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 (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 (TTY 1-800-955-8770).
Information and/or a full copy of Sunshine Health's current QI Program Description is available upon request.