HomeMy WebLinkAboutMINUTES - 06032008 - C.98 TO: BOARD OF SUPERVISORS
- _ Contra
FROM: WILLIAM B.WALKER, M.D.
Health Services Director
,!i'amNw Costa
DATE: May 6,"2008 ti�
SUBJECT Approval of Contra Costa Health Plan's Quality Management couiz�;�� Co my
Annual Work Plan
SPECIFIC REQUEST(S)OR RECOMMENDATION(S) &BACKGROUND AND JUSTIFICATION
.RECOMMENDATION:
APPROVE the Contra.,Costa.Health Plan's Quality Management Program, including,the Quality Management Program Description, the
Annual Work Plan, and the 2007 Program Evaluation, and AUTHORIZE the Chair of the Board to sign the document.
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 2008 Annual Quality Management Work Plan, which describes the quality improvement activities CCHP expects to'develop
and implement in 2008. As part of the 2008 Work Plan, CCHP will perform focused review studies required by the state Department of
Health Services as part of the Local Initiative program. The 2007 Program Evaluation reflects the status of the initiatives proposed in the
2008 Quality Management Work Plan:
l
The Quality Management Program,the 2008 Annual Work Plan, and the 2007 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
The three above documents need to be signed and approved by the full board of supenvisors'and chair of the board. The three1 signature
pages will then need to be returned to CCHP for proper filing.
FISCAL IMPACT:
None
ATTACHMENTS:
Quality Management Program Description for 2008, Annual Quality.Management Work Plan for 2008, and Quality Management Program
Evaluation for 2007
CONTINUED ON ATTACHMENT: X YES SIGNATU 1
------------ ---
--------------------------------------
------- --------------------- ----- -------------------------- -
OMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COM ITTEE
/1APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARV, APPROVE AS RECOMMENDED ER
i
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
7 UNANIMOUS(ABSENT AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES:. SHOWN.
ABSENT: ABSTAIN:
ATTESTED
CONTACT: Patricia Tanquary,CCHP313-6004 JO LLEN,CLERK OF THE BOARD OF
SUPERVI R AND COUNTY ADMINISTRATOR
CC: Jill Lorrekovich,CCHP
Patricia Tanquary,CCHP
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CONTRA. C OSTA
HEALTH PLAN
ArDivisiori of Contra'Costa Health Services
QualityManagement
Program Description 2008
QM Program Description 2008 Page 1 of 19
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ManagementQuality Description
^ �R��� `
�^ .�uv/u ----'--.,..]Introduction '
—r—'-------'-------------'—'--'~--------3 �
Mission.................................. ...............................................................................3
Purpose ------~--.---^-----.—~--^---.-------.—.—.,..3
, cope —~....—..—~—..—...—.—.—._.—...—..—.—..,..--,--.-.--.3
' Objectives ........; ~......—.--.—..—_...^.—^—.--..—..._.--....—._......3
��� Responsibility_ Authority /��vw ��� �w^x.°� ...............................................................4 �
The Contra Costa County Board of Supervisors ..................................................4
TheQuality Council................................................................................................5
' — Medical Director........... .......................................................................................5
Director of Quality Management............................................,.—...------,_'5
��,n�l�*�, ��f Activities
�
`�—�~~�� Management Program
QMDelegation .—.—....-----..-_.-,_..---.---.—..---.--.—.__-.6Quality Improvement Initiatives �
................. —.--^.....-~----------.6
Preventive Health and Clinical Practice Guidelines.............................................6
Annual QM ProgramEvaluation...................................................._.-.--.--..6 .
QM Documents..-._.--_----.--.---.—.--_.—.—.—.—.-.7 �
Coordination
� ` � m��������� ���� Activities
^
��{Y �%% wx �.����� ���,� /o��Il��D0eB—�—...------.7Credentialing '
—.—.—..--,.—..---.—.-----._ —..,.-7 '
Member Grievance / .'--..--------..--_--.-----.—_—..7
Utilization M ..................................... —.....--.-_.._._.7
Advice Nurse d .—.— .........
Case Management Program..................................................................................8
Health Education Program.................................................................................. .8
Cultural and Linguistic Services...........................................................................8 '
Disciplinary Action..........................----.—......--..---..—..-_............8
Safety Improvement Activities.____.___,___.______._ .......................
Confidentiality .—..---.---.-------.----.—.--....----.--..-9
` .
