CCNC has developed quality improvement and care management initiatives that achieve access, quality, utilization and cost objectives by improving the management of patient care. These initiatives aim to assess the needs and severity of their enrolled population in order to target care and disease management initiatives where they are most beneficial. Each network has at least one designated clinical director who is a physician champion taking the lead in spreading quality improvement initiatives throughout their network. Additionally, each network designates QI teams, each with a lead QI Coordinator, to employ the model of rapid cycle quality improvement developed by the Institute for Healthcare Improvement (IHI). This model stresses setting aims, establishing measures, making system changes that remove barriers to excellent care. The QI Coordinators work with their network QI team, other network staff, primary care practices, and community partners to meet program-wide performance metrics in effort to improve quality and contain cost. Network QI Coordinators meet with each other on a regular basis to share best practices and develop improvement strategies that will generate improvement within their network, but also contribute to meeting overall statewide program objectives.
Community Care relies on health networks organized and operated to support PCPs and the medical home. At the heart of these networks are quality improvement and care management initiatives: targeted, patient-focused, physician-created programs that help health professionals provide excellent care at a reasonable cost. Using patient data, these professionals analyze population needs, choose the best care opportunities to pursue and then help define the performance standards they will be expected to meet. This physician-oriented approach to improvement is key to obtaining provider support for the medical home model.
Creating a quality improvement initiative
Community Care’s clinical directors ask the following questions when deciding whether to implement a particular quality improvement (QI) initiative:
- Are there are enough Medicaid enrollees with the disease/condition addressed by the proposed QI to obtain a return on investment?
- Will best practices lead to predictable and improved outcomes?
- Are appropriate evidence-based practice guidelines available?
- Will physicians support the process?
- Will patient education and support improve outcomes?
- Are best practices and outcomes measurable, reliable and relevant?
- Does evidence suggest that the proposed quality measures will improve care?
- Is there room for improvement? Does a gap exist between best practices and everyday practice?
- Can baselines for need, performance and improvement be measured longitudinally?