Quality - Behavioral Healthcare Providers

BHP’s Quality Management and Improvement Program

The BHP Quality Program provides the framework by which BHP assesses and improves the quality of care and service, clinical outcomes, and customer satisfaction throughout the network. BHP is a fully accredited NCQA Managed Behavioral Health Organization. Full Accreditation is granted for a period of three years to those plans that have excellent programs for continuous quality improvement and meet NCQA’s rigorous standards.

BHP currently has numerous quality programs and initiatives and several departments within BHP collaborate to provide data, analytics and support for the quality program and activities. In general BHP’s quality programs fall into the following categories:

Clinical Services
Member Services
Network Services
Preventative Health and Screening Services
Clinical Practice Guidelines
Patient Safety

BHP reports on the results of their quality program in the annual year report. You can view a copy of the most recent year-end report to the right in our download column.

Clinical Practice Guidelines

BHP has developed five clinical practice guidelines to help practitioners make decisions about appropriate health care for specific clinical circumstances. These guidelines are based on scientific evidence, professional standards, and/or expert opinion. They are reviewed and updated at least every two years, or more frequently if new evidence becomes available or if national guidelines change. You can access these guidelines to the right, under Downloads.

ADHD Clinical Practice Guideline
Autism Spectrum Guidline
Bipolar Clinical Practice Guideline
Chemical Health Clinical Practice Guideline
Depression Clinical Practice Guideline

Behavioral Health Screening Programs

BHP has two defined behavioral health screening programs; one is designed to screen for co-existing mental health and substance use disorders, the other is designed to screen for Generalized Anxiety Disorder. The screening program for co-existing conditions utilizes results from the PHQ-9 and the CAGE-AID, while the screening program for Generalized Anxiety Disorder utilizes the GAD-7 screening tool. These screening programs assist BHP staff in identifying potential mental health and substance use concerns in members. BHP uses the results of these screening programs to help members access and schedule appropriate behavioral health services and also coordinates care by relaying the results of the screening program to any providers or practitioners the member is scheduled with. The co-existing screening program is administered to eligible members through BHP’s Intake department and through the Complex Case Management Program (POP). The screening program for Generalized Anxiety Disorder is also administered through the Complex Case Management Program (POP).

Important Information

If you have questions about our quality program, please

FAQ

1What is NCQA?

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. NCQA reviews include rigorous on-site and off-site evaluations conducted by a team of physicians and managed care experts. A national oversight committee of physicians and behavioral health providers analyzes the team’s findings and assigns an accreditation level based on the MBHO’s performance compared to NCQA standards. NCQA MBHO Accreditation standards are intended to help organizations achieve the highest level of performance possible, reduce patient risk for untoward outcomes, and create an environment of continuous improvement. There are approximately 60 standards for quality included in the following categories: Quality Management and Improvement Utilization Management Credentialing and Recredentialing Members’ Rights and Responsibilities Preventive Behavioral Health Care Services

2Why have I been chosen for a chart audit?

As part of a NCQA quality initiative BHP conducts chart audits to monitor adherence to BHP’s clinical practice guidelines. Providers are chosen randomly for chart audits based on if they have seen BHP patient’s in the past year and if the patients have a diagnosis associated with one of BHP’s clinical practice guidelines. Chart audits are not meant to be punitive in nature, and are used to report on the quality of services provided by the BHP provider network.