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

External Quality Review
Quarterly Meeting
Wednesday, September 23, 2009
2:00 p.m. – 3:30 p.m.
WELCOME!
EQR Quarterly Meeting
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Welcome to all participants
Overview of agenda
Webinar do’s and don’ts
Evaluation form
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.
Questions?
Overview of EQR Technical Report
for FY 2008–2009
Presenter:
Gretchen Thompson, MBA, CPHQ
Executive Director, State and Corporate Services
2008-2009 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
2008-2009 EQR Technical Report
 Summarizes the activities and findings
from the third year of the EQR contract
 Includes summary findings by MCO type
(HMO, PSN, PMHP/CWPMHP, and
NHDP) as well as overall conclusions and
recommendations
2008-2009 EQR Technical Report
Data used to evaluate MCO performance:
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Validation of PIP results
Validation of performance measure results
HEDIS® results
HEDIS® is a registered trademark of the
National Committee for Quality Assurance
(NCQA)
2008-2009 EQR Technical Report
Other EQR activities:
 Technical assistance
 Dissemination of education (quarterly
meetings, website, trainings)
 Focused reviews of compliance with
access, structural, and operations
standards
Validation of Performance
Improvement Projects (PIPs)
Validation of PIPs
100%
2
7
90%
8
5
7
6
80%
5
7
70%
15
9
30
5
1
19
60%
50%
7
40%
6
2
32
10
30%
21
16
16
2007
(n=23)
2008
(n=24)
16
23
20%
5
7
8
10%
0%
2
2006
(n=53)
2007
(n=46)
2008
(n=50)
2006
(n=0)
HMO
2007
(n=16)
PSN
HMO
PSN
NotMet
MetStatus
Status
2008
(n=16)
2006
(n=20)
2007
(n=26)
2008
(n=29)
2006
(n=8)
NHDP
PMHP
NHDP
PMHP
Partially
Status
Partially
MetMet
Status
NotStatus
Met Status
Met
PIP Conclusions
 For the same PIPs submitted each year, the number
of PIPs receiving a validation status of Met declined
as the PIPs progressed to more challenging
activities
 For all PIPs submitted each year, the number of
PIPs receiving a Met validation status improved
from the first year to the third year
PIP Conclusions
 For the Study Design Stage all MCO types
addressed from 56 to 100 percent of Partially
Met and Not Met evaluation elements
 HMO PIPs received more Partially Met and Not Met
validation status than Met
 PSN PIPs with a Met validation status declined by 50
percent and more PIPs received a Partially Met and
Not Met validation than in the previous year
PIP Conclusions
 PMHP PIPs demonstrated a slight decline where
more PIPs received a Not Met validation status in
2008-2009 than in the previous year. However,
16 PIPs received a Met validation status, which
was the same as the previous year
 NHDP PIPs with a Met validation status declined
by 50 percent and more PIPs received a Partially
Met and Not Met validation than in the previous
year
Validation of 2007
Performance Measure Results
Validation of Performance Measures
Evaluation of Performance Measure Reporting by Plan/Model Type
Plan
Type
MCO
Model Type
HMO—NonReform
Are Standardized
Performance
Measures
Reported?
Are Performance
Measures Eligible
for Validation?
Yes
Yes
Comments
Standard HEDIS measures
Standard HEDIS measures
and Agency-defined
measures
Standard HEDIS measures
Standard HEDIS measures
and Agency-defined
measures
MCO HMO—Reform
Yes
Yes
PIHP
PSN—Non-Reform
Yes
Yes
PIHP
PSN—Reform
Yes
Yes
PIHP
PMHP/CWPMHP
Yes
Yes
Agency-defined measures
Yes
Yes
Agency/DOEA-defined
measures
MCO NHDP
Validation of Performance Measures
HMOs
 Reform and Non-Reform HMOs report HEDIS
performance measures.
 Reform HMOs report on two Agency-defined
measures.
 Most HMOs received measure designations of
Report for all performance measures
 Three Non-Reform HMOs received Not Report
for the Annual Dental Visits measure
 Two Reform HMOs received a Not Report for
the Use of Beta Agonist measure
Validation of Performance Measures
PSNs
 Reform and Non-Reform PSNs report
HEDIS performance measures.
 Reform PSNs report on two Agencydefined measures.
