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Performance Improvement Projects

Performance Improvement Projects (PIPs), are the method health plans use to improve clinical and non-clinical services. PIPs provide a structured approach to measuring performance, implementing change to improve performance, and measuring the resulting outcomes. Changes that lead to favorable sustained results become permanent standards, practices, or procedures. Changes that are not successful should be revised and re-measured so that improvements are made.

Managed Care Organization/Behavioral Health Organization requirements under the Code of Federal Regulations (42 CFR 438.240) state that PIPs be designed to achieve significant improvement, sustained over time, in clinical and nonclinical areas that are expected to have a favorable effect on health outcomes and/or member satisfaction.

 

Behavioral Health                                     Physical Health                                   Child Health Plan Plus