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.
Gaps & Needs Analysis
The Gaps & Needs Analysis Report is an annual study of our area and the people who live here. 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.
While the first full fiscal year as Trillium saw us grow with the number of enrollees served, geographic area covered, and providers contracted, the transition was seamless and enrollees never saw a drop in services. We have not just met our objectives, but exceeded them in so many ways.
Local Business Plan
The Local Business Plan (LBP) is an MCO/LME 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 state-wide initiatives as well as to outline initiatives that address regional needs identified in our Gaps & Needs Analysis.
Quality Management Plan
The annual Trillium Health Resources Quality Management (QM) Plan outlines efforts to maintain and improve services for enrollees. 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, enrollee satisfaction, education and outreach to enrollees 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.
Perception of Care Survey
Formerly known as the Consumer Satisfaction Survey, the Perception of Care Survey is conducted face-to-face with current service recipients or family members. The survey includes questions about access to services, cultural sensitivity, treatment planning, outcomes, social connectedness and overall satisfaction.
Enrollee Satisfaction Survey
Provider Satisfaction Surveys
Provider Satisfaction Surveys are conducted annually. Effective 2013, DHHS developed and collected the results of the survey, which was administered in October.
URAC is a national accreditation organization designed to promote continuous improvement in the quality and efficiency of health care management. Accreditation is an evaluative, rigorous, transparent, and comprehensive process in which a health care organization undergoes an examination of its systems, processes, and performance by an impartial external organization (accrediting body) to ensure that it is conducting business in a manner that meets predetermined criteria and is consistent with national standards. 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 consumer 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 consumers’ 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 Medical Assistance (DMA) 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).