AFL 1 1 1 3 Total 66 Total Number of 20 day POC Reviews Type of Monitoring January February March Total Routine 5 7 2 14 Post-Payment 1 1 2 4 IR 0 1 0 0 Complaint 0 1 0 1 QOC 0 0 1 1 Health & Safety 0 1 0 1 AFL 0 0 1 1 Total 22 Total Number of Pre-Sanction Reviews Type of Monitoring January February March Total Routine 1 1 0 2 Total 2 Total for All 387 Top Significant Accomplishments Identified Accomplishment Factors That Supported Success Re-Credentialing Mailing Notification: Timely mailing and improved process of determining clean and flagged applications. Documented MD initial credentialing information that thoroughly assisted in the re-credentialing process. Enhanced oversight process with Network manager, MD and QM QM Monitoring transitioned to Network Identified Interim Clinical Monitoring Manager. Team collaboration with QM team during transition. B3 Services Implementation: Respite, Community Guide, Peer Support, SE/MH, SE/IDD, Personal Care, Physician Consult Non Innovations Pending: One Time Transitional Cost Network Development support and collaboration with SHC departments and community stakeholders/providers 94% Re-Credentialing Completed Standardized process for releasing letters in timely manner. LIPS can access CAQH as applicable to their enrollment. Collaboration with QM QOC process and MD approval. Identified Areas of Need and Possible Solutions Item/Area of Need Identified Recommended Solutions Re-Credentialing and Shaping the Network: Providers who haven’t billed. But decline to voluntarily terminate or amend their contract. Establish billing requirement and/or evaluate current contract requirements. Data reports that identify actual needs per catchment zip code
Internal Workplan for Monitoring Network Operations Review request for sanctions and response to request for trends. Quarterly QM Staff 6 sanctions, 1 appealed, 1 upheld Data Integrity for NC TOPPS. Quarterly QM Staff Completed and providers contacted to make corrections Internal Workplan for Monitoring Health Call Center/Customer Services Review random sample of Emergent clients to ensure they are seen within 2 hrs of the contact/STR. Quarterly QM staff All in sample were seen within 2 hours Review IRR reports for outliers and ensure corrective action taken when needed. Quarterly QM Director and Customer Services Director No issues identified Internal Workplan for Monitoring Care Coordination Review and trend management reports including IRR fidelity to policies and procedures and corrective action taken when required. Quarterly QM Director and Care Coordination Director Details below by section Review random sample of care coordination to ensure documentation is occurring as required, including integrated care scripts are being used. Quarterly QM Director and Care Coordination Director MH Care Coordination Director and QM Director reviewed. Utilizing new tools results: 94% compliance rate.
Review QOCs for trends in service types and or providers. Quarterly QM Director Documentation concerns go across all providers and cover areas of services provided not true to model; notes not written, assessments not complete or accurate, polypharmacy, outpatient and enhanced services are the ones with the most concerns. Review critical incidents to identify trends in service type submitting incidents. Quarterly Complaints and Incident Reports Manager Largest majority of incidents are sent by residential providers. Also noted are a number of providers not submitting incident reports timely. A plan of correction process has been implemented for those providers. Internal Workplan for Monitoring Communications Department Review the Annual Training Plan to monitor inclusion of feedback from external and internal sources, including CLT . Biannually QM Director, Training Coordinator and/or Community Relations Director N/A Internal Workplan for Monitoring Information Technology IT will report validation of data transfer. Quarterly Will be reported by IT at QMC
7/1/2013 Measures for the 4th Quarter 2013 (Apr, May, Jun) are as follows: Routine – 86% (172 out of 201) of Routine Callers kept their appointment within 14 days, this exceeded the Statewide Performance Goal and our Sandhills Center Measurable Goal. Urgent – 86% (82 out of 95) of Urgent Callers kept their appointment within 48 hours, this exceeded the Statewide Performance Goal and our Sandhills Center Measurable Goal. Routine Measures (86%) exceeded Baseline (71%) by +15%, Urgent Measures (86%) exceeded Baseline (75.5%) by +10.5% July 30, 2013 QMC comments based on results 6th measurements[Core 20 (f) & Core 20(h)] Interventions/Actions implemented based on results of 6th measurement [Core 21(f)] Periodic Measurements at least annually [Core 23(d)] and re-measurement for changes or improvements to baseline [Core 23(e)] Date of Measurement Result of Measurement Date Reported to QM Committee 10/15/13 Measures for the 1st Quarter 2013 (Jul, Aug, Sep) are as follows: Routine – 87% (52 out of 60) of Routine Callers kept their appointment within 14 days, this exceeded the Statewide Performance Goal and our Sandhills Center Measurable Goal. Urgent – 89% (120 out of 135) of Urgent Callers kept their appointment within 48 hours, this exceeded the Statewide Performance Goal and our Sandhills Center Measurable Goal. Routine Measures (87%) exceeded Baseline (71%) by +16%, Urgent Measures (89%) exceeded Baseline (75.5%) by +13.5% October 22, 2013 QMC comments based on results 7th measurements[Core 20 (f) & Core 20(h)] Interventions/Actions implemented based on results of 7th measurement [Core 21(f)] Periodic Measurements at least annually [Core 23(d)] and re-measurement for changes or improvements to baseline [Core 23(e)] Date of Result of Measurement Date Reported to