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

Welcome to the EQR Quarterly
Meeting!
Wednesday, September 24, 2008
1:00 p.m. – 3:00 p.m. (EDT)
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External Quality Review
Quarterly Meeting
Wednesday, September 24, 2008
1:00 p.m. – 3:00 p.m.
WELCOME!
EQR Quarterly Meeting
Welcome to all participants
Overview of agenda
Webinar do’s and don’ts
Evaluation Forms
EQR Quarterly Meeting
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during the call.
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hold at any time during the meeting.
Overview of EQR Technical Report
for 2007/2008
Presenter:
Peggy Ketterer, RN, BSN, CHCA
Executive Director, EQRO Services
2007-2008 EQR Technical Report
• Required annually by the
Balanced Budget Act of 1997
(BBA)
• Includes conclusions regarding the
quality and timeliness of, and
access to, care furnished by
contracted MCOs and PIHPs
2007-2008 EQR Technical Report
• Summarizes the activities and
findings from the second year of
the EQR contract
• Includes summary findings by
MCO type (HMO, PSN,
PMHP/CWPMHP, and NHDP) as
well as overall conclusions and
recommendations
2007-2008 EQR Technical Report
Data used to evaluate performance
included:
• Validation of PIP results
• Validation of performance measure
results
• Consumer satisfaction survey data
• HEDIS® results
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)
2007-2008 EQR Technical Report
Other EQR activities:
• Technical assistance on enrollee race,
ethnicity, and primary household
language
• Value-based purchasing methodologies
• Evaluation of AHCA quality strategy
• Dissemination of education (quarterly
meetings, website, trainings)
2007-2008 EQR Technical Report
Reform and Non-Reform:
• Most data that was available to
evaluate performance (with the
exception of PIPs) was limited to
HMOs with a non-reform contract.
The 2008-2009 EQR Technical
Report will include additional data
from reform plans.
HMO Findings
• Most objective data available to
evaluate performance
• PIPs*–Nearly 70 percent received
Met validation status, 15 percent
received a Partially Met status, and
15 percent received a Not Met
validation status
*Included both reform and non-reform submissions
HMO Findings
2006–2007 PIP Validation Status
HMO
Met
Partially Met
Not Met
Total
2
21
30
53
2007–2008 PIP Validation Status
HMO
Met
Partially Met
Not Met
Total
32
7
7
46
HMO Findings
• Performance Measures–Eight of
the 12 HMOs were assigned an
audit result of “Report, (“R”) for all
of the performance measures
required by AHCA, indicating there
were no issues noted that resulted
in a bias to any of the rates.
HMO Findings
• Performance Measures–Four
HMOs received “Not Report,”
(“NR”) findings for the Controlling
High Blood Pressure measure,
which led to those health plans not
being able to report rates for this
measure.
HMO Findings
• Consumer satisfaction surveys
(CAHPS®)–Overall, statewide HMO
performance on the composite and
global measures for the adult and child
surveys was average, although the
child survey results were slightly better
than the adult survey results.
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
HMO Findings
• One HMO (Vista Health Plan,
Inc.—Vista South Florida)
exceeded the statewide average
for all four global ratings for the
child Medicaid CAHPS survey.
HMO Findings
7
6
Number of Weighted Average Rates
6
5
5
4
3
3
2
1
1
0
0
0
0 TO 10
10 TO 25
25 TO 50
50 TO 75
2006 National Medicaid Percentile Range
75 TO 90
90 TO 100
HMO Findings
• HEDIS Measures–results showed
below average to average
performance for the Women’s
Care dimension which included
Breast Cancer Screening,
Chlamydia Screening in Women,
and Timeliness of Prenatal Care
measures.
