Quality Improvement

Vaya Health’s Quality Management and Improvement Program (QMIP) works with staff, providers, stakeholders, and individuals we serve to measure how well we’re meeting the Vaya members’ 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, is focused on health outcomes rather than just health care process, and aligns with 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 TBI needs, as well as care specific to the needs of individuals with an I/DD or a TBI.

The program is designed to support, promote, and operationalize 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.

The description of our QMIP is updated each year and defines program goals, objectives, and strategies. Key elements of our program 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 integrated across all levels of the organization from the Board of Directors, the Chief Medical Officer, and multidisciplinary teams.
  • Performance Improvement Projects (PIPs) and Quality Improvement Activities (QIAs), which may develop from the NC Department of Health and Human Services (NCDHHS), performance reports, surveys, or as a result of issues identified by the QIC, Vaya staff and leadership, network providers, or CFAC representatives. PIPs and QIAs are monitored for progress toward specific improvement 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 planned for the upcoming fiscal year, estimated dates for completion, 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.

QMIP overview

QM Program Structure and Operations

The Regulatory Compliance and Quality Committee (RCQC), a subcommittee of Vaya’s Board of Directors, is responsible for reviewing performance data and other measures of quality to ensure Vaya is meeting or exceeding NCDHHS requirements. The RCQC is also kept aware of PIPs, QIAs, and other activities of the QIC and has the authority to recommend new quality improvement initiatives.

Vaya’s Chief Medical Officer (CMO) oversees all QM initiatives via the QIC. The CMO and the Quality Director of NC Medicaid Managed Care are co-chairs of QIC. This committee meets at least once per quarter and recommends, review 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 (ISD), to refine all quality and data integrity standards, to produce accurate clinical and non-clinical metrics, and to report to NCDHHS. This provides a basis for stratification, regional reporting, and reporting of quality measures for all provider types and patient populations. Throughout this process, the PRT maintains appropriate communication with NDCHHS, 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 aligns with the NC Medicaid Managed Care Quality Strategy which provides a framework for delivering 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 (LTSS)
  • Coordinated care for the whole person
  • Alignment with external review and accreditation standards such as NCQA Health Plan Accreditation
  • A comprehensive and well-qualified network of providers, including Tailored Care Management providers
  • Development and implementation of a robust provider support plan
  • 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 (NC Medicaid Direct). Vaya focuses PIPs and/or QIAs on addressing quality of clinical care, safety of clinical care, quality of service, and/or member experience.

For 2024, Vaya plans to implement the following PIPs/QIAs:

  • Medicaid Mental Health Follow-up after Discharge – Seven Day
  • Follow-up after Emergency Department Visit for Mental Illness – Seven Day
  • Transitions to Community Living Separation Rate
  • Service Authorization Request Decision Timeliness
  • Employer of Record Improvement Project

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 surveys designated by NCDHHS. This includes surveys of Vaya members and/or providers and performance data:

Vaya is focused on delivering 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 will continue to partner with members and stakeholders to implement strategies that focus on health outcomes, further develop our value-based contracting efforts, and integrate behavioral health and physical health services.

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1-800-962-9003