External Quality Review Quarterly Meeting

Wednesday, September 23, 20092:00 p.m. – 3:30 p.m.

WELCOME!

EQR Quarterly Meeting

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, CPHQExecutive 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: 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

HMO PSN NHDP PMHP

Met Status Partially Met Status Not Met Status

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 MeasuresEvaluation of Performance Measure Reporting by Plan/Model Type

Plan Type

Model Type

Are Standardized Performance

Measures Reported?

Are Performance

Measures Eligible for Validation?

Comments

MCOHMO—Non-Reform

Yes Yes Standard HEDIS measures

MCO HMO—Reform Yes YesStandard HEDIS measures and Agency-defined measures

PIHP PSN—Non-Reform Yes Yes Standard HEDIS measures

PIHP PSN—Reform Yes YesStandard HEDIS measures and Agency-defined measures

PIHP PMHP/CWPMHP Yes Yes Agency-defined measures

MCO NHDP Yes YesAgency/DOEA-defined measures

Validation of Performance MeasuresHMOs

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 MeasuresPSNs

Reform and Non-Reform PSNs report HEDIS performance measures.

Reform PSNs report on two Agency-defined 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 MeasuresPMHPs/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-DefinedPerformance Measure Results

Florida Medicaid PMHP/CWPMHP Performance Summary:Follow-Up After Hospitalization for Mental Health

Performance Measure

Performance Measure Rate

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 MeasuresNHDPs

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-DefinedPerformance 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

1

5

8

4

0 0

3

7

3

4

1

00

1

2

3

4

5

6

7

8

9

0 TO 10 10 TO 25 25 TO 50 50 TO 75 75 TO 90 90 TO 100

2007 National Medicaid Percentile Range

Nu

mb

er

of

We

igh

ted

Av

era

ge

Ra

tes

Non-Reform Reform

Health Plan Performance Compared to National Medicaid Percentiles

Pediatric Non-Reform HEDIS Measures

• 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

PediatricReform HEDIS Measures

Women’s CareNon-Reform HEDIS Measures

There were no MCOs who performed above the high performance level (HPL)

Women’s CareReform HEDIS Measures

There were no MCOs who performed above the high performance level (HPL)

Living With Illness (Part 1)Non-Reform HEDIS Measures

Living With Illness (Part 2)Non-Reform HEDIS Measures

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

Living With Illness (Part 2)Reform HEDIS Measures

One Reform plan was not required to report the Controlling High Blood Pressure measure.

2008-2009 EQR Technical ReportAssessment 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 2009- 2010

2008-2009 EQR Technical Report

Questions?

PIP Validation Activities for 2009-2010

2:50 p.m. – 3:05 p.m.

Presenter:

Christi Melendez, RN, CPHQEQRO Project Manager, PIPs

Overview

PIP Activities – Completed– Scheduled

Important Dates

PIP Submission Tips

PIP Activities Completed

Completed

Statement of Intent (SOI) August 14th: Notification sent to MCOs August 28th: MCOs submitted SOI information

PIP Submission Letter September 9th: Submission letter distributed to

MCOs with study topics identified for validation

Statement of Intent (SOI)

103 SOIs received from 26 HMOs23 SOIs received from 7 PSNs24 SOIs received from 12 PMHPs35 SOIs received from 15 NHDPs

185 SOIs submitted

120 PIPs to be validated

PIP Submission Letters

Letters sent on September 9, 2009

Included: 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– ddriscoll@hsag.com– 602.745.6260

Christi Melendez– cmelendez@hsag.com – 602.745.6339

Questions?

Upcoming EQR Activities

Presenter:

Yolanda Strozier, MBAEQRO 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, 2009Requested 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, 2009Site 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, 2010Site visits for PMHPS/CWPMHP will occur in May, 2010

Upcoming EQR activities

Questions?