Women’s Care
Range of 2007 Rates
80%
70%
60%
50%
40%
30%
20%
10%
0%
Breast Cancer
Screening, 42-51
Years
Breast Cancer
Screening, 52-69
Years
Breast Cancer
Screening,
Com bined
Highest Plan Rate
Cervical Cancer
Screening
Chlam ydia
Chlam ydia
Screening, 16-20 Screening, 21-25
Years
Years
FL Weighted Average
Chlam ydia
Screening,
Com bined
Lowest Plan Rate
Tim eliness of
Prenatal Care
HMO Findings
• HEDIS Measures–results for most
measures within the Living With
Illness dimension ranked below
average to average.
Living with Illness – Diabetes Care
Range of 2007 Rates
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Diabetes Care-Eye Exam
Diabetes Care-LDL Screening Diabetes Care-LDL level <100
Highest Plan Rate
FL Weighted Average
Lowest Plan Rate
Diabetes Care-Nephropathy
Living with Illness
Range of 2007 Rates, cont’d
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Asthm a, 5-9
Years
Asthm a, 10-17
Years
Highest Plan Rate
Asthm a, 18-56
Years
Asthm a,
Com bined Rate
Controlling High Controlling High Controlling High
Blood Pressure, Blood Pressure, Blood Pressure,
16-45 Years
46-85 Years
Com bined
FL Weighted Average
Lowest Plan Rate
PMHP Findings
• Limited objective data to evaluate
• PIPs–Slightly more than 69 percent
received Met validation status, 22
percent received a Partially Met
status, and 9 percent received a Not
Met validation status
• Consumer satisfaction surveys–
unable to use for comparison
purposes
PMHP Findings
2006–2007 PIP Validation Status
PMHP
Met
Partially Met
Not Met
Total
0
7
1
8
2007–2008 PIP Validation Status
PMHP
Met
Partially Met
Not Met
Total
16
5
2
23
PSN Findings
Limited objective data to evaluate
• Nearly 63 percent received Met
validation status, none received a
Partially Met status, and slightly over
37 percent received a Not Met
validation status
• Consumer satisfaction surveys–
unable to use for comparison
purposes
NHDP Findings
Limited objective data to evaluate
• PIPs–62 percent received Met
validation status, 19 percent received
a Partially Met status, and 19 percent
received a Not Met validation status
• Consumer satisfaction surveys–
unable to use for comparison
purposes
NHDP Findings
2006–2007 PIP Validation Status
NHDP
Met
Partially Met
Not Met
Total
0
7
13
20
2007–2008 PIP Validation Status
NHDP
Met
Partially Met
Not Met
Total
16
5
5
26
2007-2008 EQR Technical Report
Assessment of MCO Strengths and
Weaknesses:
• HSAG developed a methodology to
identify strengths and weaknesses in
performance in key EQR areas
• Used objective data (PIPs,
performance measure results, and
consumer survey performance
results)
2007-2008 EQR Technical Report
Assessment of MCO Strengths and
Weaknesses:
• HEDIS measures that exceeded the
high performance level (national 90th
percentile) were considered a
strength for the MCO
• HEDIS measures that fell below the
low performance level (national 25th
percentile) were considered a
weakness for the MCO
2007-2008 EQR Technical Report
Assessment of MCO Strengths and
Weaknesses:
• CAHPS measures that were statistically
higher than the state average were
considered a strength for the MCO
• CAHPS measures that were statistically
lower than the state average were
considered a weakness for the MCO
2007-2008 EQR Technical Report
Assessment of MCO Strengths and
Weaknesses:
• Within the technical report, HSAG
prepared a set of tables displaying each
MCO’s strengths and weakness based
on the methodology
• Strengths and weaknesses were also
grouped into categories of quality,
timeliness, and access to care
High Performers
• High performers were identified as
MCOs that demonstrated strengths
in quality, access, and timeliness
for every EQR activity that
produced plan-specific results. Two
MCOs met this criteria.
High Performers
Jackson Memorial Health Plan
• Both PIPs received a “Met” validation
finding. One PIP addressed quality and
access and the other addressed
timeliness.
• JMH exceeded the 90th percentile for two
HEDIS measures, both addressing quality.
• JMH exceeded the state average for two
CAHPS measures, both addressing
quality.
