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HomeMy WebLinkAboutMINUTES - 10122004 - C64 TO: BOARD OF SUPERVISORS= " �� Contra FROM: WILLIAM B. WALKER, M.D. •' ; Health Services Director ��. �'�,a�°, Costa DATE: September 27, 2004 `°�-i-•----- y` County SUBJECT: Approval of Contra Costa Health Plan's Quality management 2004 Annual Work Plan CAP SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: Approve the attached document, which contains Contra Costa Health Plan's Quality Management Program, including the Quality Management Plan, the Annual Work Plan, and the 2003 Program Evaluation. BACKGROUND:. Contra Costa Health Plan is required by state law and regulation to have a written Quality Management Program and Plan approved by its governing body. CCHP has been operating under a Board of Supervisors' approved Quality Management Program and Plan. However, the state Department of Health Services, as part of its approval process for the CCHP Local Initiative, has required that CCHP submit a new Quality Management Program and Plan every year to involve the Board of Supervisors, as the governing body, more directly in the Quality Management process. The Quality Management Plan describes the goals, objectives, and activities of the Quality Management Program. It also contains the 2004 Annual Quality Management Work Plan, which describes the quality improvement activities CCHP expects to develop and implement in 2004. As part of the 2004 Work Plan, CCHP will perform focused review studies required by the state Department of Health Services as part of the Local Initiative program. The Quality Management Program and 2004 Annual Work Plan has been reviewed and approved by: • The Contra Costa Health Plan Quality Council, April 27, 2004 • The Contra Costa Health Plan Managed Care Commission, May 19, 2004 The Joint Conference Committee, September 17, 2004 FISCAL IMPACT: None ATTACHMENTS: Quality Management Program Description for 2004, Annual Quality Management Work Plan for 2004, and Quality Management Program Evaluation for 2003 CONTINUED ON ATTACHMENT: YES SIGNATURE: `✓ � '" '� ---------- ------------------------------------------------------------------------------------------------------------------------------------- ------- ECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE i-, PROVE OTHER r 1 SIGNATURE(S): ACTION OF BOA ON �>:� - r. -` APPROVE AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN UNANIMOUS(ABSENT)��"°#'ice= ) AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN. ABSENT: ABSTAIN: ATTESTED` � y CONTACT: Ken Tilly,CCHP 373-6498 JOHN SWEETEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR CC: Jill Lorr8-kovich,CCHP Ken Tilly,CCHP � r BY { .t�F DEPUTY � ) t C N 'T. STA HEALTH LAN A Division of Contra Costa Health Services Quality Manage ent TABLE OF CONTENTS Quality Mana entent Program Description 2004 l Introduction Page 2 II Mission Page 2 III Purpose Page 2 IV Scope Page 2 V Objectives Page 2 VI Authority and Responsibility Page 3 Contra Costa Board of Supervisors Page 3 Y The Quality Council Page 4 o Medical Director Page 4 o Clinical Management Coordinator Page 5 o Director of Quality Management Page 5 o Quality Management Nurse{s} Page 6 VII Aspects of Care and Service Page 6 VIII CCHP'sQMP Committee Structure Page 6 Board of Supervisors Page 6 Joint Conference Committee Page 7 Clinical Coordinating Committee Page 9 Clinical Coordinating Subcommittees Page 9 o Quality Council Page 10 o Credentialing Committee Page I I c Appeals Committee Page 13 o Pharmacy and Therapeutics Committee Page 14 Public Advisory&Other Coordinating Committees Page 15 o Managed Care Commission Page 15 IX QM Delegation Page 17 X Quality Management Process and Initiatives Page 18 Process Page 18 r Quality Improvement Initiatives Page 19 XI Coordination ofCCIIP QM Program Activities Page 20 Credentialing Page 20 r Member Grievance Process Page 20 Utilization Management Program Page 20 Telephone Triage Program Page 21 Cooperative Care Management Program Page 21 r Disease Management Program Page 21 y Perinatal Program Page 21 Health Education Program Page 21 XII Annual QM Program Evaluation Page 21 XIII Disciplinary Action Page 22 XIV Confidentiality Page 22 XV Conflict of interest Page 22 XVI CCHP Organization Structure Page 24 XVII Quality Management"fable of Organization Page 25 Page 1 of 26 Qualify Mana ement Program Description 2004 1. INTRODUCTION Contra Costa Health Plan (CCHP) is the Contra Costa County operated Health Maintenance Organization (HMO), the first Federally-qualified HMO in the country operated by local government. CCHP contracts with individual providers, Contra Costa Regional Medical Center and Health Centers (CCRMC&HC) and raiser Permanente to arrange comprehensive health .arc services. CCHP provides health care for public and private employee groups, private individuals, Medi- Cai and Medicare beneficiaries, and low-income county residents. CCHP's overall commitment is serving the County's most vulnerable populations. 11. MISSION Tbc goal of CCHP's Quality Management Program (QMP) is to ensure that quality, appropriate health care and related services provided meet or exceed members' and other customers' eypa: at ions. The QMP mission is carried out in accordance with CCHP's organizational mission to provide affordable, high quality, accessible health care with integrity and compassion to al that use our programs. 111. PURPOSE The CCHP QMP description will inform internal and external customers about how CCHP will promote, manage, and document improvement in the quality of health care and other related services provided to its members, through a continuous system of planning, monitoring, assessing, and improving. IV. SCOPE The scope of CCHP's QMP activities include the quality of clinical care and the quality of service for all services including, but not limited to, preventive, primary, specialty, emergency, and ancillary care services. The scope of activities reflect CCHP's population in terms of age groups, disease categories and special risk status, and include, but are not limited to, services provided in institutional settings, ambulatory care, home care and mental health. V. OBJECTIVES Identify opportunities for improvement through a system of monitoring, which includes satisfaction surveys, complaints, focused studies, facility inspections, medical-record audits and analysis of HEDIS and administrative data. Member and community input is considered an integral part of all systems of monitoring and shall be incorporated into selection of improvement activities through a variety of methods. Page 2 of 26 Implement change, as appropriate, in the range of health-care services provided by CCHP to its members. Establish priorities for ongoing monitoring and focused-review studies with emphasis on access, preventive services, high volume,high risk, or problem-prone care or services. Confirm that CCHP delegated providers' Quality Assessment and Improvement Program structure, staff, and processes are in compliance with all provisions of CCHP's QM Plan, QM policies and procedures, and meet professionally recognized standards. Comply with internal and external standards and requirements related to quality improvement activities. Assure that members can achieve resolution to problems or perceived problems relating to access to care or other quality issues through Member Services and QM grievance procedures. Members may also communicate problems or concerns to other regulatory agencies that are outlined in their Evidence of Coverage booklet. Monitor processes and systems of care related to the movement of members along the continuum of care and ensure continuity of care that meets the members'needs and expectations. Maintain Program Descriptions and/or policies and procedures for QM, Disease ;Management Program, Perinatal Care Management Program, Health Education, including Culture and Linguistics Program, and the facility and medical record review portion of the credentialing process. Assure that contracted physicians can achieve resolution to problems or perceived problerns relating to member's access to care or relating to physician membership in CCHP through QM procedures. VI. AUTHORITY AND RESPONSIBILITY Though CCHP retains ultimate accountability for quality oversight, quality management is a shared responsibility between CCHP and its delegated contracted providers. CCHP"s primary delegated providers are CCRMC, Health Centers and Kaiser Perinanente. The Contra Costa County Board of Supervisors has the ultimate responsibility for development and implementation of the QMP. The Board of Supervisors is responsible for reviewing and approving the QMP on at least an annual basis. The Board of Supervisors is the ultimate decision-making body for all contract approvals and terminations, physician disciplinary action, and approval of action taken with regard to member or physician grievances. To ensure that action necessary to implement the QMP is taken in a timely manner, the Board of Supervisors delegates responsibility for day-to-day operations of CCHP to the CCHP Chief Executive Officer(CEO), who, in turn,has empowered the Joint Conference Committee and QC to periodically review and take action, as may be required, with regard to contracting; physician disciplinary actions, and member and physician grievances, subject to the Board of Supervisors' approval. Page 3 of 26 The Quality Council €QQ Inas the primary responsibility for implementing and directing the Q W� It is responsible for developing and making recommendations to the Board of Supervisors or the JCC regarding quality management standards, criteria by which care will be measured, and priorities for which aspects of care will be monitored. The QC analyzes duality of care studies, indicators, utilization reports, grievances, and survey data and makes recommendations to the Board of Supervisors or the JCC regarding changes to be made to the QMP. "he QC is also responsible for receiving, handling, and making recommendations to the Board of Supervisors or the JCC regarding quality of care issues and member and physician grievances. The, CCHP Quality Management department (QM) administratively supports the QC with responsibility for managing the quality operations for the non-delegated providers as well as providing oversight of quality management activities for contracted delegated providers. QM ro eives and investigates any potential quality of care allegation and directs information to thcz: appropriate committee or unit for further action. In addition, QM is responsible for compiling reports and summaries of recommendations of spe>,ific committees (as is set forth in detail below) for presentation to the QC, the JCC, and to the Board of Supervisors. QM staff are health care professionals supervised by licensed/physicians who act as CCHP Medical Directors and Consultants. A. Medical Director Reports to the CCHP CEO. The Medical Director is responsible for the administration and coordination of medical management of CCHP with assistance from the Clinical Management Coordinator, a licensed registered nurse. The Medical Director, together with medical consultants who are licensed physicians,oversees the activities the Quality Management Department, Utilization Management Department, Cooperative Care Management Department and the Credentialing Program; including the following: I Medical policy development 2. Clinical practice guidelines 3. Medical review and severity leveling of member grievances and implementing corrective action and/or peer review as appropriate 4. Provider education/implementation of disease management and health promotion programs 5. Coordination of physician membership to JCC, QC and Credentialing Committees B. Clinical Management Coordinator Page 4 of 26 The Clinical Management Coordinator(CMC)is a registered nurse reporting to the Medical Director of CCHP. The CMC is a member of CCHP's Executive Committee and co-chairs the Clinical Coordinating Committee with the Quality Management Director. The CMC assists the Medical Director with coordination of CCHP's clinical programs. The CMC guides the activities identified by the Clinical Coordinating Committee. I. Summarizes clinical issues and reports to the Executive Committee. 2. Recommends strategic direction and policy for clinical projects and programs. 3. Guide implementation efforts for clinical programs. 4. Reports clinical activities to other committees as needed, such as the Joint Conference Committee and the Managed Care Commission. 5. Participates in other committee activities as needed, such as Administrative Coordinating Committee. 6. Assists with reviewing data, reporting, developing recommendations, and guiding improvement efforts. 7a Assists with recommendations and improvement efforts to achieve appropriate utilization and efficient use allocation of resources. 8. Assists the Quality Management Director with HEDIS. 9. Assists the Quality Management Director with Disease Management Initiatives. 10. Assists the clinical departments to meet regulatory and accreditation requirements. C. Director of Quality Management Reports to the CCHP Medical Director. The Director of QM is responsible for development and implementation of the annual QM Program and the QM department operations. The Department is comprised of the CCHP Health Education Program, the Disease Management and Perinatal Care Management and Quality Operations. Management responsibilities for quality activities within the QM department include: I. Compliance activities for QM regulatory and accreditation requirements. 2. Development and implementation of disease management initiatives. 3. Development and implementation of health education/promotion program. 4. Development and administration of DHS required Internal Quality Improvement Projects. (IQIPs). 5. Oversight of the QM review for quality of clinical care grievances and occurrences, 6. Oversight of the credentialing program onsite facility review and corrective action process. 7. Development and annual review and revision of QNIP description, policies and procedures. S. Coordination of annual HEDIS audit and production of HEDIS measures. 9. Development and oversight of QM provider delegation audit activities. Page 5 of 26 M Quality Management QM Nurse(s) Reports to the Director of Quality Management. An actively licensed registered nurse whose QM responsibilities include: I. Coordination of HEDIS hybrid measure production. 2. Design of clinical care quality studies and chart abstraction tools. 1 Analysis of data and production of reports. 4. Review of clinical care grievances and occurrences, development of response letters, and monitoring of provider corrective action plans. 5. On-site review of facilities and medical records as part of the credentialing/re- credentialing process. 6. Development and monitoring of facility review corrective action plans. 7. Oversight of contracted provider on-site QM, credentialing, preventive services and medical records delegation audits, with development and monitoring of corrective action plans. VII. ASPECTS OF CARE ANIS SERVICE CCHP's Quality Management department, in coordination with other CCHP units, monitors s > ' g.spects of care and service. These aspects or activities of care and service include, but are not iinnited to: a. Accessibility/Availability of care b. Continuity/Coordination of care c. Under/Over Utilization d. Mental Health Care e. Chronic/Acute Care f. High Risk/High Volume Services g. Preventive Health Care h. Member and Physician/Satisfaction i. Medical Quality of Care Grievance Resolution VIII, CCHP's QMP COMMITTEE STRUCTURE Committees: A. Beard of Supervisors Contra Costa County Board of Supervisors, which is elected through general elections, is the governing body of the CCHP. The Board of Supervisors is ultimately responsible for development and implementation of the QMP, for contracting, physician disciplinary action, and action taken with regard to physician and member grievances. 1. Activities Page 6 of 26 a. Develops policy in consultation and with the recommendation of the JCC. b. Reviews, evaluates, and acts upon the annual QMP and Work Plan. c. Reviews, evaluates, and acts upon QM reports that are submitted at least quarterly and more frequently as may be required. d. Receives, evaluates and acts upon recommendations of the CCHP Credentialing Committee. e. Appoints JCC membership. f. Reviews, evaluates, and acts upon findings of the JCC. 2. Membership There are five (5) members of the Board of Supervisors. Each is elected through general elections in one of the five districts of Contra Costa County for a term of four(4) years, 3. Chair The chairmanship of the Board of Supervisors rotates among the five board members annually. 4. Meetings The Board of Supervisors holds weekly public meetings in accordance with the Brown Act. To preserve the confidentiality of some discussion and reports, the Board of Supervisors has the authority to meet in executive session (without any members of the public present). B. Joint Conference Committee The mechanism by which the Board of Supervisors implements the QMP and exercises oversight of the CCHP is the JCC of the Board of Supervisors and the CCHP. All meetings of the JCC are open to the public because of the public nature of the Board of Supervisors. As with the Board of Supervisors,the JCC has the authority to discuss confidential matters in executive session, when members of the public will be excused. Y. Activities a. Promotes communication between the Board of Supervisors, QC, and CCHP administration. b. Assesses and monitors the overall performance of CCHP and its contracted providers including,but not limited to, the quality of care and service provided to members. c. Receives, evaluates, and makes recommendations to the Board regarding the reports and recommendations of the QC. Such reports include reports regarding the current and on-going activities of the QM department and are made on a quarterly basis or more frequently as may be required. d. Reviews, evaluates, and makes recommendations to the Board, annually or more frequently as required, regarding modification of the QMP and work plan, and implementation of the QMP and work plan. e. Receives, evaluates, and takes action with regard to reports from CCHP's QM Director and Medical Director regarding the current and on-going activities of Page 7 of 26 the QM department on a quarterly basis or more frequently as may be required. Any action taken by the JCC is subject to approval by the Board of Supervisors. f. Reviews, modifies, approves, and implements provider sanctions and contract terminations. Any action taken by the JCC is subject to approval by the Board of Supervisors. g. Reviews, evaluates, and acts upon Medical Policy Guidelines, subject to the Board of Supervisors' approval. h. Receives and reviews quarterly reports regarding Grievance Committee activity. The JCC makes recommendations to the Board of Supervisors regarding corrective action that may be necessary to improve reporting or implementation of the QMP. The JCC can, if necessary, take immediate action to implement an immediate change to the QMP or how the QMP is implemented. Such action is subject to review and approval of the Board of Supervisors. i. Oversees Protection of Confidentiality of Quality information as cited in Evidence Code 1157 and Health and Safety Code 1370. 2. Membership The JCC shall not exceed nine(9) total members: a. Two(2)members from the Board of Supervisors, appointed by the Board. These two members have full voting privileges. b. Two(2)physician members appointed by the Board from among any of the providers of the CCHP delegated and non-delegated provider networks. To fill these positions, the CCHP Medical Director will solicit nominations by announcing the vacancy to all providers. The CCHP Medical Director will select the candidates and present them to the Board for approval. These two members each have a one-year term and have full voting privileges. c. One(1)member is the CCHP Medical Director.This member has ex- officio status without voting privileges. d. One(1)member is the Director of Health Services of Contra Costa County. This member has ex-officio status without voting privileges. e. One(1)member is the CCHP CEO Executive Director. This member has ex-officio status without voting privileges. f: One (1)member is the Health Services Chief Financial Officer. This member has ex-officio status without voting privileges. g. One(1)member is the chairperson of the Managed Care Commission. This member has ex-officio status without voting privileges. 3. Chair The Chair of the JCC is a member of the Board of Supervisors. The Chair is elected annually. 4. Meetings Page 8 of 26 Meetings of the JCC are held at least quarterly and are open to the public, except for confidential matters that may be discussed and acted upon in executive session. C. Clinical Coordinating Committee (CCC) The Clinical Coordinating Committee(CCC) serves as a forum to share, discuss, and problem- solve clinical issues. The CCC reports to the Executive Committee, reporting updates on clinical issues, accomplishments, and problems. Updates are shared with other committees as necessary. This committee is the link between the following committees: Quality Council and its subcommittee(s), Pharmacy and Therapeutics Committee, and the Credentialing Committee. The CCC coordinates clinical programs, clinical departments, and special projects including resource management, disease management, HEDIS, advice nurses, appeals and grievances, clinical practice guidelines, facility site reviews,peer review,health education, culture and linguistics, grants, long term care, and new technologies. 1. Activities a. Enhances collaboration to guide new and existing clinical programs. b. Recommends strategic direction and policy for clinical projects and programs. c. Reviews progress and accomplishments of clinical projects and programs. d. Facilitates problem-solving for clinical projects and programs. e. Recommends actions and improvement efforts to achieve appropriate utilization and efficient allocation of resources. f. Reviews relevant data, such as NEDIS, and guides improvement efforts. g. Facilitates problem-solving for benefit and regulatory clinical projects and programs. b. Assists clinical departments to meet regulatory and accreditation requirements. 2. Membership All members of the Clinical Coordinating Committee are voting members. a. Co-chair—CCHP Clinical Management Coordinator b. Co-chair_.CCHP Quality Management Director c. CCHP Medical Director d. CCHP Triage Nurse Director e. CCHP UM/Case Management Director f. CCHP Network Development Coordinator g. CCHP Planning Director b. CCHP Pharmacy Director i. CCHP Long Term Care integration Project Director 3. Meetings The Clinical Coordinating Committee meets monthly. D. Clinical Coordinating Subcommittees 1. The Quality Council (QC) Page 9 of 26 The Quality Council (QC) is the principal committee for coordinating and directing Quality Management activities for CCHP, including but not limited to: quality management,member and provider grievances, peer review and credentialing, and utilization management. Activities a. Receives, evaluates, and acts upon the reports of subcommittees. b. Reviews, evaluates, and mares recommendations to the Board of Supervisors or the JCC, annually, regarding the status of contracted providers to whom quality management,utilization management, credentialing, medical records and member rights and responsibilities activities have been delegated. c. Receives recommendations from the Credentialing Committee and evaluates the recommendations by integrating provider-specific quality of care, utilization management, and other data made available by the CCHP Credentialing Committee, The QC makes recommendations to the Board of Supervisors or the JCC regarding the credentialing status of providers. d. Receives Quality Management occurrence and grievance reports, quarterly or more frequently as required, regarding potential member or provider quality issues. The QC investigates such occurrence and grievances reports and makes recommendations to the Board of Supervisors and the JCC regarding resolution of quality of care issues or implementation of any corrective action that may be required. e. Receives and reviews, at least quarterly and more frequently as may be necessary, reports from the Director of QM regarding unit activities including,but not limited to: Quality Improvement projects, Disease Management program status, Health Education, Cultural and Linguistics issues, Facility Site Review status or issues, occurrence and grievance volume and trends, delegation audit scores and recommendations. The Quality Committee evaluates these reports and makes recommendations to the Board of Supervisors and the JCC regarding implementation of any corrective action that may be required. f. Receives UM reports quarterly or more frequently as required. The QC evaluates such reports and makes recommendations to the Board of Supervisors and the JCC regarding implementation of corrective action that may be required. g. Receives Grievance Committee activity reports monthly and more frequently as required. The Quality Committee evaluates such reports and makes recommendations to the Board of Supervisors and the JCC regarding implementation of corrective action that may be required h. Reviews and makes recommendations to the Board of Supervisors and the JCC, annually or more frequently as required, regarding modifications to be made to the QMP, Work Plan, and other Quality Management reports. Page 10 of 26 i. Reviews and evaluates Quality Management reports pertaining to medical, Pharmacy and Therapeutics, and benefit interpretation policy issues. The QC makes recommendations to the Board of Supervisors and the.ICC regarding trends and modifications to be implemented. J. Distributes Quality Management and other CCHP information to individually contracted providers via the Medical Director through letters, newsletters, policies and procedures, provider manuals, and other appropriate methods. k. Reports to CCHP senior administration for the purpose of planning and designing services for and administering CCHP operations. 1. Provides additional medical review of appeals/reconsiderations by physician committee members as required. m. Reviews and approves clinical practice guidelines periodically. Membership Members of the QC will include: a. The CCHP Medical Director with full voting privileges. b. A licensed physician consultant designated by the CCHP Medical Director c. The Quality Chair or designee from each of CCHP's delegated provider networks with full voting privileges. d. Director of CCRMC & HC QM Department with full voting privileges. c. The CCHP QM Director with full voting privileges. f. A minimum of two (2) independent physicians from any of the CCHP contracted provider networks, with at least one representing the individually contracted physician network. To fill these positions, the CCHP Medical Director will solicit nominations by announcing the vacancy to all providers. The physician members will be appointed and annually re-appointed by the CCHP Medical Director. Interested physicians will be solicited when vacancies occur. These members serve one-year terms and have full voting privileges. g. The CCHP Authorizations/Utilization Manager with full voting privileges. h. The CCHP Member Services Manager with full voting privileges. i. Note: For peer review issues, only medical providers may vote. Chair The QC is chaired by the CCHP Medical Director or designee Meetings The QC meets monthly, a minimum of nine (q) times yearly. 2. Credentialing Committee The Credentialing Committee considers CCHP contracted provider credentials for initial credentialing, re-credentialing, and primary-level appeal disputes. The Credentialing Committee reports to the QC monthly, or more frequently as required, with recommendations regarding credentialing status and disciplinary action. Page 11 of 26 Additionally, the Committee refers quality related issues to other appropriate subcommittees as indicated. Activities a. Receives reports regarding delegated credentialing actions and policies quarterly.. b. Conducts primary appeals of credentialing disputes and makes recommendations to the Board of Supervisors or the Joint Conference Committee regarding such appeals. c. Reports issues that potentially implicate quality of care issues to other subcommittees for investigation and action. d. Recommend applicants for credentials or re-credentialing to the QC. e. Reviews information from the facility site review process and recommends necessary corrective action f. Considers pertinent grievance and occurrence information as part of the re-credentialing process and where appropriate notifies the QC or the Medical Director of potential quality issues that may require intervention. g. Reviews and recommends credentialing policy and procedure modifications to the QC annually or more frequently as required. Membership a. The CCHP Medical Director or designee with full voting privileges. b. The CCRMC&HC: Credentialing Committee Chairperson or his/her representative. This member has full voting privileges. c. The CCHP Director of Provider Affairs, without voting privileges. d. At least two (2)independent physicians from any of the CCHP contracted providers, with at least one representing the individually contracted physician network. One of these shall be a primary care physician; the other shall be a specialty care physician. To fill these positions, the Assistant Medical Director will solicit nominations by announcing the vacancy to all providers. The Medical Director will select and appoint the most qualified candidates. Members serve at least one-year terms and have full voting privileges. e. The QM department staff who support the committee without voting privileges. f: The Credentials unit staff whom supports the committee without voting privileges. Chair The CCHP Medical Director or designee chairs the Credentialing Committee, Meetings The Credentialing Committee meets monthly, at a minimum of nine times a year. 3. Appeals Committee Page 12 of 26 The Appeals Committee provides the first level of appeal for all non-urgent requests for reconsideration of denied,modified or deferred services, payment for denied claims, and unsatisfactory resolution of formal grievances and acts as an avenue of member representation within the CCHP Health Plan, The Committee also reviews complaints against CCHP members for appropriate action. Requests for reconsideration may be received from members or their legal representative. The voting quorum for this committee is at least three Committee members, with at least one Committee member from clinical staff. The Authorizations/Utilization :Management Coordinator shall review the case in advance, and determine if medical specialist or additional administrative staff opinions are warranted. CCHP members and/or their appointed designees are infon-ned of their right to attend this meeting to present their case in advance of the meeting. In cases where there is a potential of risk or injury to CCHP employees, the CCHP member will not be allowed to present their case in person but may designate someone to participate on their behalf. The Appeals Committee reports to the QC, on a monthly basis or more frequently as may be required, with summary reports of its activities, including trending of grievance and appeal data, and reports on specific cases that require review by the QC. Activities a. Reviews and determines, subject to the QC: and the Board of Supervisors' approval, Requests for Reconsideration of denied claims and/or denied, modified or deferred services. K Reviews and determines, subject to the QC and the Board of Supervisors' approval, appeals of grievances not resolved to a member's satisfaction. c. Reviews all case review requests submitted by a third party, including Pair Hearings, and coordinates CCHP's response, as appropriate. d. Reviews and determines, subject to the Quality Council and the Board of Supervisors' approval, complaints against CCHP members e. Considers investigative, administrative matters associated with member and provider grievance reviews. £ Assures that files are confidentially maintained by the Member Services Unit for 6 years. & Acts as the patient advocate within CCHP. h. Hearing appeals for loss of coverage issues due to cancellation or late premium.payments Scope of Authority a. Refers issues regarding benefits of contract revisions to the UM Committee. Page 13 of 26 b. Recommends contract revisions for member materials. c. Recommends quality improvement activities d. Approves or denies grievance appeals based on majority vote, subject to the approval of the QC and the Board of Supervisors. e. Upholds or overturns the denial of services or claims based upon majority vote, subject to the approval of the QC and the Board of Supervisors. f. Recommends action against a member, which may include plan-initiated dis- enrollment, to the QC. g. Recommends to the QC that suspicious activities be reported to the Fraud Unit for investigation. iVlembershit� a. Non-Clinical: Manager of Member Services, full voting privileges Business Services Manager or Claims Supervisor, with full voting privileges. b. Clinical: Medical Director or Designee Physician Consultant Authorizations/Utilization Manager or UM Nurse In the specialized case where a medical specialist opinion is warranted, the specialist will have full voting privileges. Meetings The Appeals Committee meets ad hoc as needed and generally once each month. Resolution of expedited appeals of denied services is described in Member Service policies. (Reference MS8.001.M2, MS8.017.C2, MS8.026.MR) 3. Pharmacy And Therapeutics Committee The Pharmacy and Therapeutics Committee is responsible for the oversight of drug utilization trends, maintenance of the pharmacy management program, and ongoing development and oversight of the CCHP drug list. The Pharmacy and Therapeutics Committee reports to the QC semi-annually or more frequently as may be required. Activities a. Reviews drug utilization patterns and establish guidelines and protocols that help ensure high quality, cost-effective drug therapy. b. Analyzes new drugs and determine their status for inclusion to the CCHP drug list. c. Reviews the drug list and mare additions and deletions as necessary based on objective pharmacoeconomic evaluation of their relative therapeutic efficacy, safety, and cost. d. Considers and approves pharmacy prior authorization policies. e. Reports potential clinical issues to the QC for further investigation and action. Page 14 of 26 Membership Voting members: CCHP Medical Director CCHP Pharmacist CCRMC Physician-Primary Care CCRMC Physician-Primary Care CCRMC Pharmacist CPN Physician Practicing physician(s), representing a medical specialty as needed in accordance with the agenda Practicing community phanmacist(s) contracted with CCHP Non-voting;members CCHP Phanmacy Benefit Management Company representative pharmacist(s) Chair: The Chair of the Phanmacy and Therapeutics Committee is the CCHP Medical Director. Meetings- Meetings are held quarterly. E. Public Advisory & Other Coordinating Committees 1. Managed Care Commission The Managed Care Commission (MCC)is the principal public advisory board to CCHP. The goal of the MCC is to help assure the attainment of CCHP's strategic goals and objectives. The MCC reports directly to the Board of Supervisors annually and more frequently as required. Activities a. Consider the health care concerns for all members served by CCHP. b. Assure provider, consumer, and community, as well as gender, ethnic, cultural, and geographically diverse population input to deliberations and decision-making. c. Conduct long-range planning and policy formulation, and make recommendations to the Board of Supervisors (BOS), County HSD Director and CCHP Chief Executive Officer(CEO). This includes adopting an annual work plan and list of goals and priorities as well as an annual report describing major activities and accomplishments. d. Study and make recommendations to the CCHP CEO regarding operational objectives,policies and procedures, and recommend changes. Page 15 of 26 e. Assure effectiveness of quality(including good outcomes), by ongoing and periodic reviews of information produced through MIS reports and other sources. f. Regularly review the CCHP operational budget and amendments thereto. g. Advise the BOS, HSL} Director, and CCHP CEO, of the overall progress, constraining or threatening needs, and special problems of CCHP. h. Encourage public understanding of CCHP and provide support throughout the county for its development. i. Prioritize and assign issues to appropriate committees. j. Provide input, including from traditional and safety-net providers, regarding CCHP's Cultural and Linguistic Services Plan and such reports to the State as required. This shall include advisement on educational and operational issues affecting groups who speak a primary language other than English, as well as cultural competency. Membership There are fifteen (15)members, appointed by the Board of Supervisors; no less than one Medi-Cal subscriber, a Medicare subscriber or beneficiary, a Commercial subscriber, an individual sensitive to medically indigent needs, a non-contracting physician, and at least one other non-contracting provider. , The remaining nine(9)seats are at large members, non-contracting with CCHP. The Health Services Director, CCHP CEO, and the Board of Supervisors serve as ex- officio members without voting privileges. Committees The Commission has an Executive Committee, three (3) standing subcommittees, one(1) special subcommittee, and Ad Hoc committees. a. Executive Committee. The Executive Committee is a five-member Committee made up of the MCC Chair, Vice-Chair, immediate past Chair, and two (2) members elected from the membership as a whole. At least one member must be a member of CCHP. b. The Executive Committee shall meet on an "as needed"basis. Special meetings of the Executive Committee shall comply with the Brown Act advance written notice requirements. StandingSubcommittees: The standing subcommittees meet for 30 minutes to one(1)hour prior to the scheduled MCC meetings. The subcommittees will snake recommendations to the MCC as needed. 1) Quality Assurance. Study health care delivery and new, alternative, or improved modes of diagnosis and treatment. Review quality assurance studies and reports such as HEDIS. Analyze health education services and wellness promotion programs. Review disease management plans and results of interventions. Analyze all legislative and regulatory changes that may impact quality. 2) Resource Management. Study plan budgets, expenditures, and cost and utilization trends. Review resource management efforts including Page 16 of 26 advice nurse services, care management, pharmacy program., utilization management, and authorization. Analyze legislative and regulatory changes with financial impact. 3) Customer Relations: Analyze member and consumer issues including geographic, gender; ethnic, cultural, accessibility, availability, and acceptability, and other facets of consumer concerns. Examine satisfaction reports, review outreach and enrollment campaigns and analyze legislative and regulatory changes and may impact customers. Special Subcommittees 1) Governance and MCC Operations Committee: Recommend structural and governance changes of the Commission and its standing and special committees and annually recommend a slate of officers for the MCC. Assist in MCC member recruitment, orientation, and retention efforts. Make recommendations to MCC. 2) Ad Hoc Committees: There may be Ad Hoc Committees of the MCC. These will be created by the MCC for special issues or concerns that do not fit into the work of the standing committees or that may involve several of them. MCC will assign membership and duration of these committees. Chair The Chair of the Managed Care Commission is elected by Commission members. The Chair presides at all MCC meetings and represents the MCC at all CCHP Joint Conference Committee meetings. Meetings The Managed Care Commission meets a minimum of six (6)times yearly. For more detailed information, review the Managed Care Commission by laws. IX. QM DELEGATION CCHP may delegate all or part of the QM program to a contracted provider group. Delegated quality monitoring status is granted to contracted providers upon successful demonstration of the required scope of quality monitoring activities. Prior to delegation, the contracted provider group's QMP will be evaluated to assess its ability to carry out required activities. If CCHP delegates all or part of the QMP, CCHP will develop a written description of the delegated activities, the delegates' accountability for these activities, the frequency of reporting to the plan and the process by which oversight will be accomplished. An annual delegation oversight audit is performed on CCHP's delegates using a standardized delegated audit tool or other appropriate tool. (Reference QM 14.301). Page 17 of 26 X. QUALITY MANAGEMENT PROCESS AND INITIATIVES A. Process 1. Study Topic The QM department will assess potential study topics to determine their relevance to CCHP population. In addition, the Quality Management Department will determine CCHP`s ability to make and/or direct improvements in care and/or services related to the selected study topic. Each topic or measure selected will have an established goal and/or benchmark. 2. Study Planning The QM department will consider the following issues when planning a quality study: a. Feasibility. b. Establishment of timelines. c. Assessment of appropriate dates of service and/or outcome data. d. Adequacy of sample size. 3. Practice Guidelines Where indicated, clinical practice guidelines will be developed based on reasonable medical evidence and nationally recognized guidelines. The guidelines will be submitted to CCHP QC for review and approval. CCIIP will measure its performance against selected guidelines. The guidelines will be updated or reviewed periodically and communicated to health plan providers and appropriate staff. 4. Quality Indicators CCHP will develop quality indicators appropriate to the study question. The indicators will be objective and measurable, and based on the most current HEDIS version if appropriate. S. Data Analysis Plan CCHP will develop a data analysis plan prior to data collection. It will be clear and non-contradictory, include potential data collection problems, and detail the method for determining whether to review the whole at-risk population or a sample of the population. Page 18 of 26 6. Measurement Tool(s) CCHP will use measurement tool(s) appropriate for obtaining the information pertinent to the study topic and indicators, accompanied by sufficient written instructions, and appropriate to the level of experience of the data collection staff. 7. Validation of Collected Data CCHP will assess the approximate degree of correlation between the administrative data entries and the corresponding medical record entries and the accuracy of the medical record abstraction, if applicable. 8. Data Analysis CCHP will correctly perform the appropriate descriptive and statistical tests. The meaningful key data and study results will be presented clearly. Appropriate personnel will evaluate the analyzed data to identify barriers to improvement. 9. Interpretation of Findings CCHP will appropriately interpret and analyze key findings, using a multi- disciplinary approach that will include bio-statistical consultation, 10. Communication of Findings CCHP will present study results and follow-up actions to the appropriate health plan staff, committee(s), mernbers, and providers. 11. Improvement Plan CCHP will develop and implement a detailed improvement plan based on the study findings. Appropriate interventions will be selected and implemented to improve system and/or practitioner performance. The plan will be reviewed by the Clinical Coordinating Committee prior to implementation. D. Quality Improvement Initiatives Specific quality improvement, disease management, health education/promotion, and culture&linguistics initiatives for 2004 will be determined through a collaborative process including CCHP/CCHS clinical and administrative management staff. Additionally, QM will meet with DHS and other Focal Initiatives to select local and statewide collaborative improvement projects. These projects will be described in detail in the annual QM work plan, which will be finalized by the end of each calendar year and considered an addendum to the QMP. Page 19 of 26 XI. COORDINATION OF CCHP QM PROGRAM ACTIVITIES QMP activities outside the scope of the Quality Management Department require action from other departments and administrative divisions. These activities include credentialing;, member grievance process, utilization management (UM), and advice nurse telephone triage program and, care management programs. Activities with a significant bearing on quality are linked through QC and described as follows: A. Credentialing CCHP has written policies and procedures for the purpose of provider credentials review to confirm that all contracted providers possess the practice experience, licenses, certifications, privileges, professional liability coverage, education, and professional and other qualifications to provide a level of quality of care consistent with professionally recognized standards, and that network providers meet the credential requirements of applicable state and federal agencies. Site visits are conducted, if applicable, for both credentialing and re-credentialing. The credentialing process, activity and decision results are reviewed by the CCHP Credentialing Committee. The Credentialing Committee reports monthly to QC with recommendations for accepting a provider's application, for disciplinary action to be taken against a physician, or for termination of a physician's contract. The QC reviews the recommendations of the Credentialing Committee and provides any additional information that may be pertinent to the provider's membership to the Board of Supervisors. The Contra Costa Board of Supervisors exercise final approval of credentialing/recredentialing/reappointment decisions for the CCHP contracted providers. In cases where a person or committee believes that a provider poses a threat to himself, to a member, or to a third party, immediate disciplinary action may be taken to restrict the provider's credentials with CCHP. (Reference CRI 1.006.A.) B. Member Grievance Process Member grievances are received and logged in Member Services. Grievances that raise clinical quality-related issues are referred directly to the QM Unit for review, tracking, and resolution. The QM department tracks quality of care grievances for identifying potential trends. Where appropriate; system change is recommended or corrective action is implemented. A QM grievance report and recommendations for remedial action are submitted quarterly, and more frequently as may be required, to QC. (Reference MS8.001.M2, MS8.026.MR, MS8.017.C2) C. 'Utilization Management Program CCHP`s Utilization Management (UM) Program, staffed by actively licensed registered nurses and non--licensed Medical Record Technicians, oversees the delivery of health care to members through a process of prospective, concurrent, and retrospective review, to Page 20 of 26 determine the appropriateness of health care services, and to achieve an optimal level of quality. (Reference the UM Program Description.) D. Telephone Triage Program CCHP's Telephone Triage program, staffed by actively California licensed Registered Nurses, provides health care advice and education to CCHP members utilizing the hospital and clinic system, and those county residents lacking health care coverage. (Reference the Telephone Triage Quality Management Program Description and Procedures) E. Cooperative Care Management Program CCHP'S Cooperative Care Management Unit (CCM), a hybrid model (medical/social and field/telephonic), is staffed by actively licensed registered nurses, clinical social workers, and marriage and family therapists. The CCM Unit employs a collaborative process that assesses,plans, implements, coordinates,monitors, and evaluates options and services to meet a client's health needs through communication and available resources to promote quality outcomes. (Reference the Cooperative Care Management Program Policy and Procedure Manual) F. Disease Management Program CCHP'S Disease Care Management Program, staffed by actively licensed registered nurses and a community health worker, identifies and educates high-risk asthma patients and facilitates and coordinates their assessment,treatment, and treatment compliance, through a collaborative process including patient and provider telecommunication and patient home visiting services. G. Perinatal Program CCHP'S Perinatal Care Management Program, staffed by actively licensed registered nurses, identifies and educates high-risk obstetrical patients and facilitates and coordinates their assessment, treatment, and treatment compliance, through a collaborative process including patient and provider telecommunication services and innovative patient participation incentive programs. H. Health Education Program CCHP'S Health Education Program, staffed by a health education specialist, oversees and monitors State mandated health education and cultural/linguistic services through a collaborative process with provider and community resources that performs needs assessments,planning, development, implementation and evaluation. (Reference the Health Education Program Description) XII, ANNUAL QM PROGRAM EVALUATION Annually,CCHP will evaluate the effectiveness of its QM programs, activities and initiatives. The evaluation will be submitted to the QC for input and approval, generally during the first quarter of each calendar year for the previous year's activities. Page 21 of 26 XIII. DISCIPLINARY ACTION When a quality issue or trend is identified and attributed to a specific physician, and is severe enough to warrant reportable disciplinary action, the QC will take action in accordance with the 'CCHP credentialing appeal process (CR 11.006A). In such cases, physicians are entitled to Judicial Review. The CCHP CEO will arrange for this review according to the Judicial Review Policy. Corrective action will be reported to the Contra Costa County legal council for subsequent reporting to the Medical Board of California (MBC) and the National Practitioners Data Bank (NPDB). XIV. CONFIDENTIALITY All quality files and other quality data or information are maintained in a manner that protects patient and provider confidentiality. CCHP's QM information is not discoverable or admissible in a court of law as specified in Section 1157 of the California Evidence Code and Section 13701 of the .Health and Safety Code. All CCHP employees sign a statement of confidentiality upon employment. CCHP complies with all federal privacy mandates per the Health Insurance Portability Act of 1996 (HIPPA). Additionally, participants in CCHP's QC, Credentialing, Peer Review and Grievance committees sign an additional statement of confidentiality related to the review of medical quality of care issues. XV. CONFLICT OF INTEREST Any individual who has been professionally involved in an issue or case may not participate in the review, evaluation, or final disposition of the case. 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