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

External Quality Review Quarterly
Meeting
Monday, March 21, 2011
1:00 p.m. –2:30 p.m.
WELCOME!
Page 1
EQR Quarterly Meeting
• Welcome to all participants
• Overview of agenda
• Webinar do’s and don’ts
• Evaluation Forms
Page 2
EQR Quarterly Meeting
Note to all participants:
• Please DO place your phone on mute during
the call.
• Please DO NOT place your phone on hold at
any time during the meeting.
Page 3
HMO/PSN
HEDIS 2010 (CY 2009) HEDIS Results
Monday, March 21, 2011
1:25 p.m. – 2:20 p.m.
Presenter:
Melissa Brashear, MBA, CPA
Executive Director, Audits (HSAG)
State and Corporate Services
Page 4
Performance Measures
Related to Pediatric Care
Page 5
Well-Child Visits—15 Months (Zero Visits)
70.0
Well-Child Visits in the First 15 Months of Life, Zero Visits
64.4
10%
65.0
65.4
Non-Reform
8%
60.0
57.5
55.0
6%
56.6
5.3%
2%
40.0
6.2%
50.9
HEDIS
50th Percentile
4.3%
50.0
4%
45.0
Reform
46.6
49.2
3.0%
2.8%
44.0
HEDIS 75th Percentile
44.5
43.6
1.6%
HEDIS 25th Percentile 0.7%
0%
35.0
2008 Weighted
HEDIS 2008Average
Non-Reform
2009 Weighted
Average
HEDIS 2009
Reform
2010 Weighted Average
Performance Target
Note: Lower rates are better for this measure.
Page 6
Well-Child Visits—15 Months (Zero Visits)
• Compared with the HEDIS 2009 results, both
plan types declined in performance (their rates
increased).
• The Reform weighted average exhibited a
greater and statistically significant decline.
Page 7
Well-Child Visits—15 Months (6 Visits)
70.0
Well-Child Visits in the First 15 Months of Life, 6+ Visits
64.4
100%
65.0
65.4
Non-Reform
60.0
80%
64.4%
57.5
55.0
60%
50.0
40%
45.0
56.6
Reform
50.9%
44.0% 46.6
43.6%
50.9
49.2%
HEDIS 50th Percentile
46.0%
49.2
35.1%
HEDIS 75th Percentile
44.5
44.0
43.6
HEDIS 25th Percentile
40.0
20%
35.0
0%
HEDIS 2008
2008 Weighted Average
Non-Reform
HEDIS 2009
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 8
Well-Child Visits—15 Months (6 Visits)
• Compared with the HEDIS 2009 results, both
plan types showed a statistically significant
decline in HEDIS 2010 performance and were
at least 18 percentage points below AHCA’s
performance target.
Page 9
Well-Child Visits 3–6 Years
80.0
Well-Child Visits in the 3rd-6th Years of Life
100%
75.6
75.0
80%
Non-Reform
74.9%
74.9
71.1%
71.4%
71.4
72.5%
75.6%
74.0
74.9%
Reform
72.5
60% 70.0
72.7%
71.1
68.2
40%
HEDIS 50th
Percentile
67.6
65.0
HEDIS 75th
Percentile
20%
60.0
0%
HEDIS 2008
2008 Weighted Average
Non-Reform
HEDIS 2009
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 10
Well-Child Visits 3–6 Years
• The HEDIS 2010 Non-Reform plan weighted
average reached AHCA’s performance target
and exceeded the Reform plan weighted
average by approximately 2 percentage points.
Page 11
Adolescent Well Care
55.0
Adolescent Well-Care Visits
100%
51.4
51.4
Non-Reform
50.0
80%
46.4
44.2
45.0
60%
42.4
41.7%
40%
40.0
44.2%
Reform
46.0
51.4%
46.0% 46.4%
46.3%
45.7%
HEDIS 50th
42.1
41.7
Percentile
HEDIS 75th
Percentile
20%
35.0
0%
HEDIS 2008
2008 Weighted Average
Non-Reform
HEDIS 2009
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 12
Adolescent Well Care
• The HEDIS 2010 weighted averages for both
Non-Reform and Reform plans were below
AHCA’s performance target, with the Reform
plans performing slightly better than the NonReform plans.
