Medicaid Quality Strategy

Requirements as outlined under Code of Federal Regulation 42 CFR 438.200 - 204 delineate State responsibilities for adoption of a Quality Strategy. 42 CFR 438.202(a) states that States will have a written strategy for assessing and improving the quality of managed care services offered by all [Managed Care Organizations] MCOs and [Prepaid Inpatient Health Plans] PIHPs.

 

The 2007 State of Colorado Quality Strategy was adopted January 2007 after commentary was obtained from stakeholders and the public.

 

2007 Quality Strategy    

  

HEDIS  

Standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans.

 

Client Satisfaction Surveys - CAHPS  

Standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care. 


Studies 

Focused Studies identify opportunities and meaningful interventions that will promote quality care.

Interventions developed based on recommendations from the Focused Studies.

 

Performance Improvement Projects 

Performance Improvement Projects (PIPs) are the method health plans use to improve clinical and non-clinical services.

 

Performance Measure and Encounter Data Validation 

Behavioral Health Organization Performance Measure Validation - annual validation activities outlined in the CMS protocol.

 

Encounter Data Validation - evaluates the accuracy and completion of administrative encounters for behavioral health services.

 

BHO Quality Plans & Annual Evaluations

Health Care Policy and Financing (the Department) requires Behavioral Health Organizations (BHOs) to complete and submit annually a Quality Improvement Plan and Annual Quality Report.  These reports note findings and opportunities for improvement and list techniques used the BHOs to improve performance.

 

Reports 

Annual Technical Reports and Legislative Reports on Status of Pediatric Health Care Quality Performance Measures

 

Site Reviews / Audits 

Site Reviews- performed on-site at the MCO/PIHP health care delivery system sites to assess the physical resources and operational practices in place to deliver health care.