National Healthcare Quality Week is a vital time to recognize the dedication of healthcare professionals who strive to improve the quality of care. From October 20 through October 26, healthcare organizations can emphasize the need for innovation, collaboration, and accountability in healthcare practices. This week also serves as an opportunity to reflect on successes, address challenges, and foster a culture of quality improvement that benefits patients, members and communities alike. In honor of National Healthcare Quality Week, we’re spotlighting three Magellan Health employees:

• Vivian Fain, senior manager, quality improvement
• Brandi Smith, director of quality
• Maria Brachelli-Pigeon, quality improvement director, Magellan Behavioral Health of Pennsylvania

Continue reading to learn more about Vivian, Brandi and Maria’s work in healthcare quality:

Are there any initiatives with healthcare quality that you’re currently working on?

Vivian: I am currently working on performance improvement initiatives related to the identification and submission of critical incidents. This is a major undertaking that unites local providers, care coordinators, and utilization management. This is particularly significant when it comes to securing the safety and welfare of the most vulnerable populations we serve.

Brandi: I am currently partnering with the continuous improvement team and the overall data management plan. I work with the data management and data analytics team to help identify the correct metrics and data elements to build out our scorecards. These scorecards will be essential to reporting our data with a higher consistency and quality. These scorecards will not only be accessible to the employer team but will be built with filters that will make other business units more accessible in Magellan and ensure consistency in reporting across the company.

Maria: As part of the quality team, we often have many healthcare quality related initiatives running concurrently. I appreciate that in my current role I have ability to help shape the scope of projects and measure outcomes of the activities. However, as a healthcare quality professional, I’d argue that most, if not all, discussions we step into benefit from a healthcare quality lens. This means that whether we’re participating in a single discussion or supporting a larger initiative, the principles of healthcare quality can be leveraged to support improvements internally and externally.

How did you get involved with the healthcare quality field?

Vivian: I didn’t seek being involved with the healthcare quality field; the field found me. After many years providing direct care service, I wanted to do something more. At the time, I had no insight into the functions of managed care and how it related to the behavioral health field I was passionate about. Eight years ago, I interviewed for a completely different position than what I’m in, and I was subsequently recommended for a position in quality, that change the path of my career and led me to do what I do today.

Brandi: I got involved with the healthcare quality field by accident. I went to school for accounting and when I graduated college, I got a job in the accounting field. That job wasn’t a great fit for me, so while I looked for my next big adventure, I took temporary jobs with a temp company. One of the temporary positions was at GreenSpring Health in Columbia, Maryland. That temporary job led to a permanent position at GreenSpring in the quality department in 1996. GreenSpring was purchased by Magellan. Since then, I have jumped around to some other departments, but have always returned to my roots in the quality department.

Maria: I was fortunate that another strong quality professional took a chance on me and extended me an offer for a position on the quality team. When I accepted the role I’m currently in, I had no formalized training in healthcare quality. The learning curve was profound. I say now with confidence that it was an excellent move for me. I can also share that before I started my employment at Magellan, that I was impassioned to have a larger role in finding way to improve our community behavioral health system. I worked many years as a clinician treating families and individuals with significant trauma and other behavioral health needs. This role granted me firsthand witness to momentous challenges that my clients experienced with the system, and I came to Magellan with a desire to help triage the barriers I’d observed. I initially joined Magellan as a member of the clinical team, and deeply appreciated what I learned working in that capacity, but feel I’ve found a home working in the quality field.

What are some of the most challenging and rewarding aspects of working in healthcare quality? 

Vivian: What I love about my job is seeing the changes made to direct care services secondary to the performance improvement initiatives my team rolls out. The systemic changes we request of providers/facilities, cascade benefits not only to the members we serve, but also have a direct impact for all patients who receive services from the facilities and providers we engage through the performance improvement process. The most challenging aspect of working in healthcare quality is the fast pace in which things take place.

Brandi: One challenge of working in quality are the audits that we do. Audits are a critical piece of work to maintain our excellent level of care that we give to our members and providers. These audits provide valuable feedback to our staff and supervisors allowing us to deliver the same excellent service no matter which person answers the phone. Audits are always evolving to meet the needs of our internal and external customers. For me, the most rewarding aspect of working in quality is when someone identifies an issue, and I can find a solution. I am a problem solver at my core. This is what makes quality such an interesting place to work. We get to be involved in both the front-end work and the back-end reporting and analytics. Identifying issues before they turn into larger problems provides a sense of accomplishment that isn’t always available in other departments. It’s satisfying to send that email that says this issue has been resolved. I love working in the employer world because of the amazing partnerships quality has with our front-end colleagues.

Maria: Addressing challenges can be one of the most rewarding aspects of working in healthcare quality. Quality engages many tools to tackle barriers: the five why’s to understand root cause, we use Pareto charts to decide where impact could be most profound, Gannt charts to build out projects, Lean Six Sigma and Kaizen methods to identify steps in processes that aren’t value-added and eliminate waste, etc. We can help develop rapid cycle projects using the plan-do-study-act model to assess impact of interventions. Making processes more efficient, measuring improvements, and highlighting successes is very rewarding.

