Quality Care is Our Top Goal
We are committed to improving the health of all Community Care members. Our mission is to provide the highest quality mental health and substance use programs and services at the lowest possible cost, delivered in an environment that promotes recovery.
We help a diverse group of people. We do all that we can to meet your special needs and preferences. We also make sure our staff and providers are sensitive to cultural diversity. We are able to meet your special requests related to cultural, racial, ethnic, and linguistic needs, and other special requests, as we have a diverse provider network.
Community Care has a Quality Improvement (QI) Program that is overseen by a Quality Improvement (QI) Committee. The QI Committee includes representatives from the community and Community Care leadership. The QI Committee identifies issues that are important to you. We set goals for these areas and check them annually to be sure we meet our goals. The QI Committee studies the results of our measurement activities and takes action to improve performance when we do not achieve our goals. This entire process is ongoing. We continually measure our performance, study results, and work to improve our processes and services.
The overall goals of Community Care's QI Program are to:
- Provide the highest possible quality care that recognizes your cultural diversity and your unique needs and preferences.
- Honor your choices.
- Provide timely care and service.
- Make your overall experience highly satisfying.
- Ensure your safety to the highest degree possible.
- Promote continuity and coordination of care.
- Provide outstanding customer service.
Some of the things we check are:
- The structure of our network to be sure we have the right number of providers and facilities within an appropriate driving distance of members.
- The timeliness of appointments to be sure members with urgent care needs can see a provider within 24 hours, and members with routine care needs can see a provider within 7 calendar days
- The time it takes customer service to answer the telephone to be sure your calls are answered within 30 seconds or less.
- Member complaints to be sure we fully investigate complaints and take appropriate actions within the required time frames for routine and clinically urgent complaints.
- Member appeals to be sure we give enough consideration to issues of disagreement and take appropriate actions within the required time frames for routine and clinically urgent complaints.
- Overall member satisfaction with Community Care's services and providers so we can identify areas of dissatisfaction and take actions to improve in these areas. We have many other areas that we measure to ensure quality care.
Community Care conducts an annual member satisfaction survey. One thing this survey measures is satisfaction with Community Care customer service staff. In 2019, our customer service member satisfaction rates were 67.2% for the adult survey and 63.7% for the child survey. While the adult rate did not meet the 70% goal and the child rate was below the 78% goal, the adult score decreased only slightly when compared to the 2018 rates. The child rate also decreased slightly from the 2018 rates. The Board Quality Improvement Committee (BQIC) agreed to maintain the established goals of 78% and 70% for the adult and child rates, respectively. To continue to improve on these rates, several interventions have been implemented. Customer service staff receive training specifically on child services available to members to better answer your questions. Customer Service staff also end each call by asking, “Are you satisfied with your call today?” In addition, an automated member satisfaction survey at the end of each call has been implemented where members report satisfaction with their calls 98.3% of the time
Community Care is also working to improve the rate of follow-up appointments after an inpatient mental health hospitalization. This is measured at both 7 days and 30 days post discharge. For 2018, 56.6% of members attended an aftercare appointment within 7 days of an inpatient mental health discharge. The goal was 62%. In 2018, 73.1% of members attended an aftercare appointment within 30 days of an inpatient mental health discharge. The goal was 78%. Community Care meets with certain providers that did not meet the goal. We have many other areas that we measure to ensure quality care. If you would like to learn more about these other areas or our QI Program, please contact us.
We are pleased that the results of our monitoring activities show that we improved upon or met most of our goals. We have very few member complaints. The results of our annual member satisfaction survey show you are very satisfied with Community Care and our providers.
The QI Program always considers your safety in its measurement activities. We are very concerned about continuity and coordination of care because it is an important member safety issue. It is important for your doctors to work together to improve the safety and effectiveness of your behavioral health treatment and your results. Exchange of information is encouraged between both behavioral and physical health providers to enhance your safety and well-being. We measure to be sure that when you receive care from more than one provider, both providers exchange information as appropriate. We encourage you to share treatment and medication information with all of your providers to help ensure safety. This is important if you are prescribed psychotropic medications or if you have physical health issues or other physical concerns, such as smoking or obesity, along with a behavioral health condition. Be sure to sign the Consent to Release Information form so your providers can communicate with each other to help you. Community Care has efforts in place to continually educate providers and members about the benefits of coordinated care. We require quality improvement plans from providers who do not meet our goals.
If you would like to learn more about Community Care's QI Program and our progress in meeting our goals, please call or write to us. If you would like a copy of our QI Policy, we will send it to you. If you have suggestions for improving our QI Program, please let us know. Community Care has an Adult Member Advisory and Parent Advisory meeting that reviews many of our quality improvement activities and provides suggestions for how we can better meet your needs. If you would like to join either meeting, please let us know.
For more information, to make a suggestion, to request a copy of the Quality Improvement Program, or to participate in the Adult Member Advisory or Parent Advisory meetings, contact us at the number for the county where you live.
You can also write to us at:
Community Care Behavioral Health Organization
Quality Management Department
339 Sixth Ave., Suite 1300
Pittsburgh, PA 15222