Common use of Performance Improvement Projects Clause in Contracts

Performance Improvement Projects. (PIPs) A. The Contractor shall design and implement PIPs that are focused on areas of concern to conduct on an ongoing basis. B. The Department will work with the EQRO and the MCOs to identify regionally based collaborative PIPs that would be feasible and impactful for the Kentucky healthcare community. All parties will work together to develop strategies and detailed processes for implementing and coordinating efforts for regional collaborative PIPs. To support a collaborative process, the Contractors shall perform the following activities: 1. Define the scope of the PIP, identify target populations, set improvement goals, and define comprehensive interventions; 2. Coordinate with existing State or MCO initiatives, as applicable; 3. Support development of meeting agenda topics, writing quarterly reports, and identifying subject matter experts who should attend meetings based on the agenda items, and writing quarterly reports upon Department request. 4. Provide adequate funding and staffing resources to execute the PIP. 5. Evaluate the successes and challenges of interventions on an ongoing basis, and provide quarterly progress reports and an annual findings report to the Department. DMS will give final approval for the collaborative PIP design and establish required timelines for ongoing meetings and coordination among the involved parties. C. As required by the Department, the Contractor shall implement an additional PIP if findings from an EQR review or audit indicate need or if directed by CMS. The Contractor shall assist the Department by supplying readily available data, soliciting input and supporting clinicians. D. Implement PIPs as identified and requested for conduct by CMS. The Contractor’s PIPs shall include the following elements: A. Measurement of performance using objective quality indicators and measures and minimum performance levels as defined collaboratively by the Department, the EQRO, and Contractor prior to commencement of each PIP. In determining indicators and measures, the Department and Contractor shall work to confirm they are not misaligned with those being used in other projects and that they are measurable and can be tracked. The Department shall have final decision and approval of required indicators and data definitions of each; B. Implementation of interventions to achieve improvement in the access to and quality of care; C. Evaluation of the effectiveness of the interventions based on the performance measures; and D. Planning and initiation of activities for increasing or sustaining improvement. The Contractor shall be committed to ongoing collaboration for service and clinical care improvements through efforts such as development of best practices, use of Encounter data-driven performance measures and establishment of relationship with existing organizations engaged in provider performance improvement through education and training in best practices and data collection. The Contractor shall develop collaborative relationships with local health departments, behavioral health agencies, community-based health and social agencies and health care delivery systems to achieve improvements in priority areas. Linkages with local public health agencies is essential for achievement of public health objectives. Evidence of adequate partnerships should include formal documentation of meetings, input from stakeholders and shared responsibility in the design and implementation of PIP activities. The Contractor shall complete each PIP in a period determined by the Department to allow information on the success of the project in the aggregate to produce new information on quality of care each year. Each PIP will use a study period approved by the Department. The Contractor shall continuously monitor its own performance on a variety of dimensions of care and services for Enrollees, identify areas for potential improvement, undertake system interventions to improve care and services, and monitor the effectiveness of those interventions. The Contractor shall participate in the quarterly quality meetings or more frequent meetings with the Department to review progress in achieving the identified goals and targeted improvements for the PIP focus areas. The Department may request ad-hoc meetings as it deems necessary to, for example, address areas of non-compliance. The Department will provide the Contractor with reasonable advance notice of meetings, generally at least five (5) Business Days when possible. The Contractor shall provide to the Department, no later than fourteen (14) Business Days prior to each quarterly meeting, an electronic report detailing the Contractor’s progress, successful strategies, and challenges in achieving improvements. The Contractor shall report the status and results of all required PIPs to the Department as required in 42 C.F.R. 438.330(c)(3) with sufficient detail for the Department to evaluate the reliability and validity of the data and the conclusions drawn. The Contractor’s final report shall follow a format as approved by the Department, and must provide detailed information that addresses all items, as applicable, that are outlined in the CMS Protocol for Performance Improvement Projects, PIP Review Worksheet. The Contractor shall validate if improvements were sustained through periodic audits of the relevant data and maintenance of the interventions that resulted in improvement. While undertaking a PIP, no specific payments shall be made directly or indirectly to a provider or provider group as an inducement to reduce or limit Medically Necessary services furnished to an Enrollee.

