Performance Improvement Projects. 4.12.6.1 As part of its QAPI program, the Contractor shall conduct clinical and non-clinical performance improvement projects in accordance with DCH and federal protocols. In designing its performance improvement projects, the Contractor shall: · Show that the selected area of study is based on a demonstration of need and is expected to achieve measurable benefit to the Member (rationale); · Establish clear, defined and measurable goals and objectives that the Contractor shall achieve in each year of the project; · Measure performance using Quality indicators that are objective, measurable, clearly defined and that allow tracking of performance and improvement over time; · Implement interventions designed to achieve Quality improvements; · Evaluate the effectiveness of the interventions; · Establish standardized performance measures (such as HEDIS or another similarly standardized product); · Plan and initiate activities for increasing or sustaining improvement; and · Document the data collection methodology used (including sources) and steps taken to assure data is valid and reliable. 4.12.6.2 Each performance improvement project must be completed in a period determined by DCH, to allow information on the success of the project in the aggregate to produce new information on Quality of care each year. 4.12.6.3 The Contractor shall perform the following required performance improvement projects, as agreed upon by the Parties (see Section 4.12.6.5), beginning January 1, 2012, ongoing for the duration of the GF Contract period: · Well-child visits; · ADHD Medication follow up; · Immunization rates; · Dental-children · Obesity-children · Comprehensive Diabetes Care; · Avoidable Emergency room utilization; · Member satisfaction, and · Provider satisfaction 4.12.6.4 Each PIP will use the calendar year as the study period. 4.12.6.5 Each PIP will use the study question and study indicators agreed upon by DCH and the CMOs. 4.12.6.6 Each CMO will submit the designated PIPs to DCH and/or the EQRO using the DCH specified template and format by June 30 of each contract year with the exception of the member satisfaction PIP which is due by August 1. 4.12.6.7 The EQRO will evaluate the CMOs’ PIP performance on an annual basis. DCH reserves the right to request modification of the PIPs based on this evaluation. Modifications will be discussed with each CMO prior to implementation.
Appears in 2 contracts
Sources: Contract for Provision of Services (Wellcare Health Plans, Inc.), Contract (Centene Corp)
Performance Improvement Projects. 4.12.6.1 As part of its QAPI program, the Contractor shall conduct clinical and non-clinical performance improvement projects in accordance with DCH and federal protocols. In designing its performance improvement projects, the Contractor shall: · • Show that the selected area of study is based on a demonstration of need and is expected to achieve measurable benefit to the Member (rationale); · • Establish clear, defined and measurable goals and objectives that the Contractor shall achieve in each year of the project; · • Measure performance using Quality indicators that are objective, measurable, clearly defined and that allow tracking of performance and improvement over time; · • Implement interventions designed to achieve Quality improvements; · • Evaluate the effectiveness of the interventions; · • Establish standardized performance measures (such as HEDIS or another similarly standardized product); · • Plan and initiate activities for increasing or sustaining improvement; and · • Document the data collection methodology used (including sources) and steps taken to assure data is valid and reliable.
4.12.6.2 Each performance improvement project must be completed in a period determined by DCH, to allow information on the success of the project in the aggregate to produce new information on Quality of care each year.
4.12.6.3 The Contractor shall perform the following required performance improvement projects, as agreed upon by the Parties (see Section 4.12.6.5), beginning January 1, 2012, ongoing for the duration of the GF Contract period: · • Well-child visits; · • ADHD Medication follow up; · • Immunization rates; · • Dental-children · • Obesity-children · • Comprehensive Diabetes Care; · • Avoidable Emergency room utilization; · • Member satisfaction, and · • Provider satisfaction
4.12.6.4 Each PIP will use the calendar year as the study period.
4.12.6.5 Each PIP will use the study question and study indicators agreed upon by DCH and the CMOs.
4.12.6.6 Each CMO will submit the designated PIPs to DCH and/or the EQRO using the DCH specified template and format by June 30 of each contract year with the exception of the member satisfaction PIP which is due by August 1.
