COMMITMENT TO QUALITY

For Optum Idaho, Quality Assurance and Performance Improvement  (QAPI) is not a department, but a central tenet in the way we conduct all aspects of our operation.  We are continually monitoring multiple areas of our performance; our impact on members, families, other stakeholders and providers; and constantly looking for ways to improve.

Our comprehensive QAPI program encompasses outcomes, quality assessment, quality management, quality assurance, and performance improvement.  The QAPI program includes data driven, focused performance improvement activities designed to meet the behavioral health needs of our members /member families, State of Idaho contract requirements and federal  regulations. 

Member input and guidance is critical to transform the mental health system, which is why we actively engage with members through various committees, boards and organizations to ensure their voice is a part of our decision-making process. We also conduct quarterly member satisfaction surveys that influence how we monitor and adjust our operations to help us meet and exceed performance metrics.

Upon request, Optum makes information available about the QAPI Program, including a description of the QAPI Program and a report on our progress in meeting goals.

Quality Assurance & Performance Improvement Committee

Role/Purpose:

 

  • The QAPI Committee’s purpose is to oversee, organize, and evaluate all quality improvement activity.   It is responsible for the implementation of the Outcomes Management & Quality Improvement Plan with the mission to improve the behavioral health and well-being of the Membership it serves, promote high quality behavioral care, and a focus on recovery and resiliency for Members and families.   
  • The QAPI Committee also is responsible for reviewing measurements, outcomes, and reports that show progress toward system transformation.  Areas that do not show progress toward desired outcomes are targeted for improvement efforts through the establishment of cross functional teams to address systems issues on a periodic and time-limited basis.  
Peer Review Committee

Role/Purpose

  • The Peer Review Committee reviews member cases related to reported critical incidents and identified quality of care concerns and Initiates engagement, monitoring and outreach activities with network agencies/individual practitioners as necessary.
  • The Peer Review Committee is not responsible for reviews related to member service requests.

The Provider Advisory Committee reports to the QAPI Committee.

Provider Advisory Committee

Role/Purpose:

  • The purpose of the Optum Idaho Provider Advisory Committee is to establish a forum for representatives from the qualified service providers to provide recommendations, input and prioritization of initiatives or issues impacting the provider community.  The Committee is also a forum for providers to bring forth their recommendations for changes to procedures, enhancements to systems or to discuss/plan key initiatives to put forth to IDHW.

The Provider Advisory Committee reports to the QAPI Committee.

Recovery and Resiliency Council

Role/Purpose:

  • The Recovery and Resiliency Council’s role is to collaboratively review, contribute, and suggest from a member’s perspective potential gaps and needs as well as successes and notable improvements to the delivery of services in the Optum Idaho Behavioral Health Plan. The Recovery and Resiliency Council provides a forum to promote community and regional representation and solicit feedback to improve services provided our members.

The Recovery and Resiliency Council reports to the QAPI Committee.

Clinical Service Advisory Committee

Role/Purpose:

  • The Clinical and Service Advisory Committee is responsible for reviewing inter-rater reliability, utilization and outcomes data for tracking and trending of quality of care and service.  The Committee is also responsible for approving and modifying all utilization management criteria and practice guidelines tailored to the specific needs, regulatory requirements and policies of Optum Idaho.

The Clinical Service Advisory Committee reports to the QAPI Committee.