Quality Management

CBH’s Quality Management (QM) Program aims to provide the structure and processes to improve the clinical care and quality of services for our members. QM program development includes multidirectional input from the Board of Directors, Officer Team, Quality Improvement Committee, members, and providers. CBH requires that providers develop internal quality improvement processes that enhance and support the quality of care delivered.

Provider Participation in Quality Improvement Activities

CBH requires that providers cooperate in activities that improve the quality of care and services and member experience. This includes the collection and evaluation of data and participation in CBH’s quality improvement (QI) activities. Such activities may include, but are not limited to:

  • Providing the information requested through Provider Bulletins and Provider Notices
  • Adhering to Clinical Practice Guidelines and Performance Standards
  • Participating in Quality Management activities, including chart reviews, root cause analysis, action plans, quality improvement plans, and the complaint and grievance processes
  • Reporting on Performance Metrics requested through the P4P, VBP, and the performance evaluation processes
  • Engaging in credentialing activities

The Quality Improvement Video Training Series

Quality is Everyone’s Responsibility! CBH has developed the Quality Improvement Video Training Series, a series of short informational videos, to provide a shared quality improvement language and support the use of Quality Improvement tools and methodology across our organization and within our entire network of care. Establishing a quality improvement framework allows organizations to develop a continuous, systematic approach to identify and solve problems, leading to measurable improvement for the quality of care and services delivered to members. There are many quality improvement frameworks available for use. CBH does not endorse a specific framework but recommends that network providers adopt an approach that works best for the organization.

The Quality Improvement Video Training Series provides an overview of quality improvement and methodologies and basic quality improvement tools that can be utilized across quality improvement framework methodologies.

Part 1: What is Quality Improvement? (10 minutes)

This video provides a definition of quality improvement, identifies the importance of using teams for quality improvement activities, and provides an overview of common quality improvement framework methodologies.

Part 2: Workflow Processes (6 minutes)

This video provides an overview of visual workflow charts and detailed process mapping so organizations can understand the current process before making improvements.

Part 3: Root Cause Analysis Training (10 minutes)

This video provides detailed instructions for completing a root cause analysis which includes brainstorming, a grouping of like-ideas into an affinity diagram, and the development of a fishbone diagram. The use of this standardized approach will help quality improvement teams better understand possible causes of an adverse event or identify system flaws for correction. CBH has developed a companion root cause analysis tool that can be found here.

Part 4: The 5 Whys Technique (6 minutes)

This video provides a technique for digging deeper into a possible root cause.

Part 5: Driver Diagrams (7 minutes)

This video provides a detailed overview of how to develop a Driver Diagram. Driver Diagrams are used to identify solutions or ideas that will lead to change/improvement. This tool can be used when organizations are working toward improving an existing process, creating a new process, or improving performance toward a specific goal.

Part 6: Plan, Do, Study, Act (PDSA) Cycles (12 minutes)

This video provides a detailed overview of how to develop and implement a PDSA cycle. PDSA cycles are used to systematically study the implementation of a change idea for improvement. CBH has developed a companion PDSA cycle tool that can be found here.

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