Quality Care is Our Top Goal

We are committed to improving the health 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 help a diverse group of people. We do all that we can to meet our member’s special needs and preferences. We also make sure our staff and providers are sensitive to cultural diversity. We are able to meet our member’s special requests related to cultural, racial, ethnic, and linguistic needs, and other special requests, as we have a diverse provider network.

Community Care has Quality Improvement (QI) Program that is overseen by a Quality Improvement (QI) Committee. The QI Committee includes representatives from the community and Community Care leadership. The QI Committee identifies issues that are important to you. We set goal for these areas and check them annually to be sure we meet our goals. The QI Committee studies the results of our measurement activities and takes action to improve performance when we do not achieve our goals. This entire process is ongoing. We continually measure or performance, study results, and work to improve our processes and services.

The overall goals of Community Care’s QI Program are to:

Provide the highest possible quality care that recognizes cultural diversity and your unique needs and preferences.
Honor choices.
Provide timely care and service.
Make your overall experience highly satisfying.
Ensure your 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 review results from measurement activities and member 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. The also foster 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 providers 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 customer service to answer the telephone to be sure your calls are answered within 30 seconds or less.
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 appeals.
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.
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.

Community Care conducts and annual member satisfaction survey. One thing this survey measures is satisfaction with Community Care customer service staff. In 2022, our customer service member satisfaction rates were 72.7% for the adult survey and 64.9% for the child survey. The adult rate did not meet the 78% goal nor did the child rate meet the 72% goal. The adult and child scores decreased when compared to the 2021 rates. To continue to improve on these rates, several interventions were implemented and continue. Customer service staff end each call by asking, “Are you satisfied with you call today”. If a member answers in the negative, the call is immediately routed to a customer service representative to address the issue. Customer service staff continue to receive trainings on different aspects of our available services to improve member satisfaction. In addition, an automated member satisfaction survey at the end of each call continues. Member report satisfaction with their calls over 97% 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 2021, we broke the data down further by race. The 7-day follow-up rates post discharge were:

White members – 43.8%
Black members – 40%
American Indian/Alaskan Native members – 51.7%
Asian members – 48.1%
Other or chose not to respond – 44.1%

The 30-day follow-up percentages post discharge were:

White members – 65.1%
Black members – 58.2%
American Indian/Alaskan Native members – 70.4%
Other or chose not to respond – 64.3%

A trend analysis revealed that all 7-day follow-up rates reflected decreases for all races from 2020 to 2021, except for the Asian population. For 30- day follow-up, the rates for White and Black populations decreased from 2020 to 2021, while the rates increased for all other races (American Indian/Alaskan Native, Asian and Other or chose not to respond). Community Care did a root cause analysis on the rates that fell below the goal to look for disparities. A statistical analysis was included to determine the disparities. Interventions to target the disparities were developed. We will continue to focus on improving the 7- and 30-day follow-up rates.

We are pleased that the results of our monitoring activities show 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 your safety in its measurement activities. We are very concerned about the 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 important when members are prescribed psychotropic medications or if they have physical health issues or 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 you will find useful.

If you would like to learn more about Community Care’s QI Program or 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.