The staff of Quality Improvement are committed to ensuring the supports and services provided to the people we serve by the Provider Network is one of the highest quality and exceed expectations. The team is responsible for the oversight of the Behavioral Health Care Provider Network System to ensure that Providers are improving the person’s care experience, advancing the health of the population, and reducing the per capita cost of health care.
Our team of qualified professionals address the four areas: Performance Improvement, Performance Monitoring, Performance Measurement, and External Quality Reviews and Accreditation functions.
Each year, the department formulates a Quality Assessment Performance Improvement Plan (QAPIP) and develops a Work Plan that aligns with Detroit Wayne’s Strategic Plan.
The QAPIP aligns with The National Committee for Quality Assurance (NCQA) and the Michigan Department of Health & Human Services (MDHHS) QAPIP as DWIHN is held accountable by MDHHS and its external quality review organization – Health Services Advisory Group.
Additionally, key functions and activities performed are:
Behavior Treatment Management and Oversite
Ensuring Access & Availability
Monitoring, compliance and claims verification of the Provider Network
Sentinel, Critical Events and Incident analysis and reporting
DWIHN maintains Committees, which help with the implementation of programming, and works in partnership with our Providers to improve quality of care and services. The Committees give them an opportunity to provide input into programs offered to people we serve.
Quality Assessment Performance Improvement Program
The Quality structure is described in the DWIHN’s Quality Assessment Performance Improvement Program (QAPIP). This aligns with the regulatory requirements of the Michigan Department of Health and Human Services (MDHHS), External Quality Review (EQR), and best practice for total quality management.
The QAPIP is facilitated by Quality Improvement within DWIHN, and includes but is not limited to the ten (10) functions identified in the Application for Participation. Quality Improvement is organized around four (4) core functions: Performance Improvement, Performance Measurement, Performance Monitoring and External Quality Review/Accreditation. DWIHN retains ultimate responsibility for these functions and requires the contracted providers to perform these functions:
Performance Improvement Function
This function is responsible for total quality management/continuous quality improvement activity. This involves the development of annual Quality Assessment and Performance Improvement plans, reports and implementation of the QAPIP. Performance Improvement includes the facilitation of the Quality Improvement Steering Committee (QISC).
The QISC oversees the quality function and is composed of key units within DWIHN, providers, consumers and practitioners. It reports to the Program Compliance Committee of the Board of Directors. The QISC receives performance reports from DWIHN Units and has a functional subcommittee structure that reports to it.
Performance Monitoring Function
The Performance Monitoring function is responsible for compliance monitoring of our entire system. DWIHN through its performance monitoring will set standards, conduct performance assessments, conduct remote and on-site monitoring of providers in the network; monitor facility quality improvement process, and facility provider education and oversight.
Additionally, the performance monitors are responsible for other key functions required by MDHHS. All MDHHS and Integrated Care Organization (ICO) site visits, corrective action plans and improvement plans are coordinated by the performance monitoring staff. New program enrollment reviews and Medicaid Enrollment reviews are conducted by the performance monitors. This involves a site visit to ensure any new program or program requiring Medicaid enrollment meet the minimum requirement for participation in our network.
External Quality Review (ERQ) and Accreditation Functions
These functions are responsible for coordinating outside entity review processes. This will specifically address EQR and our plan to pursue accreditation by National Council on Quality Assurance (NCQA). EQR is a Balance Budget Act requirement of CMS that MDHHS contract with an independent entity to review the quality of the Prepaid Inpatient Health Plans (PIHPs) as a condition of the waiver. MDHHS contracts with Health Services Advisory Group (HSAG) out of Arizona. They conduct three reviews annually: Compliance Monitoring, Performance Measure (ISCAT) Validation, and Performance Improvement Project (PIP) Validation.
It is an expectation by MDHHS that at a minimum DWIHN also provides the following ten *functions:
Developing an annual Quality Assessment and Performance Improvement Program (QAPIP) plan and report.
Conducting performance assessments
Conducting on-site monitoring of providers in the provider network.
Managing regulatory and corporate compliance,
Managing outside entity review processes (e.g., external quality review, PIHP accreditation),
Facilitating quality improvement process,
Facilitating provider education and oversight,
Analyzing critical incidents and sentinel events.
*All of these functions are not the direct responsibility of the Quality unit but may be connected through the Quality Improvement Program Structure under the Quality Improvement Steering Committee.