Performance Improvement Projects Sample Clauses
Performance Improvement Projects a. The Contractor shall ensure performance improvement projects, including any performance improvement projects required by CMS that focus on both clinical and nonclinical areas are conducted.
b. Each performance improvement project shall be designed to achieve significant improvement, sustained over time, in health outcomes and beneficiary satisfaction, and shall include the following elements:
i. Measurement of performance using objective quality indicators.
ii. Implementation of interventions to achieve improvement in the access to and quality of care.
iii. Evaluation of the effectiveness of the interventions based on the performance measures.
iv. Planning and initiation of activities for increasing or sustaining improvement.
c. The Contractor shall ensure the status and results of each project conducted are reported to the Department as requested, but not less than once per year.
Performance Improvement Projects. A. The Contractor shall conduct a minimum of two Performance Improvement Projects (PIPs) per year, including any PIPs required by DHCS or CMS. DHCS may require additional PIPs. One PIP shall focus on a clinical area and one on a non-clinical area. (42 C.F.R. § 438.330(b)(1) and (d)(1).) Each PIP shall:
1) Be designed to achieve significant improvement, sustained over time, in health outcomes and beneficiary satisfaction;
2) Include measurement of performance using objective quality indicators;
3) Include implementation of interventions to achieve improvement in the access to and quality of care;
4) Include an evaluation of the effectiveness of the interventions based on the performance measures collected as part of the PIP; and,
5) Include planning and initiation of activities for increasing or sustaining improvement. (42 C.F.R. § 438.330(d)(2).)
B. The Contractor shall report the status and results of each performance improvement project to the Department as requested, but not less than once per year. (42 C.F.R. § 438.330(d)(3).)
Performance Improvement Projects. (PIPs)
A. The Contractor shall design and implement PIPs that are focused on areas of concern to conduct on an ongoing basis.
B. The Department will work with the EQRO and the MCOs to identify regionally based collaborative PIPs that would be feasible and impactful for the Kentucky healthcare community. All parties will work together to develop strategies and detailed processes for implementing and coordinating efforts for regional collaborative PIPs. To support a collaborative process, the Contractors shall perform the following activities:
1. Define the scope of the PIP, identify target populations, set improvement goals, and define comprehensive interventions;
2. Coordinate with existing State or MCO initiatives, as applicable;
3. Support development of meeting agenda topics, writing quarterly reports, and identifying subject matter experts who should attend meetings based on the agenda items, and writing quarterly reports upon Department request.
4. Provide adequate funding and staffing resources to execute the PIP.
5. Evaluate the successes and challenges of interventions on an ongoing basis, and provide quarterly progress reports and an annual findings report to the Department. DMS will give final approval for the collaborative PIP design and establish required timelines for ongoing meetings and coordination among the involved parties.
C. As required by the Department, the Contractor shall implement an additional PIP if findings from an EQR review or audit indicate need or if directed by CMS. The Contractor shall assist the Department by supplying readily available data, soliciting input and supporting clinicians.
D. Implement PIPs as identified and requested for conduct by CMS. The Contractor’s PIPs shall include the following elements:
A. Measurement of performance using objective quality indicators and measures and minimum performance levels as defined collaboratively by the Department, the EQRO, and Contractor prior to commencement of each PIP. In determining indicators and measures, the Department and Contractor shall work to confirm they are not misaligned with those being used in other projects and that they are measurable and can be tracked. The Department shall have final decision and approval of required indicators and data definitions of each;
B. Implementation of interventions to achieve improvement in the access to and quality of care;
C. Evaluation of the effectiveness of the interventions based on the performance measures; and
D. Plann...
Performance Improvement Projects. Each MCP must conduct performance improvement projects (PIPs), including those specified by ODJFS. PIPs must achieve, through periodic measurements and intervention, significant and sustained improvement in clinical and non-clinical areas which are expected to have a favorable effect on health outcomes and satisfaction. MCPs must adhere to ODJFS PIP content and format specifications. All ODJFS-specified PIPs must be prior-approved by ODJFS. As part of the external quality review organization (EQRO) process, the EQRO will assist MCPs with conducting PIPs by providing technical assistance and will annually validate the PIPs. In addition, the MCP must annually submit to ODJFS the status and results of each PIP. MCPs must initiate the following PIPs:
i. Non-clinical Topic: Identifying children/members with special health care needs.
