PacifiCare Behavioral Health (PBH) is committed to providing the highest quality behavioral health care available to its members. One method for achieving this is through adherence to policy and procedures and standards developed by PBH, state and federal agencies, and national accrediting organizations such as the National Committee for Quality Assurance (NCQA).
The primary goal of the QI Program is to determine adherence to the standards defining service quality and to ensure continual improvement in quality. PacifiCare Behavioral Health does not delegate quality improvement responsibilities to any contracted individual or group regardless of the nature of the contracted relationship. PBH's QI Program is an integrative process that links knowledge, structures, and processes to enhance quality throughout the organization and improve outcomes for members.
PacifiCare Behavioral Health has adopted the following NCQA Standards and integrated them into its QI Program:
PBH has clearly defined QI structures and processes and assigns responsibilities to appropriate individuals.
PBH's Quality Improvement Program is comprehensive and fully operational.
Contracts with individual practitioners, groups and organizational providers specify that contractors cooperate with the PBH's Quality Improvement Program and with the Quality Improvement Programs implemented by the member's medical health plans.
PBH implements mechanisms to assess and improve member satisfaction.
PBH adopts and disseminates clinical practice guidelines, practice parameters, or consensus statements for providing behavioral health care services to members of its covered population.
PBH ensures that the behavioral health care services provided to its covered population are coordinated and integrated with general medical care.
The scope and content of the QI program reflect PBH's delivery system and the relevant clinical issues that affect members of its covered population.
PBH uses data collection, measurement, and analysis to track clinical and service indicators. These issues include, but are not limited, to high-volume diagnosis or services, high-risk diagnosis or services and over and under utilization.
PBH also assess the effectiveness of these interventions through systematic follow-up.
PBH evaluates the overall effectiveness of its QI Program activities and demonstrates improvements in the quality of clinical care and service to its members.