High Performers
Access Behavioral Health
• Both PIPs received a “Met”
validation finding. One PIP
addressed quality and timeliness
and the other addressed access to
care.
Conclusions and
Recommendations
• Most objective data addressed only
quality of services.
• Overall, the Florida Medicaid
managed care programs
demonstrated some improvements
in performance during the second
year of activities.
Conclusions and
Recommendations
• All MCO types made great
improvements in PIPs.
• HMO consumer satisfaction survey
results also showed some areas of
strength for a few HMOs, with one
exceeding the statewide average
across all four global ratings.
Conclusions and
Recommendations
• HMO performance on certain
HEDIS measures showed room for
improvement.
Conclusions and
Recommendations
• Recommendations included the need
for MCOs to address all evaluation
elements that received a Partially
Met or Not Met validation finding on
the next PIP submission.
• For performance measures, the
MCOs should target low-performing
measures for improvement efforts.
Conclusions and
Recommendations
• MCOs may also consider conducting
a PIP on consumer satisfaction.
• AHCA should continue efforts to
implement a value-based purchasing
initiative that includes incentives for
improved performance on select
HEDIS measures.
2007-2008 EQR Technical Report
Questions?
Upcoming EQR Activities
Yolanda Strozier, MBA
Project Manager, EQRO Services
Upcoming EQR activities
The next EQR Quarterly Meetings are
scheduled for:
Wednesday, January 14, 2009 (AHCA Offices)
One-on-One TA sessions Tuesday, January 13, 2009
Wednesday, March 25, 2009 (Webinar)
Upcoming EQR activities
Validation of PIPs:
• Submission date for selected PIP
forms and documentation is
Monday, October 6, 2008
Upcoming EQR activities
Collaborative PIPs:
• The next PMHP conference call is
October 22nd at 11:00 a.m.
Upcoming EQR activities
Validation of Performance Measures:
• Request for documentation for the
HMOs/PSNs was sent out
on September 10, 2008
• Documentation is due to HSAG on
Monday, October 20th, 2008
• Requested items: HEDIS BAT, ISCAT
questions, HEDIS data file, audit report
Upcoming EQR activities
Validation of Performance Measures
(NHDPs):
• Completed ISCAT and other requested
documents are due to HSAG by
September 26, 2008
• Site visits for NHDPs scheduled for
October/November
Upcoming EQR activities
Questions?
Florida’s Quality Strategy
Peggy Ketterer, RN, BSN, CHCA
Executive Director, EQRO Services
Deborah McNamara, LCSW/PMP
Medicaid Quality Coordinator
Quality Strategy
What is a quality strategy?
• A written strategy for assessing and
improving the quality of managed
care services offered by all MCOs
and PIHPs
• Requirement within the Balanced
Budget Act of 1997 (42 CFR
§438.202)
Quality Strategy
Other BBA Requirements:
• Each state must obtain input of
recipients and other stakeholders in
the development of the strategy
and make the document available
for public comment before adopting
it as final.
Quality Strategy
Other BBA Requirements:
• Each state must ensure that all
MCOs comply with the standards
established by the State
• Each state must conduct periodic
reviews of the strategy to evaluate
its effectiveness
Quality Strategy
Required elements must include
procedures that:
• Assess the quality and appropriateness
of care and services
• Identify race, ethnicity, and primary
language of enrollees
• Regularly monitor and evaluate MCO
compliance with standards
Quality Strategy
Required elements must include
procedures that:
• Identify performance measures and
levels for MCOs
• Ensure arrangements for EQR
• Ensure appropriate use of intermediate
sanctions
• Ensure information systems that
support the quality strategy operations
Quality Strategy
Open discussion with meeting
participants
Facilitator: Deborah McNamara
Quality Strategy
To access information on Florida’s Quality
Assessment and Improvement Strategies
view:
http://ahca.myflorida.com/Medicaid/quality
_mc/index.shtml
Facilitator: Deborah McNamara
Quality Strategy
Questions?
External Quality Review Quarterly
Meeting
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PARTICIPATION!