PIP Library : CalEQRO

PIP Video Trainings

CalEQRO's Performance Improvement Project (PIP) video series guides county staff through the PIP process.

Training #1

Bringing Ideas to Successful PIP Concept

Training #2

From Idea to PIP - SUD Example

Training #3

Tips and Common Mistakes

PIP Clinic Webinars and Presentations

Materials from CalEQRO’s PIP Clinic Webinars and In-person Presentations are linked below.

2019 PIP Presentations

PIP CalQIC 2019: PowerPoint

2018 PIP Presentations

PIP Clinic December 2018: Webinar | PowerPoint

PIP Clinic June 2018: Webinar | PowerPoint

PIP CalQIC 2018: PowerPoint

2017 PIP Presentations

PIP Clinic July 2017: Webinar | PowerPoint

PIP Clinic December 2017: Webinar | PowerPoint

PIP CalQIC 2017: PowerPoint

2016 PIP Presentations

PIP Clinic May 2016: Webinar | PowerPoint

PIP Clinic (LA) October 2016: Webinar | PowerPoint | Document

PIP Clinic (SAC) October 2016: Webinar | PowerPoint | Document

2015 PIP Presentations

PIP Clinic February 2015: Webinar | PowerPoint | Document

PIP Clinic June 2015: Webinar | PowerPoint

PIP Clinic September 2015: Webinar | Document

PIP CalQIC 2015: PowerPoint

PIP Development by Validation Steps


Below you will find examples from California Mental Health Plans (MHPs) for each validation of the nine steps of CMS EQR Protocol 3: Validating Performance Improvement Projects (PIPs)1 . These PIPs are included here as a representation of how to construct each step of a PIP to meet the CMS EQR Protocol 3 validation steps.

STEP 1: Select and Describe Study Topic and Methodology

San Luis Obispo – Medium MHP – Clinical PIP – Integration of Mental Health and Substance Use Screening and Assessment


The goal of this PIP is to improve the accurate identification of co-occurring diagnoses and provide “right size” services to beneficiaries from the start. This PIP focuses on the assessment process and protocol for providing an effective assessment for both substance use disorders and mental health disorders. The MHP cited numerous studies and literature that identified prevalence of co-occurring conditions.


STEP 2: Define and Include the Study Question(s)

Santa Theresa – Example MHP – Clinical PIP – Seeking Safety Implementation


The goal of this PIP is to reduce functional impairment due to substance use among youth (ages 12-20 years) who are enrolled in outpatient mental health treatment. All youth age 12-20 receiving county outpatient behavioral health treatment (n=1,265) will be screened for substance abuse at intake and at annual review. Beneficiaries screening positive (estimated at 35 percent) will receive at least one Seeking Safety module. Seeking Safety is an evidence-based intervention for beneficiaries struggling with substance abuse.


STEP 3: Identify Study Population

San Diego – Large MHP – Non-Clinical PIP – Client Engagement After Discharge from a Psychiatric Hospital


The goal of this PIP is to improve the timeliness of follow-up care for individuals discharged from an acute psychiatric hospital stay who were not previously open to outpatient services at the time of admission. The initial change was to provide a specific aftercare appointment. The MHP added follow-up reminder calls to the process. This PIP involved piloting of the process at the MHP’s psychiatric hospital, and then extending it to other contract/partner hospitals.


STEP 4: Select and Explain the Study Indicators

Sacramento – Large MHP - Non-Clinical PIP – Implementing a Streamlined E-Scheduling Tool to Increase Timeliness to First Offered Appointment


The goal of this PIP is to reduce wait times by beneficiaries across the Sacramento County MHP system of care. This PIP, through the use of the EHR Scheduler tool, allows the MHP to offer an appointment during the initial call requesting services, and to notify the provider to contact the perspective beneficiary within 24 hours. The interventions in this PIP aim to change the current business process used to schedule first appointments through the use of the EHR Scheduling module.


STEP 5: Sampling Methods

PIP to be added at a later date



STEP 6: Develop Study Design and Data Collection Procedures

Sonoma – Medium MHP - Non-Clinical PIP – Enhancing Timeliness of Assessments and Treatments for Youth and Families


The goal of this PIP is to increase the timeliness of assessments and treatment for youth. At the time of PIP initiation, youth assessments were not meeting the ten-business-day standard. Assessments were taking 27.8 days (on average). The PIP used CANS data to monitor quality outcomes to ensure that beneficiaries are receiving high quality and effective treatment.


STEP 7: Develop and Describe Study Interventions/Improvement Strategies

Orange County – Large MHP – Clinical PIP – Increasing rates of step-down to ongoing care following hospital discharge


The goal of this PIP is to increase rates of step-down to outpatient services following inpatient discharge among adult clients by applying an intervention that utilizes peer mentors to provide support to clients during the transition from inpatient discharge to outpatient care. This PIP, although early on in implementation, has a well-designed staged intervention plan.


STEP 8: Data Analysis and Interpretation of Study Results

San Diego – Large MHP – Clinical PIP - Therapeutic Homework


The goal of this PIP is to improve treatment results and shorten lengths of treatment. The MHP examined the topic of therapeutic homework, an intervention aimed at improving the engagement of youth with their treatment. The MHP implemented this PIP and interventions in phases, starting with a pilot site that included 693 youth beneficiaries.


STEP 9: Assess Whether Improvement is “Real” Improvement

Tuolumne – Small MHP - Clinical PIP - Engaging Clients through the Intake and Assessment Process


The goal of this PIP is to reduce the time to initial assessment, and examine if that would lead to lower no-show rates and improve the beneficiaries’ hope in the recovery process. This PIP uses Snyder’s Hope Scale.

PIP Excellence

Examples of PIPs that were successfully implemented


San Diego – Large MHP – Clinical PIP

Therapeutic Homework

The goal of this PIP is to improve treatment results and shorten lengths of treatment. The MHP examined the topic of therapeutic homework, an intervention aimed at improving the engagement of youth with their treatment. The MHP implemented this PIP and interventions in phases, starting with a pilot site that included 693 youth beneficiaries.

PIP Narrative | PIP Validation Tool

San Diego – Large MHP – Non-Clinical PIP –

Client Engagement After Discharge from a Psychiatric Hospital

The goal of this PIP is to improve the timeliness of follow-up care for individuals discharged from an acute psychiatric hospital stay who were not previously open to outpatient services at the time of admission. The initial change was to provide a specific aftercare appointment. The MHP added follow-up reminder calls to the process. This PIP involved piloting of the process at the MHP’s psychiatric hospital, and then extending it to other contract/partner hospitals.

PIP Narrative | PIP Validation Tool


1. https://www.medicaid.gov/medicaid/quality-of-care/downloads/eqr-protocol-3.pdf