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QI Program

The Quality Improvement Program focuses on meeting the needs and expectations of our members, providers/practitioners, communities, regulatory/accreditation agencies, and other key stakeholders of the NH Medicaid Program. NH Healthy Families supports and fully complies with the Quality Strategy set by the Department of Health and Human Services for the New Hampshire Medicaid Care Management Program. It also directs activities designed to improve the health for all NH Healthy Families’ members, as well as addressing their cultural and linguistic needs.

The Quality Improvement Program of NH Healthy Families provides an infrastructure to monitor, evaluate and improve the quality of clinical care and services provided to our members including medical, behavioral health, and vision care.  NH Healthy Families incorporates all demographic groups, benefit packages, care settings, and services into its quality activities. NH Healthy Families’ Quality Improvement Committee (QIC) assumes oversight of the Quality Program. The Committee evaluates the effectiveness of each department’s and subcommittee’s activities. This includes analysis and recommendations regarding identified trends, follow-up, barrier analysis, and interventions required in order to improve the quality of care and/or service to members, implement corrective actions as appropriate, and act as a communication channel to the Board of Directors.

NH Healthy Families encourages feedback from our members and providers to improve our program. Our Member Advisory Board (MAB), as one of the subcommittees of the QIC, consists of representatives from our member population and parents of members.  This group met quarterly to discuss concerns, changes and initiatives that affect members.  Committee participants were encouraged to provide feedback, to have their perspectives considered in plan decisions. Quality improvement initiatives were designed, monitored and evaluated throughout the year as a result of some of this information, in addition to the review of standard clinical and non-clinical indicators.  Those indicators consist of metrics, set by the National Committee for Quality Assurance (NCQA), the national accreditation agency for health plans. We have clinical practice guidelines for certain conditions. Members can ask for a copy of these guidelines.

HEDIS® (Healthcare Effectiveness Data and Information Set) is a tool that helps us make sure our members are getting the care they need.  We compare our results to other health insurance plans.  Every year we like to share some of the quality improvement efforts and the results of our HEDIS® monitoring with members and let them know what we are doing to improve their health.

 Depending on their medical needs, age and gender, members may receive a phone call or a letter from NH Healthy Families to remind them to get their recommended preventive screenings and/or recommended medical care for chronic conditions.  We also remind our physician practitioners and primary care providers that their patients are due or past due for their recommended screenings. Our outreach programs help you be the healthiest you can be.

NH Healthy Families completed member and provider focused improvement interventions in the following areas:

  • Breast Cancer Screening
  • Cervical Cancer Screening
  • Colorectal Cancer Screening
  • Comprehensive Diabetes Care
  • Childhood Immunizations
  • Well Child Visits

NH Healthy Families continuously reviews our successes and opportunities for improvement and every year we look at the results of the data collected.  From here, we decide what we should focus on the next year, our goal is to achieve at least the 75th National Medicaid percentile short term but overall target is to exceed the 90th percentile.

Quality Improvement Highlights

Measure (HEDIS®)

2019

2018

Benchmark Achieved

Childhood Immunization Status- Combination #10

47.20

43.55

75th

Comprehensive Diabetes Care – HbA1c Testing

91.73

92.15

75th

Well-Child Visits in the First 15 Months of Life – 6+ Visits

73.24

76.64

90th

Adolescent Well – Care Visits

67.15

61.44

75th

Opportunities for Improvement

Measure

2019

2018

Benchmark Achieved

Breast Cancer Screening

59.77

61.55

50th

Cervical Cancer Screening

64.48

59.37

50th

Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication

79.23

83.61

25th

Well Child Visits in the Third, Fourth, Fifth and Sixth Years of Life

78.10

76.89

50th

Credentialing Standards

For consideration to participate in the NH Healthy Families network, all licensed physicians and other licensed healthcare professionals who have an independent relationship with NH Healthy Families must complete an application for participation and submit copies of applicable supporting documentation.

Cultural Competency Plan

NH Healthy Families is committed to establishing multicultural principles and practices throughout its organizational systems of services and programs. That mission is supported by facilitating the process by which NH Healthy Families can respond to the health care needs of all individuals, regardless of their ethnic, cultural, religious beliefs or language. Our Cultural Competency plan is reviewed and updated annually.

Click to see the full Cultural Competency plan (PDF)

Participation in QI

NH Healthy Families requires providers and practitioners to cooperate with all Quality Improvement activities, as well as allow the use of provider and/or practitioner performance data, to ensure the success of the QI Program. The NH Healthy Families QI Program is outlined in the QI Program Updates and is available upon request. If you are interested in learning more about NH Healthy Families’ QI Program, please contact NH Healthy Families at 1-866-769-3085 and ask to speak with the Quality Improvement Department.

CAHPS®

NH Healthy Families is dedicated to partnering with providers to help maximize opportunities to improve patient care and the member’s experience with their health plan and their providers. We use a tool titled CAHPS® (Consumer Assessment of Healthcare Providers and Systems) to gauge member experience. 

NH Healthy Families is proud to have achieved Health Plan Commendable Accreditation from NCQA.