Transcript Overview of 2004-2005 External Quality Review (EQR) Activities

Overview of HMO
HEDIS 2006 Results
11:00 a.m.–11:30 a.m.
March 28, 2007
Florida Medicaid
HEDIS 2006 Results
Presented by:
Peggy Ketterer, RN, BSN,
CHCA
Presentation Overview
I. Welcome
II. Key Measure Results
III. Upcoming Changes in HEDIS
2007
IV. Questions and Comments
HEDIS is a registered trademark of the National Committee
for Quality Improvement (NCQA)
Dimensions of Care
• Pediatric Care
• Women’s Care
• Living with Illness
Analytics
Comparative
– Florida 2006 weighted average
compared to the national 2005
Medicaid 50th percentile
Distribution
– Range of MHP reported rates
Distribution Graphs
100%
Highest Rate
90%
High
Outlier
80%
FL Weighted
Average
70%
60%
Low
Outlier
50%
40%
Lowest Rate
30%
20%
10%
0%
Measure 1
Highest Plan Rate
Measure 2
Weighted Average
Lowest Plan Rate
Florida 2006 Results Compared to
National Benchmarks
Statewide HEDIS Rates Compared to National Medicaid Percentiles
12
11
Number of Statewide HEDIS Rates
10
8
6
4
4
2
1
1
0
0
0
0 TO 10
10 TO 25
25 TO 50
50 TO 75
2005 National Medicaid Percentile Range
75 TO 90
90 TO 100
Pediatric Care
Pediatric Care
Statewide performance results ranged
from below average to above average.
Pediatric Care
•Statewide results for the Well-Child Visits in the Third,
Fourth, Fifth, and Sixth Years of Life and Adolescent
Well-Care Visits measures were average when
compared nationally.
•Well-Child Visits in the First 15 Months of Life—Zero
Visits and Well-Child Visits in the First 15 Months of
Life—Six or More Visits, had performance results below
the LPL.
•A wide range of reported rates was observed for the
Well-Child Visits in the First 15 Months of Life—Six or
More Visits measure.
Pediatric Care
Range of 2006 Rates
100%
90%
80%
70%
60%
50%
40%
30%
20%
Reverse
Measure
10%
0%
Well-Child 1st 15 mos, 0 Well-Child 1st 15 mos,
Visits
6+ Visits
Highest Plan Rate
Well-Child 3rd-6th
Years of Life
FL Weighted Average
Adolescent Well-Care
Visits
Lowest Plan Rate
Pediatric Care
Improvement efforts to consider for well-child measures:
•Barriers to improvement could be identified and
evaluated in terms of greatest impact. A good barrier
analysis can assist in targeting interventions that would
bring about the most effective results.
•HMOs may want to focus on tracking and monitoring
missing medical records during medical record pursuit.
•Provider and member reminders and education have
been shown to have positive affects on health plan
performance.
Pediatric Care
•The HMOs may want to evaluate noncompliant cases
(children in the eligible population who did not meet
numerator compliance) and try to determine the
reasons why they were noncompliant.
•The HMOs should also consider evaluating cases that
are defined as missed opportunities.
Women’s Care
Women’s Care
Overall performance for the Women’s
Care dimension was below average
to average.
Women’s Care
•None of the HMOs had a rate above the HPL
for this dimension of care.
•Five of the nine HMOs that reported a rate for
the Breast Cancer Screening measure
performed below the LPL.
•One HMO performed below the LPL in all three
Chlamydia Screening in Women measures.
Women’s Care
For Breast Cancer Screening, rates may have
been hampered in 2006 because the hybrid
method was retired for this specific measure.
HMOs that may have relied on medical record
review for the Breast Cancer Screening
measure in the past likely observed a reduction
in their performance.
Women’s Care
Range of 2006 Rates
70%
60%
50%
40%
30%
20%
10%
0%
Breast Cancer Screening Chlamydia Screening, 16- Chlamydia Screening, 2120 years
25 years
Highest Plan Rate
FL Weighted Average
Chlamydia Screening,
Combined
Lowest Plan Rate
Women’s Care
Improvement efforts to consider for breast
cancer screening measure:
•Conduct a barrier analysis survey to
identify why women are not getting the
needed screenings.
•Mobile mammography/extended hours.
Women’s Care
Improvement efforts to consider for the
Chlamydia Screening in Women
measure:
•Analyze physician and lab coding
practices.
Women’s Care
•Missed opportunities could be examined
to identify barriers to improvement and
target specific interventions.
Living with Illness
Living with Illness
The overall statewide results in the Living
With Illness dimension were above
average when compared with national
Medicaid percentiles; however, caution
should be exercised when interpreting or
extrapolating results due to significant
changes to the HEDIS specifications for
the asthma measure.
Living with Illness
• Significant changes were made in the
2006 measure specifications.
• Nationwide and in Florida, these
changes resulted in lower eligible
populations and higher rates.
Living with Illness
Overall, the HMOs should still implement quality
improvement initiatives to increase rates. To
realize improvement in the asthma measures:
•Strong, focused case management programs
are essential.
•The use of an internal registry that contains
current,
member-level
data,
such
as
claims/encounters and lab tests with results that
are shared with the managing physicians, are
very effective.
Living with Illness
Range of 2006 Rates, cont’d
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Asthma, 5-9 Years
Asthma, 10-17 Years
Highest Plan Rate
Asthma, 18-56 Years
FL Weighted Average
Asthma, Combined
Rate
Lowest Plan Rate
Changes to HEDIS 2007
Changes to Existing Measures
•Breast Cancer Screening – lowered age
criteria to 40 years old, reporting in two
age cohorts.
Changes to Existing Measures
•Chlamydia Screening in Women – Minor
coding changes were made to the
denominator identification algorithms and
numerator identification codes
Changes to Existing Measures
•Use of Appropriate Medications for
People with Asthma – Minor coding
changes were made to the denominator
identification algorithms
Changes to Existing Measures
•No changes were made to any of the
well-child measures. For HEDIS 2008,
NCQA is considering retiring the hybrid
method.
Questions?