What does Healthcare Quality Week mean to you? Is there anything else you’d like to highlight about healthcare quality?

Vivian: I appreciate the recognition for what those in the field of healthcare quality are tasked to accomplish. The continuous quality improvement process we seek to replicate is no easy task for those resistant to change and is often misunderstood, while the benefits are far reaching and often taken for granted. Further, I would like to highlight the unseen nature of what we do, operating in the background of direct care, to ensure the direct care provided to patients is backed by high expectations.

Brandi: Healthcare quality week means that people get a small glimpse into the world of quality that not everyone gets in the normal day to day. Raising awareness of quality is important, as quality collaborates with every department in the organization. Quality can’t be successful without that collaboration, and whether you realize it or not, you have likely contributed to successful quality outcomes.

Maria: Healthcare Quality Week creates a dedicated time and space to reflect on how incorporation of quality principles in our work can be impactful for our staff, our customers, and our business. For me, this week is a time to extend appreciation to the individuals that are working in the background to improve workflows and outcomes. The quality teams across Magellan Health are extremely collaborative and supportive of one another. We are fortunate to have developed this network of professionals. I’m grateful to have kind and caring coworkers to partner on projects. In general, you’ll hear quality professionals share proclamations like, “quality is everyone’s job.” While it is important for a few of us to have knowledge/expertise on the quality framework to help drive strategies, all staff can have a role in quality.

Magellan’s collection of HEDIS (Healthcare Effectiveness Data and Information Set) quality measures for 2017 has entered the final phase of data collection. You’ve probably heard of the acronym HEDIS – but what does it stand for and what does it mean to you? The Healthcare Effectiveness Data and Information Set – HEDIS — was created by the National Committee for Quality Assurance (NCQA) to measure the clinical quality performance of health plans.  This is accomplished through the collection and analysis of data documenting the clinical care received by individual plan members from providers, influenced through activities and programs delivered by the health plans.  The data is aggregated and reported collectively to reflect the ‘collective’ or population-based care received by the plan’s membership.  These reports have become a major component of quality rating systems that measure the clinical quality performance of health plans by Centers for Medicare & Medicaid Services, states offering Medicaid and other entities. Right now, Magellan has entered the final phase of data collection for HEDIS quality measures for 2017.

There are 91 HEDIS 2017 measures, but it’s important to note that the number may vary from year to year as new measures are added to the set and some are retired. The measures cover many aspects of healthcare including preventive care such as screening tests (e.g., mammograms) and immunizations, management of physical and mental health conditions, access and availability of care, patient experience, utilization and relative resource use.  Data is reported individually for each product and line of business

Measure data is collected is a variety of ways.  Claims are the major source of data, but specific measures may also allow plans to survey members or to access member medical records for additional data not captured in claims.  This type of data collection (combined claims and chart data) is called hybrid.  The final phase of data collection for health plans choosing to do hybrid runs from January through May and is often called MRR for medical record retrieval, or simply ‘chart chase.’  Final HEDIS data covering services rendered in 2016 and prior will be submitted to NCQA by June 15, 2017.  Final health plan ratings for all lines of business are published on the NCQA website by October 2017.

For health plans, HEDIS ratings can be very important. The scores on measures can help them understand quality of care being delivered to their members in some of the most common chronic and acute illnesses.  Higher scores can help compete more effectively in various markets. HEDIS score reporting are often required in public markets as well, where the results are often reported to the states, or occasionally counties, in which the plans reside.

Behavioral health and pharmacy are well represented in the HEDIS measure set. Behavioral health has multiple measures that include ensuring continuity of care, appropriate psychotropic medication management/adherence, and initiation and engagement of drug and alcohol abuse treatment.  Pharmacy measures focus on medication management of acute and chronic physical and mental illness, appropriate medications in the elderly, and management of polypharmacy.  Specialty measures are directed toward inappropriate imaging.

So, what is the value of HEDIS to Magellan?  Aside from being a collection and reporting contract requirement for many of our customers and our own health plan, HEDIS gives Magellan valuable information about the populations we serve.

By following the behavioral health data, we collect, for example, we can identify gaps in network performance in patient follow-up patterns, management of drug and alcohol abuse, and prescribing and adherence to medications.  This allows us to design and implement interventions that can improve outcomes and reduce cost of care.

The same type of analysis/intervention applies to physical health conditions.  Analysis of HEDIS data helps identify gaps in care, particularly preventive care, in such important and chronic populations as patients with diabetes mellitus, patients with cardiovascular disease, and patients with lung disease.  We can also identify and address at-risk pediatric populations who fail to complete preventive care such as immunizations, dental and well-child care.

As the healthcare industry moves more and more toward value-based purchasing, all providers, insurers and their vendors are necessarily increasingly focused on the quality of care that is delivered.  The impact of this should be better outcomes for our members.

Find more articles about NCQA here