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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.

Medicaid HEDIS Rates for Calendar Year 2016 and 2017

Adult Measures 2016 2017
Adult BMI Assessment 84.62% 87.35%
Adults Access to Preventive/Ambulatory health Services 66.89% 68.87%
Childhood Immunizations 2016 2017
Combo 3 (Dtap, IPV, MMR, HIB, HepB, VZV, PCV) 72.60% 75.18%
Combo 10 (all of the above plus HepA, RV & Flu) 24.04% 26.52%
Adolescent Immunizations 2016 2017
Combo 1 (meningococcal & Tdap) 67.31% 71.29%
Combo 2 (meningococcal, Tdap & HPV) 11.90% 26.52%
Childhood Measures 2016 2017
Lead screening 64.11% 66.40%
Adolescent Well-Care 46.97% 51.58%
Annual Dental visit (2-21years) 45.34% 47.52%
Access to PCP (12-24 months) 92.34% 93.11%
Access to PCP (25 months – 6years) 85.65% 85.16%
Access to PCP (7-11years) 86.30% 84.88%
Access to PCP (12-19Years) 81.15% 80.07%
BMI Percentile 80.29% 86.37%
Counseling for Nutrition 74.76% 77.37%
Counseling for Physical Activity 66.11% 70.32%
Well-Child visits first 15 months of life 2016 2017
No visits 3.33% 2.92%
1 visit 2.75% 2.43%
2 visits 3.85% 1.95%
3 visits 6.29% 4.14%
4 visits 11.95% 8.03%
5 visits 20.76% 13.14%
6+ visits 51.08% 67.40%
Well-Child visits in 3rd, 4th , 5th, 6th years of life 71.81% 76.16%
Behavioral Healthcare Measures 2016 2017
Antidepressant Medication Management (Acute Phase) 47.55% 50.59%
Antidepressant Medication Management (Continuation phase) 32.34% 35.84%
Follow up care for children prescribed ADHD Medication (Initiation phase) 54.78% 46.79%
Follow up care for children prescribed ADHD Medication (Continuation Phase) 69.46% 64.46%
F/U after Hospitalization for Mental Illness (7 day) 42.44% 32.50%
F/U after Hospitalization for Mental Illness (30 day) 56.14% 52.64%
Initiation of Alcohol & Other drug Abuse/Dependence Treatment 43.37% 46.78%
Engagement of Alcohol & Other drug Abuse/Dependence Treatment 6.28% 7.87%
Cardiovascular Conditions 2016 2017
Statin Therapy for patients with Cardiovascular Disease – Received Therapy 44.05% 72.92%
Statin Therapy for patients with Cardiovascular Disease – 80% Adherence 50.21% 55.46%
Controlling High Blood Pressure 45.19% 37.71%
Persistence of Beta-Blocker Post-MI 50.30% 74.13%
Comprehensive Diabetes Care 2016 2017
HbA1c Testing 66.44% 85.40%
HbA1c Control <8 33.56% 47.45%
Eye Exam 46.53% 60.83%
Medical attention for Nephropathy 83.80% 93.43%
Statin Therapy for Patients with Diabetes – Received Therapy 34.58% 60.30%
Statin Therapy for Patients with Diabetes – 80% Adherence 54.62% 57.49%
Medication Management: monitoring
of patients on persistent medications
2016 2017
ACE inhibitors or ARBs 91.49% 92.13%
Diuretics 91.72% 92.20%
Total 91.66% 92.16%
Musculoskeletal Conditions 2016 2017
Anti-rheumatic drug for  Rheumatoid Arthritis 53.77% 68.11%
Use of Imaging studies for Low Back pain 61.29% 62.37%
Respiratory Conditions 2016 2017

Medication Management Asthma – 75% compliance

21.94%

24.98%

Asthma Medication Ratio

59.47%

62.17%

Appropriate testing for Children with Pharyngitis

66.53%

66.66%

Appropriate treatment for Children with URI

88.70%

88.82%

Avoidance of Antibiotics in Adults with Bronchitis

28.70%

27.67%

Rx Management for COPD (Corticosteroid)

39.71%

67.36%

Rx Management for COPD  (Bronchodilator)

49.21%

82.93%

Customer Service 2016 2017

Call Answer Timeliness

82.92%

82.50%

Women’s Health Measures 2016 2017

Breast Cancer Screening

35.63%

58.50%

Cervical Cancer Screening

46.19%

58.39%

Chlamydia Screening

64.74%

64.23%

Timeliness of Prenatal Care

78.85%

79.56%

Postpartum Care

60.58%

60.10%

Member Experience 2016 2017

Getting Care easily

80.48%

85.62%

Getting Care Quickly

90.51%

90.65%

Customer Service

85.99%

86.94%

Rating of Personal Doctor

75.74%

74.9%

Rating of Health Plan

71.10%

68.86%

For questions about the QI Program and our progress on meeting goals, call Member Services at 1-866-796-0530 (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 1-866-796-0530 (TDD/TTY 1-800-955-8770).

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