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

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

3. 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

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

5. PIP Library

6. PIP Library

7. 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

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

9. PIP Library PIP Development by Validation Step
CMS EQR Protocol 3: Validating Performance Improvement Projects (PIPs)
care/downloads/eqr-protocol-3.pdf

10. 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.

11. 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)

12. 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.

13. 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)

14. 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.

15. 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)

16. 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.

17. 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.

18. 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)

19. 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.

20. PIP Library – Step 5 Step 5 – Sampling Methods
PIP to be added at a later date.

21. 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.

22. 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)

23. 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.

24. 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)

25. 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.

26. 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.

27. 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)

28. 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”.

29. 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)

30. 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?

31. 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)

32. Questions Amy McCurry Schwartz, Esq., MHSA EQRO Consultant
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