AG 2002 12 16 (Regular) - Laserfiche WebLink

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Network Development. True partnerships with Providers will be essential in assuring development of a network that is responsive to individual consumer choices and that will fulfill Piedmont's commitment tl~rough the Local Business Plan to develop a local network that will enable all consumers to receive the care they need in the community. Partnerships with providers include the development of a Network Provider Council, a Global Continuous Quality Improvement System, and Provider representation on the Clinical Advisory Committee. An annual training plan and provider relations staff of the LME will further support competency and communications. The Piedmont LHE will employ relational contracting to specify requirements for network providers that reflect the value placed on quality, best practices and the achievement of individual and system outcomes. Access. Easy access will be possible through designated Comprehensive Community Providers, and through a Call Center system. Consumers will be able to access care from any location through a 1-800 number. A minimum of two Comprehensive Community Providers per county will be strategically located in each county for site based access for consumers. Emergency care will be managed by the LME on a 24/7 basis, through the Call Center, which will arrange for an appropriate intervention from network providers. Comprehensive providers will provide the LME with adequate assessments and baseline demographics that will be used to enroll the person into the system and authorize services. Authorization thresholds will be developed to optimize "auto authorization" for "usual and customary" clinical profiles, allowing the LME to focus authorization and utilization management on high cost/high frequency services/users and on retrospective sampling and concurrent analysis. Quality. The success of the system will be closely tracked through monitoring of outcomes and consumer satisfaction. Quality management is an essential role of the LME. This will include the development of ONE system for Quality Management which will be inclusive of all Network Providers. This one system will reflect common goals and management and the fact that every provider contributes to the quality of the system as a whole. This system of quality management will be supportive of all providers who strive to meet the standards of the network. A Global Continuous Quality Improvement (CQI) Committee will have oversight for quality management of the network and will be inclusive of Network Providers, consumers and family members. Additionally, the LME will have internal capacity to monitor the system performance for health and safety, protection of consumer rights, response to complaints and grievances, as well as for implementation of best practices, consumer satisfaction, and consumer outcomes achievement. This oversight process will include participation of consumers and family members who are trained in these functions. Annually, through the development of the Continuous Quality Improvement Plan, key indicators and targets will be established. These will be monitored throughout the year by the LME and the Continuous Quality Improvement system of committees at the provider level with oversight by the Global CQ! Committee. Community Education and Collaboration. Education, collaboration and community relationships developed by the LME will be critical to paving the way for expanded support for and involvement of consumers in their local communities. The LME will develop an organized system of education and outreach through an Annual Community Assessment and Plan. Additionally, the LlVlE will establish an interagency system of communication and support with local agencies that will be time efficient and effective in coordinating resources and collaborative planning for the needs of consumers in behavioral health and developmental disabilities. Financial Strateqy: In order to use the LME model as the engine by which reform occurs, it will be necessary to re- deploy existing dollars more efficiently and effectively. Piedmont is interested in a financial Page3 t~'_1 Piedmont Local Business Plan Executive Summary