Quality | MDwise

MDwise Commitment to Quality Care

MDwise is committed to pursuing opportunities for improvement of MDwise Hoosier Healthwise and MDwise Healthy Indiana Plan members’ general health, health outcomes and service through ongoing comprehensive assessment and quality improvement activities.

MDwise prioritizes efforts that reduce health care disparities and promote health equity across Indiana. As a result, the National Committee for Quality Assurance (NCQA) has recognized MDwise with Multicultural Health Distinction. As an awardee, MDwise demonstrates exceptional culturally and linguistically appropriate services and encourages compassionate care that is sensitive to our diverse membership.

MDwise establishes and maintains the MDwise Quality Improvement (QI) program, which is designed to lead to improvements in the delivery of health care and services, inclusive of both physical and behavioral health, to its members, as well as in all health plan functional areas.

The MDwise quality improvement initiatives strive to achieve significant improvement over time in identified clinical care and non-clinical care/service areas that are expected to have a favorable effect on health outcomes, service received and member and provider satisfaction.

MDwise develops and implements an annual QI work plan and policies and procedures to guide the implementation of the quality improvement program initiatives in accordance with the National Committee for Quality Assurance (NCQA).
The MDwise QI program and policies and procedures provide the framework and structure by which the organization can identify aspects of clinical care and service issues relevant to MDwise members.
The annual MDwise QI work plan prioritizes and defines health and clinical care and service activities to be monitored and evaluated in the calendar year. The QI work plan is specific to the MDwise member population, monitoring activities and interventions for improving both health outcomes and the delivery of health care services across the continuum of services available to MDwise members.
MDwise utilizes HEDIS measures to monitor quality at the health plan and provider level.
MDwise conducts an annual CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey to determine member satisfaction with the plan and network providers.
Pay for Value (P4V) is a MDwise program developed to implement health system improvements that promote good health and health outcomes for MDwise members. Pay for Value initiatives are designed to be congruent with federal and state priorities for Medicaid, state focus studies and the MDwise QI work plan.
MDwise is focused on providing services to members that are culturally and linguistically appropriate. The national CLAS standards that are developed by the Office of Minority Health are used as a guide in ongoing activities and in developing improvement projects.
The MDwise QI program and work plan are evaluated annually to measure program effectiveness and to revise and/or establish new program improvement goals and initiatives.

MDwise works collaboratively in the development, coordination and evaluation of QI activities that promote the quality and safety of clinical care and service to MDwise members.

The QI program and MDwise policies and procedures and contract agreements indicate the dual involvement of MDwise administration and their providers in identifying and participating in the QI program activities and initiatives.

You can find more details in the MDwise provider manual.

HEDIS and Quality Initiatives

2024 HEDIS Toolkit

Quality Education Flyers

Adults’ Access to Preventive/Ambulatory Health Services (AAP)
Asthma Medication Ratio (AMR)
Attachment A: (PND-E) Standardized Depression Screening Assessments
Breast Cancer Screening (BCS-E)
Cervical Cancer Screening (CCS, CCS-E)
Child and Adolescent Well-Child Visits (WCV)
Childhood Immunization Status (CIS, CIS-E)
Colorectal Cancer Screening (COL-E)
Follow-Up After Emergency Department Visit for Substance Use (FUA)
Follow-Up After Emergency Department Visit for Substance Use pg. 2 (FUA)
Health Needs Screenings (HNS)
Lead Screening in Children (LSC)
Oral Evaluation, Dental Services (OED)
Prenatal and Postpartum Care (PPC)
Prenatal Depression Screening and Follow-Up (PND-E)
Well-Child Visits in the First 30 Months of Life (W30)

Vaccine Schedule - Vaccine schedule for all children from birth to 16 years of age provided by Indiana Immunization Coalition. The provided vaccination schedules are compatible with recommendations of the Advisory Committee on Immunization Practices (ACIP), the US Center For Disease Control (CDC), The American Academy of Pediatrics (AAP) and The American Academy of Family Physicians (AAFP) and endorsed by the Indiana State Department of Health.

