Date of Graduation
Summer 8-9-2022
Document Access
Restricted Project/Capstone - USF access only
Degree Name
Master of Science in Nursing (MSN)
College/School
School of Nursing and Health Professions
Program
Kaiser cohort MSN capstone
First Advisor
Catherine Coleman
Abstract
Quality Oversight for External, Contracted Behavioral Health Providers
Abstract
Problem: Lack of a formal process for review of external, individually contracted behavioral health practitioners who provide care to health plan members could result in a multi-million dollar fine for failure to meet regulatory oversight requirements.
Context: In 2013, a regulatory assessment determined the HMO was not providing adequate access to mental health services and fined the HMO’s health plan $4.2 million. One of the strategies to mitigate the lack of adequate access to behavioral health services was to contract with external therapist groups and individual therapists to augment care. A quality oversight process for external, credentialed providers was needed to ensure the care health plan members received met or exceeded community standards.
Interventions: The goal was to define a process for peer review of external contracted providers. A team of interprofessional stakeholders was convened to define the goal, determine the test of change, develop the appropriate workflow, measure the outcome.
Measures: Outcome measure was one documented process for review of the individually credentialed behavioral health provider which meets regulatory requirements The process measure was engagement of the team. The balancing measure was the need for additional Behavioral Health department staff.
Results: The workflow was finalized in the project timeframe, and will be tested in August. Meeting attendance by the workgroup stakeholders was 81% for eight meetings, with 121 workgroup communications between January and June.
Conclusion: The interprofessional workgroup was able to successfully develop one workflow for testing within the project timeframe. This project demonstrated an important organizational step in advocating for health plan members by ensuring consistent quality of behavioral health care.
Recommended Citation
Vroman, Janice, "Quality Oversight for External, Contracted Behavioral Health Providers" (2022). Master's Projects and Capstones. 1378.
https://repository.usfca.edu/capstone/1378
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