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Quality Improvement Interventions

The purpose of having a quality management system is to improve the quality of your program.  While data directs you to areas requiring improvement, further work is needed to understand the root causes and contributors to poor performance.   States often bring together stakeholders representing diverse perspectives to study and discuss performance data and the factors that may be at play when performance trends decline or problems persist.  Engaging members, clinicians, providers and policymakers in quality management at this stage is especially important for MLTSS programs where the complexity of the population and the interaction of multiple delivery systems combine to make it very difficult to isolate where best to target an improvement intervention.

Even with good information on a quality problem, there is not always a clear path to improvement.  The repository of LTSS evidence-based practices is far less evolved than in primary and acute care. Also, depending on the MLTSS program model, there may not be a single point of accountability around which to build an intervention.  The nature of these factors and their policy and payment implications may mean that the state needs to play a larger role in designing and implementing quality improvement efforts than in traditional Medicaid managed care.  

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