Quality Care is Our Top Goal
We are committed to improving the health status of all Community Care members. Our mission is to provide the highest quality mental health and substance use programs and services at the lowest possible cost, delivered in an environment that promotes recovery. We serve a diverse membership and strive to make sure special needs and preferences are met and that staff and providers are sensitive to cultural diversity. We are able to meet members' special requests related to cultural, racial, ethnic, and linguistic needs, and other special requests, as we have a diverse provider network.
Community Care has a Quality Improvement (QI) Program that is overseen by a QI Committee. Members of the QI Committee include representatives from the community and Community Care leadership. The QI Committee reports to the Board of Directors, who reviews and approves the QI Program. The QI Committee determines measurement activities, defines measurement methodologies, sets performance goals and measures against these goals, analyzes results quantitatively and qualitatively, and implements interventions to improve performance when goals are not met. This is an ongoing process and not discontinuous at the end of the year. We complete an annual evaluation of QI Program activities and overall effectiveness of the program. This evaluation clearly shows our QI Program and structure is effective.
The overall goals of Community Care's QI Program are to:
- Provide the highest possible quality care that recognizes the cultural diversity of each member and his or her unique needs and preferences.
- Honor member choices.
- Provide timely care and service.
- Make the overall experience highly satisfying for reach member.
- Ensure member safety to the highest degree possible.
- Promote continuity and coordination of care.
- Provide outstanding customer service.
We receive input from the provider community through the Provider Advisory Committee (PAC). Network practitioners on the PAC keep Community Care informed about what is happening in the network and provide recommendations to the QI Program about activities such as clinical practice guidelines. The PAC also reviews results for measurement activities and member and provider satisfaction surveys to provide input from the practitioner's perspective. The PAC is involved when new QI activities or initiatives are planned to ensure their perspective is adequately reflected in the process. This also fosters buy-in for new projects. Community Care places high value on maintaining a collegial relationship with our provider network.
Some of the things we monitor are:
- The composition of our network to be sure we have the right number of practitioners and facilities within an appropriate driving distance of members.
- The timeliness of appointments to be sure members with urgent care needs can see a provider within 24 hours, and members with routine care needs can see a provider within 7 calendar days.
- The time it takes Community Care customer service staff to answer the telephone when members call to be sure members' calls are answered within 30 seconds.
- Member complaints to be sure complaints are fully investigated and actions are taken as appropriate within the required time frames for routine and clinically urgent complaints.
- Member appeals to be sure adequate consideration is given to issues of disagreement and actions are taken as appropriate within the required time frames for routine and clinically urgent complaints.
- Member complaints about providers.
- Overall member satisfaction with services provided by Community Care and its providers so we can identify areas of dissatisfaction and take actions to improve in these areas.
- Overall provider satisfaction including satisfaction with the Utilization Management process so we can identify areas of dissatisfaction and take actions to improve in these areas.
- Adherence to clinical practice guidelines so we can improve clinical safety. Community Care continually seeks to implement new and innovative interventions to improve the rate of follow-up after inpatient discharge.
In 2020, our customer service member satisfaction rates were 65.2% for the adult survey and 69.2% % for the child survey. The adult rate did not meet the 70% goal and the child rate was below the 78% goal. The adult score decreased slightly when compared to the 2019 rates, while the child rate did increase from the 2019 rates. The Board Quality Improvement Committee (BQIC) agreed to maintain the established goal of 70% for the adult rates and adjust the goal to 70% for the child rates. To continue to improve on these rates, several interventions have been implemented. Customer Service staff also end each call by asking, “Are you satisfied with your call today?” Customer service staff continue to receive training specifically on child services available to members to better answer your questions which appears to have increased satisfaction rates. In addition, an automated member satisfaction survey at the end of each call has been implemented where members report satisfaction with their calls 98% of the time.
Community Care is also working to improve the rate of follow-up appointments after an inpatient mental health hospitalization. This is measured at both 7 days and 30 days post discharge. For 2019, 57.3% of members attended an aftercare appointment within 7 days of an inpatient mental health discharge. The goal was 62%. In 2019, 73.7% of members attended an aftercare appointment within 30 days of an inpatient mental health discharge. The goal was 78%. Community Care meets with certain providers that did not meet the goal. We have many other areas that we measure to ensure quality care. If you would like to learn more about these other areas or our QI Program, please contact us.
We are pleased that the results of our monitoring activities show that we improved upon or met most of our goals, and we have very few complaints. The results of our annual member and provider satisfaction surveys show that members are satisfied with both Community Care and our providers, and providers are satisfied with Community Care and the services we provide.
The QI Program always considers member safety in its measurement activities. We are very concerned about continuity and coordination of care because it is an important member safety issue. Collaboration between providers is essential for safe and effective behavioral health treatment and can improve member outcomes. Exchange of information is encouraged between both behavioral and physical health providers to enhance members' safety and well-being. We measure to be sure that when members receive care from more than one provider, both providers exchange information as appropriate. We encourage members to share treatment and medication information with all of their providers to help ensure safety. This is especially important when members are prescribed psychotropic medications or if they have physical health issues/other physical concerns, such as smoking or obesity, along with their behavioral health condition. Our Consent to Release Information form is available on our website for you to download and use. Please visit Provider Resources on ccbh.com for many other forms that you will find useful.
If you would like to learn more about Community Care's QI Program and our progress in meeting our goals, please call or write to us. If you would like a copy of our QI Policy, we will send it to you. If you have suggestions for improving our QI Program, please let us know. If you would like to serve on the Provider Advisory Committee, please let us know.
For more information, to make a suggestion, to request a copy of the Quality Improvement Program or to participate on the Provider Advisory Committee, call us toll-free at 1-888-251-2224.
You can also write to us at:
Community Care Behavioral Health Organization
Quality Management Department
339 Sixth Ave., Suite 1300
Pittsburgh, PA 15222
Review the Annual Evaluation Executive Summary.