Provider-Payer Partnerships as an Engine for Continuous Quality Improvement

Abstract

The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.

A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact

“…Specific barriers were improper goals and poor planning [36,86,88], fragmentation of quality assurance policies [87], inadequate reinforcement to staff [36,90], time constraints [85,86], resource inadequacy [86], and work overload [86]. These barriers can be addressed through strengthening leadership [86,87], CQI-based mentoring [94], periodic monitoring, supportive supervision and coaching [43,53,87,92,95], participation, empowerment, and accountability [67], involving all stakeholders in decision-making [86,87], a providerpayer partnership [64], and compensating staff for afterhours meetings on CQI [85]. The strategic dimension, characterized by a strategic plan and integrated CQI efforts, is devoted to processes that are central to achieving strategic priorities.…”

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies

“…At the system level, data are a powerful tool for quality improvement and will be increasingly tied to financing as alternative payment models evolve (91). However, very few quality measurement standards exist for crisis services.…”