��oD��� K�fY�1�r�st--.--.-------.------.—.---.-,,------..9 �
'
���� �
K���X������ ������� 10
���r� -----.,—.-..-------.—.--..---
Boandnf Supervisors RBOR\................................................ .............................l0 -
Joint Conference Committee (]CC)....................................................................}l
Clinical Leadership Group (C7G)............... ............................ ..........................l2
The Quality Council (QC) ---'.—.--...-----..-------...-----....l2
AppealsCommittee.............................................................................................l4
Pharmacy And Therapeutics.Cornmittee............................................................l5
Managed'
Core ..................... ...............................................]6
Managed Care.CooloiSmioo Cmmmittee & Subcommittees..l7
Approved by Quality Council:...............................................................................
Approved by the Managed Care ...................................................lQ
Approved by the Joint Conference Committee....................................................}9Approved
bythe BOS.........................................................................................}9
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[}M Program Description 200'0 Page 2ofl9
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QUALITY MANAGEMENT PROGRAM DESCRIPTION 2008
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) and Kaiser Permanente to arrange comprehensive health care
services.
CCHP provides health care for public and private employee groups,private
individuals, Medi-Cal, Healthy Families 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 2008 Page 3 of 19
J
• 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
Qualify 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 2008 Page 4 of 19
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. The.Medical Director, together with medical consultants who
DIRECTOR are licensed physicians, oversees the activities the QM Department, Utilization
Management Department, Case 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
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 . Development and implementation of disease management initiatives.
MANAGEMENT . Development and implementation of health education and health promotion
initiatives.
• Development and administration of California Department of Health Care
Services (DHCS)-required Quality Improvement Projects. (QIPs).
• Oversight of the QM review for quality of clinical care grievances and
occurrences.
• 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.
QM Program Description 2008 Page 5 of 19
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.
QUALITY Specific quality improvement, disease management, health
IMPROVEMENT education/promotion, and culture & linguistics initiatives for 2008 will be
INITIATIVES determined-through a collaborative process including CCHP/CCHS clinical and
administrative management staff. Additionally, QM will meet with the DHCS
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 Care 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 2008 the 2 DHCS required
QIPs are
• Reducing Health Disparities
• Emergency Room Statewide Collaborative—Reducing Avoidable Visits
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 Description 2008 Page 6 of 19
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:
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. Grievances that raise Part D
Pharmacy related issues are referred to the Pharmacy Department for review,
investigation, tracking, and resolution. The QM and Pharmacy Departments
track quality of care grievances for identifying potential"trends: 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 UM Program Description.)
QM Program Description 2008 Page 7 of 19
ADVICE NURSE Nurses in CCHP's Advice Nurse Unit provide health care advice and education.
UNIT to CCHP members and those county residents lacking health care coverage.
CCHP's Advice nurses are registered nurses with active California licenses.
The CCHP Advice Nurse Unit received full URA accreditation in 2001 and has.
maintained compliance with URAC standards.
(Reference the Advice Nurse QM Program Description and Procedures)
CASE CCHP'S Case Management Unit(CM), a hybrid model (medical/social and
MANAGEMENT field/telephonic), is staffed by actively licensed registered nurses, clinical social
PROGRAM workers, or marriage and family therapists. The CM 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, Case Management Program Description, in the
Utilization Management Program Manual)
HEALTH CCHP'S Health Education Program,staffed by a senior health education
EDUCATION specialist, oversees and monitors state mandated health education contractual
PROGRAM agreements. Through a collaborative process with providers and community
resources, staff is responsible for community needs assessments,program
planning, development, implementation and evaluation. (Reference the
Health Education Program Description),
CULTURAL AND The purpose of the Cultural and Linguistic Services Department is to plan,
LINGUISTIC develop' implement, support and evaluate cultural and linguistic services
SERVICES available to CCHP members including those mandated by our contracts with.
regulatory agencies. The Cultural and Linguistic staff is responsible for
overseeing interpretative services, translation of CCHP key documents, and
the assessment of member's cultural and linguistic needs. Other duties
included are provider and staff training to increase cultural and linguistic
competency to continue providing optimal healthcare services to our
- members.
