Quality Management Update March 18, 2015

New Performance Improvement Project (1) Title: Controlled Substance Prescription Monitoring Program Database Use PIP Goals: 1. Increase Controlled Substance Prescription Monitoring Program prescriber registration (database). 2. Increase the number of prescribers that access the Controlled Substance Prescription Monitoring Program database. 2 Reaching across Arizona to provide comprehensive quality health care for those in need

Performance Improvement Project Participants Collaboration with: o Arizona State Board of Pharmacy o Arizona Department of Health Services o Attorney General’s Office o AHCCCS Contractors o AHCCCS Divisions/Units:  Clinical Quality Management  Medical Management  Operations  Office of the Director  Chief Medical Officer  Pharmacy Director 3 Reaching across Arizona to provide comprehensive quality health care for those in need

Performance Improvement Project Anticipated Outcomes Increase in number of prescribers registered to use the Controlled Substance Database Increase in the number of prescribers using the Controlled substance Database Improved coordination of care (and prescribing) Decreased adverse outcomes (unexpected deaths, hospitalizations, infants born with opioid addiction, etc.) Reduction in prescriber shopping (emergency departments, primary care providers, etc.) 4 Reaching across Arizona to provide comprehensive quality health care for those in need

New Performance Improvement Project (2) Title: Early Identification and Treatment of Developmental Issues PIP Goals: 1.Increase use of developmental screening tools. 2.Decrease age at which children with developmental issues are identified (and referred for treatment services). 5 Reaching across Arizona to provide comprehensive quality health care for those in need

Performance Improvement Project Participants Collaboration with: o Arizona Department of Health Services – Division of Behavioral Health Services o Department of Economic Security, Division of Developmental Disabilities o AHCCCS Contractors o Community organizations such as the Autism Community, Arizona Chapter of the American Academy of Pediatrics, Health Care Systems, etc. o AHCCCS Divisions/Units:  Clinical Quality Management (Quality Improvement and Maternal and Child Health)  Behavioral Health Administrator  Office of the Director – Chief Medical Officer  Operations 6 Reaching across Arizona to provide comprehensive quality health care for those in need

Performance Improvement Project Anticipated Outcomes Increase use of developmental screening tools: o Parents' Evaluation of Developmental Status (PEDS) o Ages and Stages Questionnaire (ASQ) o Modified Checklist for Autism in Toddlers (M-Chat) Reduce age at which children with developmental issues are identified. Increase referrals for treatment of children identified through screening as having a developmental issue. Note: Network capacity will be an additional focus area in this PIP. 7 Reaching across Arizona to provide comprehensive quality health care for those in need

Quality of Care Concerns Increase in “immediate care need or care needed today” issues. o Referrals received from Legislators, Attorney General’s Office, Advocates, Law Firms, Licensure, AHCCCS Director’s Office, AHCCCS Client Advocates Office, etc. Increase in “high profile” cases – those that are in the media or have the potential to be in the media. May not always seem like a quality of care issue, but if they are not resolved upon identification, may become a quality of care issue. As the AHCCCS population has increased, so has the number and types of quality of care cases. 8 Reaching across Arizona to provide comprehensive quality health care for those in need

Quality of Care Concerns Focusing on the content of the responses received from Contractor Quality Management o Information should clearly indicate the what, where, why, when and how of the situation and what the resolution was. o If AHCCCS CQM is able to read the relevant points we are able to close the case, if not, there is more work for Contractor Quality Management and AHCCCS CQM staff in the form of follow-up. Contractors are not consistently communicating with members or contacting them resulting in more calls to the referral sources. For Long Term Care complaints, a trend in Contractors referring to the provider to “self-investigate” the complaint. Anticipate more to come….. 9 Reaching across Arizona to provide comprehensive quality health care for those in need

Thank You. 10 Reaching across Arizona to provide comprehensive quality health care for those in need