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Quality Improvement Program

Sunshine Health's Quality Improvement (QI) Program focuses on preventive health. The program creates plans, puts those plans into action, and measures efforts to improve your health and safety. 

The QI Program strives to make a difference in health outcomes. It develops actions to improve member and provider satisfaction. Sunshine Health involves providers within our plan. The providers assist with developing and monitoring activities of the QI Program as well as providing insight into preventive health resources and information.

Take a look at some of our Quality Measures as well as all other Medicaid health plans performance. We are also committed to providing culturally competent care.

HEDIS Rates for Calendar Year 2016 and 2017

Childhood Immunizations20162017

Combo 3 (Dtap, IPV, MMR, HIB, HepB, VZV, PCV)

78.61%

77.62%

Combo 10 (all of the above plus HepA, RV & Flu)

23.32%

28.95%

Adolescent Immunizations20162017

Combo 1 (meningococcal & Tdap)

68.27%

68.86%

Combo 2 (meningococcal, Tdap & HPV)

17.07%

29.68%

Childhood Measures20162017

Lead screening

70.92%

72.85%

Adolescent Well-Care

57.18%

64.96%

Annual Dental visit (2-21years)

62.82%

63.79%

Access to PCP (12-24 months)

97.94%

97.70%

Access to PCP (25 months – 6years)

91.26%

91.26%

Access to PCP (7-11years)

92.50%

85.60%

Access to PCP (12-19Years)

90.66%

81.35%

BMI Percentile

83.65%

90.27%

Counseling for Nutrition

82.69%

84.91%

Counseling for Physical Activity

67.31%

78.59%

Well-Child visits first 15 months of life20162017

No visits

1.20%

0.97%

1 visit

0.60%

0.49%

2 visits

3.46%

2.19%

3 visits

6.29%

3.16%

4 visits

5.87%

8.76%

5 visits

31.93%

20.68%

6+ visits

38.55%

63.75%

Well-Child visits in 3rd, 4th , 5th, 6th years of life

78.39%

85.16%

Behavioral Healthcare Measures20162017
Antidepressant Medication Management (Acute Phase)

21.74%

37.50%

Antidepressant Medication Management (Continuation phase)

17.39%

18.75%

Follow up care for children prescribed ADHD Medication (Initiation phase)

71.03%

51.67%

Follow up care for children prescribed ADHD Medication (Continuation Phase)

78.16%

61.54%

F/U after Hospitalization for Mental Illness (7 day)

60.52%

44.46%

F/U after Hospitalization for Mental Illness (30 day)

80.34%

70.74%

Initiation of Alcohol & Other drug Abuse/Dependence Treatment

47.12%

47.21%

Engagement of Alcohol & Other drug Abuse/Dependence Treatment

13.17%

12.08%

Comprehensive Diabetes Care20162017

HbA1c Testing

100%

81.25%

HbA1c Control <8

20%

25%

Eye Exam

60%

43.75%

Medical attention for Nephropathy

80%

100%

Respiratory Conditions20162017

Medication Management Asthma – 75% compliance

29.79%

33.68%

Asthma Medication Ratio

77.56%

71.84%

Appropriate testing for Children with Pharyngitis

61.85%

62.71%

Appropriate treatment for Children with URI

87.71%

87.91%

Customer Service20162017

Call Answer Timeliness

84%

79.71%

Female’s Health Measures20162017

Chlamydia Screening (Age 16-20)

71.05%

70.08%

Timeliness of Prenatal Care

73.04%

60.91%

Postpartum Care

49.57%

48.18%

Member Experience20162017

Getting Needed Care

89.3%

86%

Getting Care Quickly

91.4%

97%

Customer Service

85%

85%

Rating of Personal Doctor

88.5%

95%

Rating of Health Plan

56.1%

77%

For questions about the QI Program and our progress on meeting goals, call Member Services at 1-855-463-4100 (TDD/TTY 1-800-955-8770).

The QI Program also reviews services provided to our members. We have clinical practice guidelines for certain conditions. If you would like a copy of these guidelines or need more information about programs call us at 1-855-463-4100 (TDD/TTY 1-800-955-8770).

Information and/or a full copy of Sunshine Health's current QI Program Description is available upon request.