Quality Improvement
Advanced Health’s culture, systems, and processes are structured around the overarching purpose of improving members’ care, health outcomes, and experiences. The Quality Management and Improvement (QMI) Program utilizes a systematic approach to quality improvement initiatives, employing reliable and valid methods of monitoring, analysis, evaluation, and enhancement in the delivery of health care to all members, with a specific emphasis on those with diverse ethnic or cultural backgrounds or special health care needs.
QMI Program Objectives and Goals
Advanced Health aims to deliver appropriate care to improve Members’ health status, identifying those at risk and implementing evidence-based interventions. The strategies are designed to achieve sustainable health improvements, evidenced through the annual Transformation and Quality Strategy plan that incorporates elements of the Quality Assurance and Performance Improvement Plan (QAPI) and OHA’s Health System Transformation strategies. This plan is reviewed and adopted by the Advanced Health Board of Directors.
Performance improvement projects (PIPs), focus studies, and other QI initiatives are designed and implemented in accordance with principles of sound research design and appropriate statistical analysis. The results of these studies are used to evaluate the appropriateness, level-of-care, and services delivered against established standards and guidelines for the provision of that care or service. Each QI initiative is also designed to allow Advanced Health to monitor improvement over time.
The QMI Program integrates QAPI activities across all care and service areas, aiming to address concerns, enhance services, and integrate care for health plan members. Objectives include planned activities, interventions, program scope, assessment, staff assignments, timelines, and implementation strategies. Annual assessments review services and care, incorporating new service areas or population changes into the QAPI plan. The QMI program objectives and activities undergo annual review and adjustments as necessary. Progress is monitored and documented within the QI work plan, ensuring continuous quality improvement and alignment with Advanced Health’s overarching goals.
QMI Program Structure
The ultimate oversight for the care and services provided to Members rests with Advanced Health’s board of directors. The board assigns accountability for the QMI Program to the Chief Medical Officer and the Senior Executive for Quality Assurance (the Executive Program Director). To support the QMI and engage stakeholders, Advanced Health convenes the Interagency Quality Committee (IAQC), which includes representatives from all sectors of the Advanced Health provider network.
The IAQC’s purpose includes:
- Identifying opportunities to transform the quality of care for Members
- Identifying areas of improvement within the organization
- Functioning as quality leaders to ensure improvement information is dispersed and implemented among staff, providers, and clinics
- Promoting safe clinical practices
This is accomplished through a comprehensive, network-wide system of ongoing, objective, and systematic monitoring; the identification, evaluation, and resolution of process problems; the identification of opportunities to improve Member outcomes; and the education of Members, providers, clinics, and staff regarding the Quality Improvement (QI), Utilization Management (UM), and Credentialing and Re-Credentialing programs.
Scope and Activities
The QMI program’s scope prioritizes high-risk, high-volume, or problematic areas, focusing on patient/member safety and care quality. It aligns with the CCO contract’s quality improvement initiatives covering nine components of the Transformation and Quality Strategy (TQS) set by OHA. This alignment fosters innovation and minimizes duplication by integrating health transformation efforts with federally mandated quality elements.
Advanced Health’s quality team reviews and adopts an annual Quality, Accountability, and Performance Improvement (QAPI) Plan based on managed care industry standards. The QAPI incorporates traditional quality/risk/utilization management approaches to identify problems, issues, and trends, with the objective of developing improvement opportunities. Most often, initiatives are selected based on data that indicates the need for improvement in a particular clinical or non-clinic focus area and includes targeted interventions that have the greatest potential for improving health outcomes or service standards.
The Oregon Health Authority Quality Incentive Program
OHA’s Quality Incentive Program serves as a tool to motivate and guide CCOs in improving healthcare quality for OHP members. It achieves this by focusing on specific areas for improvement, providing financial incentives, using a data-driven approach, and prioritizing the needs of vulnerable populations.
Every year, OHA allocates quality pool funding from a percentage of aggregate payments made to all CCOs for the year. The CCO’s performance is measured by OHA, which sets a Benchmark target for all CCOs in Oregon to work toward. Additionally, OHA sets an Improvement target unique to each CCO, based on their performance from the previous year. To meet an incentive measure, a CCO must reach either the statewide Benchmark target or its individual Improvement target.
Annual CCO Quality Incentive Program
Advanced Health’s contract with the Oregon Health Authority requires that providers participate in the distribution of any financial incentives earned through the performance metric program. Additionally, community-based social service organizations that contribute to attaining certain incentive metrics must be rewarded for their work from the available financial resources allocated to coordinated care.
Incentive metrics are integral to the success of the CCO model. OHA encourages health plans and their provider partners to develop innovative approaches to serve Oregon Health Plan members. These metrics measure the quality of care, access to care, and health outcomes for individuals enrolled in CCOs. OHA develops the measures and awards funds from the quality pool to CCOs based on their annual performance. Each CCO establishes its methodology for distributing the incentive funds to participating providers.
The Advanced Health methodology is developed in partnership with the provider community and is reviewed and approved by both Advanced Health’s Boards of Directors. Advanced Health deducts the administrative fee and taxes from funds received from OHA prior to distribution. The methodology outlined for the current year’s incentive is here (link).
2024 CCO Incentive Measure List:
- Assessments for Children in DHS Custody
- Childhood Immunization Status
- Cigarette Smoking Prevalence
- Depression Screening and Follow-Up
- Diabetes: HbA1c Poor Control
- Health Aspects of Kindergarten Readiness: CCO System-Level Social Emotional Health
- Immunizations for Adolescents
- Initiation and Engagement of Alcohol and Other Drug Treatment
- Oral Evaluation for Adults with Diabetes
- Preventive Dental or Oral Service Utilization
- Screening, Brief Intervention and Referral to Treatment (SBIRT) for Drug and Alcohol Use
- Timeliness of Postpartum Care
- Child and Adolescent Well-Child Visits for Ages 3-6
- Health Equity Meaningful Language Access
- Social Determinants of Health: Social Needs Screening and Referral
Resources & Contracts
Technical Specifications and Guidance Documents for CCO Incentive Measures
If you have any questions, please contact Advanced Health’s Quality team.
Lisa Castle, Quality Improvement Specialist, Lisa.Castle@advancedhealth.com
Naomi Brazille, Healthcare Quality and Risk Adjustment Manager, Naomi.Brazille@advancedhealth.com