Page 13
Lead Screening in Children
Lead
Screening
in Children
Annual
Dental Visit,
Total
60
100%
100%
51.3
50.6
50
80%
80%
Non-Reform
45.1
42.8
76.5%
40
Reform
27.9
60%
60%
30
27.9
55.2%
46.7%
17.7
20
40%
40%
11.3
20%
17.7%
51.5%
50.6%
27.5
HEDIS 50th Percentile
17.8
33.4%
HEDIS 75th
Percentile
27.9%
10
53.1%
17.8%
11.3%
18.5%
HEDIS 10th Percentile
0
0%
HEDIS 2008
HEDIS 2009
2009 Weighted
AverageAverage
2008 Weighted
AverageAverage2009 Weighted Average2010 Weighted
2010 Weighted
Non-Reform
Reform
Performance Target
Page 14
Lead Screening in Children
• The HEDIS 2010 weighted averages for both
Non-Reform and Reform plans were at least 20
percentage points below AHCA’s performance
target.
• However, the Non-Reform plans showed a
statistically significant improvement in their
performance in HEDIS 2010 of 6.4 percentage
points.
Page 15
Annual Dental Visits
60
Annual Dental Visit, Total
50.6
100%
51.3
50
80%
Non-Reform
45.1
42.8
40
Reform
27.9
60%
30
17.7
20
40%
27.9
50.6%
27.5
HEDIS 50th Percentile
17.8
33.4%
HEDIS 75th
Percentile
27.9%
11.3
10
20%
17.7%
18.5%
17.8%
HEDIS 10th Percentile
11.3%
0
0%
HEDIS 2008
2008 Weighted Average
Non-Reform
HEDIS 2009
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 16
Annual Dental Visits
• Although the HEDIS 2010 weighted averages
for both Non-Reform and Reform plans were at
least 15 percentage points below the AHCA
performance target, the HEDIS 2010
performance demonstrated an improvement over
HEDIS 2009.
Page 17
Childhood Immunization Status—
Combo 2
Childhood Immunization Status, Combination 2
100% 85
80%
HEDIS 75TH percentile = 80.0%
80
71.3%
75
80.0%
HEDIS 2008 50th percentile =
75.4%
68.9%
63.5%
61.8%
60%
70
Non-Reform
40%
Reform
63.5
65
61.8
20%
0%
60
55
2009 Weighted Average
2010 Weighted Average
HEDIS 2009
Non-Reform
Reform
Performance Target
Page 18
Childhood Immunization Status—
Combo 2
• Although the HEDIS 2010 weighted averages
for both Non-Reform and Reform plans were
below AHCA’s performance target, both plan
types showed statistically significant
improvements over their HEDIS 2009
performance.
Page 19
Childhood Immunization Status—Combo 3
Childhood Immunization Status, Combination 3
HEDIS 250th percentile = 68.6%
100%
74.3%
80%
63.6%
60%
52.0%
61.8%
53.7%
40%
20%
0%
2009 Weighted Average
Non-Reform
2010 Weighted Average
Reform
Performance Target
Page 20
Childhood Immunization Status—Combo 3
• Although the HEDIS 2010 weighted averages
for both Non-Reform and Reform plans were
about 10 percentage points below AHCA’s
performance target, both plan types showed
statistically significant improvement in their
performance from HEDIS 2009.
Page 21
Follow-up Care for Children Prescribed
ADHD Medication, Initiation
Follow-up Care for Children Prescribed ADHD Medication, Initiation
100%
HEDIS 2008 50th percentile = 65.9%
80%
60%
42.2%
41.6%
40%
37.8%
20%
0%
2010 Weighted Average
Non-Reform
Reform
Performance Target
This was the first year this measure was included in the analysis; therefore, no comparison data were available.
Page 22
Follow-up Care for Children Prescribed
ADHD Medication, Initiation
• The rate for Reform plans was slightly below
the performance target.
