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Quality Improvement Projects 101 Presenters: Linda Isbell, Director of Network Operations Amanda Outlaw, Director of Provider Monitoring Cordelia Chavis, Director of Quality Improvement
Quality Improvement Projects 101
Presenters:Linda Isbell, Director of Network Operations
Amanda Outlaw, Director of Provider MonitoringCordelia Chavis, Director of Quality Improvement
Disclaimer:Information provided in this presentation pertains only to the counties in the Eastpointe LME/MCO catchment area. This information is specific to Eastpointe and may not apply to other LME/MCO’s, providers, stakeholders or individuals outside the Eastpointe catchment area.
Presentation slides are brief, bullet points of information and should not be used out of context.
Contract Requirements
Elements of Quality Improvement Projects
Provider Monitoring
Director of Network Operations, Linda Isbell
Eastpointe MCO is evaluated annually by External Review Organization(EQRO) to evaluate compliance with state and federal regulations. The review determines the level of performance demonstrated by Eastpointe. During our review in November, it was recommended that we develop and implement a written plan and process that will hold providers accountable for individual Quality Improvement Projects (QIPS).
ALL agencies with a Medicaid or State contract are required to submit three (3) Quality
Improvement Projects (QIP) annually to the Quality Improvement Department.
MEDICAIDArticle II, #4(h)
The Contractor shall use best efforts to provide data to the
LME/PIHP in the implementation of any studies or improvement
projects required of the LME/PIHP by the Department. Contractor
and LME/PIHP will mutually agree upon the data to be provided for these purposes, and the format and time frame for provision of
the data
STATEArticle II, #4(h)
The Contractor shall use best efforts to provide data to the
LME/PIHP in the implementation of any studies or improvement
projects required of the LME/PIHP by the Department. Contractor
and LME/PIHP will mutually agree upon the data to be provided for these purposes, and the format and time frame for provision of
the data.
Director of Quality Improvement, Cordelia Chavis
An initiative to measure and improve the service and/or care provided by the organization
Identifies Problems/Gaps
Areas of concern
Simply ..opportunity for improvement
Improves clinical outcomes for enrollees
Results in increased enrollee satisfaction
Reduces over-all cost of total health care benefits provided
Improves operations internally
Produces organizational ‘best practices’ and supports or even develops industry-wide ‘best practices’
Overall healthier population/community
Company Name:
Activity/Project Name
Project Staff Involved
Reason for Selection
Action Taken
Evaluation of Results
Project Barriers
Project Outcome
Activity/Project Name: The activity name should explain the purpose of the activity and begin with an action word that accurately states what the activity is designed to do (e.g., “improving,” “increasing,” “decreasing,” “monitoring”).
Examples are listed below.
Improve the patient experience of care
Improve access to behavioral health services
Decreasing practitioner complaints with the referral process.
Increase percentage of members who attend 2nd appointment
Improve NC TOPPS submission
Project Name: Increase percentage of members who received a face to face service within 48 hours
Name, Title and Credentials of staff involved with the project
Who is knowledgeable about the project ?
Project Staff Involved
Example Staff involved:
Cordelia Chavis, MSW, Director of Quality Improvement
Linda Isbell, MA, Director of Network Operations
Amanda Outlaw, MA, LPC, Director of Provider Monitoring
Reason for selection:
Give a narrative of why your agency chose this as a project. What problem/issue were you to address? Why is this project important? Why did you chose this project?
Example:Frequently, member/enrollees failed to attend scheduled urgent appointments, despite follow up calls being made by the Member Call Center. Data indicated that 68.33 % of individuals determined to need urgent care were provided face to face service within 48 hours. The remaining 32% were not seen within 48 hours.
This Quality/Performance Improvement Project will assist the organization in achieving our goal that people in need receive appropriate services for recovery, growth and quality care. Timely access to care is critical to protect member’s health and safety, minimize adverse consumer outcomes and promote consumer engagement in services.
.
What did you do to carry out the project?
Steps that went into implementing the change
All the steps that went into implementing change!
Example:• Collect/analyze data
• Reminder Calls to members
• Survey members on reasons for missed appointment
Evaluation of Results Look at the data
Look for trends and patterns(trend among complaint)
Analyze your data
Example:Data was reviewed and discussed for FY 2014 by QIP workgroup consisting of Medical Director, Member Call Center Director, Director of Network Operations, QI Director, Director of MH/SA Care Coordination, Chief of Clinical Operations and Chief of Quality Management. Presented "reason for appointment missed" report to workgroup. First Q -Baseline goal of 70% was met, with remeasurement of 76.6%. Second Q -Baseline goal of 70% was met, with remeasurement of 70.8%.
Project BarriersWhat’s preventing change?
Why aren’t you reaching your goals?
Example: Lack of transportation in rural areasLack of appointment availability
Project OutcomeWhat was the result of the project?
Did you see an increase ? Decrease?
Example: No increase in appointment attendance was observed during 3rd quarter.
Member Call Center making reminder calls the day before the appointment did not impact the project.
Incident Reporting(do you have a high amount of incident reports?)Surveys
Medical Record Reviews(peer review)
Focused Care Studies
Claims
Grievance and Appeals Data
NC TOPPS
Provider Monitoring Result
Director of Provider Monitoring Amanda Outlaw
Non submission of Quality Improvement Activities but not limited to may result in requirement to submit a Plan of Correction(POC).
Remember the role of
Provider Monitoring Department is to:✓ Ensure compliance with standards, quality assurance, routine monitoring,
targeted/focused monitoring and monitoring required for Provider per Provider Contract.
✓ Provide follow-up to complaints from consumers, service providers, stakeholders, and other MCO Departments.
✓ Provide Technical Assistance to providers regarding compliance with standards, quality of care issues, performance expectations, development
and monitoring of corrective action plans.
QI Projects are due by close of business
July 31, 2019.
Projects can be submitted:
Via email at [email protected]
Cordelia Chavis,
Director of Quality Improvement
This Photo by Unknown Author is licensed under CC BY-NC
