
- Strengthened oversight of delegated entities (dental, pharmacy, transportation).
- Addressed compliance gaps through Corrective Action Plans.
- Improved credentialing and recredentialing processes.
Recommendations for 2025
- Enhance HEDIS® and CAHPS® performance.
- Expand maternal health and health equity initiatives.
- Strengthen care coordination and chronic condition management.
- Increase provider and member engagement.
- Address SDoH through integrated community partnerships.