Page 23
Follow-up Care for Children Prescribed
ADHD Medication, Continuation and
Maintenance Phase
Follow-up Care for Children Prescribed ADHD Medication, Continuation
HEDIS 2008 50th percentile = 65.9%
100%
80%
67.2%
48.4%
60%
47.7%
40%
20%
0%
2010 Weighted Average
Non-Reform
Reform
Performance Target
This was the first year this measure was included in the analysis; therefore, no comparison data were available.
Page 24
Follow-up Care for Children Prescribed
ADHD Medication, Continuation and
Maintenance Phase
• Although the figure shows that the Reform
plans performed better than the Non-Reform
plans and AHCA’s performance target by
almost 20 percentage points, the total sum of
eligible Reform members was 61. Therefore,
caution should be used in interpreting the
results.
Page 25
Best Practices for
Pediatrics Care Measures
The most effective interventions were those that
targeted specific barriers.
• Member interventions conducted in conjunction
with provider interventions
• Electronic tracking tools and provider prompts
• Multicomponent and stepped interventions
• Improve access to care and transportation
Page 26
Best Practices for
Pediatrics Care Measures, continued
•
•
•
•
Partnerships with outside entities
Alternative testing strategies
Immunization registries
Systematic Follow-up for Children With ADHD
• Repeat information/emphasize common
message
Page 27
Performance Measures
Related to Women’s Care
Page 28
Cervical Cancer Screening
Cervical Cancer Screening
100%
72.0%
80%
60%
56.6%
53.8%
48.2%
55.3%
52.2%
50.8%
40%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 29
Cervical Cancer Screening
• Non-Reform plans continue to show better
performance than the Reform plans.
Page 30
Breast Cancer Screening
Breast Cancer Screening
100%
80%
56.4%
56.8%
60%
47.5%
51.4%
50.1%
40%
20%
0%
2009 Weighted Average
Non-Reform
2010 Weighted Average
Reform
Performance Target
Page 31
Breast Cancer Screening
• Both the Non-Reform and Reform weighted
averages showed a statistically significant
improvement in performance in 2010.
• The Reform plans’ HEDIS 2010 performance
exceeded the performance target.
Page 32
Timeliness of Prenatal Care
Timeliness of Prenatal Care
88.7%
100%
80%
75.1%
71.6%
66.2%
69.0%
69.4%
66.8%
60%
40%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 33
Timeliness of Prenatal Care
• Reform plans demonstrated a statistically
significant increase of 8.3 percentage points
from HEDIS 2009 to HEDIS 2010 and
performed better than the Non-Reform plans.
Page 34
Postpartum Care
Postpartum Care
100%
80%
60%
65.5%
58.5%
52.8%
50.1%
52.6%
51.5%
52.3%
40%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 35
Postpartum Care
• Although the HEDIS 2010 weighted averages
for both plan types showed an improvement
from HEDIS 2009, the performance was still
below the HEDIS 2008 weighted averages.
Page 36
Best Practices for
Women’s Care Measures
The most effective interventions primarily addressed
barriers related to access and lack of awareness.
• Physician and patient reminders
• Alternative types of providers
• Train practitioners in communication skills
• Improving access and awareness
• Physician tools and resources
Page 37
Best Practices for
Women’s Care Measures, continued
• Chlamydia educational materials developed and
distributed separately
• Implementing standard interventions for cervical
cancer screening
• Continually modify interventions
Note: Many of the same interventions used to increase
cervical cancer screening rates can be applied to
chlamydia screening.
Page 38
Performance Measures
Related to Living with Illness
Page 39
Diabetes Care—HbA1c Testing
Diabetes Care, HbA1c Testing
100%
80%
84.3%
74.7%
78.8%
82.9%
80.0%
76.4%
75.1%
60%
40%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 40
Diabetes Care—HbA1c Testing
• The HEDIS 2010 weighted averages for both
Non-Reform and Reform plans showed steady
improvement over the previous two years, with
the Reform plans nearly meeting the AHCA
target.
Page 41
Diabetes Care—Poor HbA1c Control
Diabetes Care, HbA1c Poor Control
100%
80%
60%
48.5%
48.3%
51.7%
47.1%
46.5%
45.4%
39.7%
40%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Note: Lower rates are better for this measure.
