|
|
Quality Improvement (QI) describes an integrated process that links knowledge, structures, processes, and outcomes in order to enhance quality throughout an organization. The Optima Behavioral Health Quality Improvement program (OBH-QI) uses continuous quality improvement methods to provide comprehensive behavioral health care services with internal Optima Behavioral Health departments and externally with contracting providers, facility providers, and health plans. OBH-QI is fully integrated with the Optima Health Quality Improvement program.
The Medical Director has overall responsibility for the Quality Improvement plan and has oversight responsibilities for the following committees:
Quality Improvement Committee (QIC)
The QIC is responsible for the comprehensive review, analysis, and enhancement of the quality improvement initiatives and processes.
Medical Care Review Committee (MCRC)
The MCRC conducts peer reviews of SBHS behavioral healthcare treatment, assesses new technologies and treatments, and recommends improvements to the QIC for clinical care and service delivery.
Credentialing Committee (CC)
The CC conducts the initial credentialing and subsequent recredentialing (every two years) review processes for all providers seeking contracted status with OBH.
Quality Initiatives
The Quality Improvement department is actively involved in the development, implementation, monitoring, and analysis of numerous activities and seeks opportunities for continuous improvement. These activities include:
- Access Study - A study designed to improve response rates to members' requests for services.
- HEDIS® Follow-up After Hospitalization for Mental Illness - A behavioral health standard that addresses members being seen for follow-up treatment within 7 days and 30 days after hospitalization.
- HEDIS® Antidepressant Medication Management – a behavioral health standard that addresses the successful pharmacological management of depression in adults during the acute and continuation phases of treatment.
- Clinical Guidelines – Research, development, publication, and implementation of inpatient and outpatient treatment protocols for use by providers.
- Preventive Health and Wellness – Development of programs for the general membership and for members who have received behavioral health services.
- Surveys – Conducted to obtain information from members and providers about OBH services and clinical treatment.
- Treatment Record Review – Conducted periodically to ensure quality documentation standards are met and to provide opportunities for improvement.
- Continuity and Coordination of Care – Activities geared to improving communication and collaboration between Primary Care Practitioners and Behavioral Health Practitioners.
- In-service Education – Offered to providers and employees of contracted commercial practices and community services boards.
Members and providers are invited to provide comments and feedback about the QI plan. Contact:
Optima Behavioral Health
Quality Improvement Department
4417 Corporation Lane, Suite 250
Virginia Beach, VA 23462
Telephone: (757) 552-7500
Fax: (757) 552-7176
Quick Links:
 Learn More about Quality Improvement
Learn More about Optima Health
|