Common use of Performance Improvement Priority Areas and Projects Clause in Contracts

Performance Improvement Priority Areas and Projects. 1. The HMO must develop and ensure implementation of program initiatives to address the specific clinical needs that have a higher prevalence in the HMO’s enrolled population served under this Contract. These priority areas must include clinical and non-clinical Performance Improvement projects. The Department strongly advocates the development of collaborative relationships among HMOs, local health departments, community based behavioral health treatment agencies (both public and private), and other community health organizations to achieve improved services in priority areas and must report complete encounter data for all services provided. Linkages between managed care organizations and public health agencies is an essential element for the achievement of the public health objectives, potentially reducing the quantity and intensity of services the HMO needs to provide. The Department and the HMO are jointly committed to on going collaboration in the area of service and clinical care improvements by the development and sharing of “best practices” and use of encounter data-driven performance measures (MEDDIC-MS). The HMO must annually monitor and evaluate the quality of care and services through performance improvement projects for at least two of the priority areas specified by the Department and listed in subsections 3. below, or an HMO may propose to address alternative performance improvement topics by making a request in writing to the Department. In addition, to two performance improvement projects required under subsection 3 below the HMO may be required to conduct up to two additional performance improvement initiatives and submit reports as required to achieve performance goals specified in the MEDDIC-MS technical specifications. The final or on-going status report for each project must be submitted by October 1 of each calendar year, or as may be specified in the MEDDIC-MS technical specifications. The performance improvement topic must take into account the prevalence of a condition among, or need for a specific service by, the HMO enrollees served under this Contract; enrollee demographic characteristics and health risks; and the interest of consumers or purchasers in the aspect of care or services to be addressed. The report for each performance improvement project must address each of the following points in order for the Department to evaluate the reliability and validity of the data and the conclusions described in the study:

Performance Improvement Priority Areas and Projects. 1. The HMO must develop and ensure implementation of program initiatives to address the specific clinical needs that have a higher prevalence in of the HMO’s HMO‟s enrolled population served under this Contract. These priority areas must may include clinical and non-clinical Performance Improvement projectsProjects. The Department strongly advocates will permit the development of collaborative relationships among the HMOs, local health departments, community community-based behavioral health treatment agencies (both public and private), and other community health organizations to achieve improved services in priority areas and must report complete areas. Complete encounter data for all reported services must be provided. Linkages between managed care organizations and public health agencies is an essential element for the achievement of the public health objectives, potentially reducing the quantity and intensity of services the HMO needs to provide. The Department and the HMO are jointly committed to on going collaboration will collaborate in the area of service and clinical care improvements by the development and sharing of “best practices” and use of encounter data-data- driven performance measures measures. 1. The State has the authority to select a particular topic for the PIPs. For 2009 submission, plans must focus one of the PIPs on the following items: a) Pay for performance minimum thresholds-If the plan fails to meet one or more minimum threshold requirements for the Department‟s combined pay for performance program (MEDDIC▇▇▇▇▇▇▇▇ ▇▇, ▇, d, i), the plan must submit at least one PIP to improve its performance in the focus area(s) where it has failed to meet the minimum threshold. b) Stretch performance goal-MSThe plan designs an intervention targeted to meet its stretch performance goal in the focus area identified by DHS for its pay for performance program (▇▇▇▇▇▇▇▇ ▇▇, ▇, d, iii). In this case, the plan will submit a study topic which includes an intervention to improve its performance in that focus area to meet the stretch performance goal. 2. Health plans can choose other study topics based on the Department‟s priority areas. The HMO must annually monitor and evaluate the quality of care and services through performance improvement projects for at least two of the priority areas specified by the Department and listed in subsections 3. below, or an HMO may propose to address alternative performance improvement topics by making a request in writing to during the Department. In addition, to two performance improvement projects required under subsection 3 below preliminary topic selection summary process; approval is at the HMO may be required to conduct up to two additional performance improvement initiatives and submit reports as required to achieve performance goals specified in the MEDDIC-MS technical specificationsDepartment‟s discretion. The final or on-going status report for each project must be submitted by October 1 of each calendar year, or as may be specified in the MEDDIC-MS technical specificationsDepartment‟s priority areas are: a) Clinical i. HealthCheck ii. The performance improvement topic must take into account the prevalence of a condition among, or need for a specific service by, the HMO enrollees served under this Contract; enrollee demographic characteristics and health risks; and the interest of consumers or purchasers in the aspect of care or services to be addressedTobacco cessation iii. The report for each performance improvement project must address each of the following points in order for the Department to evaluate the reliability and validity of the data and the conclusions described in the study:Blood lead testing iv. Childhood immunizations v. Healthy birth outcomes vi. Diabetes management vii. Asthma management viii. Childhood obesity interventions

