Quality Improvement and Outcomes

In collaboration with the LDH, youths, families, providers and stakeholders, Magellan facilitates quality activities that promote CSoC goals, sustain recovery and resiliency for youths and families and promotes high-quality care as defined by the Institute of Medicine, which is characterized as safe, effective, member-centered, timely, efficient and equitable care. All quality activities reinforce Magellan Health’s goals, and are organized under the following three themes:

• Positively influencing the health and well-being of individuals by improving clinical outcomes, assuring member safety, and adding value through efficiency.
• Enhancing service delivery for Members and their families.
• Ensuring that all core business processes are innovative, and meet or exceed contract, regulatory, and accreditation guidelines.

We measure and evaluate clinical care and patient safety, preventive health services, and member services.

We pursue opportunities to improve these processes and determine to what extent interventions have had a positive effect on outcomes.

We identify opportunities for improvement through clinical review activities, including review of core performance indicators, utilization management, prevention and condition/disease management, member and provider satisfaction, and high-volume provider site visits.

Louisiana Treatment Record Review (TRR) Auditing Tool

Treatment Record Reviews (TRRs) serve an important function in our QI program, including evaluating the quality of care delivered to CSoC members and adherence to federal/state requirements and Magellan standards for records. Please see the following resources developed by Magellan to support providers in understanding and complying with record requirements.

• TRR Provider Guide This guide outlines the processes and procedures for conducting TRR’s, by Magellan of Louisiana for providers rendering any of the specialized behavioral health services (SBHS) offered under Medicaid managed care. It provides a detailed list of the review audit tools used by our reviewers.
• TRR-FSO Provider Guide The guide outlines the processes and procedures for conducting TRR’s for the FSO provider organization under Medicaid managed care. It provides a detailed list of the review audit tools used by our reviewers.
• TRR Training Module Presentation provides an overview of the TRR process, including reviewing provider responsibilities for ensuring compliance with Medicaid, Louisiana Department of Health (LDH) and Magellan requirements for documentation and record keeping practices.

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