Quality Improvement

Quality Improvement

Quality Assessment and Performance Improvement

The Behavioral Health Department has a comprehensive and ongoing Quality Assessment and Performance Improvement (QAPI) Program, rendered through the Quality Management (QM) Program. The QM mission is to ensure Medi-Cal members and residents of Alameda County receive timely access to appropriate, cost-effective, and quality behavioral health care services within the Mental Health Plan (MHP) and Drug Medi-Cal-Organized Delivery System (DMC-ODS). Structure, processes, and outcomes are the prioritized quality measures. An annual Quality Improvement Work Plan (QIWP) covers monitoring performance and quality improvement projects and activities. A Quality Improvement Committee (QIC) further monitors, reviews, and improves the quality of behavioral health care services. Additionally, annual External Quality Reviews (EQR), rendered by the State-contracted independent review organization, serve to provide targeted system performance improvement opportunities. All quality improvement activities utilize broad internal and external stakeholder (e.g. BHD leadership, contract providers, family members, and peers) input and involvement.

Quality Management

The ACBHD Quality Management (QM) Program is comprised of Quality Assurance (QA), Quality Improvement (QI), and Utilization Management (UM). The following provides an overview of the responsibilities and functions of the three units.

Quality Assurance (QA)

QA has overall oversight and monitoring responsibility for the quality of services, inclusive of ensuring that applicable Federal, State, and local laws, regulations, and policies are met by all ACBHD providers. Below are examples of QA functions:

  • Establishes clinical record documentation standards and conducts clinical chart audits
  • Receives, resolves, and monitors beneficiary grievances and appeals with annual analysis and trends reporting to the ACBHD Quality Improvement Committee (QIC)
  • Clinical review of Unusual Occurrences with annual analysis and trends reporting to the ACBHD QIC
  • Develops and renders provider training
  • Develops and renders Brown Bag Q&A sessions and Technical Assistance (TA)
  • Serves as ACBHD lead for the Department of Health Care Services (DHCS) Triennial System and Non-Hospital Service Chart Review Audit
  • Conducts and monitors Medi-Cal Site Certification for contracted and county-operated mental health programs

Quality Improvement (QI)

QI has overall responsibility for developing, implementing, and overseeing the department’s federally mandated Quality Assessment & Performance Improvement (QAPI) Program. Through the lens of system structure and operations, QI collaborates with key stakeholders, including ACBHD leadership, contract providers, consumers, and family members, to build a culture of Continuous Quality Improvement (CQI). Below are examples of QI functions:

  • Directs Quality Improvement Committee (QIC) and subcommittees
  • Develops and evaluates Quality Improvement activities, including Performance Improvement Projects (PIP)
  • Develops and evaluates Quality Improvement Work Plan (QIWP)
  • Serves as ACBHD lead for annual External Quality Review Organization (EQRO) reviews
  • Develops and implements performance assessment and monitoring strategies
  • Collects, analyzes, and reports performance measurement data
  • Coordinates ACBHD’s Policies & Procedures

Utilization Management (UM)

UM has overall responsibility to strategically design and implement Federal and State regulations and laws as it pertains to coverage and authorization of services, assuring that beneficiaries have appropriate access to services. UM evaluates medical necessity, appropriateness and efficiency of services, with an emphasis on high-level and high-cost services. Prospective, concurrent, and retrospective review methodologies are utilized to determine service access, appropriateness, and cost-effectiveness. Service and payment authorization determinations are rendered in accordance with medical necessity and appropriate level-of-care criteria and tools. Below are examples of UM functions:

  • Develops and implements utilization data reporting systems to identify utilization trends and provider patterns
  • Service authorization for a range of Specialty Mental Health Services, including but not limited to acute psychiatric hospital, residential treatment, and day treatment
  • Service authorization for Substance Use Disorder residential treatment services
  • Serves as ACBHD lead for the DHCS Triennial Short Doyle/Medi-Cal (SD/MC) Hospital (aka John George Psychiatric Hospital) Chart Audit