The Florida Health Partners (FHP) Quality Management Department is committed to the principles of continuous quality improvement. FHP’s Quality Management Program (QM) encompasses both quality assessment and performance improvement functions. A primary goal of the QM Program is ensuring the treatment we provide to our members is accessible, appropriate and results in effective outcomes. The QM Program also works to assure treatment is provided in accordance with the state and federal regulations governing Medicaid.
FHP’s Quality Management Program is designed to accomplish goals such as:
- Monitoring providers to ensure access standards are met; clinical care is appropriate, recovery-oriented and of high quality; client care is coordinated between all providers, both physical and behavioral health; and chart documentation meets published criteria.
- Measuring, reporting and reviewing the performance of FHP against state, federal, national and internal criteria to determine where system interventions, corrective actions and performance improvement projects are needed.
- Collecting and reviewing utilization data for positive or negative treatment patterns, and to identify both under and over utilization.
- Investigating, reviewing and responding appropriately to all identified quality of care issues and adverse incidents.
Quality Management Activities Measurement and Results
FHP conducts quality measurement and monitoring activities using various tools, including:
- Member Satisfaction Survey Results
- Performance Indicator Reports
- Chart audit summaries, and other data reports
Results of measurement and monitoring activities are evaluated and summarized in the annual Quality Management Program Evaluation.
PROVIDER MONITORING
Access to Care
FHP monitors the provider network for compliance with required access to care standards. AHCA requires the following performance standards related to access:
- Emergent appointments – available immediately
- Urgent appointments – available within 23 hours
- Routine appointments – available within 7 calendar days
Routine appointment definition: Members who are initially presenting for Outpatient services must be offered a clinical assessment appointment within 7 days of request. FHP monitors this using an Access to Care Log (submitted by providers monthly), Grievances related to Access, Member Satisfaction survey results, and by conducting open shopper calls from the call center.
Chart Audits
FHP’s contract with the State of Florida requires us to evaluate the quality and appropriateness of care that members receive. FHP performs random provider chart audits in order to give feedback to providers on the quality of the documentation found in the audited charts, as charts are a critical component of the work providers engage in with clients. Chart audits are one measure of the quality of care that our members are receiving.
Chart audits review the following areas in the medical record: Assessment Treatment Planning, Discharge Planning, Coordination of Care and Progress Notes. A passing score on the audit is greater than or equal to 80%. If a provider fails an initial audit, a re-audit is performed in approximately six months.
Adverse Incidents
To manage care effectively and assure the safety of members, FHP investigates and reviews adverse incidents that have resulted in harm or potential harm to a member participating in treatment. Providers are expected to report adverse incidents on an Adverse Incident Form (linked below) within 24 hours of the occurrence for sentinel events (e.g., suicides, homicides, unexpected deaths), and within 48 hours for all other incidents.
For more information on adverse incidents and reporting requirements, link to:
- FHP/NFBHP Provider Quality Handbook
- Adverse Incident Form
PERFORMANCE IMPROVEMENT PROJECTS (PIP) AND STUDIES
Coordination of Care PIP
The Coordination of Care PIP is targeting improved coordination of care between Medicaid physical and behavioral health providers for Medicaid members who are receiving FHP services and are also diagnosed with diabetes, asthma, cardiovascular disease, or chronic use of opiods. This population represents a high-risk group who has co-occurring mental health and medical conditions. The goal of this PIP is to improve coordination of care between behavioral and physical health providers for this population.
For informational handouts to give to clients, link to:
- Information about Medicaid Primary Care Providers- Coming soon
- Information about Medicaid Primary Care Providers – Spanish- Coming Soon
- How to Talk to Your Doctor Brochure
- Aftercare brochure
- Aftercare brochure – Spanish
- Wellness brochure
- Wellness brochure – Spanish
Provider Newsletters
The FHP Quality Management department distributes routine newsletters for providers with information related to contract requirements, innovative initiatives and updates for plan management. The following links will lead you to the most recent newsletters:
