Quality Improvement Plan and Projects 101

Transcription

1 Quality Improvement Plan and Projects 101

2 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 s, 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.

3 Understanding Quality Improvement(QI) Plans Understanding Quality Improvement Projects(QIPS)

4 Eastpointe Local Management Entity/Managed Care Organization(LME/MCO) recommends Network Providers..develop and implement a Quality Management (QM) Plan that mirrors the LME/MCO. The Plan shall include both Quality Assurance (QA) and Quality Improvement (QI) activities and processes.

5 This Photo by Unkn Definitions Quality Assurance (QA)- ensuring that your agency meets the basic requirements as required by law, Medicaid, contract, rules, etc. Quality Improvement (QI)- reviewing current practices and determining how you can exceed the basic requirements as required by law, Medicaid, contract, rules, etc. Quality Improvement Plan(QI)- Purpose and function of agencies Quality Management Program, outlines goals, objectives and committee structure.

6 Eastpointe LME/MCO recommends to have only one QA/QI Plan for your agency. If your agency covers more than one LME/MCO, it would be expected that any QI goals will directly affect every LME/MCO served.

7 Demographics: Agency Name Your legal agency name Address Corporate address Date Date plan was completed QI Plan Contact Your agency Contact Person, Position, and address, in case the MCO has questions about the plan Agency Scope of Service(s) Provided - Identify service and site specific information.

8 Agency Mission/Vision Statement- purpose of the agency- it defines your customers, describes the responsibilities towards these customers and the main objective that supports the company in accomplishing the mission. Agency Goals- overall agency goals Quality Management Committee (QMC) Minutes [Your agency should have evidence that the committee meets at a minimum quarterly]

9 Your agency should have Policies and Procedures for the following and your QI Plan should be able to reference these: Credentialing and Privileging of Staff Staff Training Plan Incident Reporting Complaint/Grievances of Consumers Member Rights Review of Medical Records Rescheduling of Initial and Aftercare Appointments Consumer Satisfaction Survey

10 Your agency should have evidence of: Examples of Consumer Satisfaction Survey Disaster Plan QI Goals for Agency Your QI Plan should be able to reference the above

11 Agency Goals What are your agency QI Goals? They should: Reflect the mission statement of your agency Be measurable and time limited Should be reflected within your QI Plan

12 Quality Management/Improvement Committee Your QI Plan should describe the: Purpose of your QM/QI committee QM/QI Committee members and meeting schedule How QM/QI Committee utilizes data to make QI decisions for your agency & how that data is gathered and disseminated

13 Utilization of data continued.. Examples: peer review, incident reporting trends, complaint trends

14 Your QI Plan should describe the following: Subcommittees: Incident reporting Human Rights Complaint/Grievance Corporate Compliance Credentialing QA review of Records/Peer review Any additional Committees

15 Your QI Plan should describe: How your agency includes stakeholder participation within your committees/qm Processes (examples) Part of committee Consultant Assist with Surveys Board Participation

16 Your QI Plan should demonstrate how your agency utilizes the subcommittee reporting information to provide better services to consumers QM Committee Human Rights Incident Reporting Complaints

17 Your QI Plan should describe Staff Training Describing how your agency addresses required staff trainings as defined by Core Competencies and Service Definitions Describes the Training Plan and Orientation- it is usually helpful that specific job types have a listing of required trainings and annual updates Describes how your agency determines when & what types of additional training may been needed

18 Your QI Plan should describe Outcome Measures How you ensure that staff is trained and knowledgeable about NC TOPPS How you ensure outcomes are collected and used to improve the lives of consumers who receive services from your agency How you utilize NC TOPPS data for QI within your agency How you ensure compliance with NC TOPPS within your agency

19 Your QI Plan should: Describe your agency s process for completion of Consumer Satisfaction Surveys. Include the method of: Collection Frequency System of communicating results Use of data

20 Your QI Plan should explain your Disaster Plan Describes your agency s disaster plan Describes how your members are made aware of the plan Describes how staff training is conducted to carry out the Disaster Plan

21 Your QI Plan should: Describe how your agency implements QI Projects. Include in the process: Identification of projects, How staff is involved with the projects, How the projects will be used to involve care.

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23 Quality Improvement Project (QIP): An initiative to measure and improve the service and/or care provided by the organization.

24 Activity Name: The activity name should succinctly encompass 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. Improving claims turn-around time to providers Improving access to behavioral health services Decreasing practitioner complaints with the referral process. Increase percentage of members who receive a face to face service within 48 hours to 50%. Goals must be specific and measurable!

25 . Project Basis: Give a narrative of why your agency chose this as a project. What problem/issue were you to address? Why is this project important? Example: Frequently, member/enrollees failed to attend scheduled urgent appointments, despite follow up calls being made by the Member Call Center. Data indicated that % 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.

26 Study Question: is an answerable inquiry into a specific concern or issue. Example: Will increasing appointment availability increase percent of members who receive a face to face service within 48 hours? Strategies: How are your going to carry out the project? What are you going to use to collect you data? Objectives/timelines of the project. Example: Paid claims data, member satisfaction surveys Interventions: What did you do to carry out the project? Improve? Example: Reminder calls to members the day before appointment

27 Elements Required within the QI Projects: A. Quantifiable Measures Numerator: Describe here the criteria being assessed for the service or care Example: # of calls that received a service within 48 hours Denominator: the event being assessed or members who are eligible Example: # of calls during the quarter who were determined to need urgent care First Measurement Period Dates Baseline Benchmark: What goal are you trying to achieve? Source of Benchmark: Is this a national or statewide standard? Baseline Goal: This is the goal, your agency wants to meet Population Affected: Who does this project affect?

28 B. Quantifiable Measures Date Approved by Global Quality Improvement Committee Date of Meeting Minutes Reflecting Approval by GQIC Time Frames C. Baseline Methodology Data Sources/ Collection Methodology: Paid claims, surveys, etc. Data Sampling: Did you use a sample? Data Collection Cycle: weekly, monthly, quarterly

29 Section 2: Data/Results Table Time Period Measurement Covers Measurement Rate or Results Section 3: Analysis Cycle Time Period and Measures That Analysis Covers Analysis and Identification of Opportunities for Improvement.

30 Section 4: Interventions Table Interventions Barriers That Interventions Address Section 5: Chart or Graph (Optional) Section 6: Group/Committee Expertise in evaluating the activity Staff Name, Title and Experience listed

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32 This Photo by Unknown Author is licensed under CC BY-NC

33 Cordelia Chavis, Director of Quality Improvement (910) This Photo by Unknown Author is licensed under CC BY-NC