Quality Control Policy

MAPFRE Medicare Excel is dedicated to offer health services of the highest quality. To reach this goal, we count on the Quality and Performance Improvement program, which is organized by comities composed by interdisciplinary groups that integrate clinical and administrative personnel. This includes a Quality Improvement program directed to participating beneficiaries, which is focused in reaching excellence in prevention services that are provided to the Medicare beneficiaries. We utilize measured instruments with specific indicators that are developed by the guidelines of the actual clinical practices and established by the regulated standards and accredited agencies.

Quality and Performance Improvement Program

Provides a base in assessment care and health services which are offered to the insured. It's based on the philosophy of continuous improvement that includes:

• Quality and assessment Measurement
• Recognition of opportunities to improve the quality of clinical care and services by continuous monitoring throughout our claims data, and administration, etc.
• Plan development of the quality improvement
• Creation and evaluation of the plan effectiveness
• Reports to the comities
• Communication and education to the assured and providers

Each respective department of MAPFRE Medicare Excel has the responsibility to provide a continuous monitoring to improve the quality of activities. This structure includes:

• Risk Management
• Customer Services
• Provider Relationships
• Information system
• Sales and Marketing
• Regulations and Compliance Issues
• Use and Quality activities
• Enrollment system

Annually, we develop a work plan throughout the comities for the clinical quality and service improvement. This includes monitoring activities and an evaluation of the current year. It's a progressive plan in which the activities can be re evaluated and actualized when needed.

Quality Improvement Program for Primary Doctors and Participating Providers.

MAPFRE Medicare Excel developed a system that evaluates the quality of care provide by, primary doctors and participating providers that measure compliance with the established standard measurements.
The Quality Assessor is responsible to visit the primary doctors and participating providers for the achievement and discussion of the quality evaluations, presentation of the results of the HEDIS measurements and serve as a help agent in the implementation of corrective measurements. The Quality Program will develop a comparative quality profile of each primary doctor according to his specialty. This profile permits us to identify areas of improvement in which we can be more efficient in the interventions that we provide. In the aspect of Health Care we evaluate the following:

• Documentation of the Clinical File
• Documentation of Preventive services of chronic condition (Diabetes Mellitus,   Asma, Hypertension, (CHF COPD) and in circle of life (Geriatric).
• Inspection of the Physical facilities
• HEDIS measures (Health Plan Employer Data & Information Set)
• Confidential Information
• Coordination and Continuity of medical care
• Patient Security