4.12.6.7 The EQRO will evaluate the CMOs’ PIP performance on an annual basis. DCH reserves the right to request modification of the PIPs based on this evaluation. Modifications will be discussed with each CMO prior to implementation.
Appears in 1 contract
Sources: Contract for Provision of Services (Wellcare Health Plans, Inc.)
Performance Improvement Projects.
4.12.6.1 As part of its QAPI program, the Contractor shall conduct clinical and non-non- clinical performance improvement projects in accordance with DCH and federal protocols. In designing its performance improvement projects, the Contractor shall: · • Show that the selected area of study is based on a demonstration of need and is expected to achieve measurable benefit to the Member (rationale); · • Establish clear, defined and measurable goals and objectives that the Contractor shall achieve in each year of the project; · • Measure performance using Quality indicators that are objective, measurable, clearly defined and that allow tracking of performance and improvement over time; · • Implement interventions designed to achieve Quality improvements; · • Evaluate the effectiveness of the interventions; · • Establish standardized performance measures (such as HEDIS or another similarly standardized product); · • Plan and initiate activities for increasing or sustaining improvement; and · • Document the data collection methodology used (including sources) and steps taken to assure data is valid and reliable.
4.12.6.2 Each performance improvement project must be completed in a period determined by DCH, to allow information on the success of the project in the aggregate to produce new information on Quality of care each year.
4.12.6.3 The Contractor shall perform the following required performance improvement projects, as agreed upon by the Parties (see Section 4.12.6.5), beginning January 1, 2012, ongoing for the duration of the GF Contract period: · • Well-child visits; · • ADHD Medication follow up; · • Immunization rates; · • Dental-children · • Obesity-children · • Comprehensive Diabetes Care; · • Avoidable Emergency room utilization; · • Member satisfaction, and · • Provider satisfaction
4.12.6.4 Each PIP will use the calendar year as the study period.
4.12.6.5 Each PIP will use the study question and study indicators agreed upon by DCH and the CMOs.
4.12.6.6 Each CMO will submit the designated PIPs to DCH and/or the EQRO using the DCH specified template and format by June 30 of each contract year with the exception of the member satisfaction PIP which is due by August 1.
4.12.6.7 The EQRO will evaluate the CMOs’ PIP performance on an annual basis. DCH reserves the right to request modification of the PIPs based on this evaluation. Modifications will be discussed with each CMO prior to implementation.
Appears in 1 contract
Sources: Contract for Provision of Services
Performance Improvement Projects. 4.12.6.1 As part of its QAPI program, the Contractor shall conduct clinical and non-clinical performance improvement projects in accordance with DCH and federal protocols. In designing its performance improvement projects, the Contractor shall: · Show that the selected area of study is based on a demonstration of need and is expected to achieve measurable benefit to the Member (rationale); · Establish clear, defined and measurable goals and objectives that the Contractor shall achieve in each year of the project; · Measure performance using Quality indicators that are objective, measurable, clearly defined and that allow tracking of performance and improvement over time; · Implement interventions designed to achieve Quality improvements; · Evaluate the effectiveness of the interventions; · Establish standardized performance measures (such as HEDIS or another similarly standardized product); · Plan and initiate activities for increasing or sustaining improvement; and · Document the data collection methodology used (including sources) and steps taken to assure data is valid and reliable.
4.12.6.2 Each performance improvement project must be completed in a period determined by DCH, to allow information on the success of the project in the aggregate to produce new information on Quality of care each year.
