Performance Improvement Projects (PIPs)

HSAG has more than 10 years of experience reviewing, validating, and evaluating performance improvement projects (PIPs). Since 1997, HSAG has successfully validated hundreds of different PIPs conducted by a variety of managed care organizations (MCOs), prepaid inpatient health plans (PIHPs), behavioral health organizations (BHOs), and other managed care entities. In addition, HSAG has developed and facilitated a variety of statewide collaborative PIPs, targeting specific areas for improvement that are high priorities for state Medicaid agencies. HSAG’s exposure to this variety of topics and health plan models provides it with extensive experience to develop, structure, and conduct successful PIPs that bring about true, sustained quality improvement.

Validation of PIPs is one of the core activities that the external quality review organization (EQRO) conducts on an annual basis. PIPs are designed to assess and improve processes and improve outcomes of care. Typically, PIPs consist of a baseline, an intervention period, and a remeasurement. The validation process includes a structured assessment and scoring method. This approach provides a consistent validation process and a mechanism for providing MCOs and PIHPs with specific feedback and recommendations for the PIP study. This structured method of assessing and improving processes is expected to have a favorable effect on Medicaid member health outcomes because it is based on the well-proven principles of the quality improvement process.

The Centers for Medicare & Medicaid Services (CMS) specifies protocols EQROs are to use in evaluating the soundness and results of the PIPs implemented by managed care organizations (MCOs). HSAG’s validation tool and process have been described by CMS as "outstanding." HSAG validates PIPs:

• According to guidelines outlined in the CMS publication, Validating Performance Improvement Projects, A Protocol for Use in Conducting Medicaid External Quality Review Activities, Final Protocol, Version 1.0, May 1, 2002.
• Using an internally developed PIP validation tool that is based on the protocol.

HSAG provides technical assistance to both MCOs and states to assist with understanding CMS requirements, appropriately constructing and conducting valid PIPs, identifying barriers to improvement, and implementing interventions intended to bring about improvements. By working with state Medicaid agencies across the nation, HSAG has compiled a wealth of information and expertise to help MCOs conduct PIPs that result in positive outcomes and sustained quality improvement.