Page 42
Diabetes Care—Poor HbA1c Control
• The HEDIS 2010 weighted averages for both
the Non-Reform and Reform plans performed
better than HEDIS 2009, with Non-Reform
plans showing a statistically significant
improvement.
• Nonetheless, both plan types were still below
the AHCA performance target by more than 5
percentage points.
Page 43
Diabetes Care—LDL-C Screening
Diabetes Care, LDL-C Screening
100%
80%
75.6%
79.9%
76.3%
83.3% 77.9%
80.0%
77.8%
60%
40%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 44
Diabetes Care—Care—LDL-C Screening
• The HEDIS 2010 weighted averages for both
plan types showed continual improvement
from previous years, although the changes
were not statistically significant.
• For HEDIS 2010, the weighted average for the
Reform plans exceeded the AHCA target,
while the weighted average for the NonReform plans was only 0.1 percentage point
below the target.
Page 45
Diabetes Care—LDL-C Level <100
Diabetes Care, LDL-C Control (<100 mg/dL)
100%
80%
60%
37.2%
33.8%
35.3%
40%
29.5%
29.3%
35.8%
29.4%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 46
Diabetes Care—LDL-C Level <100
• Both the Non-Reform and Reform weighted
averages in HEDIS 2010 increased from
HEDIS 2009, with the Non-Reform plans
showing a statistically significant
improvement.
Page 47
Diabetes Care—Eye Exams
Diabetes Care, Eye Exam (Retinal) Performed
100%
80%
62.7%
60%
41.9%
40%
36.3%
48.2%
43.9%
45.2%
35.6%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 48
Diabetes Care—Eye Exams
• Both the Non-Reform and Reform weighted
averages continued to increase for HEDIS 2010,
with the Non-Reform plans showing a
statistically significant improvement.
Page 49
Diabetes Care—Monitoring Nephropathy
Diabetes Care, Medical Attention for Nephropathy
100%
81.8%
80%
77.1%
79.2%
81.8%
80.2%
76.1%
77.1%
60%
40%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 50
Diabetes Care—Monitoring Nephropathy
• The weighted averages for the Reform plans
showed improvement each year, and also met
the AHCA performance target for HEDIS
2010.
Page 51
Controlling High Blood Pressure
Controlling High Blood Pressure
100%
80%
59.9%
60%
52.7%
51.5%
55.8%
53.0%
53.5%
46.2%
40%
20%
0%
2008 Weighted Average
Non-Reform
2009 Weighted Average
Reform
2010 Weighted Average
Performance Target
Page 52
Controlling High Blood Pressure
• Compared with the HEDIS 2009 weighted
averages, the HEDIS 2010 Non-Reform
weighted average showed a slight
improvement, whereas the Reform plans had a
slight decline.
Page 53
Use of Appropriate Medications for People
with Asthma (Total)
Use of Appropriate Medications for People with Asthma, Total
100%
90.6%
86.9%
86.9%
87.6%
83.6%
80%
60%
2009 Weighted Average
Non-Reform
2010 Weighted Average
Reform
Performance Target
Note: Since the age range used for this measure for HEDIS 2009 (5–56 years of age) was different from the range used for HEDIS 2010
(5–50 years of age), caution should be used when interpreting the trending results.
Page 54
Use of Appropriate Medications for
People with Asthma (Total)
• The Reform plans are approaching the
performance target and performed slightly
better than the Non-Reform plans in HEDIS
2010.
Page 55
Antidepressant Medication Management—
Effective Acute Phase Treatment
Antidepressant Medication Management, Effective Acute Phase
Treatment
100%
80%
60%
HEDIS 2008 50th percentile =
45.1%
48.3%
51.0%
46.3%
45.4%
48.9%
40%
20%
0%
2009 Weighted Average
Non-Reform
2010 Weighted Average
Reform
Performance Target
Page 56
Antidepressant Medication Management—
Effective Acute Phase Treatment
• Reform plans performed better than NonReform plans and exceeded the performance
target during HEDIS 2009 and HEDIS 2010.
