QUALITY MANAGEMENT

Ventura County Behavioral Health (VCBH), a department of the Ventura County Health Care Agency (HCA), provides a system of coordinated services to address the specialty mental health and substance use treatment needs of Ventura County. The Department is committed to excellence through “best practices” and a consumer-driven and culturally competent approach to service delivery. VCBH staff are dedicated to reducing suffering and enhancing recovery from mental illness and/or substance use issues. VCBH believes that consumer and family member involvement is critical to meeting our commitment to excellence and for profound change in consumers’ lives. Therefore, VCBH is dedicated to integrating consumers and family members across the Department’s organization and activities.

VCBH Quality Management (QM) Program

The VCBH Quality Management Program is accountable to the VCBH Director, resides within the Administration Division and is overseen by the Administration Division Chief, the Compliance Senior Manager and the QI/EHR Senior Manager. QM is focused on the successful implementation of the Behavioral Health Department’s stated mission and goals and is responsible for reviewing the quality of behavioral health services provided to Medi-Cal beneficiaries and ensuring compliance with contract requirements and relevant Federal and State regulations. The Quality Management Program is also responsible for: quality improvement projects; performance outcome tracking and analyses; and ensuring overall quality in service delivery. The principles of wellness, recovery, resiliency, and cultural competency are embedded within and direct all Quality Management activities and projects. The QM Program consists of five units that work collaboratively to achieve the goals of the annual Quality Assessment and Performance Improvement Work Plan. The units, described in further detail below include: Quality Assurance, Quality Improvement, Medical Records, Training, and Pharmacy.

Quality Assurance (QA)

QA activities include ensuring and monitoring compliance with contract requirements, Federal and State regulations, and Department policies and procedures. QA staff are responsible for policy and procedure development; utilization review (UR); inpatient and outpatient service authorization; documentation training; processing provider appeals, beneficiary grievances and appeals, and Out-of-Network service authorization requests; provider credentialing; monitoring provider network adequacy; facilitating Presumptive Transfers and ensuring the completion of Medi-Cal site certifications for all internal county programs and contracted providers. In the event that fraud, waste, or abuse are suspected or identified, QA staff make a report to the HCA Compliance Officer and investigate incidents, as needed, to identify procedures to prevent future incidents and resolve quality of care issues.

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Additional Resources

2020 Mental Health Implementation Plan for Medi-Cal Specialty Mental Health Services

As the Mental Health Plan responsible for provision of Specialty Mental Health Services (SMHS) for eligible Ventura County Medi-Cal beneficiaries, VCBH is required to maintain a current Implementation Plan describing services provided and protocols implemented to ensure compliance with State and Federal rules and regulations (CCR, tit. 9, §§ 1810.310).

 

Quality Improvement (QI)

The VCBH Quality Improvement unit is responsible for the coordination, planning, oversight, and communication of quality improvement principles, projects, analyses, and findings to achieve the Department’s mission, vision, and goals. The principles of wellness, recovery, resiliency, and cultural competency serve to direct all Quality Improvement activities and projects. The QI team monitors and evaluates Mental Health Services and Substance Use Services that are provided by VCBH.   

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QI activities include the use of performance measures and outcome data to identify and prioritize areas of strength and areas for improvement. The QI unit prepares the annual Quality Assessment and Performance Improvement Work Plan (QAPI) after evaluating progress on the prior year’s QAPI goals. The QAPI includes current state, measurable goals and data which guide QM activities throughout the year. Additionally, QI staff lead Performance Improvement Projects (PIPs), as well as the Quality Management Action Committee (QMAC), the multidisciplinary entity including community stakeholders that advises on policy and performance improvement efforts. Other activities include collecting beneficiary/family satisfaction surveys and informing providers of the results, and evaluating beneficiary grievances, appeals and fair hearings at least annually to ensure that practices are in place to address any identified quality of care concerns.

Quality Management Action Committee (QMAC)

The purpose of the QMAC is to provide recommendations and oversight of Behavioral Health’s QAPI and other quality management activities. QMAC representation includes MHP practitioners, community providers, consumers, and family members. The QMAC reviews, evaluates, and advises on results of QI/QM activities designed to improve the access, quality of care, and outcomes of the service delivery system.

The QMAC meets quarterly for an all-member session for data review and guidance on process improvement efforts and quality of care areas of focus, such as, grievances/appeals, change of provider trends, access, satisfaction, and quality data. The QMAC also convenes ad hoc committees on a time-limited basis for focused discussion to support carrying out QAPI-related activities. If you are interested in participating in the QMAC, contact vcbh.quality@ventura.org.

External Quality Review Reports

An External Quality Review (EQR) is the annual analysis and evaluation by an External Quality Review Organization (EQRO) of aggregated information on quality, timeliness, and access to the health care services that a managed care plan, or its contractors, furnish to Medicaid beneficiaries. “Quality of Care External Quality Review.” Medicaid.gov, Centers for Medicare & Medicaid Services.

The External Quality Review reports below present the most recent fiscal year EQR findings for Ventura County Mental Health and Drug Medi-Cal Organized Delivery System programs.