 All PSNs received measure designations
of Report for all performance measures
 Many PSNs had very small populations for
several required measures
Validation of Performance Measures
PMHPs/CWPMHP
 All PMHPs and the CWPMHP received a Fully
Compliant [CMS] measure designation for two of the
three required performance measures
 Four of the PMHPs received a Substantially
Compliant designation for Number of Enrollees
Admitted to State Mental Health Treatment Facilities
 One PMHP received a Not Valid designation because
it did not have any valid data to report
 For 2009-2010, AHCA eliminated the requirement to
report the Number of Enrollees Admitted to State
Mental Health Treatment Facilities measure
PMHP/CWPMHP Agency-Defined
Performance Measure Results
Florida Medicaid PMHP/CWPMHP Performance Summary:
Follow-Up After Hospitalization for Mental Health
Performance Measure Rate
Performance Measure
Highest Rate
Median
Lowest Rate
Follow-Up with Mental Health
Practitioner
31.2%
17.8%
11.0%
Follow-Up with Mental Health
Practitioner and/or Case Manager
55.2%
29.6%
15.5%
Follow-Up with a Case Manager
42.8%
14.7%
4.0%
Readmission Rate
30.2%
22.9%
15.7%
Number of Enrollees Admitted to
State Mental Health Treatment
Facilities
0.12%
0.09%
0.00%
Validation of Performance Measures
NHDPs
 All 14 NHDPs, who reported performance
measures, were able to report valid results
 All performance measures were based on
enrollment
 Four NHDPs received a Substantially
Compliant measure designation for one or
more of the four performance measures
 None of the issues resulted in a significant
bias to the final reported performance
measure rates
NHDP Agency-Defined
Performance Measure Results
Florida Medicaid NHDP Rates for
Agency-Defined Performance Measures
Performance Measure
Performance Measure Rate
Highest Rate
Median
Lowest Rate
Disenrollment Rate
26.3%
18.4%
6.6%
Retention Rate
98.6%
94.9%
88.9%
Voluntary Disenrollment
Rate
10.3%
4.2%
2.1%
Average Length of
Enrollment (Months)
32.83
16.08
5.09
HEDIS Measure Results
Non-Reform and Reform
HEDIS Results
Health Plan Performance
Compared to National Medicaid Percentiles
9
8
Number of Weighted Average Rates
8
7
7
6
5
5
4
4
3
3
4
3
2
1
1
1
0
0 TO 10
10 TO 25
25 TO 50
50 TO 75
2007 National Medicaid Percentile Range
Non-Reform
Reform
0
0
0
75 TO 90
90 TO 100
Pediatric
Non-Reform HEDIS Measures
Florida Medicaid HEDIS 2008 Performance Summary: Pediatric
Care for Non-Reform Plans
100%
90%
5
80%
2
70%
10
60%
10
Not Report (NR)
50%
Above Average
40%
Average
8
30%
3
Below Average
20%
3
10%
3
0%
Well-Child 1st 15 Months Well-Child 3rd-6th Years
of Life
of Life—6+ Visits
•
•
•
Adolescent Well-Care
Visits
Annual Dental Visits
HEDIS measures results showed below average to average performance for the Pediatric Care dimension
There were no MCOs who performed above the high performance level (HPL)
Eight plans did not provide the benefit required for Annual Dental Visits
Pediatric
Reform HEDIS Measures
Florida Medicaid HEDIS 2008 Performance Summary: Pediatric
Care for Reform Plans
100%
1
1
90%
80%
1
2
7
70%
Not Applicable (NA)
60%
11
50%
40%
13
Not Report (NR)
14
5
Above Average
Average
30%
Below Average
20%
10%
4
3
2
0%
Well-Child 1st 15 Months Well-Child 3rd-6th Years
of Life
of Life—6+ Visits
Adolescent Well-Care
Visits
Annual Dental Visits
Women’s Care
Non-Reform HEDIS Measures
Florida Medicaid HEDIS 2008 Performance Summary: Women's Care
for Non-Reform Plans
100%
90%
2
1
1
80%
70%
6
60%
Not Applicable
(NA)
Above Average
50%
40%
11
12
Average
30%
6
20%
10%
0%
Cervical Cancer Screening
Timeliness of Prenatal Care
Postpartum Care
There were no MCOs who performed above the high performance level (HPL)
Below Average
Women’s Care
Reform HEDIS Measures
Florida Medicaid HEDIS 2008 Performance Summary: Women's
Care for Reform Plans
100%
1
90%
6
80%
6
70%
60%
Not Applicable (NA)
4
50%
13
Above Average
Average
40%
Below Average
10
30%
20%
6
10%
0%
Cervical Cancer Screening
Timeliness of Prenatal Care
Postpartum Care
There were no MCOs who performed above the high performance level (HPL)
Living With Illness (Part 1)
Non-Reform HEDIS Measures
Florida Medicaid HEDIS 2008 Performance Summary:
Living with Illness for Non-Reform Plans (Part 1)
100%
1
1
1
1
1
1
90%
1
3
80%
70%
1
3
6
60%
