Gila River Health Care Corporation
Gila River Health Care Corporation
PROVIDER MANUAL
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Arizona Department of Health Services

Division of Behavioral Health Services
PROVIDER MANUAL
Gila River Regional Behavioral Health Authority Edition

8.4.1 Introduction
ADHS/DBHS is committed to establishing high quality behavioral health services. One method for achieving this is through adherence to the standards and guidelines set by the Centers for Medicare and Medicaid Services (CMS). Conducting Performance Improvement Projects consists of utilizing a comprehensive protocol endorsed by CMS. For Medicaid, the standards and guidelines used in the protocol for conducting Medicaid External Quality Review Activities ensure that Medicaid managed care organizations meet the quality assurance requirements set forth in the Balanced Budget Act (BBA) of 1997. One way that ADHS/DBHS adheres to CMS standards and guidelines and, in turn, promotes improvement in the quality of the behavioral health care provided to behavioral health recipients, is through the development and implementation of Performance Improvement Projects (PIPs).

What are performance improvement projects (PIPs)?
A PIP is an initiative to:

  • Implement system interventions to improve quality;
  • Evaluate the effectiveness of system interventions; and
  • Measure performance.

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PIPs are designed to:

  • Demonstrate achievement and sustainment of improvement for significant aspects of clinical care and non-clinical services; and
  • Correct significant systemic issues that come to the attention of ADHS/DBHS in part through:
    • Internal surveillance and service delivery monitoring,
    • Tracking and trending of complaints/allegations of abuse
    • Provider credentialing and profiling
    • Utilization management reviews, and
    • Member and/or provider satisfaction surveys.

What PIPs are currently in progress?
Currently there are four ongoing PIPs; three projects address clinical topics and one project addresses a non-clinical topic. Specific information concerning current PIPs can be found in Section IIIA of the ADHS/DBHS Quality Management/Utilization Management Annual Plan.

The three clinical Projects are:

  • Medication Management: Informed Consent for Psychotropic Medication Prescription
    The purpose of this project is to affect positive clinical outcomes through increased consumer understanding, compliance and empowerment by improving the practice of obtaining and documenting informed consent from consumers/parents/legal guardians for all prescribed psychotropic medications.
  • 0-5 Assessment
    The purpose of this project is to develop and implement a comprehensive assessment for children from birth to age five in order to improve the quality of care provided to this age group.
  • Psychotropic Medication
    The purpose of this project is to improve psychiatric services provided to behavioral health recipients by increasing the quality of documentation used to justify the use of multiple medications.

The non-clinical project is:

  • Access to Care: Appointment Availability for Routine Assessment
    The purpose of this project is to improve access to care for persons receiving behavioral health services by assuring that appointments are available for routine assessments within 7 days from the date of referral.

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8.4.2 References
The following citations can serve as additional resources for this content area:

8.4.3 Scope
To Whom Does this Apply?

T/RBHA and behavioral health providers.

8.4.4 Did you know…?
The Performance Improvement Project (PIP) protocol includes activities that public and private sector tools have in common.

The PIP protocol is based on a guidebook produced by the National Committee for Quality Assurance (NCQA) under a contract with CMS. The guidebook is entitled "Health Care Quality Improvement Studies Managed Care Settings: A guide for State Medicaid Agencies."

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8.4.5 Objective
To make sure that T/RBHAs and behavioral health providers understand and actively participate in the implementation of the Performance Improvement Projects (PIPs).

The purpose of health care quality Performance Improvement Projects is to assess and improve processes, and thereby outcomes, of care. In order for such projects to achieve real improvements in care, and for interested parties to have confidence in the reported improvements, PIPs must be designed, conducted and reported in a methodologically sound manner.

8.4.6 Procedures
T/RBHA subcontracted providers play an integral role in the implementation of the ADHS/DBHS Performance Improvement Projects (PIPs). Behavioral health providers may be asked to participate with any or all aspects of the PIP implementation process.

There are ten (10) steps to be undertaken when conducting PIPs:

  1. Select the study topic(s). In general, a clinical or non-clinical issue selected for study should affect a significant number of behavioral health recipients and have a potentially significant impact on health, functional status or satisfaction.
  2. Define the study question(s). It is important to clearly state, in writing, the question(s) the study is designed to answer. Stating the question(s) helps maintain the focus of the PIP and sets the framework for data collection, analysis, and interpretation.
  3. Select the study indicator(s). A study indicator is a quantitative or qualitative characteristic reflecting a discrete event (e.g., an older adult has/has not received a flu shot in the last 12 months), or a status (e.g., a person’s blood pressure is/is not below a specified level) that is to be measured. Each project should have one or more quality indicators for use in tracking performance and improvement over time.
  4. Use a representative and generalizable study population. Once a topic has been selected, measurement and improvement efforts must be system-wide. A decision needs to be made as to whether to review data for the entire population or use a sample of the population.
  5. Use sound sampling techniques (if sampling is used). If a sample is to be used to select members of the study, proper sampling techniques are necessary to provide valid and reliable information on the quality of care provided. When conducting a study designed to estimate the rates at which certain events occur, the sample size has a large impact on the level of statistical confidence in the study estimates.
  6. Reliably collect data. Procedures used to collect data for a given PIP must ensure that the data collected on the PIP indicators are valid and reliable. Validity is an indication of the accuracy of the information obtained. Reliability is an indication of the repeatability or reproducibility of a measurement. Potential sources of data include administrative data (e.g., enrollment, claims, encounters), medical records, tracking logs, results of any provider interviews and results of any recipient interviews and surveys. Data can be collected from either automated data systems or by a manual review of records.
  7. Implement intervention and improvement strategies. Real, sustained improvements in care result from a continuous cycle of measuring and analyzing performance, and developing and implementing system-wide improvements in care. Actual improvements in care depend on thorough analysis and implementation of appropriate solutions.
  8. Analyze data and interpret study results. Data analysis begins with examining the performance on the selected clinical or non-clinical indicators. The analysis of the study data should include an interpretation of the extent to which the PIP was successful and what follow-up activities are planned as a result.
  9. Plan for “real” improvement. When a change in performance is found, it is important to know whether the change represents “real” change or random chance. This can be assessed in several ways, but is most confidently done by calculating the degree to which an intervention is statistically significant; and
  10. Achieve sustained improvement. Real change results from changes in the fundamental processes of health care delivery. Such changes should result in sustained improvements. In contrast, a one-time improvement can result from unplanned accidental occurrences or random chance. If real change has occurred, the project should be able to achieve sustained improvement.

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8.4 Performance Improvement Project
Last Revised: 06/30/06
Effective Date: 06/01/2006

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