Quality Management Program

Colorado Health Partnerships’(CHP) Quality Management Department is committed to the principles of continuous quality improvement. CHP’s Quality Management Program (QM) encompasses both quality assessment and performance improvement functions. A primary goal of the QM Program is ensuring the treatment we provide to our members is accessible, appropriate and results in effective outcomes. The QM Program also works to assure treatment is provided in accordance with the state and federal regulations governing Medicaid.

CHP’s Quality Management Program is designed to accomplish goals such as:

  • Assuring member needs are met and that the treatment provided results in successful outcomes.
  • Integrating member feedback and results of member satisfaction surveys into quality planning and improvement projects.
  • Monitoring providers to ensure access standards are met; clinical care is appropriate – recovery oriented and of high quality; client care is coordinated between all providers, both physical and behavioral health; and chart documentation meets published criteria.
  • Measuring, reporting and reviewing the performance of CHP against state, federal, national and internal criteria to determine where system interventions, corrective actions and performance improvement projects are needed.
  • Collecting and reviewing utilization data for positive or negative treatment patterns, and to identify both under and over utilization.
  • Investigating, reviewing and responding appropriately to all identified quality of care issues and adverse incidents.

Quality Management Activities

Measurement and Results

CHP conducts quality measurement and monitoring activities using various tools, including:

  • FactFinders® Member Satisfaction Survey Results
  • Performance Indicator Reports
  • Chart audit summaries, and other data reports

Results of measurement and monitoring activities are evaluated and summarized in the annual Quality Management Program Evaluation.

Performance Highlight

Improving performance is a core belief of the Colorado Health Partnerships’ Quality Improvement Steering Committee and Clinical Advisory/Utilization Management Committee (QISC/CAUMC).  The QISC/CAUMC employs a variety of techniques to evaluate and improve performance and outcomes to identify potential performance/quality improvement initiatives. When available, the Committee compares performance to national benchmarks, performance of other BHOs or like organizations, and to previous year’s performance. Statistical testing may be applied, when appropriate, to determine whether an increase or decrease in performance is truly (significantly) valid, or whether the difference is due to a random variation. Trending over time is also useful in showing where performance may be improving (or declining) even if testing doesn’t show a significant difference from one time period to the next. When differences are detected, further analysis will occur. This may include analysis of more detailed or updated data, input from members or providers closely involved in the specific activity being evaluated to better understand what is occurring, or evaluation of circumstances or barriers that may be impacting performance. Once this process is completed, changes or interventions are often developed and implemented, and re-measurement occurs to determine whether the changes made have had a positive impact upon performance. The re-measurement is typically evaluated to determine whether the changes were effective, or whether more time, revision or additional change is necessary for improvement.

One of CHP’s efforts is to bring the information contained in this website to providers in an easy to access and understand manner. The examples provided examine a variety of areas such as: Access to Care, Complaints and Grievances, Member Satisfactiona as seen in the trending report. All information is associated with fiscal year 2016 and will be updated annually or when warranted.

Provider Monitoring

Chart Audits

CHP’s contract with the State of Colorado requires us to evaluate the quality and appropriateness of care that members receive. CHP performs random provider chart audits in order to give feedback to providers on the quality of the documentation found in the audited charts, as charts are a critical component of the work providers engage in with clients. Chart audits are one measure of the quality of care that our members are receiving.

Chart audits review five areas in the medical record: Administrative/Claims, Assessment Treatment Planning, Discharge Planning and Progress Notes. A passing score on the audit is ≥ to 80%. If a provider fails an initial audit, a re-audit is performed in approximately six months.

In 2008, the number of charts with a passing audit score was lower than expected. Identified areas for improvement include: Treatment and Discharge Planning.

