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 tracks and reports 172 quality measures to the New York State Department of Health. Each quality measure sets a benchmark for the structure of the plan, a service provided, a member health outcome, or a member interaction. Fidelis Care’s performance is evaluated against those quality measures.

In 2017, 85 percent of Fidelis Care’s reported quality measures matched or outperformed Statewide averages. 

In 2017, Fidelis Care increased efforts to encourage members to get the clinical and preventive care available to them.

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.

In 2017, Fidelis Care successfully raised the CMR completion rate from 68.4 percent to 78.1 percent. In 2018, our target is 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.

Diabetes and HIV management programs are also offered. These programs teach members how to manage their health condition, and they connect members to community support and services.

In 2017, Fidelis Care increased our commitment to members who most needed quality care by increasing our Case Management staff by 25 percent. 

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 organization in meaningful ways. 

Two new surveys were introduced in 2017 to learn more about how to better serve our members: the New Member Survey, to evaluate member experience during first-time enrollment; and the Experience of Care and Health Outcomes Survey (ECHO), to evaluate the experience of members who use behavioral health services.

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.