The safety of our members is of the utmost importance. MercyCare is committed to ensuring
safety is addressed for our members by focusing on safety in the following ways:
- Member education
- Monitors adverse events
- Medical record audits
- Site visits
- Member complaint resolution process
- Pharmacy management
- Continuity and coordination of care projects
- Clinical practice guidelines
- Electronic medical records
Member Education
MercyCare provides safety information to members on its website. This includes:
- MercyCare Knowledgebase, which is available through the MercyCare website
This online tool provides access to a wealth of evidence-based health information and tools to better manager their health. It provides:
- A vast library on health topics, medications and a Learning Center
- Interactive tools
- Decision Tools to help members make informed decisions that better fit their needs
- The MercyCare website provides members with information regarding Wisconsin
- CheckPoint, a site sponsored by the Wisconsin Hospital Association in partnership with the State of Wisconsin
- Encourage improved patient-physician communication through the Ask Me 3 website
- Notify members of their rights and responsibilities along with additional quality and safety resources
Adverse Events
MCHP monitors adverse events by identifying quality related issues during all health plan
activities, i.e., customer service complaints, inpatient reviews, case management. Identified
issues are referred to a peer review process if chart review confirms a possible quality issue.
Medical Record Audit
In 2011, MercyCare performed a medical record audit for the purpose of:
- Assessing medical record documentation practices against organizational standards
Quality Improvement Program Evaluation
- Monitoring confidentiality of medical records
- Reviewing for documentation of all ancillary, therapeutic, and diagnostic services/tests
- Evaluating medical record systems and standards for the availability of medical records
- Quantifying the quality of medical records management in comparison with expected performance goals
MercyCare has established quantifiable performance goals for medical records management
and notifies practitioners of these goals along with medical record standards. MercyCare
notifies practitioners of their medical record audit scores and deficiencies along with
improvement recommendations. In efforts to improve medical record documentation, re-audits
are done for practitioners that do not pass.
Site Visits
MercyCare reviews all practitioner sites prior to credentialing them to ensure sites are in
compliance with our site requirements. The site visit tool addresses safety by reviewing medical
records, accessibility, confidentiality, and physical accessibility and appearance. Two site visits
have been done thus far in 2010. No deficiencies were detected.
Member Complaints Review
In order to address member complaints, a process improvement activity was implemented. Members who call regarding an access issue are transferred to a nurse
who works with them and the clinics to assure that the members receives the care needed in a
timely manner.
Pharmacy Management
MercyCare manages medication safety through the implementation of prior authorizations and
quantity limits in order to:
- Prevent over-utilization
- Ensure appropriate use of medications
- Identify abuse or diversion in the case of narcotics
- Reduce exposure of members to new medications with uncertain side-effects
Continuity and Coordination of Care
MercyCare strongly supports continuity and coordination of care between behavioral health and
primary care physicians. MercyCare reviews inpatient psychiatric admissions to network
providers to verify whether or not the psychiatric discharge summary has been sent to the
primary care physician. The psychiatric discharge summary is a key piece of correspondence
since it includes the member’s diagnosis, discharge medications, and follow-up
recommendations.
MercyCare reviews charts for the successful transfer of admit notes and the psychiatric
discharge summaries to primary care physicians. This review is completed for each network
hospital on a quarterly basis. This intervention was designed using feedback from the
Behavioral Health Advisory Committee.
The following figure demonstrates the success rate of this project. The “Initial” result indicates
the percentage of discharge summaries sent prior to MercyCare review, and the “Final” result
indicates the percentage of discharge summaries sent after MercyCare review and intervention.
Clinical Practice Guidelines
MercyCare has clinical practice guidelines in place to ensure the care members are receiving is in keeping with the latest standards and to assist members with making decisions
related to their health. These guidelines are available to all physicians and members.
Overall Summary
MercyCare continues to exhibit progress in quality measures and customer service as
evidenced by the improvement in our overall national ranking. We will continue to maintain our
current quality task forces to serve as improvement forums to identify barriers and implement
specific interventions.