For Providers: Provider Online Services

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
  • Mental Health Statistics Improvement Program (MHSIP) Consumer Survey
  • Youth Services Survey for Families (YSS-F)
  • 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 Satisfaction and Penetration Rates.  All information is associated with fiscal year 2015 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:

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:

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

The Coordination of Care PIP is targeting improved coordination of care between Medicaid physical and behavioral health providers for Medicaid members who are receiving CHP services and are also diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder.  This population represents a high-risk group who frequently has co-occurring medical conditions. The goal of this PIP is to improve coordination of care between behavioral and physical health providers for this population.

CHP conducted an audit of 411 charts, which constituted a representative sample, for clients with the diagnoses listed above, to determine the degree to which coordination was occurring for clients in treatment. 

Our findings included:

  • 46% of the charts had documentation (a note or letter) of communication with a physical health provider.
  • 73% of the charts showed documentation of a PCP (or other regular physician) in the chart.

For more information on coordination requirements between behavioral and physical health providers, link to:

For Informational handouts to give to clients, link to:


Adults Age 60+ PIP

The Adults Age 60+ PIP focuses on increasing the engagement rate of adults age 60+ in treatment.  This frequently underserved population is at high risk for depression and other mental health issues due to medical conditions, chronic pain, loss of independence and stigma associated with mental health treatment.  The goal of this PIP is to encourage Medicaid-eligible adults age 60 and older to seek mental health services by sending informational materials to this population in a series of mail-based outreach efforts.

For Informational handouts to give to clients, link to:

For questions, please contact Colorado Health Partnerships Quality Management Department at 1-800-804-5040 M-F during regular business hours.