4.12.6.3 The Contractor shall perform the following required performance improvement projects, as agreed upon by the Parties (see Section 4.12.6.5), beginning January 1, 2012, ongoing for the duration of the GF Contract period: · Well-child visitsvisits during the first fifteen (15) months of life; · ADHD Medication follow upBlood lead screening; · Immunization ratesChildhood immunization rates (comb 2); · Dental-children · Obesity-children · Comprehensive Diabetes Care; Access to care for members aged 20 - 44 · Avoidable Emergency room utilization; · Member satisfaction, and · Provider satisfaction
4.12.6.4 Each PIP will use the calendar year as the study period.
4.12.6.5 Each PIP will use the study question and study indicators agreed upon by DCH and the CMOs.
4.12.6.6 Each CMO will submit the designated PIPs to DCH and/or the EQRO using the DCH specified template and format by June 30 of each contract year with the exception of the member satisfaction PIP which is due by August 1year.
4.12.6.7 The EQRO DCH will evaluate the CMOs’ CMOs PIP performance on an annual basis. DCH basis and reserves the right to request modification of the PIPs based on this evaluation. Modifications will be discussed with each CMO prior to implementation.
4.12.6.8 The Contractor shall perform the following required non-clinical performance improvement projects: · One (1) in the area of Member satisfaction; and · One (1) in the area of Provider satisfaction;
4.12.6.9 The Contractor shall perform one (1) optional non-clinical performance improvement project from the following areas: · Cultural competence; · Appeals/Grievance/Provider Complaints; · Access/service capacity; or · Appointment availability.
Appears in 1 contract
Performance Improvement Projects. 4.12.6.1 As part of its QAPI program, the Contractor shall conduct clinical and non-clinical performance improvement projects in accordance with DCH and federal protocols. In designing its performance improvement projects, the Contractor shall: · Show that the selected area of study is based on a demonstration of need and is expected to achieve measurable benefit to the Member (rationale); · Establish clear, defined and measurable goals and objectives that the Contractor shall achieve in each year of the project; · Measure performance using Quality indicators that are objective, measurable, clearly defined and that allow tracking of performance and improvement over time; · Implement interventions designed to achieve Quality improvements; · Evaluate the effectiveness of the interventions; · Establish standardized performance measures (such as HEDIS or another similarly standardized product); · Plan and initiate activities for increasing or sustaining improvement; and · Document the data collection methodology used (including sources) and steps taken to assure data is valid and reliable.
4.12.6.2 Each performance improvement project must be completed in a period determined by DCH, to allow information on the success of the project in the aggregate to produce new information on Quality of care each year.
4.12.6.3 The Contractor shall perform the following required performance improvement projects, as agreed upon by the Parties (see Section 4.12.6.5), beginning January 1, 2012, ongoing for the duration of the GF Contract period: · Well-child visitsvisits during the first fifteen (15) months of life; · ADHD Medication follow upBlood lead screening; · Immunization ratesChildhood immunization rates (combo 2); · Dental-children · Obesity-children · Comprehensive Diabetes CareAccess to care for members aged 20 – 44; · Avoidable Emergency room utilization; · Member satisfaction, and · Provider satisfaction
4.12.6.4 Each PIP will use the calendar year as the study period.
4.12.6.5 Each PIP will use the study question and study indicators agreed upon by DCH and the CMOs.
4.12.6.6 Each CMO will submit the designated PIPs to DCH and/or the EQRO using the DCH specified template and format by June 30 of each contract year with the exception of the member satisfaction PIP which is due by August 1year.
4.12.6.7 The EQRO DCH will evaluate the CMOs’ CMOs PIP performance on an annual basis. DCH basis and reserves the right to request modification of the PIPs based on this evaluation. Modifications will be discussed with each CMO prior to implementation.
4.12.6.8 The Contractor shall perform the following required non-clinical performance improvement projects: · One (1) in the area of Member satisfaction; and · One (1) in the area of Provider satisfaction.
4.12.6.9 The Contractor shall perform one (1) optional non-clinical performance improvement project from the following areas: · Cultural competence; · Appeals/Grievance/Provider Complaints; · Access/service capacity; or · Appointment availability.
Appears in 1 contract