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Quality Improvement Program

Quality Improvement Program


The purpose of the Quality Improvement Program of MCS Advantage, Inc., a subsidiary of MCS Healthcare Holdings, LLC, is to provide the infrastructure for continuous monitoring, oversight, evaluation, and improvement of care, safety, and service. Quality Improvement (QI) Program activities are coordinated with other performance monitoring activities and management functions including, but not limited to, utilization management and care management.

The Quality Program activities for MCS include, but are not limited to:

  • Annual Quality Evaluation
  • Quality projects
  • The Model of Care
  • AAAHC Accreditation
  • Care and disease management
  • Risk management
  • Patient safety
  • Credentialing
  • Claims evaluation
  • Customer service and customer satisfaction
  • Development of the provider network

The program aims to continually improve the quality, availability, access, coordination and continuity of care, and the service provided to our members. Also, this program focuses on the monitoring and evaluation of the performance of the Model of Care for both the Chronic and Dual Special Needs Plans.

Ensuring member satisfaction is also part of the general purpose for the Quality Program. The QI Program includes a Member Satisfaction Committee, as well as an annual simulated satisfaction survey. These initiatives increase the individual and collective satisfaction of our members.

MCS Advantage, Inc. measures and reports the performance by using the measuring tools nationally recognized and required by regulatory agencies.


Other satisfaction evaluation processes

Internal Surveys


The members and providers’ experiences with the services provided by MCS Healthcare Holdings, LLC and its subsidiary MCS Advantage, Inc., is very important.

At the end of the services offered by our Call Centers and Service Centers, Internal satisfaction surveys are conducted. The information obtained from these surveys helps us monitor the level of satisfaction of our members and providers with the services received and to implement and evaluate quality improvement initiatives.

The results from the first and second quarter of 2024 are as follows:


Members


MCS Classicare Call Center

98.51% of the surveyed members reported being satisfied after receiving services from the MCS Classicare Customer Service Call Center.

Service Centers

98.18% of members who visited one of the 12 service centers throughout the island reported being satisfied with the service they received.

Care Management

98.7% of the surveyed MCS Classicare members reported being satisfied after receiving services through the Care Management Program.

Transition of Care

99% of the members who were surveyed after receiving assistance through the 30-day Transition of Care Program, reported being satisfied with the services received.


Providers


Call Center for Provider’s Service

98.78 % of the surveyed providers reported being satisfied with the services received from the Provider’ Service Call Center and 98.38% of the calls were solved in the provider’s first attempt.

Credentialing Process

95% of providers surveyed after the initial credential evaluation process reported satisfaction with the process. After the credentialing renewal process that occurs every three years, 95% of providers reported being satisfied.

Visits to Providers

99% of the providers reported being satisfied with the service received during the health plan representative's visit.

The satisfaction levels of our members and providers are a very important tool to evaluate the success of the quality strategies integrated to the services we offer.

Each year, Medicare evaluates plans based on a 5-star rating system.


Results of the Mental Health Services Quality Program
FHC of Puerto Rico, Inc.


Mental Health Quality Improvement Program and its evaluation


The Quality Improvement Program for Integrated Mental Health Care at MCS Solutions describes the goals, objectives, responsibilities, scope, and work plan for all quality activities. The Mental Health Quality Program is comprised of the FHC Board of Directors, the Quality Improvement Committee (QIC), the Quality Department, and committees reporting to the QIC, all within FHC.

The purpose of the Annual Quality Improvement Program Assessment is to summarize the program's activities and achievements throughout the year. The annual assessment reviews and documents the overall effectiveness of the Quality Improvement Program, including the quality of clinical and non-clinical services, as well as operational improvements. This report covers the period from January 1, 2023, to December 31, 2023.

Program Goals

The goals of the Quality Improvement Program include, but are not limited to:

  • Continuously improving the mental health care of members
  • Ensuring access to services
  • Measuring, analyzing, and enhancing the quality of mental health services provided to members

Program results and achievements

  • Follow-up after psychiatric hospitalization: More than 75% of psychiatric discharges for Platino members attended a follow-up appointment within 30 days of discharge, and more than 40% had the follow-up appointment within the first seven (7) days after discharge.
  • Member experience with mental health services: In 2023, our members' experience with mental health services was very positive, highlighting a high level of satisfaction. According to our latest survey, 89.4% of members were satisfied with the services, and FHC had fewer than one (1) grievance per thousand members during 2023.
  • Call Center performance: Our Access Center staff ensured access to services for the majority of members who contacted us by phone. Less than 1% of calls were abandoned before being answered by one of our case managers, and 93% of incoming calls were answered within 30 seconds or less.
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