Quality and Health Improvement Reports
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).
- 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 Measure and Encounter Data Validation: Behavioral Health Organization Performance Measure Validation are 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.
- Annual Technical Reports: Annual Technical Reports and Legislative Reports on Status of Pediatric Health Care Quality Performance Measures
- Site Reviews/Audits: Site Reviews are 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.
- Experience of Care and Health Outcomes (ECHO) Surveys: Satisfaction surveys for clients who have recieved behavioral Health care services.
- 2018 Denver Health 412 Audit: Encounter Data Validation *Denver Health disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- 2017 Denver Health 412 Audit: Encounter Data Validation *Denver Health disagrees on a number of findings included in this report and has submitted their disagreement with the report to the Department*
- Quality Health Improvement Project - Improving Access to Key Services for At-Risk Children and Families.
- 2018 BHO 411 Audits: Encounter Data Validation
- 2017 BHO 411 Audits: Encounter Data Validation
- Quality and Health Improvement 2016 Data Report
- Performance Improvement Projects (PIPs): Improvement projects completed by the Department’s contracted health plans
Starting in 2015 some online reports include an Accessible format that list just the Executive Summary. Non-Accessible reports including all content can be requested by contacting the Department’s Quality and Health Improvement Unit.