Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. F. Quality Monitoring and Incentives


Quality measurement and improvement is an integral part of CCNC's work, and most of CCNC's quality monitoring is self-initiated. CCNC tracks 28 quality measures at the program, network, and practice level. Most measures are related to chronic diseases (including diabetes, asthma, heart failure, and hypertension) and disease prevention (such as cancer screening for adults). Two are specific to behavioral health, but not to adults: baseline glucose and baseline lipids in children prior to initiation of antipsychotics, then upon follow-up. CCNC also measures rates of preventable ED use and hospitalizations. The current set of quality measures was developed by a work group that included local clinicians and representatives of all 14 CCNC networks, who met over the course of a year for in-depth review of candidate measures. Quality measures are reviewed on an annual basis, and final measures are approved by vote of the CCNC clinical advisory board.

Allowing the local networks and PCPs to have ownership of quality- improvement efforts is an important part of CCNC's quality-improvement approach. Each network is responsible for piloting potential solutions and monitoring implementation, which is led by local physicians. Networks voluntarily share best practices solutions with other networks.

CCNC produces electronic quarterly reports at the practice level that compare quality measures for each practice over time and with other practices. These reports also list the patients for whom quality measures were not met so that the practice can put systems in place to better serve these patients. To evaluate cost savings, North Carolina's DMA contracts with an actuarial firm to evaluate whether CCNC is achieving projected cost savings targets.

CCNC has several mechanisms in place to promote evidence-based practices and to help providers avoid harmful practices. CCNC's provider portal (see below) calculates patient medication adherence and helps prevent medication errors. It also generates clinical care alerts that indicate, for example, whether patients with chronic illness have received the tests recommended by clinical care guidelines. In addition, two of the behavioral health program initiatives (the North Carolina ACCEPT project and ASAP [see Section E]) are designed to promote evidence-based, cost-effective prescribing practices and prevent patient harm. CCNC is also working with the state to implement an incentive-based payment system for PCPs, which would award higher payments to those who are providing evidence-based care.

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