(Reference the Cultural& Linguistic Services 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
QM Program Description 2008 - - Page 8 of 19
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 1996 (HIPAA). Additionally, participants in CCHP's QC,
Credentialing, Pharmacy &Therapeutics, 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:
Quality Management Organization Chart
Chief Executive Officer
Patricia Tanquary
Medical Director
James Tysell, MD
Medical Consultants
Diane Dooley, MD
Troy Kaji, MD
Quality Management Director
Ken Tilly
Health Education ER Avoidable Visits QIP
Access Monitoring Reducing Health Disparities QIP
HEDIS Quality of Care Grievance Management
Cultural and Linguistic Services
QM Program Description 2008 Page 9 of 19
QM COMMITTEE STRUCTURE
LEoardof Supervisors
Joint Conference CCHP Executive Credentials Managed Care
Committee Committee Committee Commission
Clinical
Leadership _____ Quality Council Quality Customer Resource
Group' Assurance Relations Management
Pharmacy and Appeals
Therapeutic Committee
Committee
CSun
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 contracting/contract termination and the approval of appointments to
CCHP's public advisory body, the Managed Care Commission.
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 and MCC membership.
�ive
Reviews, evaluates, and acts u on findin s of the JCC.
MEMBERSHIP (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 present).
QM Program Description 2008 Page 10 of 19
oil
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.
• Reviews, evaluates and acts upon the Member Services Activities Report,
including appeals and grievances information, made annually or more
frequently as may be required.
• Reviews, evaluates and acts upon member satisfaction, care quality and other
member and provider,survey results, as they become available.
MEMBERSHIP The JCC shall not exceed nine.(9)total members:
VotingPges .
• 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 CCHP 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 2008 Page 11 of 19
• Director of Health Services of Contra Costa County.
• CCHP Chief Executive Officer.
• Health Services Chief Financial Officer.
• Chair,Managed Care Commission.
CHAIR The Chair is a member of the BOS, appointed 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.
PURPOSE The Clinical Leadership Group (CLG) serves as!`a forum to share; discuss, and
problem=solve clinical issues and enhance collaboration to guide new and
existing programs.
RESPONSIBILITIES • Recommends strategic direction and policy-for clinical projects and
programs.
• Reviews progress and accomplishments of CCHP clinical projects and
programs and facilitates problem solving.
• 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.
MEMBERSHIP All members are CCHP staff with voting_privileges.
• Medical Director
• Medical Consultants
• Quality Management Director
•, UM/Case Management Director
CHAIR Quality Management Director
FREQUENCY Monthly
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 QM occurrence and grievance/appeals reports, quarterly or more
QM Program Description 2008 Page 12 of 19
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 no_t
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
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 CCHP 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 Safety and Performance Improvement Department or
designee
QM Program Description 2008 Page 13 of 19
• CCRMC Chair of the Performance Improvement Committee or designee.
0 The.CCHP Quality Management Director
• The CCHP Authorizations/Utilization Director.
• The CCHP Member Services Manager
• The CCHP Pharmacy Director
• The CCHP Provider Relations Director
• The CCHP 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: For peer review issues, only medical providers may vote.
CHAIR CCHP Medical Director or designee
FREQUENCY I Monthly, a minimum of nine (9) times yearly
QUALITYCOUNCILSUBCOMMITTEES
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 andlor authorized 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.
• Reviews all Part D related denials, modified or deferred services as
prescribed by CMS.
• 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
QM Program Description 2008 Page 14 of 19
reviews.
• Assures that the Member Services Unit confidentially maintains Committee
files for 10 years.
Acts as the patient advocate within CCHP.
•. Refers issues regarding benefits to the BIMCommittee.
• 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.
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
QM Program Description 2008 Page 15 of 19
• 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
X7
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
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
QM Program Description 2008 Page 16 of 19
MANAGED CAM'.('01INLNIISSION (NICC)
• A Commercial subscriber
• An individual sensitive to medically indigentneeds
• 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 Chief Executive Officer
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
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.
• 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 Quality Improvement Projects and
results of interventions. Review the annual Quality Management Work
Plan.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
QM Program Description 2008 . Page 17 of 19
t
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.
I
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QM Program Description 2008 Page 18 of 1-9 I
i
Contra Costa Health Plan
Quality Management Program Description 2008
APPROVED BY QUALITY COUNCIL:
• `^^�
James R y ell, MD, Co ittee Chair Date
APPROVED BY THE MANAGED CARE COMMISSION:.
M/ haelr a, Commission Chair Date
APPROVED BY THE JOINT CONFERENCE COMMITTEE
Date '� D
daylpfB. Uilke ommittee Chair
APPROVED BY THE BOS
Date,
QM Program Description 2008 Page 19 of 19
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