WHERE WE ARE . . .
WHERE WE WANT TO GO
Trillium Health Resources participates in a number of review and analysis activities to help us examine our business practices and management operations. Although each form of evaluation measures different things, the overarching purpose of these various checks and balances is to ensure we are being as effective and efficient as possible while meeting all regulatory requirements expected of us.
The Network Adequacy Accessibility Report is an annual study of our catchment area and the people who live there. It also looks at where services are available and how people use them. Ultimately, the analysis serves as a roadmap for determining future growth based on current capacity. and identified needs.
Financial Statement and Compliance Reports
Each year, Trillium works with an independent auditor to examine our financial statements and provide an honest opinion of Trillium’s fiscal practices. The accountants view statements and materials according to the state fiscal year (July 1-June 30).
Local Business Plan
The Local Business Plan (LBP) is an LME/MCO strategic planning document looking at a three-year period for accomplishing stated goals to improve access, effectiveness, and quality of services. It includes the opportunity to address our local approach to statewide initiatives as well as to outline initiatives that address regional needs identified in our Network Adequacy and Accessibility Report.
Quality Management Plan & Evaluation
The annual Trillium Health Resources Quality Management (QM) Plan outlines efforts to maintain and improve services for members. It frames the purpose of the Quality Management Program and activities to meet state and federal regulations as well as national accreditation standards.
The annual QM Plan outlines the objectives for the year by monitoring identified quality improvement issues throughout the organization. We review and revise the QM Plan based on an annual evaluation of the QM Program.
Trillium Health Resources establishes agency-wide goals that are measured and reported routinely to the Trillium Health Resources Quality Improvement Committee. The goals in the plan may address a variety of key performance areas, including but not limited to: follow-up after hospitalization, accessibility, availability, member satisfaction, education and outreach to members and their families.
Trillium Health Resources also seeks input for the QM Plan from various external committees, such as the Global Quality Improvement Committee, Provider Network Council, and the Clinical Advisory Committee.
- 2019 - 2020 Quality Management Plan
- 2018-2019 Annual Quality Management Program Evaluation
- 2018-2019 Quality Management Plan
- 2017-2018 Annual Quality Management Program Evaluation
Member Satisfaction Survey
The Satisfaction Surveys for North Carolina Child and Adult Medicaid members provide a comprehensive tool for assessing health care experiences. DataStat, Inc. conducted the survey on behalf of The State of North Carolina Division of Health Benefits (DHB) and The Carolinas Center for Medical Excellence (CCME). The Experience of Care and Health Outcomes (ECHO®) Survey 3.0 assesses the performance of the health plans. The survey had a total of 70 questions that focused on the health care experience such as getting treatment quickly, how well clinicians communicate, getting treatment and information from the plan, perceived improvement, and overall satisfaction with counseling and treatment.
- 2018 Member Satisfaction Survey (Child)
- 2018 Member Satisfaction Survey (Adult)
- 2017 Member Satisfaction Survey (Child)
- 2017 Member Satisfaction Survey (Adult)
Perception of Care Survey
Formerly known as the Consumer Satisfaction Survey, the Perception of Care Survey is conducted face-to-face with current service members or family members. The survey includes questions about access to services, cultural sensitivity, treatment planning, outcomes, social connectedness, and overall satisfaction.
Provider Satisfaction Surveys
Provider Satisfaction Surveys are conducted annually by DHB. These surveys help to determine areas that need improvement within the network and assess provider satisfaction with Trillium, its practices, and processes.
Founded in 1990, URAC is the independent leader in promoting health care quality through accreditation, certification, education, and measurement. URAC is a nonprofit organization developing evidence-based measures and standards through inclusive engagement with a range of stakeholders committed to improving the quality of health care. Our portfolio of accreditation and certification programs span the healthcare industry, addressing health care management, health care operations, health plans, pharmacies, telehealth providers, physician practices, and more. URAC accreditation is a symbol of excellence for organizations to showcase their validated commitment to quality and accountability.
URAC accreditation requires applicants to submit policies, procedures, and other organizational information that is followed by a review. Once an application is received by URAC, a primary reviewer is assigned and coordinates all aspects of the review until a decision on accreditation has been determined.
Trillium is accredited in three programs, Health Call Center, Health Utilization Management, and Health Network with Credentialing.
- The Health Call Center provides triage and health information services to the public via telephone, website, or other electronic means. URAC’s Health Call Center Accreditation ensures that registered nurses, physicians, or other validly licensed individuals perform the clinical aspects of triage and other health information services in a manner that is timely, confidential, and includes medically appropriate care and treatment advice.
- The Health Network is made up of contracted physicians and other health care providers. URAC’s Health Network Accreditation standards include key quality benchmarks for network management, provider credentialing, quality management and improvement, and members protection.
- The Health Utilization Management is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan. URAC’s Health Utilization Management Accreditation ensures that all types of organizations conducting utilization review follow a process that is clinically sound and respects members’ and providers’ rights while giving payers reasonable guidelines to follow.
External Quality Reviews (EQR)
The North Carolina Department of Health and Human Services (DHHS) contracts with an external quality review organization (EQRO) to conduct the annual external quality review (EQR) of Trillium.
The EQRO conducts the annual review jointly with the DHHS Intradepartmental Monitoring Team (IMT), which consists of staff members from the Division of Health Benefits (DHB) and the Division of Mental Health, Developmental Disabilities, and Substance Abuse (DMH).
The annual review includes two phases: a desk review of key documents and an on-site review of administrative and clinical operations. The current EQRO for DHHS is the Carolinas Center for Medical Excellence (CCME).