For template forms that capture the critical items reviewed in chart audits, link to:

For SUD template forms that capture the critical items reviewed in chart audits, link to:

Provider Education

Member Rights

As a CHP Provider, you must be aware of and uphold Medicaid member’s rights. For more information on member’s rights, link to:

411 Training

Adverse Incidents

To manage care effectively and assure the safety of members, CHP investigates and reviews adverse incidents that have resulted in harm or potential harm to a member or significant other participating in treatment. Providers are expected to report adverse incidents on an Adverse Incident Form (linked below) within 24 hours of the occurrence for sentinel events (e.g., suicides, homicides, unexpected deaths), and within 48 hours for all other incidents.

For more information on adverse incidents and reporting requirements, link to:

Performance Improvement Projects (PIP) and Studies

Shared Decision Making Study

Shared Decision Making is the use of a structured process to ensure increased member involvement in the decision-making and goal attainment aspects of treatment. CHP completed an experimental investigation of the effectiveness of a shared decision-making model of therapeutic activity. The study represented an attempt to improve treatment outcomes and empirically test a recovery model principle that says members improve more from therapy when they are directly involved in treatment decisions. To find out more about the study results, link to:

Coordination of Care PIP

Transitions of Care: Improving the rate of completed behavioral health services within 30 days after jail release

Improving the rate of completed behavioral health services within 30 days after jail release

The intent of the study is to improve the rates of post-jail behavioral health services completed within 30 days after inmate release for Medicaid Members identified as having behavioral health needs. The specific focus of the state-chosen topic is the transition of care from the local jail setting to the community.

Nearly 4 out of 6 jail inmates had a clinical behavioral health diagnosis or received treatment by a behavioral health professional within the previous year of completing the Department of Justice’ 2002 Survey of Inmates in Local Jails (National Institute of Health, n.d.a). Comparing this rate to the National Institute of Health’s estimation that approximately 1 out of 6 adults experience behavioral health issues within a one-year period (National Institute of Health, n.d.a.), one can see the need to focus on the behavioral health needs of the jail population. CHP’s hope is to identify jail inmates who are transitioning out of the jail and into the communities and connect them with services that will facilitate mentally healthy lives and potentially have the positive consequence of keeping them out of detention facilities in the future.

Results: Baseline was 14.7% and the goal for the next year is to have it increase by 20% to 17.6%.

Update: Accessing jail release data proved more difficult than initially anticipated. CHP worked to obtain legal releases with 42 of its 43 counties. Through significant efforts, CHP has been able to gain access data for 42 counties through a single system and has determined the best way to restructure the previously-approved PIP is to include data from the all counties in the CHP region (the plan previously aimed to look at the three largest counties, El Paso, Mesa, and Pueblo). This change was proposed to the State and HSAG and was approved.

Diabetes A1C

Ambulatory Follow up

Members who are hospitalized with a mental health diagnosis are a high-risk population, representing the most severely ill psychiatric patient population. Hospitalized members exhibit the most serious of risk behaviors, including potentially violent behavior directed at themselves or others as well as the inability to provide for their own basic needs. During the hospitalization, the Members’ symptoms are stabilized and a plan for continuing care becomes a vital step in the recovery process. An ambulatory follow-up visit with a mental health practitioner after discharge is necessary to ensure that gains made during hospitalization are not lost. This follow-up care serves the critical function of promoting progress towards treatment goals, such as successful transition to the home or work environment and medication compliance. It is an essential component to insuring continuity of care and reducing the incidence of inpatient recidivism. If the patient returns to their pre-illness environment without post-hospital intervention, the risk of reverting back to the same patterns, issues, and behaviors increases. Moreover, medication non-compliance may be a serious issue impacting the individual’s safety in the community.

Analysis of 2013 CHP data indicates that only 48.6% of inpatient mental health hospitalization discharges were followed by an outpatient behavioral health service within seven days of Member discharge. CHP has consistently aimed to improve the connectedness between inpatient and outpatient providers, and the follow-up measure is an important metric of the capacity to serve our most severely ill psychiatric patient population by improving continuity of care and information transfer. Focusing on this measure allows CHP to identify providers that are performing well and learn from their processes as a means for collecting and disseminating best practices throughout the network, while identifying poor performing providers that require improvement strategies to ensure Members are receiving the stands of care that CHP upholds.