Performance Improvement Projects. Each MCP must conduct performance improvement projects (PIPs), including those specified by ODJFS. PIPs must achieve, through periodic measurements and intervention, significant and sustained improvement in clinical and non-clinical areas which are expected to have a favorable effect on health outcomes and satisfaction. MCPs must adhere to ODJFS PIP content and format specifications. All ODJFS-specified PIPs must be prior-approved by ODJFS. As part of the external quality review organization (EQRO) process, the EQRO will assist MCPs with conducting PIPs by providing technical assistance and will annually validate the PIPs. In addition, the MCP must annually submit to ODJFS the status and results of each PIP. ODJFS will identify the clinical and/or non-clinical study topics for the SFY 20098 Provider Agreement. Initiation of the PIPs will begin in the second year of participation in the ABD Medicaid managed care program. In addition, as noted in Appendix M, if an MCP fails to meet the Minimum Performance Standard for selected Clinical Performance Measures, the MCP will be required to complete a PIP.
Performance Improvement Projects. 4.12.6.1 As part of its QAPI program, the Contractor shall conduct clinical and non-clinical performance improvement projects in accordance with DCH and federal protocols. In designing its performance improvement projects, the Contractor shall: · Show that the selected area of study is based on a demonstration of need and is expected to achieve measurable benefit to the Member (rationale); · Establish clear, defined and measurable goals and objectives that the Contractor shall achieve in each year of the project; · Measure performance using Quality indicators that are objective, measurable, clearly defined and that allow tracking of performance and improvement over time; · Implement interventions designed to achieve Quality improvements; · Evaluate the effectiveness of the interventions; · Establish standardized performance measures (such as HEDIS or another similarly standardized product); · Plan and initiate activities for increasing or sustaining improvement; and · Document the data collection methodology used (including sources) and steps taken to assure data is valid and reliable.
4.12.6.2 Each performance improvement project must be completed in a period determined by DCH, to allow information on the success of the project in the aggregate to produce new information on Quality of care each year.
4.12.6.3 The Contractor shall perform the following required performance improvement projects, as agreed upon by the Parties (see Section 4.12.6.5), beginning January 1, 2012, ongoing for the duration of the GF Contract period: · Well-child visits; · ADHD Medication follow up; · Immunization rates; · Dental-children · Obesity-children · Comprehensive Diabetes Care; · Avoidable Emergency room utilization; · Member satisfaction, and · Provider satisfaction
4.12.6.4 Each PIP will use the calendar year as the study period.
4.12.6.5 Each PIP will use the study question and study indicators agreed upon by DCH and the CMOs.
4.12.6.6 Each CMO will submit the designated PIPs to DCH and/or the EQRO using the DCH specified template and format by June 30 of each contract year with the exception of the member satisfaction PIP which is due by August 1.
4.12.6.7 The EQRO will evaluate the CMOs’ PIP performance on an annual basis. DCH reserves the right to request modification of the PIPs based on this evaluation. Modifications will be discussed with each CMO prior to implementation.
Performance Improvement Projects. 4.12.5.1 As part of its QAPI program the Contractor shall conduct clinical and non-clinical performance improvement projects in accordance with DCH and federal protocols. In designing its performance improvement projects, the Contractor shall:
4.12.5.1.1 Show that the selected area of study is based on a demonstration of need and is expected to achieve measurable benefit to the Member (rationale);
4.12.5.1.2 Establish clear, defined and measurable goals and objectives that the Contractor shall achieve in each year of the project;
4.12.5.1.3 Measure performance using Quality indicators that are objective, measurable, clearly defined and that allow tracking of performance and improvement over time;
4.12.5.1.4 Implement interventions designed to achieve Quality improvements;
4.12.5.1.5 Evaluate the effectiveness of the interventions;
4.12.5.1.6 Establish standardized performance measures (such as HEDIS or another similarly standardized product);
4.12.5.1.7 Plan and initiate activities for increasing or sustaining improvement; and
4.12.5.1.8 Document the data collection methodology used (including sources) and steps taken to assure data is valid and reliable.
4.12.5.2 Each performance improvement project must be completed in a period determined by DCH, to allow information on the success of the project in the aggregate to produce new information on Quality of care each year.