Page 57
Antidepressant Medication Management—
Effective Continuation Phase Treatment
Antidepressant Medication Management, Effective Continuation
Phase Treatment
100%
80%
HEDIS 2008 50th
percentile = 28.3%
60%
40%
31.2%
36.0%
29.8%
31.3%
29.1%
20%
0%
2009 Weighted Average
Non-Reform
2010 Weighted Average
Reform
Performance Target
Page 58
Antidepressant Medication Management—
Effective Continuation Phase Treatment
• For HEDIS 2010, Reform plans performed
better than Non-Reform plans and exceeded
the AHCA performance target.
Page 59
Best Practices for
Living with Illness Measures
• Comprehensive Diabetes Care
– Support groups
– Diabetic Health Management Program
– Patient outreach
• Controlling Blood Pressure
– Reminder systems for preventive care
– Stepped care approach to antihypertensive drug
therapy
Page 60
Best Practices for
Living with Illness Measures, Continued
• Asthma Management
– Asthma registry
– Assign quality managers to high-volume providers
– Incentive program for providers and members
• Antidepressant Medication Management
– Collaborative care model
– Self-care tip sheets
– Practitioner tool kit
Page 61
Performance Measures
Related to Access to Care
Page 62
Adults’ Access to Preventive/Ambulatory
Health Services, 20-44 Years
Adults' Access to Preventive/Ambulatory Health Services, 20-44 Years
100%
80%
69.1%
71.8%
67.9%
71.2%
84.8%
60%
40%
20%
0%
2009 Weighted Average
Non-Reform
2010 Weighted Average
Reform
Performance Target
Page 63
Adults’ Access to Preventive/Ambulatory
Health Services, 20-44 Years
• The HEDIS 2010 Non-Reform and Reform
weighted averages declined from the HEDIS
2009 averages, with the Non-Reform plans
showing a slightly greater decline than the
Reform plans.
Page 64
Adults’ Access to Preventive/Ambulatory
Health Services, 45-64 Years
Adults' Access to Preventive/Ambulatory Health Services, 45-64 Years
100%
82.1%
84.9%
84.7%
81.2%
80%
88.3%
60%
40%
20%
0%
2009 Weighted Average
Non-Reform
2010 Weighted Average
Reform
Performance Target
Page 65
Adults’ Access to Preventive/Ambulatory
Health Services, 45-64 Years
• Compared with HEDIS 2009 performance, the
Non-Reform plans exhibited a slight but
statistically significant decline in performance
in HEDIS 2010, whereas the Reform plans had
a small but not statistically significant increase
in performance.
Page 66
Best Practices for
Access to Care Measures
•
•
•
•
•
•
Educating patients on health care navigation
Establishing a member awards program
Coordinating transportation
Participating in health fairs
Providing a “medical home”
Convenient service hours
A patient-centered care model can also improve
screening and chronic disease management HEDIS
measures.
Page 67
HMO/PSN HEDIS Results
Questions?
Page 68
Upcoming EQR Activities
Monday, March 21, 2011
Presenter:
Yolanda Strozier, MBA
Associate Director,
State and Corporate Services
Page 69
Upcoming EQR activities
• The next EQR Quarterly Meetings:
– Wednesday, June 8, 2011 (AHCA Offices)
One-on-one TA sessions Tuesday, June 7, 2011
– Week of September 26, 2011 (Webinar)
– Wednesday, January 11, 2012 (AHCA
Offices)
One-on-one TA sessions Tuesday, January 10, 2012
– Week of March 19, 2012 (Webinar)
Page 70
Upcoming EQR activities
• Finalization of PIP Validation Reports (April
2011).
• Annual PIP Summary Report and Strategic
Summary Report (April–June 2011).
Page 71
Upcoming EQR activities
Next Steps
• PIPs are submitted to AHCA/DOEA— August
2011
• MCOs will receive HSAG’s “Statement of
Intent” (SOI) survey on Wednesday, August
10, 2011.
• Completed SOI’s due to HSAG on Monday,
August 29th.
Page 72
External Quality Review Quarterly
Meeting
THANK YOU FOR YOUR
PARTICIPATION!
Page 73