WELCOME! External Quality Review Quarterly Meeting Wednesday, June 18, 2008 10:00 a.m. – 3:30 p.m. WELCOME!

External Quality Review Quarterly Meeting

Wednesday, June 18, 200810:00 a.m. – 3:30 p.m.

WELCOME!WELCOME!

EQR Quarterly Meeting

• Welcome to all participants

• Overview of agenda

• Refreshments

Health Services Advisory Group, Inc. Health Services Advisory Group, Inc.

EQR Quarterly MeetingEQR Quarterly Meeting

Overview of Current Activities Overview of Current Activities and Upcoming EQR Activitiesand Upcoming EQR Activities

June 18, 2008June 18, 2008Presented by:Peggy Ketterer, RN, BSN, CHCAExecutive Director, EQR Services

Current EQR Activities

Overview of activities

conducted during

state fiscal year 2007-2008

Current EQR Activities

Performance Improvement Projects (PIPs)• Completed validation of two PIPs per MCO• Produced and finalized the Annual PIP

Validation Summary Report• Produced and finalized the Annual PIP

Strategic Summary Report

Current EQR Activities

Performance Improvement Projects (PIPs)• Facilitated three collaborative PIPs (still in

process)• Draft Annual Statewide Collaborative PIP

Methodology Report is due to AHCA in early July, 2008

• Technical assistance activities with MCOs, AHCA, and DOEA - ongoing

Current EQR Activities

Validation of Performance Measures • Completed validation of performance

measures reported by non-reform HMOs• Produced and finalized Annual Validation of

Performance Measures report• Conducting validation of performance

measures reported by PMHPs (in process)

Current EQR Activities

Validation of Performance Measures • Developed specifications for

PMHPs/NHDPs

Current EQR Activities

Monitoring of MCO Contract Compliance • Working with AHCA and DOEA on

monitoring tools and potential areas of standardization within and across each MCO type

• Working on ensuring that the monitoring process meets all Balanced Budget Act of 1997 (BBA) requirements

• Conducting validation audits of AHCA’s monitoring of fraud and abuse

Current EQR Activities

Strategic HEDIS® Analysis

• Produced and finalized HEDIS 2007 Strategic Analysis Report on non-reform HMOs

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)

Current EQR Activities

Technical Assistance – Enrollee Race, Ethnicity, and Primary Language

• Provided technical assistance as needed • Awaiting implementation of new FMMIS

system for improvements in collecting and reporting

• Produced a draft report on technical assistance activities provided during the year

Current EQR Activities

Value-Based Purchasing

• Provided technical assistance as needed • Participated in conference calls with Brady

Augustine and Tom Warring• Provided literature review results related to auto-

assignment algorithms, encounter data submission, and return on investments

• Produced a draft report on technical assistance activities provided during the year

Current EQR Activities

Evaluation of AHCA Quality Strategy

• Completed review of updated Quality Strategy

• Participated in monthly calls with AHCA Quality Strategy lead, Deborah McNamara

• Produced a draft report on the findings from the review of the updated Quality Strategy

Current EQR Activities

Focused Study – Behavioral Health Prior Authorization Process

• Produced a draft report on the Behavioral Health Prior Authorization Focused Study

Current EQR Activities

Dissemination and Education

• Conducted four quarterly meetings during the fiscal year

• Conducted one-on-one technical assistance sessions

• Maintained myfloridaeqro.com website• Weekly communications with AHCA,

monthly progress reports

Current EQR Activities

EQR Technical Report

• Completed analysis of 2007 CAHPS® data• Internal analysis underway• Draft report due to AHCA in July, 2008

CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)

Current EQR Activities

Technical Assistance to AHCA (as needed)

• Consumer-reported satisfaction surveys• Quality Strategy• Validation of PIPs

Year Three EQR Activities

Overview of activities to be

conducted during

state fiscal year 2008-2009

Year Three EQR Activities

MARK YOUR CALENDARS!!!!