11
50%
11
11
9
7
40%
9
30%
20%
6
10%
0%
Diabetes Care
HbA1c Testing
1
1
Diabetes Care
Poor HbA1c Control
Diabetes Care
Good HbA1c
Control
Below Average
Average
2
Diabetes Care
LDL-C Screening
2
1
Diabetes Care
LDL-C Level<100
Above Average
Diabetes Care
Eye Exam
Not Applicable (NA)
Diabetes Care
Nephropathy
Living With Illness (Part 2)
Non-Reform HEDIS Measures
Florida Medicaid HEDIS 2008 Performance Summary:
Living with Illness for Non-Reform Plans (Part 2)
100%
1
90%
1
2
2
80%
3
70%
60%
4
7
Not Applicable (NA)
50%
Above Average
40%
Average
30%
7
Below Average
6
20%
4
10%
0%
Controlling High Blood Pressure
Follow-Up After
Follow-Up After
Hospitalization for
Hospitalization for
Mental Illness - 30 Days
Mental Illness - 7 Days
One plan did not offer the health benefits required for the following measures: Follow-Up After Hospitalization After 30 Days
and for Follow-Up After Hospitalization After 7 Days
Living With Illness (Part 1)
Reform HEDIS Measures
Florida Medicaid HEDIS 2008 Performance Summary:
Living with Illness for Reform Plans (Part 1)
100%
90%
4
4
4
4
4
4
4
80%
1
70%
4
60%
6
50%
8
11
40%
9
11
12
30%
8
20%
10%
6
4
1
0%
Diabetes Care
HbA1c Testing
Diabetes Care
Poor HbA1c Control
Below Average
2
Diabetes Care
Good HbA1c
Control
Average
1
Diabetes Care
LDL-C Screening
Diabetes Care
LDL-C Level<100
Above Average
Diabetes Care
Eye Exam
Not Applicable (NA)
Diabetes Care
Nephropathy
Living With Illness (Part 2)
Reform HEDIS Measures
Florida Medicaid HEDIS 2008 Performance Summary:
Living with Illness for Reform Plans (Part 2)
100%
90%
3
5
80%
5
1
70%
2
60%
50%
3
Not Applicable (NA)
6
Above Average
40%
Average
30%
20%
9
Below Average
8
5
10%
0%
Controlling High Blood Pressure
Follow-Up After
Hospitalization for
Mental Illness - 30 Days
Follow-Up After
Hospitalization for
Mental Illness - 7 Days
One Reform plan was not required to report the Controlling High Blood Pressure measure.
2008-2009 EQR Technical Report
Assessment of MCO Strengths and Weaknesses:
 HSAG developed a methodology to identify
strengths and weaknesses in performance in key
EQR areas
 A set of tables displaying objective data (PIPs and
performance measure results) highlights each
MCO’s strengths and weakness based on the
methodology
 Strengths and weaknesses were grouped into
categories of quality, timeliness, and access to
care
2008-2009 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
Overall Conclusions for PIPs and
Performance Measures
 Overall, the Florida Medicaid managed care
programs demonstrated some improvements in
performance during the third year of activities,
and some areas that need continued
improvement
 All MCOs demonstrated challenges with PIPs
– Of the PIPs that achieved a Met validation status,
most addressed quality and some addressed
access
 Statewide performance measure results
demonstrated some strengths, but more
opportunities for improvement
Recommendations for PIPs
 PIP recommendations include the need for:
– MCOs to address all evaluation elements that
received a Partially Met or Not Met validation
finding on the next PIP submission
– MCOs to select PIP topics that address access
and timeliness of services
– Statewide interventions, or future collaboratives,
that target low performing performance measures,
such as: prenatal care, cervical cancer screening,
and follow-up after hospitalization for mental
illness
Recommendations for
Performance Measures
 Performance measure recommendations
include the need for:
– Targeted improvement efforts toward
performance measures that fall below the LPL
– Consider implementing performance
measures that address access to and
timeliness of services
 AHCA should continue efforts to implement
performance-based purchasing initiatives to
improve performance on select HEDIS
measures
Compliance Update
 HSAG working closely with AHCA to develop
Access databases for use in monitoring MCO
compliance with access, structural, and
operations standards
 AHCA staff have implemented use of the
database for monitoring PMHPs
 HSAG/AHCA/DOEA revising monitoring tools to
reflect new contract provisions for HMOs, PSNs,
NHDPs
 Access database testing and implementation will
occur for HMOs, PSNs, NHDPs during FY 20092010
2008-2009 EQR Technical Report
Questions?
