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 2018, our customer service member satisfaction rates were 67.3% for the adult survey and 66.7% for the child survey. While the adult rate did not meet the 70% goal and the child rate was below the 78% goal, the child score demonstrated improvement and the adult score decreased only slightly when compared to the 2017 rates. The Board Quality Improvement Committee (BQIC) agreed to maintain this initiative as an Opportunity for Improvement with the established goals of 78% and 70% for the adult and child rates, respectively. To continue to improve on these rates, several interventions have been implemented, including call recording for customer service representatives as well as external Quality Assurance audits that review these recorded calls. An automated post-call satisfaction survey has been also implemented for all calls.
Community Care is also working to improve the rate of follow-up appointments members attend after an inpatient mental health hospitalization. This is measured at both 7 days and 30 days post-discharge. For 2017, the percent of members attending an aftercare appointment within 7 days of an inpatient mental health discharge was 56.9%, not meeting the goal of 62%. The percent of members attending an aftercare appointment within 30 days of an inpatient mental health discharge in 2017 was 74.0%, again not meeting the goal of 78%. While the follow-up rates did not meet the goals, Community Care demonstrated improvement from the 2016 rates. Additionally, Community Care has had an increased focus on improving follow-up rates and has collaborated with numerous inpatient providers to join our Value-Based Purchasing process related to increasing these rates. Community Care also meets with select individual providers not meeting 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.
The 2019 provider satisfaction survey demonstrated that providers are satisfied with Community Care's Care Management staff with 92.1% of providers indicating that their questions are answered to their satisfaction.
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.