Performance Improvement Priority Areas and Projects. 1. a. The HMO must develop and ensure implementation of program initiatives to address the specific clinical needs that have a higher prevalence in the HMO’s 's enrolled population served under this Contractagreement. These priority areas must include clinical and non-clinical Performance Improvement projects. The Department strongly advocates the development of collaborative relationships among HMOs, local health departmentsLocal Health Departments, community based HMO Contract for January 1, 2002 - December 31, 2003 behavioral health treatment agencies (both public and private), and other community health organizations to achieve improved services in priority areas and must report complete encounter data for all services provided. Linkages between managed care organizations and public health agencies is an essential element for the achievement of the public health objectives, potentially reducing the quantity and intensity of services the HMO needs to provide. The Department and the HMO are jointly committed to on on-going collaboration in the area of service and clinical care improvements by the development and sharing of “"best practices” " and use of encounter data-driven performance measures (MEDDIC-MS). The Annually, for the priority areas specified by the Department and listed below, the HMO must annually monitor and evaluate the quality of care and services through performance improvement projects for at least two of the priority listed areas specified by the Department and listed in subsections 3. Article III, W. 13 (c) or (d) below, or an HMO may propose to address alternative performance improvement topics to be addressed by making a request in writing to the Department. In addition, to two performance improvement projects required under subsection 3 below the HMO may be required to conduct up to two additional performance improvement initiatives and submit reports as required to achieve performance goals specified in the MEDDIC-MS technical specificationsspecifications in addition to two performance improvement projects required under Article III W.13.c.d. The final or on-going status report for each project must be submitted by October 1 of each calendar year1, 2003, and October 1, 2004, or as may be specified in the MEDDIC-MS technical specifications. The performance improvement topic must take into account account: the prevalence of a condition among, or need for a specific service by, the HMO enrollees served under this Contract; agreement, enrollee demographic characteristics and health risks; and the interest of consumers or purchasers in the aspect of care or services to be addressed. The Each project report must include all of the information in the Performance Improvement Project Outline in Addendum XV. b. Performance reporting will utilize standardized indicators appropriate to the performance improvement area or as specified in the MEDDIC-MS technical specifications. Minimum performance levels must be specified for each performance improvement project area, using normative standards derived from regional, national norms, or from norms established by an appropriate practice organization. Goals for improvement for the "Priority Areas" listed in c. of this section, may be set by the organization itself. The organization must address each assure that improvements are sustained through periodic audits of relevant data and maintenance of the following points HMO Contract for January 1, 2002 - December 31, 2003 -49- interventions that resulted in order for the improvement. The HMO agrees to open at least one new performance improvement project in 2002 with the report on that project to be submitted to the Department by October 1, 2003. In all cases, not less than two performance improvement projects must be reported to evaluate the reliability Department in any year and validity not less than three different projects must be reported to the Department between 2002 and 2004. These projects are in addition to any that may be required as the result of sub-goal performance on any MEDDIC-MS Targeted Performance Improvement Measures. However, if the HMO chooses to initiate or continue a project on a topic that coincides with a required MEDDIC-MS project, the Department will accept the report as fulfilling both requirements during the next contract year. The organization must implement a performance improvement project in the area if a quality improvement opportunity is identified. The HMO must report to the Department on each study, including those areas where the HMO will not pursue a performance improvement project. c. Clinical Priority Areas: 1) prenatal services; 2) identification of adequate treatment for high-risk pregnancies, including those involving substance abuse; 3) evaluating the need for specialty services; 4) availability of comprehensive, ongoing nutrition education, counseling, and assessments; 5) Family Health Improvement Initiative: Smoking Cessation; 6) children with special health care needs; 7) outpatient management of asthma; 8) the provision of family planning services; 9) early postpartum discharge of mothers and infants; 10) STD screening and treatment; 11) high volume/high risk services selected by the HMO; 12) prevention and care of acute and chronic conditions; and 13) coordination and continuity of care. Non-Clinical Priority Areas: 1) grievances, appeals and complaints; 2) access to and availability of services; 3) enrollee satisfaction with HMO customer service; and 4) satisfaction with services for enrollees with special health care needs or cultural competency of the data HMO and its providers. In addition, the conclusions described HMO may be required to conduct performance improvement projects specific to the HMO and to participate in one annual statewide project that may be specified by the study:Department.

