Vaya Health’s quality management (QM) program works with staff, providers, community stakeholders and individuals to measure how well we’re meeting the needs of our members. We use QM concepts and techniques to continuously improve the quality and appropriateness of behavioral health and intellectual/developmental disability (IDD) services and supports.
The description of our QM program is updated each year and defines goals, objectives, scope and structure. Key elements of our program include:
- The Quality Improvement Committee (QIC), which oversees the QM program 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 QM priorities and projects.
- Quality Assurance Activities, which address our performance in providing access to care, the quality and appropriateness of care, over- and under-utilization of services and the performance of network providers.
- Quality Improvement Activities (QIAs), which may develop from performance reports, surveys, or as a result of issues identified by QIC, Vaya staff and leadership, network providers or CFAC representatives. QIAs are monitored for progress towards specific improvement goals.
- An Annual Work Plan that identifies ongoing and new QIAs planned for the upcoming fiscal year, estimated dates for completion and staff responsible for each activity.
At the end of each fiscal year, Vaya reviews and evaluates progress made toward performance improvement goals during the previous 12 months. This evaluation reviews QIAs, performance trends and the overall effectiveness of our QM program.
Introduction
Vaya Health maintains an ongoing quality management (QM) program that involves Vaya staff and management, network providers, community stakeholders and individuals working together to improve the quality and appropriateness of behavioral health and intellectual/developmental disability services and supports for our members. The program acts as a formal process to monitor and evaluate our quality, efficiency and effectiveness and conduct quality improvement activities (QIAs) to address areas of need.
QM Program Structure and Operations
The Regulatory Compliance and Quality Committee (RCQC), a subcommittee of the Board of Directors, is responsible for reviewing performance data and other measures of quality to ensure Vaya is meeting or exceeding the requirements of the North Carolina Department of Health and Human Services. The RCQC is also kept aware of QIAs and other activities of the Quality Improvement Committee (QIC) and has the authority to recommend new quality improvement initiatives.
Vaya’s Chief Medical Officer (CMO) oversees all QM initiatives via the Quality Improvement Committee. The CMO and the External Review Director are co-chairs of QIC. This committee meets at least once per quarter and recommends, reviews and approves QIA proposals, updates and final reports.
Program Goals and Objectives
- To continuously improve the quality and appropriateness of behavioral health and intellectual/developmental disability (IDD) care and services delivered by our network providers.
- To identify, develop, and/or enhance activities that promote member safety.
- To ensure that members have adequate access and accessibility to care when and where it’s needed.
- To ensure that ongoing assessment and improvement work addresses the needs of Vaya’s culturally and linguistically diverse membership.
- To ensure that over-utilization and under-utilization of services is within acceptable limits by continuously reviewing utilization rates, responding proactively to trends, and making sure that service funds are used responsibly.
- To support the design of a behavioral health and IDD service delivery system that best represents the needs of our members, promotes member safety and improves outcomes for members.
- To maintain a network of qualified practitioners and providers that meet or exceed all requirements for network participation and service delivery.
- To record and report the results of monitoring activities, recommendations for QIAs and other program activities to QIC and to ensure that QIC regularly reviews appropriate documents, data and reports.
Major Accomplishments for Fiscal Year 2019-2020
- Meeting and exceeding N.C. Department of Health and Human Services (DHHS) performance measures (including the “Super Measures” benchmarks): Through collaboration with our network providers, Vaya was able exceed all performance measures and was one of only two LME/MCOs statewide to exceed all DHHS benchmarks and to incur no penalties.
- Preparing for NCQA accreditation: Vaya has worked diligently to align with NCQA standards for Managed Behavioral Health Organization accreditation, including revising or instituting new policies and procedures, manuals, QIAs, reporting requirements, system controls and more.
- Launching the Performance Data Review Workgroup: Our Performance Reporting Team established a cross-departmental workgroup that meets monthly to review performance data, provide quality assurance and initiate efforts to improve member experiences and outcomes.
- Shifting of pharmacy program focus related to the COVID-19 pandemic: Vaya’s pharmacy program worked to help members adapt to telehealth services to improve health outcomes.
Ongoing Improvements
- Continue to identify the most effective uses for staff and other resources in the QM program.
- Maintain an ongoing evaluation of the effectiveness of the current structure of QIC meetings and priorities.
- Work to find more ways and opportunities to include network providers and members in the QM process.
Vaya continually reviews data and other resources that may help identify areas for improvement. This includes surveys of our members and/or providers and performance data:
- The Consumer Perception of Care Survey assesses member satisfaction and perceptions of the quality and outcomes of mental health and substance use services provided by our provider network.
- The Experience of Care and Health Outcomes Adult and Child (ECHO) Survey assesses member experiences with the care they receive.
- The Provider Satisfaction Survey allows our network providers to give feedback on their interactions with Vaya.
- Performance data is submitted each month by Vaya to the North Carolina Department of Health and Human Services and includes information on the number of individuals receiving services, calls to our 24/7 Access to Care line, claims activity and more.