Quality Management

We Are Envisioners Driving Excellence in Healthcare Through Collaboration, Performance, and Patient-Centered Care

Through data-driven strategies, performance monitoring, provider collaboration, and member advocacy, we help ensure that every individual receives high-quality care that is accessible, culturally and linguistically appropriate, and responsive to their unique needs.

Our Integrated Quality Teams

Client Support Center (Member & Provider Services)

Our Member & Client Support Center serves as a vital connection between members, providers, and health plans. The team delivers timely assistance, resolves inquiries, facilitates access to care, and helps ensure a positive service experience. Through ongoing engagement and support, the department contributes valuable insights that help improve healthcare delivery and satisfaction.

HEDIS® and STAR Performance Programs

The HEDIS® and STAR teams focus on improving clinical quality measures and performance outcomes. By monitoring quality metrics, identifying gaps in care, and collaborating with providers, these teams help drive preventive care, chronic disease management, and overall population health improvement while supporting health plan quality initiatives.

Cultural & Linguistic Services

MPM is committed to advancing health equity and reducing barriers to care. Our Cultural & Linguistic Services team supports providers and members through language assistance services, culturally appropriate health communications, health literacy initiatives, and compliance with state and federal cultural and linguistic standards. These efforts help ensure all individuals can access and understand the care and services they need.

HCC Coding & Risk Adjustment

The HCC Coding team works collaboratively with providers to support accurate, complete, and compliant clinical documentation and risk adjustment practices. Through education, coding reviews, and data analysis, the team helps ensure patient complexity is appropriately captured, supporting optimal care coordination and population health management.

Grievance & Appeals

Our Grievance & Appeals team advocates for fair, timely, and transparent resolution of member concerns. By investigating complaints, reviewing appeals, and identifying opportunities for improvement, the team helps strengthen patient experiences, improve service quality, and support regulatory compliance.

Credentialing

The Credentialing team helps maintain a high-quality provider network by verifying that practitioners meet established professional, regulatory, and organizational standards. Through comprehensive credentialing and recredentialing processes, the team supports patient safety, provider quality, and network integrity.

QM Informatics

The QM Informatics team provides an analytical foundation that supports quality improvement initiatives across the organization. By transforming healthcare data into actionable insights, the team identifies trends, monitors performance, tracks outcomes, and informs strategic decision-making. Their work enables MPM to proactively address care gaps, improve operational efficiency, and drive measurable quality improvements.

Our Commitment to Continuous Improvement

Quality is a shared responsibility. By integrating member services, provider support, data analytics, quality measurement, health equity initiatives, credentialing oversight, and clinical documentation excellence, MPM creates a comprehensive approach to healthcare quality.

Together with our providers and community partners, we are committed to:

• Improving clinical outcomes and patient experiences
• Advancing health equity and cultural responsiveness
• Promoting patient safety and access to care
• Supporting provider success through education and collaboration
• Leveraging data to drive informed decision-making
• Ensuring compliance with regulatory and accreditation standards
• Creating healthier communities through continuous quality improvement

At MPM, quality is more than a program—it's a commitment to delivering exceptional care and service to every member, every provider, and every community we serve.