We systematically monitor and evaluate services provided by subcontractor agencies in our network. The resulting aim is to improve the process, outcome and efficiency of the complex delivery of behavioral healthcare.
SFBHN is committed to the development, implementation, and quality assurance of the network with priority given to those areas that impact individuals served and their families. As such, SFBHN systematically monitors and evaluates subcontractor services with the aim of improving the process, outcome, and efficiency of integrated healthcare services delivered to consumers. Quality Assurance takes place through a variety of methods, including but not limited to, the review of compliance and quality elements of each provider through the Provider Report Card, Contract Accountability Monitoring, complaint and grievance protocol, performance and outcome measurement monitoring, incident reporting trending and investigations, and monitoring of a provider’s ability to effectively and accurately execute evidence based practices, emerging trends, and promising practices.
Integrated Behavioral and Primary Health Care (Integrated care-IC)
It is the goal of the ME to ensure the integration of behavioral health services and primary care services to all the consumers in care. Many individuals with behavioral health issues have chronic health conditions and may have neglected their primary health needs for some time. The ME and the Southern Region are committed to developing an integrated system of care that incorporates comprehensive screening and monitoring tools that identify those affected by chronic health conditions and a system of care that meets their needs. Network Providers will be implementing Integrated Primary and Behavioral Health techniques and initiatives to meet this need. This initiative will be addressed through a continuous quality improvement plan or component in the existing agency wide continuous quality improvement plan that delineates participation in the Health Integration Initiative.
- MEHAF Self-Assessment Tool (See attached)
- System wide survey results (currently in process)
Network Service Provider Report Card
The Report Card provides a snap shot of the provider’s current compliance and status. It identifies each provider’s status in the following areas:
- Data submission, validation and accuracy
- Improvement in outcomes and performance
- Fiscal solvency and stability
- System of care quality and utilization management
- Continuous quality improvement
- Contract compliance and contract monitoring
- Corrective action plan(s) identification
The Report Card allows stakeholders to quickly identify areas of concern, note trends and monitor changes. Various sections of the Report Card have critical indicators which, if scored as failing, may require the provider meet formally with SFBHN staff to discuss issues resulting in the failing score and any corrective actions needed to immediately rectify these issues.
As an additional evaluation tool, CQI and System of Care staff will perform “Secret Shopper” exercises. For accountability purposes, the Provider Report Card tracks a provider’s performance during the exercise. The purpose of the exercise is to attempt to access services in the same manner in which individuals served would access services. The goal is to observe how the staff of provider agencies interacts with individuals served; for example, whether they treat individuals served with courtesy and empathy, and whether they offer appropriate assistance and services in a timely fashion. If the provider agency does not adequately demonstrate the ability to provide ready access to appropriate services, the findings of the “Secret Shopper” may result in an onsite visit, formal meeting, and/or corrective action.