Quality Monitoring and Improvement
The Health Plan shall have a regular quality monitoring and improvement program with defined indicators applicable to evaluating services to APIA populations, and that ensures: (1) access to a full array of culturally competent treatment modalities; (2) comparability of benefits, and (3) comparable successful outcomes for all service recipients.
The Quality Improvement Plan shall include:
- Sampling approaches of current and past APIA utilization patterns, by modality (including, pharmacotherapy), and level of care.
- Quality improvement teams, with proportionate representation of APIA consumers and APIA culturally competent Mental Health Specialists, which review data from quality indicators relating to APIA populations. If irregularities or deficiencies in care are found, special quality studies and corrective actions shall be undertaken to identify causes and address root causes/processes.
- Consumer satisfaction surveys, translated orally and in written format into local APIA languages and dialects, implemented by members of the APIA community independent from the Health Plan. Surveys shall be available in various formats to facilitate the participation of APIA consumers at all socioeconomic and educational levels. Sampling shall include involvement of Health Plan drop-outs. Evidence of a pattern of discrimination shall be a reason for termination of contract.
- Periodic assessment of functional outcomes which are valid and applicable to APIA populations, for APIA consumers and families receiving services, as well as the entire covered population. Outcomes shall be quantifiable objectives, not just process variables, and collected independently from agency billing records.
- Collection of quality and outcome data related to service provision for APIA consumers and their families are identified by the provider. Data shall be reported on a regular basis to the governing entity and used as a basis for determining contract renewal.
- Credentialing and privileging standards, specific to different disciplines, which include cultural and linguistic competence, knowledge, skills, and attitudes relevant to the APIA populations. These shall include a continuing education requirement and performance based competency evaluation.
- A record of, and regular reporting on, all appeals, grievances, and law suits, as well as informal complaints, differentiated by ethnicity of the complainant and the specific provider. Disproportionate trends by ethnicity shall require measurable and timely corrective action.
- Criteria for the removal of providers from provider panels and tracking for providers and practitioners which are open for review, analyzed by ethnicity and gender of provider and able to account for differing service needs of diverse populations, including APIAs.
- Tracking of APIA consumer movement across levels of care, of the use of intrusive, specialized or restrictive interventions, and of unusual occurrences by age, gender, ethnicity, and specific practitioner, with sanctions for desirable and unacceptable performances.
- Identification and tracking of high-cost APIA consumers resulting in the review and adaptation of their treatment plans to better address their needs.
Recommended Performance Indicators
- Presence of a Quality Improvement Plan with defines indicators applicable to evaluating services to APIA populations.
- Proportional representation of APIA consumers, providers, and community members on the quality improvement team.
- Occurrence of quality studies focusing on the use of best practice in resolution of deficiencies in the care of APIA consumers.
- APIA linguistically and culturally factored consumer satisfaction surveys which are independently administered and include Health Plan drop-outs and short term recipients.
- Regular reporting of APIA specific quality assurance data to the governing entity, including appeals and grievances.
- Systematic tracking of high-cost APIA consumers with support to treatment teams to identify and implement successful interventions.
- Systematic tracking and open reporting of persons, removed from provider panels, by ethnicity.
- APIA Consumer and family satisfaction with services.
Benchmark: Comparable to overall service population
- Rates of drop-out, grievances, restrictive care, unusual occurrences, and adverse events for APIA consumers.
Benchmark: Comparable to overall service population
- Match between level of care/restrictiveness of modality and level of treatment need for APIA consumers.
Benchmark: Level of match comparable to overall population
- APIA-relevant functional outcomes in domains of daily living (e.g., housing, access to primary health care, family role, vocational/educational/employment, community tenure.)
Benchmark: Improvement over time, rates comparable to overall community
- Comparability of access and benefit from service for APIA consumer populations.
Benchmark: Comparable rates of access, consumer satisfaction, and clinical results across overall service population
- APIA rates of recidivism into restrictive level of care or other restrictive placements.
Benchmark: Comparable to overall population served and significant reductions where inequities exist