Results: Baseline 2013: 893 discharges and follow-up rate of 48.6%

  • Four of the 8 CMHCs increased their ambulatory follow-up rates, with one increasing from 46.3% to 71.2%

Update: The goal is to improve the 7-day ambulatory follow-up rate for non-State hospitals from 48.6% to 54.5% by December 2016. The first re-measure year (calendar year 2015) yielded essentially the same follow-up rate as the baseline year (2014) – the rate decreased slightly to 47.0%, though this change was not statistically significant. With CHP as a Behavioral Health Organization (BHO) in Colorado, a Medicaid expansion state, there was uncertainty regarding how the number of hospital admissions/discharges might fluctuate with an increase in Medicaid Members. If the number of discharges increased drastically after Medicaid expansion, then capacity issues might need to be resolved in order to keep up with and increase the follow-up rate. From 2013 to 2014 there was a 60% increase in the number of hospital discharges that met study criteria. CHP’s Community Mental Health Centers (CMHCs) responded by hiring additional discharge planners and updating follow-up plans; however, with the lag in receiving claims data, problems for some CMHCs were not discovered until 6 -9 months after they began. CHP reviews data quarterly to stay apprised of shifts in follow-up and is confident that the goal of 54.5% will be reached by the targeted date.

Ambulatory Follow Up

Individuals treated with antipsychotic medications have a higher rate of type 2 diabetes than those who are not treated with antipsychotics. This assertion was the conclusion of Bellantuono et al., (2004), who completed a review of 21 studies to assess the risk of type 2 diabetes in patients treated with various types of antipsychotic drugs. Based on the conclusions of antipsychotics research, studies such as the Bellantuono study, the American Diabetes Association recommends diabetes testing at least annually for patients taking antipsychotic medications (American Diabetes Associate, 2004). Studies suggest that, generally, less than a third of people prescribed antipsychotic medications are screened for diabetes. While CHP has a diabetes testing rate that surpasses 1/3 (the baseline rate is 77%), there is still opportunity for improvement. In addition to the desire to improve diabetes testing rates, another purpose for undertaking this study is based on the State of Colorado’s Healthcare Policy and Financing (HCPF) Department’s request for the behavioral and physical health management organizations to work together. Since this study is both behavioral and physical health interrelated, the study will facilitate collaboration with the physical healthcare management entities, the Regional Care Collaborative Organizations (RCCOs), in the CHP region. CHP will work closely with the 3 RCCOs in the CHP region to exchange data and develop interventions to improve diabetes testing rates for Medicaid Members taking antipsychotic medications. CHP believes that this study will foster a close relationship between physical and behavioral healthcare management, which will improve overall healthcare for Medicaid Members in the CHP region.

Update: Some of the CMHCs in the CHP region have sites with medical providers (for example, nurses and physician assistants) located at the same physical locations as the behavioral health providers, so onsite diabetes testing is possible for many consumers. CHP as also reaches out to Members with letters informing them of the need to have glucose testing completed each calendar year. This helps ensure that consumers have diabetes testing done annually as recommended by the American Diabetes Association.

The goal is to improve the diabetes testing rate for Members who are regularly taking antipsychotics from 77.0% to 80.9% by December 2016. The first re-measure year (calendar year 2015) yielded a slight increase in diabetes testing rate compared to the baseline year (2014) – the rate increased from 77.0% to 77.9%. Interventions for 2015 include working with the RCCO physical healthcare Care Coordinators and/or providers to coordinate efforts in getting diabetes testing completed for all Members who need it. In CY15, CHP sent over 1300 letters to Members (up from 800 letters in CY13) informing them of the medical need to have glucose testing. CHP also worked to have letters with information translated to Spanish for non-English speaking Members, and this will take effect in CY16 efforts. CHP reviews data every 6 months to assess the need for additional interventions and is confident that the goal of 80.9% will be reached by the targeted date.

Results: CY13 baseline: 77%
1st re-measure CY 14: 77.9%