region/plan-specific news : California

California QI program achieves success...because of you

Each year, Magellan* conducts an evaluation of our quality and clinical programs. The sampling of results we share below represents those of QI program initiatives we undertook during the prior calendar year (2023).

However, these results don’t merely reflect our efforts or successes; they represent your effective collaboration with us to serve the members in your care.

Some highlights include:

• Magellan has attained NCQA and URAC Accreditation.
• Five quality improvement activities (QIAs) demonstrated improvement:
  • Coordination of care within the behavioral health continuum
  • Follow-up after hospitalization
  • Member satisfaction
  • Member access to care
  • Reducing member depression and anxiety.
• Magellan’s Complex Case Management (CCM) program exceeded goals in the following areas:
  • 100% of members reported improvement with Ability to Self-Manage Issues.
  • 91% of members reported Satisfaction with the CCM Program.
• Magellan’s Behavioral Health Condition Management (BHCM) program exceeded goals in the following areas:
  • The rate of coaching engagement exceeded the goal of ≥80% with an outcome of 100%.
  • 77.9% of members demonstrated clinically significant improvement in unhealthy days, exceeding the goal of ≥65%.
• The 2023 readmission rate outcome was 9.6%, exceeding the target of <11%.
• Telephone accessibility measures exceeded respective goals in 2023.
• Magellan exceeded the 90% goal of connecting members to an interpreter within 90 seconds of their request or staff identification of language assistance need, with an outcome of 97.9%.
• Accessibility of service measures met or exceeded goals:
  • Emergent and urgent appointments exceeded goals at 100%.
  • Routine follow-up appointments after initial assessment met or exceeded goals of >70% for prescribers and non-prescribers (78.1% and 75.3% respectively).
  • Geographic availability and density goals were met for all provider types and for all geographic areas.

Continued improvements in the first-call resolution initiative

• Increased efficiencies through a reduction of average handle time, minimizing hold times, and streamlining processes.
• Continuous training and development opportunities for customer service agents. This will include customer skills training, knowledge enhancement, and communication skill development to ensure agents are equipped to deliver exceptional customer experiences.

Magellan appreciates your active participation in the provider network and your involvement in quality improvement efforts that benefit all members.

*In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California, Inc. – Employer Services.