The next EQR Quarterly Meetings are scheduled for:

•Wednesday, September 24, 2008 (Forum TBD)•Wednesday, January 14, 2009 (AHCA Offices)

One-on-One TA sessions Tuesday, January 13, 2009•Wednesday, March 25, 2009 (Webinar)•Wednesday, June 10, 2009 (AHCA Offices)

Year Three EQR Activities

•Validation of PIPs

•Validation of performance measures

•Review of compliance with access, structural, and operations standards

•Strategic HEDIS® analysis reports

•Technical assistance on enrollee race, ethnicity, and primary language

Year Three EQR Activities

•Value-based purchasing methodologies

•Evaluation of AHCA quality strategy

•Focused study (Topic TBD)

•Dissemination of EQR information

•EQRO Technical Report

•Technical Assistance (consumer surveys, validation of PIPs, quality strategy, and other areas)

MCO Roles and Responsibilities related to Year Three EQR

Activities (FY 08-09)

MCO Roles and Responsibilities

Validation of Performance Improvement Projects

Validation of PIPsMCO Roles and Responsibilities

• Provide basic information on the PIPs that are currently underway (Letter of Intent)

• Complete the PIP form and provide supportive documentation for each PIP selected for validation

• Review HSAG’s completed PIP tool and summary grid, providing feedback and comments

Validation of PIPsMCO Roles and Responsibilities

• Participate in the Collaborative PIP activities– Participate in monthly conference calls– Facilitate at least one monthly conference call

(with HSAG support)

Validation of PIPsMCO Roles and Responsibilities

• Participate in the Collaborative PIP activities– Conduct key activities of the PIP following the

study design– Implement interventions– Collect and analyze two re-measurements

Project Activity by MonthValidation of Performance Improvement Projects (PIPs)

Task May Jun Jul Aug Sep Oct Nov Dec Jan 09

Feb Mar Apr May Jun

PIPs 7/08 – 9/08Statement of Intent

Requested

10/08 – 12/08Perform Individual

PIP Reviews

01/09 – 2/09Prepare Annual

Validation Summary Report

03/09 – 04/09Prepare Annual Strategic Report

OngoingCollaborative PIP Activities and Technical Assistance

10/08MCOs Submit

PIP Forms

MCO Roles and Responsibilities

Validation of Performance Measures

Validation of Performance Measures

MCO Roles and Responsibilities• Both non-reform and reform HMOs and

PSNs provide 2008 HEDIS® Baseline Assessment Tool (BAT), Interactive Data Submission System (IDSS), and Final Audit Report to HSAG

• HMOs and PSNs complete and forward supplemental questions document to HSAG

• Establish a contact person if questions arise from the HSAG review team

Validation of Performance Measures

MCO Roles and Responsibilities• PMHPs complete Information Systems

Capabilities Assessment Tool (ISCAT), source code, and when produced, performance measure rates for selected measures.

• Prepare for and participate in HSAG’s site visit (May – June annually) and post onsite audit activities.

Validation of Performance Measures

MCO Roles and Responsibilities• NHDPs complete Information Systems

Capabilities Assessment Tool (ISCAT), source code, and when produced, performance measure rates for selected measures.

• Prepare for and participate in HSAG’s site visit (Oct – Nov annually) and post onsite audit activities.

Project Activity by MonthValidation of Performance Measures (PMVs)

HMOs/PSNs (Reform and Non-Reform)Task May Jun Jul Aug Sep Oct Nov Dec Jan

09Feb Mar Apr May

PMVs

HMOs &

PSNs

11/08 – 1/09Prepare Report

10/08-11/08Receive MCO documentation

9/08

Request Documentation

Ongoing TA to AHCA/DOEAfor Performance Measure Development

Project Activity by MonthValidation of Performance Measures (PMVs)

PMHPsTask May Jun Jul Aug Sep Oct Nov Dec Jan

09Feb Mar Apr May

PMVs

PMHPs

6/08 – 7/08Prepare Report,

Review Final Rates

08/08Finalize PMV

Reports

5/08-6/08

Site Visits

Ongoing TA to AHCA/DOEAfor Performance Measure Development

03/09Request ISCAT documentation

05/09

Receive ISCAT documentation

Project Activity by MonthValidation of Performance Measures (PMVs)

NHDPsTask May Jun Jul Aug Sep Oct Nov Dec Jan

09Feb Mar Apr May

PMVs

NHDPs

12/08 – 1/09Prepare Report,

Review Final Rates 02/09Finalize PMV

Reports

10/08-11/08

Site Visits

Ongoing TA to AHCA/DOEAfor Performance Measure Development

08/08Request ISCAT documentation

09/09

Receive ISCAT documentation

MCO Roles and Responsibilities

Focused Study

Focused StudyMCO Roles and Responsibilities

• Topic of focused study is yet to be determined by AHCA.

• Upon identification of topic, MCOs will be responsible for collecting necessary medical records (if required by the methodology).

Upcoming EQR activities

•Quarterly EQR meetings (webinar and onsite at AHCA offices)

•Other meetings (including Collaborative PIP meetings and technical assistance sessions) will be scheduled in conjunction with the quarterly meetings

THANK YOU FOR YOUR PARTICIPATION!