Performance Improvement Projects: PIP Library Amy McCurry Schwartz, Esq., MHSA EQRO Consultant Behavioral Health Concepts, Inc.

Performance Improvement Projects The purpose of PIPs To assess and improve processes, and thereby outcomes, of care. 42 CFR 438.240(d) defines PIPs as having a “focus on clinical and non-clinical areas.”

Performance Improvement Projects Clinical PIPs Might Target Prevention and care of acute and chronic conditions High-volume services High-risk procedures Special health care needs

Performance Improvement Projects Non-Clinical PIPs Might Target Coordination of Care Appeals, Grievances Process Access or Authorization Member Services

PIP Library https://caleqro.com/pip-library

PIP Library

PIP Library PIP Videos Bringing Ideas to Successful PIP Concept PIP 101 series #1 From Idea to PIP – SUD Example PIP 101 series #2 Tips and Common Mistakes PIP 101 series #3

PIP Library PIP Clinic Webinars and Presentations Webinar recording (when available) PowerPoint presentation Slides

PIP Library PIP Development by Validation Step CMS EQR Protocol 3: Validating Performance Improvement Projects (PIPs) https://www.medicaid.gov/medicaid/quality-of- care/downloads/eqr-protocol-3.pdf

Step 1 – Study Topic The PIP should target improvement in either clinical or non-clinical services delivered by the MHP. Study topics must reflect consumer characteristics including demographics, prevalence of disease, and the potential consequences of disease. The topic should address a significant portion of the enrollees (or a specified sub-portion of beneficiaries) and have the potential to significantly impact consumer health, functional status, or satisfaction.

PIP Library – Step 1 Step 1 – Select and Describe the Study Topic and Methodology San Luis Obispo – Clinical PIP Integration of Mental Health and Substance Use Screening and Assessment PIP Narrative (as supplied by the MHP) PIP Validation Tool (as scored by BHC) https://caleqro.com/pip-library

Step 2 – Study Question Study Questions should be stated in a way that: Supports the ability to determine whether the intervention has a measurable impact for a clearly defined population The study question should focus on the outcomes for the consumer.

PIP Library - Step 2 Step 2 – Define and Include the Study Question(s) Santa Theresa – Clinical PIP Seeking Safety Implementation PIP Narrative (as supplied by the Example MHP) https://caleqro.com/pip-library

Step 3 – Study Population The PIP must clearly identify the ‘system’ or population, also referred to as the universe. Once the population is identified, the MHP will determine whether to study data for the entire population or a sample of that population.

PIP Library – Step 3 Step 3 – Identify Study Population San Diego – Non-Clinical PIP Client Engagement after Discharge from a Psychiatric Hospital PIP Narrative (as supplied by the MHP) PIP Validation Tool (as scored by BHC) https://caleqro.com/pip-library

Step 4 - Select Study Indicators A study indicator is a measurable characteristic, quality, trait, or attribute of a particular individual, object, or situation being studied. Each PIP should have one or more measured indicators to track performance and improvement over a specific period of time.

Step 4 – Select Study Indicators All measured indicators should be: Objective; and Clearly defined; and Based on current clinical knowledge or health services research; and Consumer outcomes (e.g., health or functional status, consumer satisfaction); or A valid indicator of these outcomes.

PIP Library – Step 4 Step 4 – Select and Explain the Study Indicators Sacramento – Non-Clinical PIP Implementing a Streamlined E-Scheduling Tool to Increase Timeliness to First Offered Appointment PIP Narrative (as supplied by the MHP) PIP Validation Tool (as scored by BHC) https://caleqro.com/pip-library

Step 5 – Sampling A sample is a statistical subset of a population that represents the entire population. Appropriate sampling is necessary to ensure valid and reliable information. Please refer to Appendix II of the EQR Protocols for an overview of sampling methodologies applicable to PIPs. Contact your Quality Reviewer for additional information if needed.

PIP Library – Step 5 Step 5 – Sampling Methods PIP to be added at a later date. https://caleqro.com/pip-library

Step 6 – Study Design and Data Collection Procedures Data collection procedures must ensure that the data used to measure performance are valid and reliable. Valid data measure what is intended to be measured, while reliable data produces consistent results. To ensure both validity and reliability, the data collection plan should specify: The data to be collected; The data sources; How and when the data are to be collected; Who will collect the data; and Instruments used to collect the data.

PIP Library – Step 6 Step 6 Sonoma – Non-Clinical PIP Enhancing Timeliness of Assessments and Treatments for Youth and Families PIP Narrative (as supplied by the MHP) PIP Validation Tool (as scored by BHC) https://caleqro.com/pip-library

Step 7 – Assess Improvement Strategies In this step, the reviewer determines the accuracy of the MHP’s plan for analyzing and interpreting the PIP’s results. Accurate PIP data analysis is critical because the MHP will implement changes in treatment and operations based on the results of a PIP.

PIP Library – Step 7 Step 7 Orange – Clinical PIP Increasing rates of step-down to ongoing care following hospital discharge PIP Narrative (as supplied by the MHP) PIP Validation Tool (as scored by BHC) https://caleqro.com/pip-library

Step 8 – Data Analysis and Interpretation of Study Results An improvement strategy is defined as an intervention designed to change behavior at an institutional, practitioner, or beneficiary level. The effectiveness of the intervention activity or activities is determined by measuring the MHP’s change in performance, according to predefined quality measures.

Step 8 – Data Analysis and Interpretation of Study Results Interventions are key to a PIP’s ability to bring about improved health care outcomes. Appropriate interventions must be identified and/or developed for each PIP to assure the likelihood of effecting measurable change. If repeat measures indicate that quality improvement actions were not successful (i.e., did not achieve significant improvement), the problem-solving process should begin again with data analysis to identify possible causes and propose and implement solutions. If the quality improvement actions were successful, the new processes should be standardized and monitored.

PIP Library – Step 8 Step 8 San Diego – Clinical PIP Therapeutic Homework PIP Narrative (as supplied by the MHP) PIP Validation Tool (as scored by BHC) https://caleqro.com/pip-library

Step 9 – Assess whether Improvement is “Real” Improvement Determining the likelihood that the results of the PIP are accurate. It is important to determine if a reported change represents “real” change or is a result of a short-term event unrelated to the intervention, or simply random chance. “Real improvement” can be assessed in several ways, but is most confidently assessed by calculating the degree to which an intervention is statistically “significant”.

PIP Library – Step 9 Step 9 Tuolumne – Clinical PIP Engaging Clients through the Intake and Assessment Process PIP Narrative (as supplied by the MHP) PIP Validation Tool (as scored by BHC) https://caleqro.com/pip-library

Step 10: Achieve Sustained Improvement If real change has occurred, the project should be able to achieve sustained improvement. Sustained improvement is demonstrated through repeated measurements over time. We'll be measuring change after phase I, II, III. More frequently is not possible because we are collecting data for clients that intake and discharge from a program after each phase. Is there anything you want added here?

PIP Library PIP Excellence - Examples of PIPs that were successfully implemented. Clinical San Diego – Therapeutic Homework Non-Clinical San Diego – Client Engagement after Discharge from a Psychiatric Hospital PIP Narrative (as supplied by the MHP) PIP Validation Tool (as scored by BHC) https://caleqro.com/pip-library

Questions Amy McCurry Schwartz, Esq., MHSA EQRO Consultant amy.mccurry@bhceqro.com 855-385-3776 x103