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Quality Management

Quality Improvement at MHN has an ongoing commitment to improve the satisfaction and quality of services for our members and providers. We are a research-focused team, using data collected from a number of internal and external sources to evaluate performance against best practices and to maintain an emphasis on continuous quality improvement in care delivery. Specifically, topics that our department covers include Access and Availability of services, Care Coordination and Continuity, Member Education, Practitioner Education and adherence to clinical Best Practices.

MHN's Quality Improvement team also facilitates accreditation and regulatory compliance with agencies including URAC, NCQA and DMHC.

The following metrics are monitored and reported quarterly to the Quality Improvement Committee Members. A Performance Improvement Plan (PIP) is initiated if any measure falls below target.

Call Responsiveness

When our members call us for services we want to make sure their call is answered by a live person within or below the industry norm of 30 seconds. Quality Improvement also looks at abandonment rates as a significant measure of our responsiveness to our members.

Cultural and Linguistic Responsiveness

Culture and linguistics should not be a barrier for members accessing their benefits, plan information or services. As a result, MHN tracks and addresses complaints and grievances to language assistance. MHN also responds requests for live translators and translations in print in a timely manner. All MHN staff is required to annually complete the Cultural Competency Awareness training.

Timely Authorizations

MHN is committed to delivering authorized services in a timely and prompt manner. This requires that our authorization process does not present as an obstacle to care. Our team monitors this metric on a quarterly basis to make sure it is within standard.

Access and Availability

Member access to care for life-threatening emergencies, non-life-threatening emergencies, and urgent situations is monitored on a quarterly basis to insure members receive prompt, appropriate care.

Care Coordination

Once members access services, MHN QI then looks at care coordination to insure that our members are receiving the best care possible. A number of qualities relating to the coordination and structure of care delivery are monitored including: making informed choices, responsiveness of services and quality of care including safety (monitoring and prevention).