Performance Improvement Projects

PIPs allow Coordinated Care Organizations (CCOs) the opportunity to identify areas of concern affecting their members and strategize ways to improve care. Designed to assess and improve healthcare processes, a PIP’s purpose is to impact healthcare delivery and outcomes of care. For such projects to achieve real improvements in care, and to ensure confidence in reported improvements, PIPs must be designed, conducted, and reported in a methodologically sound manner that meets all state and federal requirements. Validating PIPs is one of the mandatory activities described at 42 CFR §438.358(b)(1), and HSAG validates PIPs according to CMS’ EQR Protocol 1. In accordance with §438.330(d), CCOs are required to have a quality program that (1) includes ongoing PIPs designed to have a favorable effect on health outcomes and beneficiary satisfaction, and (2) focuses on clinical and/or nonclinical areas that involve the following:

• Measuring performance using objective quality indicators
• Implementing system interventions to achieve quality improvement
• Evaluating effectiveness of the interventions
• Planning and initiating activities for increasing and sustaining improvement

OHA contracted with HSAG to conduct annual evaluation of PIPs conducted by the CCOs. The goal of HSAG’s PIP validation is to ensure that the health plan and key stakeholders can have confidence that any reported improvement is related and can be linked to the quality improvement strategies and activities conducted during the life of the PIP. HSAG’s validation of PIPs includes the following two key components of the quality improvement process:

1. Evaluation of the technical structure to determine whether a PIP’s initiation (e.g., topic rationale, PIP team, aims, key driver diagram, and data collection methodology) is based on sound methods and could reliably measure outcomes.
2. Evaluation of the quality improvement activities conducted by the CCOs.

For questions related to the PIP activity or to request technical assistance, please contact:

       Kris Hartmann, MS
       PIP Project Manager, State & Corporate Services
       Telephone: 602.801.6885
       Email: KHartmann@hsag.com