Performance Improvement Projects. (PIPs) A. The Contractor shall design and implement PIPs that are focused on areas of concern to conduct on an ongoing basis. B. The Department will work with the EQRO and the MCOs to identify regionally based collaborative PIPs that would be feasible and impactful for the Kentucky healthcare community. All parties will work together to develop strategies and detailed processes for implementing and coordinating efforts for regional collaborative PIPs. To support a collaborative process, the Contractors shall perform the following activities: 1. Define the scope of the PIP, identify target populations, set improvement goals, and define comprehensive interventions; 2. Coordinate with existing State or MCO initiatives, as applicable; 3. Support development of meeting agenda topics, writing quarterly reports, and identifying subject matter experts who should attend meetings based on the agenda items, and writing quarterly reports upon Department request. 4. Provide adequate funding and staffing resources to execute the PIP. 5. Evaluate the successes and challenges of interventions on an ongoing basis, and provide quarterly progress reports and an annual findings report to the Department. DMS will give final approval for the collaborative PIP design and establish required timelines for ongoing meetings and coordination among the involved parties. C. As required by the Department, the Contractor shall implement an additional PIP if findings from an EQR review or audit indicate need or if directed by CMS. The Contractor shall assist the Department by supplying readily available data, soliciting input and supporting clinicians. D. Implement PIPs as identified and requested for conduct by CMS. The Contractor’s PIPs shall include the following elements: A. Measurement of performance using objective quality indicators and measures and minimum performance levels as defined collaboratively by the Department, the EQRO, and Contractor prior to commencement of each PIP. In determining indicators and measures, the Department and Contractor shall work to confirm they are not misaligned with those being used in other projects and that they are measurable and can be tracked. The Department shall have final decision and approval of required indicators and data definitions of each; B. Implementation of interventions to achieve improvement in the access to and quality of care; C. Evaluation of the effectiveness of the interventions based on the performance measures; and D. Planning and initiation of activities for increasing or sustaining improvement. The Contractor shall be committed to ongoing collaboration for service and clinical care improvements through efforts such as development of best practices, use of Encounter data-driven performance measures and establishment of relationship with existing organizations engaged in provider performance improvement through education and training in best practices and data collection. The Contractor shall develop collaborative relationships with local health departments, behavioral health agencies, community-based health and social agencies and health care delivery systems to achieve improvements in priority areas. Linkages with local public health agencies is essential for achievement of public health objectives. Evidence of adequate partnerships should include formal documentation of meetings, input from stakeholders and shared responsibility in the design and implementation of PIP activities. The Contractor shall complete each PIP in a period determined by the Department to allow information on the success of the project in the aggregate to produce new information on quality of care each year. Each PIP will use a study period approved by the Department. The Contractor shall continuously monitor its own performance on a variety of dimensions of care and services for Enrollees, identify areas for potential improvement, undertake system interventions to improve care and services, and monitor the effectiveness of those interventionsinterventions . The Contractor shall participate in the quarterly quality meetings or more frequent meetings with the Department to review progress in achieving the identified goals and targeted improvements for the PIP focus areas. The Department may request ad-hoc meetings as it deems necessary to, for example, address areas of non-compliance. The Department will provide the Contractor with reasonable advance notice of meetings, generally at least five (5) Business Days when possible. The Contractor shall provide to the Department, no later than fourteen (14) Business Days prior to each quarterly meeting, an electronic report detailing the Contractor’s progress, successful strategies, and challenges in achieving improvements. The Contractor shall report the status and results of all required PIPs to the Department as required in 42 C.F.R. 438.330(c)(3) with sufficient detail for the Department to evaluate the reliability and validity of the data and the conclusions drawn. The Contractor’s final report shall follow a format as approved by the Department, and must provide detailed information that addresses all items, as applicable, that are outlined in the CMS Protocol for Performance Improvement Projects, PIP Review Worksheet. The Contractor shall validate if improvements were sustained through periodic audits of the relevant data and maintenance of the interventions that resulted in improvement. While undertaking a PIP, no specific payments shall be made directly or indirectly to a provider or provider group as an inducement to reduce or limit Medically Necessary services furnished to an Enrollee.