Health Network has facilitated an increase in the number of providers returning contracts within 60 days. Identifying providers that have incomplete contracts and initiating contact through email, postal mail, and phone calls to facilitate the return of contracts. Quality Management met standards for processing and resolving complaints within 30 days. Standard is 90% and SHC met at 100% for December – February. QM and staff commitment to meeting compliance standards. Item/Area of Need Identified Recommended Solutions Issues with provider documentation continue to be a QI concern. Services are not true to model and are missing components of service definition. Organization of training and review of other services to identify service areas where documentation training is needed. High numbers of appointments are being missed. Call center is developing a text message to remind consumers of appointments. They are also developing a poster with SHC’s 800 number and outreach information. Additional Comments: Prepared by: __________________________________ Committee Chair Approved by: __________________________________ QM Committee Chair
ar. Unknown/ Not Known ……………………………………………………………………….. 3 3 0 as. Not Service Related 0 0 0 at. Other 1 0 1 au. Total (Must be ≥ to the Total # of Complaints in 1.c.) …………………………………. 79 67 12 9. Residential Is An Issue In The Complaint: (from 8.af.) ………………………………… 11 8 3 10. Identify Residential Service Type For Each Complaint Included in 9: List each complaint in only one category a. Own Home 0 0 0 b. Parents/ Guardian’s Home …………………………………………………………………… 0 0 0 c. Supervised Living 5600 A (Adult with Mental Health Concerns ………………………….. 0 0 0 d. Supervised Living 5600 B (Minor with Intellectual/Developmental Disabilities) 0 0 0 e. Supervised Living 5600 C (Adult with Intellectual /Developmental Disabilities) 2 2 0 f. Supervised Living 5600 D (Minor with Substance Abuse Concerns) …………………….. 0 0 0 g. Supervised Living 5600 E (Adult with Substance Abuse Concerns) 1 1 0 h. Supervised Living 5600 F (Alternative Family Living) - Licensed ………………………… 1 1 0 i. Supervised Living 5600 F (Alternative Family Living) - Unlicensed ……………………… 0 0 0 j. Therapeutic Foster Care 1 1 0 k. Psychiatric Residential Therapeutic Facility (PRTF): ………………………….. 2 2 0 l. Psychiatric Residential Therapeutic Facility (PRTF): within 40 miles ……. 0 0 0 m. Psychiatric Residential Therapeutic Facility (PRTF): outside 40 miles 0 0 0 n. MH Apartments- Supervised ………………………………………………………………… 1 0 1 o. Family Care Home 0 0 0 p. Level III Group Home 1 1 0 q. Level IV Group Home 0 0 0 r. SA Halfway House 0 0 0 s. Other 2 0 2
services are impacted by not receiving the services that have been medically authorized. Local network providers are impacted by being unable to provide services that have been authorized as medically necessary. Selection Process [Core 19(b), Core 20(g), Core 21 (a)(b)(i),(ii),(iii)(c)(d)(e)(f) and Core 23(a)] The Health Utilization Management/Utilization Review unit observed a trend of unused outpatient units. A report was developed to show the number of units authorized and the percentage of those units used by the provider for a specific service. The report highlighted a low usage rate for the service of Individual Psychotherapy (90837) and Group Therapy (90853). The utilization of service codes 90837 and 90853 will be closely monitored for increases in use as the providers received technical assistance. The reports will allow a measurement over time to gauge increased utilization of the service codes identified. Relation to Modules under Review [Core 21 (a)(b)(i),(ii),(iii), Core 24(a)(b)] This quality improvement project fits with the Health Utilization Management module, Version 7.0. This project is designed to measure the increased utilization of service codes 90837 and 90853. Date approved by the Quality Management Committee [Core 20(g)] Date of meeting minutes reflecting approval by Quality Management Committee [Core 20(d)] April 22, 2014 April 22, 2014 Time Frames [Core 23(c)] March 2014 – Formulated Quality Improvement Project to address low utilization rate of services. March 2014 – Developed a report to analyze trends in service code utilization. March 2014 – Collected baseline data from 2nd quarter FY 2013-2014. Ongoing – monitoring of service utilization and technical assistance to providers. July 2014 – Updated QIP and data based on transition to Alpha MCS July 2014 (and forward) – monitoring of service utilization and technical assistance to providers. Focus of Project [Core 24(a)(b)] Name of Senior Clinical Staff Person Involved [Core 24 (b)] Clinical – Will targeted training and support tools assist community providers Dr. Anthony Carraway, Sandhills Center Medical Director