Quality Management Program

Our Quality Management Program:

1. Improves the care and services provided to members based on previous performance.
2. Ensures all applicable State, Federal, and local requirements are met.
3. Supports health care providers in their care of patients.
4. Issues and renews credentials for network providers. 
5. Oversees Medical Management, Case Management, Disease Management, and Behavioral Health services.

Fidelis Care works closely with New York State Department of Health and CMS to ensure the quality of care and services goals are planned for, pursued, and achieved. Quality reporting covers a wide range of measures including: preventive care for children and adults, perinatal care, long term care, chronic care including diabetes and HIV/AIDS management, behavioral health care, and assistance with activities of daily living for the elderly.

In 2018, 93 percent of the 215 quality measures reported (Fidelis Care - Medicaid) matched or outperformed Statewide average.

As part of these efforts to ensure quality of clinical and preventive care, Fidelis Care engages in member outreach and education. 2018 member mailings focused on reminding appropriate membership of the need for a flu shot, diabetic membership of the need for recommended testing, and for new parents, a reminder of important well – child visits and childhood immunizations. These are just a few examples of the outreach the Plan does. Our goal is to be a partner in our members' health and care.

Medication Therapy Management Program

Fidelis Care’s Medication Therapy Management Program aims to prevent members from taking the wrong medications. The program identifies members who may be at risk, and works with their health care providers to prescribe the right medications based on established clinical guidelines.

Qualified members are automatically enrolled and offered a Comprehensive Medication Review (CMR) within 60 days of enrollment notification.

Fidelis Care successfully raised the CMR completion rate from 78.1% percent in 2017 to 84.7% percent in 2018, surpassing the Plan’s 2018 target of 80 percent.

Fidelis Care offers members with chronic conditions or complex health needs personalized health support from a Case Manager. Case Managers are available to help coordinate a member’s care and services with their team of health care providers.

Complex case management programs addressing Sickle Cell Disease and Hemophilia were identified as having high value to our members and offered in 2018. These programs teach members how to manage their health condition, navigate the complex health care system, and connect to community support and services.

Fidelis Care regularly conducts surveys to ensure our members are satisfied with the care and services they receive. Feedback from these surveys is used to improve our health plan in meaningful ways.

Results from the Plan’s 7 member satisfaction surveys done in 2017 drove a number of 2018 improvement efforts. Examples of improvements include: redesign of the Fidelis Care website to improve the online payment tool and ease of site navigation, provider education to encourage best practices around member engagement, member mailings to improve the member’s understanding of Plan benefits and services, and a Fidelis Care all-employee mandatory training on the role each employee has in creating positive member experiences.

Fidelis Care makes every effort to serve our members in their preferred language. Member documents are provided in our members’ preferred languages when requested, and free interpretation services are available during every phone call.