Performance Improvement Projects

Federal regulations require that a state validate Performance Improvement Projects (PIPs) performed by its Medicaid managed care organizations and prepaid inpatient health plans as part of its program of annual external quality review (EQR). Acumentra Health conducts PIP validation reviews as part of its EQR contracts.

Training for agencies and plans

In addition, Acumentra Health provides training to health plan staff to help Medicaid agencies ensure that PIPs produce meaningful results. Previous training has encompassed projects that integrate physical and behavioral health care and dental care.

Acumentra Health delivered training on the conduct of PIPs for 44 managed care plans in Oregon and Washington to help health plans carry out PIPs that meet federal managed care requirements and are more likely to result in “real” improvements in clinical outcomes and service. Learning objectives addressed understanding the purpose of PIPs; defining study indicators and population; creating a plan for data collection and analysis; documenting interventions; interpreting and discussing results; and developing or modifying interventions to sustain quality improvement.

Technical assistance for managed care quality improvement initiatives

Acumentra Health delivers technical assistance to support other health plan quality improvement activities.

• Our staff has assisted plans in establishing immunization reminder systems and using an immunization registry to facilitate a population-based approach to managing preventive services and chronic condition management.
• We also convened a group of plans to collaborate on interventions to increase the use of retinal exams for members with diabetes.