HEDIS Fax Back Form - This information is used in calculating HEDIS-based performance rates for participating MDwise providers. This program allows providers to submit additional information that is used in calculating HEDIS-based performance rates.
HEDIS Fax Back Tip Sheet

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey - CAHPS is an important member satisfaction survey conducted by health plans annually, in the spring of each year. The survey asks consumers and patients to report on and evaluate their experiences with their health care.

SMOKE-free Resources for Providers - The MDwise medical benefit covers smoking cessation services for HIP and Hoosier Healthwise members in the form of tobacco cessation counseling services.

Bright Futures - Bright Futures is a national health promotion and prevention initiative, led by the American Academy of Pediatrics and supported, in part, by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). The Bright Futures Guidelines provide theory-based and evidence-driven guidance for all preventive care screenings and health supervision visits.

Well-Child Care/EPSDT

Indiana Medicaid EPSDT HealthWatch/EPSDT provider manual

Recommendations for Preventive Pediatric Health Care- Periodicity Schedule

Lead Poisoning is Preventable Poster This poster explains the importance of performing lead screenings on all children.

What Is a Qualified Provider?

View Indiana Medicaid Provider FAQs

Find a Qualified Provider

A QP is a provider who meets the following criteria:

Enrolled as a provider in the Indiana Health Coverage Programs (IHCP).
Capable of verifying pregnancy via a professionally administered pregnancy test (home administered tests do not meet this requirement).
Attended a Qualified Provider training session provided by the Family and Social Services Administration (FSSA) or designee.
Currently providing outpatient hospital, rural health clinic or clinic services as defined in BT200910.
Able to access Provider Health Care Portal, a printer and a fax machine.
Allows PE applicants to use an office phone to facilitate the PE and Hoosier Healthwise or Healthy Indiana Plan enrollment process.

Preventive Health Guidelines

To deliver the best care, obtain optimal outcomes and maintain a healthy state for members, MDwise believes it is essential to maintain an emphasis on prevention-related health services. Obtaining regular preventive care services enables early detection, diagnosis and treatment of health problems before they become more complex and their treatment more costly. The guidelines are implemented to assist MDwise practitioners and members in making appropriate health care decisions.

MDwise uses HEDIS methodology to measure preventive health screenings. MDwise has preventive health guidelines for children, adolescents and adults for immunizations. There are also guidelines for children and adolescents for EPSDT/Healthwatch.

Clinical Practice Guidelines

In order to facilitate effective and efficient treatment of the most common medical disorders of our members, MDwise’s Medical Advisory Committee has approved and provided clinical health guidelines available to providers as a quick reference for diagnosis, treatment and prevention parameters. These guidelines adhere to recommendations asserted by accredited, professional health organizations.

Best Practices for Treating Tobacco Use and Dependence

The MDwise medical benefit covers smoking cessation services for Hoosier Healthwise and HIP members in the form of tobacco cessation counseling services.

SMOKEwise

INcontrol

As a health care provider you spend most of your day advising patients on taking care of their health and keeping medical conditions in check. But what happens when the appointment is over?

The MDwise INcontrol program is here to reinforce the messages you provide in the office. INcontrol is a care and disease management program, specially designed for patients with chronic conditions and special health care needs.

As a health care provider we welcome you to refer your MDwise patients to the INcontrol program. You can do so by calling MDwise customer service or by using the online care management referral form on the myMDwise provider portal.

Members are eligible to participate if they have any health condition such as:

Your patients will have a case or care manager assigned to them to provide services including assisting the member with transportation needs, counseling on appropriate ER usage, connecting members to social and behavioral health services and counseling on taking medications appropriately.

The MDwise INcontrol program is designed with the primary medical provider in mind. Our care managers routinely contact members to assess their adherence with the treatments you prescribed. If your patients become non-adherence we will keep you informed, especially if they are at risk for hospitalization.

MDwise INcontrol also offers additional easy-to-understand patient materials about specific medical conditions. The materials stress the importance of following the specific treatment plan of their primary medical provider.