COMMITMENT TO QUALITY
Quality Assurance and Performance Improvement (QAPI) is not a department at Optum Idaho, but rather a core tenet in how we conduct all aspects of our operations. We routinely assess multiple aspects of our performance, including our impact on members, families, other stakeholders and providers, and we are always searching for ways to improve.
Our comprehensive QAPI program encompasses outcomes, quality assessment, quality management, quality assurance and performance improvement through data driven, focused performance improvement activities designed to meet the behavioral health needs of our members, State of Idaho contract requirements and federal regulations.
Optum is committed to collaborating with the State's regional health boards and Idaho communities to improve the overall behavioral health system to benefit members. As part of our engagement with the regional behavioral health boards, we provide quarterly updates and information for increased awareness on how Optum is meeting or exceeding our contract commitments to improve the system of care. Consistent with our objective to provide relevant and transparent information to all stakeholders, you may view the Statewide Reporting here which includes performance metrics as provided to stakeholder partners.
Member input and guidance is critical to transform the mental health system, which is why we actively engage with members through various committees, boards and organizations to ensure their voice is a part of our decision-making process. We also conduct quarterly member satisfaction surveys that influence how we monitor and adjust our operations to help us meet and exceed performance metrics.
The following committees provide input, feedback and representation on a variety of issues and topics with the goal of continual improvement to our process and procedures. If you are interested in participating in one of the committees listed, please submit your interest and questions to firstname.lastname@example.org.
The purpose of the Quality Assurance/Performance Improvement (QAPI) Committee is to oversee, organize and evaluate all quality improvement activity.
Responsibilities of QAPI Committee
(1) Implement the Outcomes Management & Quality Improvement Plan's mission to:
- Improve the behavioral health system and the well-being of the members it serves.
- Promote high quality behavioral health care.
- Focus on recovery and resiliency for members and families.
(2) Reveiw measurements, outcomes and reports that show progress toward system transformation.
- Areas that do not show progress toward desired outcomes are targeted for improvement efforts through the establishment of cross-functional teams to addresss systems issues on a periodic and time-limited basis.
(3) Review utilization and outcomes data for tracking and trending quality of care and service.
(4) Approve and modify all utilization management criteria and practice guidelines tailored to the specific needs, regulatory requirements and policies of Optum Idaho.
QAPI providers oversight for the following committees: Peer Review Committee, Provider Advisory Committee, Member Advisory Committee and Utilization and Management Outcomes Team Committee.
The purpose of the Peer Review Committee (PRC) is to evaluate and improve the quality of behavioral health care services in accordance with applicable standards of care, regulations and contractual requirements.
Responsibilities of PRC
(1) Review quality of care concerns and critical incidents.
(2) Initiate engagement, monitoring and outreach activities with the network agencise or individual practitioners in response to a quality of care concern or critical incident (i.e., audits, care coordination, provider education, referrals, consultation).
(3) Reviews and approves requested corrective action plan(s) submitted by network providers.
(4)Reviews and analyzes member equality of care and critical incident case data at least quarterly to identify trends, barriers and opportunities for improvement.
The PRC reports to the Quality Assurance/Performance Improvement Committee.
The purpose of the Provider Advisory Committee (PAC) is to establish a forum for representatives from the qualified service providers to provide recommendations, input and prioritization of initiatives or issues impacting the provider community. PAC creates a forum for providers to bring forth their recommendations for change to procedures and enhancements to systems.
Responsibilities of PAC:
(1) Receive feedback from providers in the Idaho Behavioral Health Plan and create improvement strategies.
(2) Collaborate with providers to improve system of care.
(3) Review of Idaho system enhancements to assess impacts, usability and scalability.
(4) As systemic issues impacting providers are identified, gather information, review applicable report analysis and discuss trends to recommend appropriate action plan or corrective actions.
The PAC reports to the Quality Assurance/Performance Improvement Committee.
The purpose of the Member Advisory Committee (MAC) is to serve in an advisory capacity to Optum Idaho and to represent the interests of members and their families who use the services provided under the Idaho Behavioral Health Plan (IBHP).
Responsibilities of MAC:
(1) Identify any concerns or ideas that should be shared with Optum Idaho and the Idaho Department of Health and Welfare.
(2) Brainstorm ideas for streamlining processes, procedures or increasing efficiency.
(3) Identify member outreach and education opportunities around the state, with a focus on underserved communities or populations.
(4) Offer suggestions on how to introduce members to the Optum Idaho resources available to them.
The MAC reports to the Quality Assurance/Performance Improvement Committee.