Commitment to Quality
The State of Michigan uses the nationally-recognized Healthcare Effectiveness Data and Information Set (HEDIS®) to compare quality among the health plans serving the Medicaid population. Meridian has made HEDIS® improvement a corporate priority, with a goal of becoming Michigan's top Medicaid health plan based on its HEDIS® performance.
In 2012, Meridian was among the top five Medicaid health plans in the State of Michigan for the following HEDIS® measures based on the 2012 Quality Compass Reports:
- Adolescent Well-Child Visits
- Adults' Access to Preventive/Ambulatory Health Services (2-44 Years)
- Adults' Access to Preventive/Ambulatory Health Services (45-64 Years)
- Adult BMI
- Breast Cancer Screening (Combined Rate)
- Cervical Cancer Screening
- Child BMI
- Children and Adolescents' Access to PCP (12-24 Months)
- Children and Adolescents' Access to PCP (25 Months- 6 Years)
- Children and Adolescents' Access to PCP (7-11 Years)
- Children and Adolescents' Access to PCP (12-19 Years)
- Chlamydia Screening (Combined Rate)
- Comprehensive Diabetes Care- HbA1c Testing
- Controlling High Blood Pressure
- Lead Screening
- Prenatal Care
- Postpartum Care
- Well Child Visits 0-15 Months- 6+ Visits
Throughout the year, Meridian monitors its HEDIS® performance and conducts improvement activities to meet its goals, including education and outreach to members and providers.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
MHP provides all Medicaid covered benefits to our members, based on the Michigan Medicaid benefit guidelines. These benefits include preventive care,
provider office visits, diagnostic tests, home health care, inpatient hospital care, emergency room treatment, and many other services to help our members
stay healthy. MHP offers a variety of services, including:
- Member Outreach - New members receive a welcome call within the first 30 days of enrollment to verify their Primary Care Provider (PCP)
selection, and to explain MHP's managed care processes. In addition, members receive telephone calls reminding them to schedule important preventive
services such as well-child visits, immunizations, prenatal and postpartum care, and screenings for chronic conditions. MHP also helps members with
scheduling appointments and transportation if they require assistance.
- Case Management - MHP members with multiple medical issues are identified and immediately assigned to a Case Manager. The Case Manager is
trained to develop self-management interventions that can result in lower hospitalization rates. MHP also helps members who select Case Management for
themselves. The overriding philosophy of MHP is to deliver as many outpatient services as necessary to maintain member health, and avoid inpatient
- Disease Management - MHP has developed Disease Management programs that are offered to all eligible members, including Diabetes, Asthma
and Cardiovascular Disease. Members in the Disease Management programs are stratified based on claims data and are assigned to a level of one through
three, with three being the most complex. The Disease Management department provides education and outreach to members and providers.
- Health Risk Assessment (HRA) - Members are contacted by phone and asked questions regarding their medical history and current health status.
Based on the results of the HRA, members can be enrolled in disease management programs or case management services, as appropriate. MHP's member
outreach program actively encourages these members to obtain the necessary care.
All of the data gathered through these activities is captured in MHP's state of the art Managed Care System (MCS). This allows for a comprehensive approach
to preventive care and health management for our members and providers.
Provider Network and Service Area
Meridian Health Plan currently operates in 67 counties throughout Michigan and we have developed one of the largest Medicaid provider networks in the state.
MHP is continually seeking ways to improve access within our service area, as well as expanding into new service areas.
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Meridian Health Plan was formed from the merger of two clinic plans, Central Michigan Health Plan (CMHP) and American Preferred Provider Plan of Michigan
(APPPM). CMHP was founded by physicians at the Jackson Northwest Clinic located in Jackson, Michigan in December 1996.
In August 1997, Dr. David B. Cotton acquired a majority position in CMHP and assumed fiscal and administrative responsibility for the plan, which had
approximately 1,400 members. CMHP acquired APPPM in January 1999 and ultimately became operational as Health Plan of Michigan in May 1999. In January
2000, HPM acquired the Michigan membership of Family Health Plan of Ohio.
Operating as a full-service HMO since January 2000, Health Plan of Michigan obtained NCQA accreditation in May 2002
2011. On January 1, 2012, Health Plan of Michigan became Meridian Health Plan (MHP). MHP remains a physician-owned, physician-managed Medicaid health