Clinical Adverse Event Investigations promote member safety and provide opportunities to detect, identify and potentially reduce risks in the delivery of care to our members. MHP and its provider partners share in the responsibility to identify irregularities in member care and service.
The investigations, conducted within the Quality Management Department (QM), help facilitate the understanding of root cause and reduce the future occurrence of these events by promoting changes to systems and/or processes. Detection of the clinical adverse events relies upon reports from the medical management operations within MHP. The process also relies upon utilization reports that identify excessive or unnecessary services that could potentially have been avoided. Investigations are scored according to risk and documented for any trends analysis.
Peer review of a potential adverse event may occur within the Credentialing/ Peer Review Committee to ensure appropriate clinical risk decision making. Service providers involved in the case may be required to provide additional clinical information and be involved in a corrective action plan to ameliorate future risk.