4.12.5.3 The Contractor shall perform the following required clinical performance improvement projects, ongoing for the duration of the GF Contract period:
4.12.5.3.1 One (1) in the area of Health Check screens;
4.12.5.3.2 One (1) in the area of immunizations; and
4.12.5.3.3 One (1) in the area of blood lead screens.
4.12.5.3.4 One (1) in the area of detection of chronic kidney disease.
4.12.5.4 The Contractor shall perform one (1) optional clinical performance improvement project from the following areas:
4.12.5.4.1 Coordination/continuity of care;
4.12.5.4.2 Chronic care management;
4.12.5.4.3 High volume Conditions; or
Performance Improvement Projects. 8.2.1. The Contractor’s policies and procedures related to performance improvement projects shall ensure compliance with the requirements described in this section.
8.2.2. The Contractor shall have an ongoing program of performance improvement projects that focus on clinical and non-clinical areas. The Contractor shall conduct at least two (2) Performance Improvement Projects (PIPs) of which at least one (1) is clinical and at least one (1) is non-clinical as described in 42 CFR 438.240 (b)(1) and as specified in the CMS protocol (see Attachment A for website link).
8.2.3. The projects must be designed to achieve, through ongoing measurements and intervention, significant improvement, sustained over time, in clinical and non-clinical areas that are expected to have a favorable effect on health outcomes and enrollee satisfaction. Through implementation of performance improvement projects, the Contractor shall:
8.2.3.1. Measure performance using objective, quality indicators.
8.2.3.2. Implement system interventions to achieve improvement in quality.
8.2.3.3. Evaluate the effectiveness of the interventions.
8.2.3.4. Plan and initiate activities for increasing or sustaining improvement.
8.2.3.5. Report the status and results of each project to DSHS (42 CFR 438.240(d)(2)).
8.2.3.6. Complete projects in a reasonable time period as to allow aggregate information on the success of the projects to produce new information on the quality of care every year (42 CFR 438.240(d)(2)).
8.2.4. Annually, the Contractor shall submit to DSHS one (1) clinical and one (1) non-clinical performance improvement project which, in the judgment of the Contractor, best meet the requirements of a performance improvement project. Each project will be documented on a performance improvement project worksheet found in the CMS protocol entitled “Conducting Performance Improvement Projects” (see Attachment A for website link).
8.2.5. If any of the Contractor’s Health Plan Employer Data and Information Set (HEDIS®) rates on Well Child Visits in the first fifteen (15) months, six (6) or more well child visits measure), Well Child Visits in the third (3rd), fourth (4th), fifth (5th) and sixth (6th) years of life, or Adolescent Well Care Visits are below a sixty percent (60%) benchmark in 2008 or 2009, the Contractor shall implement a clinical PIP designed to increase the rates.
8.2.6. If any of the Contractor’s HEDIS® Combination 2, Childhood Immunization rates are below a seventy percent (70%)...
Performance Improvement Projects. Each MCP must conduct performance improvement projects (PIPs), including those specified by ODJFS. PIPs must achieve, through periodic measurements and intervention, significant and sustained improvement in clinical and non-clinical areas which are expected to have a favorable effect on health outcomes and satisfaction. MCPs must adhere to ODJFS PIP content and format specifications. All ODJFS-specified PIPs must be prior-approved by ODJFS. As part of the external quality review organization (EQR.O) process, the EQRO will assist MCPs with conducting PIPs by providing technical assistance and will annually validate the PIPs. In addition, the MCP must annually submit to ODJFS the status and results of each PIP. MCPs must initiate the following PIPs:
i. Non-clinical Topic: Identifying children/members with special health care needs.
ii. Clinical Topic: Well-child visits during the first 15 months of life.
iii. Clinical Topic: Percentage of members aged 2-21 years that access dental care services. Initiation of PIPs will begin in the second year of participation in the Medicaid managed care program. In addition, as noted in Appendix M, if an MCP fails to meet the Minimum Performance Standard for selected Clinical Performance Measures, the MCP will be required to complete a PIP.
Performance Improvement Projects. The Contractor shall conduct performance improvement projects that are designed to achieve, through ongoing measurements and intervention, significant improvement, sustained over time, in clinical care and nonclinical care areas that are expected to have a favorable effect on health outcomes and Member satisfaction.