Vaya Health’s Quality Management and Improvement Program (QMIP) works with staff, providers, stakeholders, and individuals we serve to measure how well we meet member needs.Members are at the heart of Vaya’s quality management (QM) program, and we value their voices.
The QMIP provides the vision and framework for Vaya’s QM activities. It focuses on health outcomes—rather than just processes—and aligns with the NC Medicaid Managed Care Quality Strategy. Vaya’s QMIP measures and emphasizes integrated care for physical health, behavioral health, intellectual/developmental disabilities (I/DD), and traumatic brain injury (TBI) needs, as well as care specific to the needs of individuals with an I/DD or a TBI.
Our program supports, promotes, and operationalizes Vaya’s mission, vision, and values. We apply evidence-based quality improvement concepts and techniques to maintain an innovative, integrated, equitable, person-centered quality measurement program that addresses both medical and non-medical drivers of health.
Vaya updates the description of our QMIP each year and defines program goals, objectives, and strategies. Key elements include:
- The Quality Improvement Committee (QIC), which oversees the QMIP and meets at least once each quarter. Members include Vaya staff, network providers, and representatives from Vaya’s Consumer and Family Advisory Committee (CFAC). The group provides guidance on QMIP priorities and projects.
- Quality priorities that are integrated across all levels of the organization from the Board of Directors, the Chief Medical Officer (CMO), and multidisciplinary teams.
- Performance improvement projects (PIPs) and quality improvement activities (QIAs), which may develop from the North Carolina Department of Health and Human Services (NCDHHS), as well as performance reports, surveys, or issues identified by the QIC, Vaya staff, network providers, or CFAC representatives. Vaya monitors PIPs and QIAs for progress toward specific goals.
- Quality assurance activities and objectives focused on health outcomes that align with the NC Medicaid Managed Care Quality Strategy integrated approach for both behavioral and physical health.
- Our Quality Assessment and Performance Improvement Program, which identifies ongoing and new PIPs and QIAs for the upcoming fiscal year, estimated completion dates, and staff responsible for each activity.
At the end of each quarter and fiscal year, Vaya reviews and evaluates progress made toward performance improvement goals. This evaluation reviews PIP and QIA performance trends and effectiveness.
Download a copy of the QMIP overview
QM Program Structure and Operations
The Regulatory Compliance and Quality Committee (RCQC), a subcommittee of Vaya’s Board of Directors, reviews performance data and other quality measures to ensure Vaya meets or exceeds NCDHHS requirements. The RCQC is also kept aware of PIPs, QIAs, and other QIC activities and has the authority to recommend new quality improvement initiatives.
Vaya’s CMO oversees all QM initiatives via the QIC. The CMO and the Quality Director of NC Medicaid Managed Care co-chair the QIC. This committee meets at least once per quarter and recommends, reviews, and approves PIPs and QIAs and provides guidance on QM priorities, projects, and initiatives.
The CMO is supported by the Deputy CMO, who is a physical health practitioner and provides guidance to the organization regarding physical health needs. The CMO provides regular guidance to the organization and is Vaya’s ultimate authority in all clinical matters. The CMO is a member of Vaya’s Executive Leadership Team (ELT) and provides regular QMIP status updates to ELT.
The QM Department structure includes a multidisciplinary team of clinical and non-clinical staff aligned to support Vaya’s strategic vision for quality. Team subject matter expertise is wide ranging and includes behavioral health, physical health, program evaluation, nursing, public health, population health management, and intervention design.
Vaya’s Performance Reporting Team (PRT) supports processes related to the development, implementation, and monitoring of performance measures, required reports, and adherence to service level agreements and performance standards with associated liquidated damages. The PRT coordinates with key stakeholders, including the Information Services Division, to refine all quality and data integrity standards, produce accurate clinical and non-clinical metrics, and report to NCDHHS. This provides a basis for stratification, regional reporting, and reporting of quality measures for all provider types and member populations. Throughout this process, the PRT maintains appropriate communication with NCDHHS, Vaya’s QM Department, QIC, ELT, and the Board of Directors.
QMIP Goals and Objectives
Our QMIP description and Quality Assessment and Performance Improvement (QAPI) workplan serve as the foundation for Vaya’s improvement efforts, with program goals and priorities embedded throughout organizational operations. Vaya’s QMIP goals are to provide rigorous outcome measurement compared to relevant targets and benchmarks, promote equity through reduction or elimination of health disparities, and reward providers for advancing quality goals and health outcomes. Vaya’s QMIP provides a framework for high-quality care through better delivery, healthier people and communities, and smarter spending. Vaya is committed to implementing an ongoing and comprehensive QM program that ensures:
- Accessibility of services
- Detection of underutilization and overutilization of services
- A sustainable program with predictable costs
- Incorporation of population health programs to improve outcomes
- Assessment and implementation of actions to address health disparities
- Identification and mitigation of unmet health related resource needs
- Appropriateness of care for members receiving long-term services and supports
- Coordinated care for the whole person
- Alignment with external review and accreditation standards, such as National Committee for Quality Assurance (NCQA) Health Plan Accreditation
- A comprehensive and well-qualified network of providers, including Tailored Care Management providers
- A comprehensive array of clinically appropriate, integrated physical health, behavioral health, and pharmacy services for individuals with complex behavioral health conditions, I/DD, and/or TBI that meet or exceed objective quality standards, regardless of the setting
Performance Improvement Projects (PIPs) and Quality Improvement Activities (QIAs)
Each year, Vaya conducts at least three NCDHHS-approved PIPs—two related to clinical performance in select areas outlined in the QMIP and one related to non-clinical performance improvement. PIPs align with the goals of the NC Medicaid Managed Care Quality Strategy and with the requirements in North Carolina’s federal Medicaid waivers and other benefit plans. PIPs and QIAs focus on addressing quality and safety of clinical care, quality of service, and/or member experience.
Vaya continually reviews data and other resources that may help identify areas for improvement. We measure outcomes related to quality of life, functional status, and member satisfaction through various surveys. This includes surveys of Vaya members and/or providers and performance data:
- The Client Perceptions of Care survey assesses member satisfaction and perceptions of the quality and outcomes of behavioral health services provided by Vaya network providers.
- The Provider Satisfaction Survey allows network providers to give feedback on their interactions with Vaya.
Vaya focuses on the delivery of equitable, high-value care that impacts both population health and the medical and non-medical drivers of health. We are committed to aligning efforts with the NC Medicaid Managed Care Quality Strategy and addressing health disparities. We continue to partner with members, providers, and stakeholders to implement strategies that focus on health outcomes, further develop our value-based contracting efforts, and integrate behavioral and physical health services.