PIP Validation Activities
for 2009-2010
2:50 p.m. – 3:05 p.m.
Presenter:
Christi Melendez, RN, CPHQ
EQRO Project Manager, PIPs
Overview
 PIP Activities
– Completed
– Scheduled
 Important Dates
 PIP Submission Tips
PIP Activities Completed
Completed
Statement of Intent (SOI)
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August 14th: Notification sent to MCOs
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August 28th: MCOs submitted SOI information
PIP Submission Letter
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September 9th: Submission letter distributed to
MCOs with study topics identified for validation
Statement of Intent (SOI)
103 SOIs received from 26 HMOs
23 SOIs received from 7 PSNs
24 SOIs received from 12 PMHPs
35 SOIs received from 15 NHDPs
185 SOIs submitted
120 PIPs to be validated
PIP Submission Letters
 Letters sent on September 9, 2009
Included:
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2009-2010 PIP validation timeline
PIP topics selected for validation
PIP Summary Form for new PIPs
Completion instructions
PIP Frequently Asked Questions
 FAQ on www.myfloridaeqro.com
 Includes FAQs for collaborative PIPs
 Examples of FAQs
– What are some resources I can use in
conducting my PIP?
– Where can I find benchmarking information for
Medicaid programs?
– What is a collaborative PIP?
 When are PIP forms and documentation
due? October 9, 2009
PIP Submission Tips
Previously Submitted PIPs
 For ongoing PIPs, use the same PIP Summary Form
that was submitted for previous year’s validation cycle.
 Highlight, bold, or add text in a different color, and
date any new information that is added to the existing
PIP Study Form.
 Strikethrough and date any information that no longer
applies to the PIP study submission.
 Ensure all Points of Clarification, Partially Met and Not
Met evaluation elements from the previous validation
cycle have been addressed in the documentation.
All PIP Submissions
 Complete/update demographic page of
PIP Summary Form.
 Only complete the PIP Summary Form
as far as the PIP has progressed.
 Be sure to include all attachments
referenced in the PIP Summary Form
(e.g. HEDIS final audit reports, manual
data collection tool, instructions, etc.)
HSAG Contacts for PIP Questions
 Denise Driscoll
– [email protected]
– 602.745.6260
 Christi Melendez
– [email protected]
– 602.745.6339
Questions?
Upcoming EQR Activities
Presenter:
Yolanda Strozier, MBA
EQRO Project Manager
Upcoming EQR activities
The next EQR Quarterly Meetings are
scheduled for:
Wednesday, January 13, 2010 (AHCA Offices)
One-on-One TA sessions Tuesday, January 12, 2010
Wednesday, March 24, 2010 (Webinar)
Wednesday, June 9, 2010 (AHCA Offices)
One-on-One TA sessions Tuesday, June 8, 2010
Upcoming EQR activities
Validation of PIPs:
Submission date for selected PIP forms
and documentation is Friday, October 9,
2009
Upcoming EQR activities
Collaborative PIPs:
 The next PMHP conference call is
Tuesday, October 27th at 11:00 a.m.
 The next HMO/PSN conference call is
November 16th at 10:00 a.m.
 The next NHDP conference call is
December 16th at 2 p.m.
Upcoming EQR activities
Validation of Performance Measures
(HMOs/PSNs):
 Request for documentation for the
HMOs/PSNs was sent out on September
11th, 2009
 Documentation is due to HSAG on Friday,
October 16th, 2009
 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 25, 2009
 Site visits for NHDPs scheduled for
October/November
Upcoming EQR activities
Validation of Performance Measures
(PMHPS/CWPMHP):
 Completed ISCAT and other requested
documents are due to HSAG by April
16, 2010
 Site visits for PMHPS/CWPMHP will
occur in May, 2010
Upcoming EQR activities
Questions?