External Quality Review Quarterly Meeting Wednesday, September 23, 2009 2:00 p.m. – 3:30 p.m. WELCOME!
Jan 01, 2016
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– [email protected]– 602.745.6260
Christi Melendez– [email protected] – 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?