QUALITY MANAGEMENT

TLC Family Care Healthplan (TLC) has implemented a comprehensive Quality Improvement Program to improve processes and systems that result in improving member health status and outcomes. The Quality Improvement Program Description is a written document that is reviewed and approved annually by the Memphis Managed Care Corporation (MMCC) Board of Directors and TLC’s Quality Improvement Committee. The Program Description addresses the goals, objectives, scope, including patient safety, structure, and processes of the Program as they relate to member care and service and the role, structure and functions of TLC’s committees. A copy of the Quality Improvement Program Description can be downloaded by clicking the link below in Helpful Resources.  If you would like to request a copy of TLC's Quality Improvement Program Description, please contact (901)725-7100 or 800-473-6523 (outside of Shelby County). Follow the prompts for the QI Department.

The Quality Improvement Committee (QIC) is responsible for the development, implementation, evaluation, and revision of the QI Program and oversight of health service delivery initiatives. The QIC has overall responsibility for coordinating all quality improvement activities throughout TLC. The QIC recommends policy decisions, establishes performance goals, analyzes performance data and trends including issues of patient safety, reviews and evaluates quality improvement activities, institutes actions as needed based on data and ensures follow-up of actions. Activities reviewed and analyzed by the QIC include but are not limited to the availability and accessibility of providers and practitioners in the network, review of clinical measures which include immunizations, cancer screening, and well-care for children and adolescents, and member and provider satisfaction with TLC. The results of the member and provider satisfaction surveys have not been received as of yet.  As soon as the data is reported to TLC, the data will be analyzed and shared with all providers via this webpage.  Member complaints/100 decreased from the baseline of 3.1 (2004) to 0.8 (2006).  Call answer time improved from the baseline of 30 seconds (2004) to 13 seconds (2006).  The call abandonment rate decreased from the baseline 6.5% (2004) to 1.7% (2006).  Several interventions were implemented in 2006 to increase member and provider satisfaction. These interventions include but are not limited to: creating a Chief Medical Officer email link on the provider website and a provider dedicated call queue, and refining the member eligibility process.

Significant improvement was seen in the following clinical measures from baseline to 2006:

• Dilated eye exam for members with diabetes mellitus from 11.21% (2003) to 36.74% (2006)
• Prenatal visits from 37.33% (2003) to 70.07% (2006)
• Postpartum visits from 31.48% (2003) to 53.53% (2006)
• Nephropathy screening for diabetes mellitus from 18.58% (2003) to 66.91% (2006)
• Adolescent immunizations from 11.19% (2004) to 30.66% (2006)
• Clinical measure interventions included member outreach via mailings and phone calls and provider outreach.

Each year, TLC evaluates the accomplishments of the Quality Improvement Program in the annual Quality Improvement Program Evaluation. The Quality Improvement Program Evaluation reports on TLC's achievements and progress in meeting the goals outlined in the QI Program and Work Plan. A copy of the Quality Improvement Program Evaluation can be downloaded by clicking the link below in Helpful Resources.  If you would like to request a copy of TLC's Quality Improvement Program Evaluation, please contact (901)725-7100 or 800-473-6523 (outside of Shelby County). Follow the prompts for the QI Department.