Performance Improvement Priority Areas and Projects. 1. The HMO must develop and ensure implementation of program initiatives to address the specific clinical needs that have a higher prevalence in of the HMO’s enrolled population served under this Contract. These priority areas must may include clinical and non-clinical Performance Improvement projectsProjects. The Department strongly advocates the development of collaborative relationships among the HMOs, local health departments, community based behavioral health treatment agencies (both public and private), and other community health organizations to achieve improved services in priority areas and must report complete areas. Complete encounter data for all reported services must be provided. Linkages between managed care health maintenance organizations and public health agencies is an essential element for the achievement of the public health objectives, potentially reducing the quantity and intensity of services the HMO needs to provide. The Department and the HMO are jointly committed to an on going collaboration in the area of service and clinical care improvements by the development and sharing of “best practices” and use of encounter data-driven performance measures (MEDDIC-MS). The HMO must annually monitor and evaluate the quality of care and services through performance improvement projects for at least two of the priority areas specified by the Department and listed in subsections Subsection 3. below, or an the HMO may propose to address alternative performance improvement topics by making a request in writing to the Department. In addition, to two performance improvement projects required under subsection 3 below the HMO may be required to conduct up to two additional performance improvement initiatives and submit reports as required to achieve performance goals specified in the MEDDIC-MS technical specifications. The final or on-going status report for each project must be submitted by October 1 of each calendar year, or as may be specified in the MEDDIC-MS technical specifications. The performance improvement topic must take into account the prevalence of a condition among, or need needed for a specific service by, the HMO enrollees served under this Contract; enrollee demographic characteristics and health risks; and the interest of consumers or purchasers in the aspect of care or services to be addressed. The report for each performance improvement project Performance Improvement Project must address each of the following points in order for the Department to evaluate the reliability and validity of the data and the conclusions described in the study:. The BCAP method for reporting outlined below is not mandated, but is an acceptable format for Performance Improvement Projects. Other formats may be used as long as the Performance Improvement Project criteria outlined is addressed.

Performance Improvement Priority Areas and Projects. 1. The HMO must develop and ensure implementation of program initiatives to address the specific clinical needs that have a higher prevalence in the HMO’s enrolled population served under this Contract. These priority areas must include clinical and non-clinical Performance Improvement projects. The Department strongly advocates the development of collaborative relationships among HMOs, local health departments, community based behavioral health treatment agencies (both public and private), and other community health organizations to achieve improved services in priority areas and must report complete encounter data for all services provided. Linkages between managed care organizations and public health agencies is an essential element for the achievement of the public health objectives, potentially reducing the quantity and intensity of services the HMO needs to provide. The Department and the HMO are jointly committed to on going collaboration in the area of service and clinical care improvements by the development and sharing of “best practices” and use of encounter data-driven performance measures (MEDDIC-MS). The HMO must annually monitor and evaluate the quality of care and services through performance improvement projects for at least two of the priority areas specified by the Department and listed in subsections 3. below, or an HMO may propose to address alternative performance improvement topics by making a request in writing to the Department. In addition, to two performance improvement projects required under subsection 3 below the HMO may be required to conduct up to two additional performance improvement initiatives and submit reports as required to achieve performance goals specified in the MEDDIC-MS technical specifications. The final or on-going status report for each project must be submitted by October 1 of each calendar year1, 2004, and October 1, 2005, or as may be specified in the MEDDIC-MS technical specifications. The performance improvement topic must take into account the prevalence of a condition among, or need for a specific service by, the HMO enrollees served under this Contract; enrollee demographic characteristics and health risks; and the interest of consumers or purchasers in the aspect of care or services to be addressed. The report for each performance improvement project must address each of the following points in order for the Department to evaluate the reliability and validity of the data and the conclusions described in the study: