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HomeMy WebLinkAboutMINUTES - 01082008 - C.124 TO: BOARD OF SUPERVISORS 9?ra - o FROM: WILLIAM B. WALKER, M.D. Health Services Director o ri auom Costa DATE: December 12, 2007 om �y�,, •„��c SUBJECT: Approvals of Contra Costa Health Plan's Quality Management °STd------ County� Annual Work Plan 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 Program Description,the Annual Work Plan, and the 2006 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 every year CCHP has been operating under a Board of Supervisors' approved Quality Management Program and Plan since 1997. The state Department of Health Services requires that CCHP submit a new Quality Management Program and Plan every year to involve the Board of Supervisors, as the governing body, directly in the Quality Management process. The Quality Management Program Description describes the goals, objectives, and activities of the Quality Management Program. It also contains the 2007 Annual Quality Management Work Plan, which describes the quality improvement activities CCHP expects to develop and implement in 2007. As part of the 2007 Work Plan, CCHP will perform focused review studies required by the state Department of Health Services as part of the Local Initiative program. The 2006 Program Evaluation reflects the status of the initiatives proposed in the 2007 Quality Management Work Plan. The Quality Management Program, the 2007 Annual Work Plan, and the 2006 Program Evaluation have been reviewed and approved by: • The Contra Costa Health Plan Quality Council • The Contra Costa Health Plan Managed Care Commission • The Joint Conference Committee FISCAL IMPACT: None ATTACHMENTS: Quality Management Program Description for 2007, Annual Quality Management Work Plan for 2007, and Quality Management Program Evaluation for 2006 CONTINUED ON ATTACHMENT: X YES SIGNATURE: L►a A All) ---------------------------------------------------------------------------------------------------------- --- -- ----- ---------------- __I::L-6-ECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE --APPROVE OTHER SIGNATURE(S): ACTION OF BOAVN APPROVE AS RECOMMENDED 4f OYHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE J' p� AND CORRECT COPY OF AN ACTION TAKEN UNANIMOUS(ABSENT K/ ) AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN, ABSENT: ABSTAIN: ATTESTED 8nv_,�Iq �I CONTACT: Ken Tilly,CCHP 313-6498 JOHN CULLEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR CC: Jill Lorrekovich,CCHP Ken Tilly,CCHP BY `I GW v DEPUTY r CONTRA COSTA HEALTH 'L . A Division of Contra Costa Health Services QualityManagement Program Description 2007 QM Program Description 2001 Page 1 of 21 VF Quality Management Program Description 2007....................... 3 Introduction.......................................................................................................... 3 Mission................................................................................................................. 3 Purpose................................................................................................................. 3 Scope.................................................................................................................... 3 Objectives............................................................................................................. 3 Authority And Responsibility.............................................................. 4 The Contra Costa County Board of Supervisors.................................................. 4 TheQuality Council............................................................................................. 5 MedicalDirector.................................................................................................. 5 Clinical Operations Officer.................................................................................. 5 Director of Quality Management......................................................................... 6 Quality Management Program Activities....................................... 6 QMDelegation...................................................................................................... 6 Quality Improvement Initiatives.......................................................................... 7 Preventive Health and Clinical Practice Guidelines............................................ 7 Annual QM Program Evaluation......................................................................... 7 QM Program Documents ..................................................................................... 7 Coordination of CCHP QM Program Activities......................... 7 Credentialing........................................................................................................ 8 Member Grievance Process.................................................................................. 8 Utilization Management Program........................................................................ 8 AdviceNurse Unit................................................................................................ 8 Cooperative Care Management Program............................................................. 8 Health Education Program................................................................................... 9 DisciplinaryAction.............................................................................................. 9 Safety Improvement Activities ............................................................................ 9 Confidentiality ..................................................................................................... 9 ConflictOf Interest .............................................................................................. 9 QM Committee Structure.................................................................... 11 Board of Supervisors (BOS) ............................................................................. 11 Joint Conference Committee (JCC).................................................................. 12 Health Plan Coordinating Committee (HPCC).................................................. 13 The Quality Council (QC).................................................................................. 14 Credentialing Committee................................................................................... 16 AppealsCommittee............................................................................................ 17 Pharmacy And Therapeutics Committee ........................................................... 18 Managed Care Commission (MCC) .................................................................. 18 Managed Care Commission(MCC) Executive Committee & Subcommittees. 19 Approved by Quality Council:........................................................................... 21 Approved by the Managed Care Commission:.................................................. 21 Approved by the Joint Conference Committee.................................................. 21 Approvedby the BOS........................................................................................ 21 QM Program Description 2007 Page 2 of 21 QUALITY MANAGEMENT PROGRAM DESCRIPTION 2007 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 Kaiser Permanente to arrange comprehensive health care services. CCHP provides health care for public and private employee groups, private individuals, Medi-Cal and Medicare beneficiaries, and low-income county residents. CCHP's overall commitment is serving the County's most vulnerable populations. MISSION The goal of CCHP's Quality Management Program (QMP) is to ensure that quality, appropriate health care and related services meet or exceed members' and other customers' expectations. 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 all that use our programs. 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. 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, 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. 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. QM Program Description 2007 Page 3 of 21 • 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 all active Quality Improvement Projects (QIPs) and internal quality programs including Health Education and Cultural and Linguistic Services. AUTHORITY AND RESPONSIBILITY THE CONTRA The Contra Costa County Board of Supervisors (BOS)has the ultimate COSTA COUNTY responsibility for development and implementation of the QMP. The BOS is BOARD OF responsible for reviewing and approving the QMP on at least an annual basis. SUPERVISORS The BOS 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 BOS 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(JCC) and the Quality Council (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 BOS' approval. QM Program Description 2007 Page 4 of 21 The Quality Council (QC)has the primary responsibility for implementing and THE QUALITY directing the QMP. It is responsible for developing and making COUNCIL recommendations to the BOS or the JCC regarding quality management standards, criteria by which care will be measured, and priorities for which aspects of care will be monitored. Reports to the CCHP CEO. The Medical Director is responsible for the administration and coordination of medical management, including behavioral MEDICAL health of CCHP with assistance from the Clinical Operations Officer, a licensed DIRECTOR registered nurse. The Medical Director, together with medical consultants who are licensed physicians, oversees the activities the QM Department, Utilization Management Department, Cooperative Care Management Department and the Credentialing Program, including the following: • Medical policy development • Clinical practice guidelines • Medical review and severity leveling of member grievances and implementing corrective action and/or peer review as appropriate • Provider education and implementation of disease management and health promotion programs • Coordination of physician membership to JCC, QC and Credentialing Committees The Clinical Operations Officer(COO) is a registered nurse reporting to the Medical Director of CCHP. The COO is a member of CCHP's Executive Committee and assists the Medical Director with coordination of CCHP's CLINICAL clinical programs. Other responsibilities for the COO include: OPERATIONS . Summarizes clinical issues and reports to the Executive Committee. OFFICER . Recommends strategic direction and policy for clinical projects and programs. • Guides the clinical activities identified by the Health Plan Coordinating Committee. • Coordinates the annual audits of delegated providers. • Guides implementation efforts for clinical programs. • Reports clinical activities to other committees as needed, such as the Joint Conference Committee and the Managed Care Commission. • Assists with reviewing data, reporting, developing recommendations, and guiding improvement efforts. • Assists with recommendations and improvement efforts to achieve appropriate utilization and efficient use allocation of resources. • Assists the clinical departments to meet regulatory, audit and accreditation requirements. • Oversees the Health Education Programs in conjunction with the Director of Quality Management. QM Program Description 2007 Page 5 of 21 Reports to the CCHP Medical Director. The Director of QM is responsible for development and implementation of the annual QM Program and the QM DIRECTOR OF Department.operations including: QUALITY . Compliance activities for QM regulatory and accreditation requirements. MANAGEMENT e Development and implementation of disease management initiatives. • Development and implementation of health education and health promotion initiatives.. • Development and administration of California Department of Health Services (CDHS)-required Quality Improvement Projects. (QIPs). • Oversight of the QM review for quality of clinical care grievances and occurrences. • Oversight of provider on-site facility site review and the corrective action process in conjunction with provider credentialing and in coordination with the Medical Director and Provider Affairs Director. • Oversight of quality management activities for non-delegated providers, and contracted delegated providers. • Development and annual review and revision of QMP description, policies and procedures. • Production of HEDIS measures and coordination of the annual HEDIS audit. • Compilation of reports and summaries of recommendations of specific committees (set forth in detail below) for presentation to the QC, the JCC, and to the BOS. QUALITY MANAGEMENT PROGRAM ACTIVITIES 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. Delegation requirements are included in the contracting process. Prior to delegation, the contracted provider group's QMP will be evaluated to assess its ability to carry out required activities. 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 Permanente. CCHP monitors delegated activities via routine reporting throughout the year. An annual delegation oversight audit is performed on CCHP's delegates using a standardized delegated audit tool or other appropriate tool. (Reference QM14.301). Identified issues are resolved and reported to the appropriate committees. QM Program Description 2007 Page 6 of 21 QUALITY Specific quality improvement, disease management, health IMPROVEMENT education/promotion, and culture & linguistics initiatives for 2007 will be INITIATIVES determined through a collaborative process including CCHP/CCHS clinical and administrative management staff. Additionally, QM will meet with the CDHS and other Local Initiatives to select local and statewide collaborative improvement projects. These projects are described in detail in the annual QIP reports to the California Department of Health Services and the annual QM work plan, which will be finalized by the end of each calendar year and considered an addendum to the QMP. For year 2007 the 4 CDHS required QIPs are • Asthma • Diabetes • Adolescent Health • Reducing Health Disparities PREVENTIVE Preventive Health Guidelines and Clinical Practice Guidelines for Contra Costa HEALTH AND Health Plan (CCHP) are developed in collaboration with CCHP's Medical CLINICAL Director, Medical Consultants, and clinical staff, physicians from the Contra PRACTICE Costa Regional Medical Center/Clinics, and physician representatives from the GUIDELINES Community Provider Network. Guidelines are reviewed approximately every two years and revised as necessary. Guidelines are distributed to primary care practitioners and relevant specialists, as well as other appropriate staff. ANNUAL QM Annually, CCHP will evaluate the effectiveness of its QM programs, activities PROGRAM and initiatives. The evaluation will be submitted to the QC for input and EVALUATION approval, generally during the first quarter of each calendar year for the previous year's activities. QM PROGRAM All these documents are approved by the QC, the JCC, the MCC and BOS: DOCUMENTS • Annual Work Plan • Program Description • Program Evaluation COORDINATION OF CCHP QM PROGRAM ACTIVITIES QMP activities outside the scope of the QM Department require action from other departments and administrative divisions. These activities include credentialing, member grievance processes, utilization management (UM), advice nurse telephone triage program and care management programs. Activities with a significant bearing on quality are linked through QC and described as follows: 1 QM Program Description 2007 Page 7 of 21 CREDENTIALING CCHP has written policies and procedures for credentialing and re- credentialing. Provider information is reviewed to confirm that all providers have appropriate practice experience, licensure,board certification, hospital privileges, professional liability coverage, education, and professional and other qualifications to provide the quality of care consistent with professionally recognized standards, health plan expectations, and applicable state and federal regulations. Site visits are conducted, if applicable, for both credentialing and re-credentialing. MEMBER Member grievances are received and logged in Member Services. Grievances GRIEVANCE that raise clinical quality-related issues are referred directly to the QM Unit for PROCESS review, investigation, tracking, and resolution. U� i eat ;a n 11 gat.110 y acktng an r e 'fix. y z e gents frac�9t�+�f t;are.,' nano� de <t pale 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, QM14.501, QM14.502, QM14.503) UTILIZATION CCHP's Utilization Management (UM) Program, staffed by actively licensed MANAGEMENT registered nurses and non-licensed Medical Record Technicians, oversees the PROGRAM delivery of health care to members through a process of prospective, concurrent, and retrospective review, to determine the appropriateness of health care services, and to achieve an optimal level of quality. CCHP's Medical Director oversees the UM Program. (Reference the UMProgram Description.) ADVICE NURSE Nurses in CCHP's Advice Nurse Unit provide health care advice and education UNIT to CCHP members utilizing the hospital and clinic system, and those county residents lacking health care coverage. CCHP's Advice nurses are registered nurses with active California licenses. (Reference the Advice Nurse QM Program Description and Procedures) COOPERATIVE CCHP'S Cooperative Care Management Unit (CCM), a hybrid model CARE (medical/social and field/telephonic), is staffed by actively licensed registered MANAGEMENT nurses, clinical social workers, or marriage and family therapists. The CCM PROGRAM 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 subsection, Cooperative Care Management Program Description, in the Utilization Management Program Manual) QM Program Description 2007 Page 8 of 21 HEALTH CCHP'S Health Education Program, staffed by a health education specialist, EDUCATION oversees and monitors State mandated health education and cultural/linguistic PROGRAM 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) DISCIPLINARY When a quality issue or trend is identified and attributed to a specific physician, ACTION and is severe enough to warrant reportable disciplinary action, the Peer Review and Credentialing Committee (PRCC) will take action in accordance with the CCHP credentialing appeal process (CR 11.004). In such cases, physicians are entitled to Judicial Review. The CCHP CEO will arrange for this review according to the Judicial Review Policy. SAFETY CCHP demonstrates a commitment to improving safe clinical practice through IMPROVEMENT • Facility Site Reviews - Medical Record documentation of unsafe environment ACTIVITIES • Pharmacy—Periodic distribution of pharmaceutical updates to providers 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 1370 of the Health and Safety Code. All CCHP employees sign a statement of confidentiality upon employment and complete training on privacy, confidentiality and security. CCHP complies with all federal privacy mandates per the Health Insurance Portability Act of 1996HII'AA . Additionally, participants in CCHP's QC, Credentialing, P ca y& h`era�`uf`i ,Peer Review and Grievance\Appeals committees sign an additional statement of confidentiality related to the review of medical quality of care issues. CONFLICT OF Any individual who has been professionally involved in an issue or case may INTEREST not participate in the review, evaluation, or final disposition of the case. QM Program Description 2007 Page 9 of 21 Quality Management Organization Chart Chief Executive Officer Rich Harrison Medical Director lames Tysell, MD Clinical Operations Officer Medical Consultants Ellen Lent-Wunderlich, RN Diane Dooley, MD Troy Kaji, MD Quality Management Director Ken Tilly CHealth Education Asthma QIP —� CFacility Site Review Diabetes QIP CHEDIS Adolescent Health QIP —� Qualit:y of Care Grievance Managernent Health Disparities QIP Cultural and Linguistic Services Perinatal _] QM Program Description 2007 Page 10 of 21 QM COMMITTEE STRUCTURE F oard of Supervisors I I Joint Conference CCHP Executive Managed Care Committee Committee Commission Health Plan Coordination Quality Council Quality Customer Resource Committee Assurance Relations Management Pharmacy and Credentials Appeals Therapeutic Committee Committee Committee -BOARD PURPOSE Contra Costa County Board of Supervisors, which is elected through general elections, is the governing body of the CCHP. The BOS is ultimately responsible for development and implementation of the QMP, for physician and other provider contracii.mg!contract termination, quid the approval of appoint rents to CCHP's public advisory, body,the Managed Care COMI-nission RESPONSIBILITIES • Develops policy in consultation and with the recommendation of the JCC. • Reviews, evaluates, and acts upon the annual QMP and Work Plan. • Reviews, evaluates, and acts upon QM reports that are submitted at least quarterly. • Receives, evaluates and acts upon recommendations of the CCHP Credentialing Committee. • Appoints JCC ar,R, C membership. • Reviews, evaluates, and acts upon findings of the JCC. MEMBERSHIP Five (5) elected members through general elections in one of the five districts of Contra Costa County for a term of four(4) years. CHAIR Rotates among the five board members annually FREQUENCY Weekly public meetings in accordance with the Brown Act. To preserve the confidentiality of some discussion and reports, the BOS has the authority to meet in executive session (without any members of the public resent). l QM Program Description 2007 Page 11 of 21 JOINT CONFERENCE COMMITTEE PURPOSE The JCC of the BOS and CCHP is the mechanism by which the BOS implements the QMP and exercises oversight of CCHP. All meetings of the JCC are open to the public because of the public nature of the BOS. RESPONSIBILITIES • Promotes communication between the BOS, QC, and CCHP administration. • 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. • Receives, evaluates, and makes recommendations to the Board regarding the reports and recommendations of the QC. These 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. • 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. • 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 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 BOS. • Reviews, evaluates, and acts upon Medical Policy Guidelines, subject to the BOS' approval. • Receives and reviews quarterly reports regarding Appeals Committee activity' • Receives and reviews reports on adherence to Privacy and Confidentiality regulations. • Revlews .eva tes and acts upon tl�e.li2ember Services ,�ctivitics lZepoxt including appeals and alievances inforinatibn, made annually or niore frequently as may be required. • .Reviews, evaluates wid acts_upon nieniber sati_sfactioii, care quality and offier mernber and provider surveyresults, as they become available. MEMBERSHIP The JCC shall not exceed nine (9) total members: Voting Privileges • Two members from the BOS, appointed by the Board. • Two physician members appointed by the Board from CCHP delegated and non-delegated provider networks. To fill these positions, nominations will be solicited by announcing the vacancy to all providers. The CCH? Medical Director will select the candidates and one alternate and present them to the Board for approval. Terms are two years with unlimited reappointments. • A quorum requires 3 of 4 voting members in attendance. The physician alternate may vote in place of a physician member for the purposes of reaching a quorum. Non- Voting Members • CCHP Medical Director. QM Program Description 2007 Page 12 of 21 JOINT / ' COMMITTEE • Director of Health Services of Contra Costa County. • CCHP CEO Executive Director. • Health Services Chief Financial Officer. • Chair, Managed Care Commission. CHAIR The Chair is a member of the BOS, _40' annually. FREQUENCY At least quarterly and are open to the public, except for confidential matters that may be discussed and acted upon in executive session. COORDINATINGHEALTH PLAN • PURPOSE The Health Plan Coordinating Committee (HPCC) serves as a forum to share, discuss, and problem-solve clinical and administrative issues, and enhance collaboration to guide new and existing programs. The HPCC reports to the Executive Committee. The HPCC 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, legislative issues, provider relations and new technologies. RESPONSIBILITIES • Recommends strategic direction and policy for clinical and administrative projects and programs. • Reviews progress and accomplishments of CCHP projects and programs. • Facilitates problem solving for CCHP projects and programs. • Recommends actions and improvement efforts to achieve appropriate utilization and efficient allocation of resources. • Reviews relevant data, such as HEDIS and satisfaction surveys, and guides improvement efforts. • Facilitates problem solving for benefit and regulatory projects and programs. • Assists departments to meet regulatory and accreditation requirements. • Operationalizes new programs throughout CCHP, providing means of communicating important information across divisional units. MEMBERSHIP All members are CCHP staff with voting_privileges. • Chief Executive Officer • Deputy Executive Director • Clinical Operations Officer • Quality Management Director • Medical Director • Triage Nurse Director LWCase Management Director • Network Development Coordinator • Planning Director • Pharmacy Director QM Program Description 2007 Page 13 of 21 PLAN COORDINATING ' • Long Term Care Integration Project Director • Director of Marketing and Member Services • Compliance Officer • Cultural &Linguistic Services Program Manager • Contracts Manager • Director of Provider Affairs • Business Services Manager CHAIR Deputy Executive Director FREQUENCY Monthly THE QUALITYCOUNCIL(QC) PURPOSE The Quality Council (QC) is the principal committee for coordinating and directing QM activities for CCHP, including but not limited to: quality management, member and provider grievances, peer review and credentialing, and utilization management RESPONSIBILITIES • Receives, evaluates, and acts upon the reports of subcommittees. • Reviews, evaluates, and makes recommendations to the BOS 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. • Receives and reviews, at least quarterly and more frequently as required, reports from the Credentialing Committee regarding the credentialing status of providers. • Receives QM occurrence and grievance/appeals 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 BOS and the JCC regarding resolution or implementation of any corrective action that may be required. • Receives and reviews, at least quarterly and more frequently as required, 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 QC evaluates these reports and makes recommendations to the BOS and the JCC regarding implementation of any corrective action that may be required. • Receives UM reports quarterly or more frequently as required. The QC evaluates such reports and makes recommendations to the BOS and the JCC regarding implementation of corrective action that may be required. • Receives Grievance Committee activity reports quarterly and more frequently as required. The QC evaluates such reports and makes QM Program Description 2007 Page 14 of 21 THE QUALITV COUNCIL(QC) recommendations to the BOS and the JCC regarding implementation of corrective action that may be required • Reviews and evaluates other reports such as access and delegation monitoring. • Reviews and makes recommendations to the BOS and the JCC, annually or more frequently as required, regarding modifications to be made to the QM Work Plan, and other Quality Management reports. • Reviews and evaluates QM reports pertaining to medical, Pharmacy and Therapeutics, and benefit interpretation policy issues. The QC makes recommendations to the BOS and the JCC regarding trends and modifications to be implemented. • Distributes QM and other CCHP information to individually contracted providers via the Medical Director through letters, newsletters,policies and procedures,provider manuals, and other appropriate methods. • Reports to CCH? senior administration for the purpose of planning and designing services for and administering CCHP operations. • Provides additional medical review of appeals/reconsiderations by physician committee members as required. • Reviews and approves clinical practice guidelines periodically. MEMBERSHIP Full Voting Privileges • The CCHP Medical Director • Licensed physician consultant(s) designated by the CCHP Medical Director • The Quality Chair or designee from each of CCHP's delegated provider networks • Director of CCRMC &HC QM Department • CCRMC &HC Utilization Review Supervisor • The CCHP Quality Management Director • The CCHP Clinical Operations Officer • The CCHP Authorizations/Utilization Director • The CCHP Member Services Manager • The CCHP Pharmacy Director • The CCHP Provider Affairs Director • The CCH?Advice Nurse Manager • 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, nominations are solicited by announcing the vacancy to all providers. The physician members will be appointed and annually re-appointed by the CCHP Medical Director. These members serve one-year terms. Note: Forpeer review issues, only medical providers may vote. CHAIR CCH? Medical Director or designee FREQUENCY Monthly, a minimum of nine (9) times yearly QM Program Description 2007 Page 15 of 21 QUALITY COUNCIL SUBCOMMITTEES CREDENTIALING COMMITTEE PURPOSE The Crede:ntialing Committee considers CCHP contracted provider credentials for initial credentialing, re-credentialing, and primary-level appeal disputes. The Credential.ing Committee reports to the QC with recommendations regarding credentialing status and disciplinary action, and refers quality related issues to other appropriate subcommittees as indicated. RESPONSIBILITIES . Receives quarterly reports regarding delegated credentialing actions and policies. • Conducts primary appeals of credentialing disputes and makes recommendations to the BOS or the JCC regarding such appeals. • Reports issues that potentially implicate quality of care issues to the QC or other subcommittees for investigation and action. • Recommends applicants for credentialing or re-credentialing to the BOS. • Reviews information from the facility site review process and recommends necessary corrective action • 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. • Reviews and recommends credentialing policy and procedure modifications to the QC annually or more frequently as required. MEMBERSHIP Full Voting Privileges • The CCHP Medical Director or designee • The CCRMC&HC Credentialing Committee Chairperson or designee • 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, nominations are solicited 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. Non-Voting Members • The CCHP Director of Provider Affairs • The QM Department staff who support the committee • The Credentials unit staff who support the committee CHAIR The CCHP Medical Director or designee FREQUENCY Monthly, at a minimum of nine times a year QM Program Description 2007 Page 16 of 21 APPEALS PURPOSE The Appeals Committee provides the first level of appeal for all non-urgent requests for reconsideration of denied, modified or deferred services, and payment for denied claims and acts as an avenue of member representation within the Contra Costa Health Plan. Requests for reconsideration may be received from members or their legal representative. 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. The Appeals Committee forwards minutes and reports to the QC after each Committee meeting. Minutes are confidentially maintained by QC for 6 years. RESPONSIBILITIES • Reviews and determines Requests for Reconsideration of denied claims and/or denied, modified or deferred services. t A767 " �+ ,yrm._:•: •,ems` _< • 1 se a" lld- odc o�, efseies escnb • Reviews and make determinations on appeals for delinquent premium disenrollment • Reviews requests submitted by a third party, including Medi-Cal Fair Hearings, and coordinates CCHP's response, as appropriate. • Reviews and determines, subject to the Quality Council approval, action to be taken on complaints against CCHP members which may include plan- initiated disenrollments. • Considers investigative, administrative matters associated with member reviews. • Assures that the Member Services Unit confidentially maintains Committee files�t rte`:MEM . • Acts as the patient advocate within CCHP. • Refers issues regarding benefits to the BIM Committee. • Recommends contract revisions for member materials. • Recommends quality improvement activities. Recommends to the QC that suspicious activities be reported to the Fraud Unit for investigation. MEMBERSHIP All members have full voting privileges The required voting quorum for this committee is at least three Committee members, one of which must be the Medical Staff M.D. and one clinical member from Utilization Management. • Manager of Member Services or designee • Business Services Manager • Claims Supervisor or designee's • 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. FREQUENCY Meets monthly or ad hoc as needed. QM Program Description 2007 Page 17 of 21 PHARMACY AND THERAPEUTICS COMMITTEE PURPOSE 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. RESPONSIBILITIES • Reviews drug utilization patterns and establishes guidelines and protocols that help ensure high quality, cost-effective drug therapy. • Analyzes new drugs and determines their status for inclusion in the CCHP drug list. • Reviews the drug list and makes additions and deletions as necessary based on objective pharmacoeconomic evaluation of their relative therapeutic efficacy, safety and cost. • Considers and approves pharmacy prior authorization policies. • Reports potential clinical issues to the QC for further investigation and action. MEMBERSHIP Voting members • CCHP Medical Director/designee • CCHP Pharmacy Director • CCRMC Primary Care Physician • CCRMC Provider-Primary Care • CCRMC Pharmacist • CPN Physician CHAIR The CCHP Medical Director or designee FREQUENCY Quarterly PUBLIC ADVISORY & OTHER COORDINATING COMMITTEES MANAGED CARE COMMISSION(MCC) PURPOSE 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 BOS annually and more frequently as required. RESPONSIBILITIES • Consider the health care concerns for all members served by CCHP. • Assure provider, consumer, and community, as well as gender, ethnic, cultural, and geographically diverse population input to deliberations and decision-making. • Conduct long-range planning and policy formulation, and make recommendations to the BOS, County HSD Director and CCHP Chief Executive Officer(CEO). This includes adopting an annual work plan and QM Program Description 2007 Page 18 of 21 MANAGED CARE COMMISSION list of goals and priorities as well as an annual report describing major activities and accomplishments. • Study and make recommendations to the CCHP CEO regarding operational objectives, policies and procedures, and proposed changes. • Assure effectiveness of quality programs by ongoing and periodic review. • Regularly review the CCHP operational budget and amendments thereto. • Advise the BOS, HSD Director, and CCHP CEO of the overall progress, constraining or threatening needs, and special problems of CCHP. • Encourage public understanding of CCHP and provide support throughout the county for its development. • Prioritize and assign issues to appropriate committees. • 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) commissioners, appointed by the BOS, all with voting privileges; • At least one Medi-Cal subscriber • A Medicare subscriber or beneficiary • A Commercial subscriber • An individual sensitive to medically indigent needs • A non-contracting physician • At least one other non-contracting provider • The remaining nine (9) seats are at large members non-contracting with CCHP. Non-voting Members • The Health Services Director • CCHP CEO The BOS serve as ex-officio members without voting privileges. CHAIR Elected by Commission members The Chair presides at all MCC meetings and represents the MCC at all CCHP JCC meetings. FREQUENCY a minimum of six (6) times yearly MANAGED CARE COMMISSION(MCC)EXECUTIVE • : SUBCOMMITTEES The MCC has an Executive Committee, three standing subcommittees, one special subcommittee, and Ad Hoc committees. MEMBERSHIP • MCC Chair • Vice-Chair • Immediate past Chair �. • Two 2 members elected from the membership as a whole. QM Program Description 2007 Page 19 of 21 f MANAGED CARE COMMISSION COMMITTEE ♦ SUBCOMMITTEES • At least one member must be a member of CCHP. FREQUENCY • "as needed" in compliance with the Brown Act advance written notice requirements STANDING Meet for 30 minutes to one hour prior to the scheduled MCC meetings. The SUBCOMMITTEES subcommittees will make recommendations to the MCC as needed. • 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. • Resource Management: Study plan budgets, expenditures, and cost and utilization trends. Review resource management efforts including advice nurse services, care management, pharmacy program, utilization management, and authorization. Analyze legislative and regulatory changes with financial impact. • 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 • Governance and MCC Operations Committee: Recommend structural and SUBCOMMITTEES 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. • 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. QM Program Description 2007 Page 20 of 21 Contra Costa Health Plan Quality ManaLyement Program Description 2007 APPROVED BY QUALITY COUNCIL: Jim Tysell, , C mmitte Chair Date 6 APPROVED BY THE MANAGED CARE COMMISSION: z�,AW, /NW&4 Z-- D�eanor Madrigal, Co sion Chair Date D APPROVED BY THE JOINT CONFERENCE COMMITTEE Date Gayle ilkema,C i ee Chair APPROVED BY THE BOS Date QM Program Description 2007 Page 21 of 21 00 w 0 0 w cl a c 4) O a'i O N N m cu T Ln 0 O fid V 1 , fu IL 0 owV O [1 0 .Q O NI C O 3 i a 0 0 7 E ca tb 0 a a: a a ac y co= c a� a '+ �7 ts7 mc vCDr GM CD .� rs r+ O p-s f9 Y �^. o b G m CD 0 ay d fl d�O-cjq C� �� �" �, C� v� b C) �, < y d by CD p G ,pt O w G ' rt ('D a Pr y ti w '+ �h C CD ry w 0 CD o G G yCD O p' ww al:�' G o G 'y'' G o• N x' R. r-� cu a '9 bp. 'd Q" w n s ti w cn 7 3 [xiy 0 w— 0 c CD O o a Co C c"o in. 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