The Office of Quality and Population Health is responsible for overseeing the quality of care given to Medicaid members, including those enrolled with contracted managed care organizations (MCOs). To make sure the care provided meets acceptable standards and Medicaid members are receiving high-quality, cost-effective care, DMAS ensures compliance with both state and federal regulations, in addition to DMAS’s policies. DMAS partners with MCOs to provide high-quality combined physical and behavioral health services that will improve the health and wellbeing of our members. The care given must meet standards for improving quality of care and services, access, changes needed in care, addressing health gaps, and timeliness.
Quality care refers to:
- Quality of physical health care, including primary and specialty care;
- Quality of behavioral health care focused on recovery and rehabilitation;
- Access and availability to primary care, behavioral health care, pharmacy services, specialty health care, and Medallion providers and services;
- Uninterrupted coordination of care across all care and service settings for smooth transitions in care and maximum care continuum; and,
- Enrollee experience and access to high-quality, coordinated, and culturally-competent clinical care and services.
The activities overseen by the Quality Improvement unit consist of the Quality Strategy, Performance Improvement Projects (PIP), regulation reviews, Technical Reports, and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicaid member satisfaction surveys for children and adults. The activities overseen by the Population Health Unit include Performance Measure Validation processes (PMV), the Medicaid Maternal and Child Health Focus Study, and the Child Welfare Focus Study.