2020 external quality review organization summary report
TRANSCRIPT
2020 External Quality Review Organization’s Summary of Activities Report
Activities and Recommendations for STAR Kids SFY 2020
Background (Slide 1 of 3)
• Each state with Medicaid managed care must have an External Quality Review Organization (EQRO)
• Since 2002, the Texas EQRO has been the Institute for Child Health Policy at the University of Florida
• The EQRO must publish an annual report of all activities completed in the state fiscal year and recommendations for both MCOs and the state
• The most recent Summary of Activities Report encompasses all activities and recommendations for state fiscal year (SFY) 2020 and is published on the HHSC quality website
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https://hhs.texas.gov/sites/default/files/documents/laws-regulations/reports-presentations/2021/eqro-summary-of-activites-report-contract-yr-2020.pdf
Background (cont.) (Slide 2 of 3)
Summary of Activities Report is organized around the CMS Protocols for EQRO activities:
CMS Required Protocols:
• Validation of Performance Improvement Projects (PIPs)
• Validation of Performance Measures
• Review of Compliance with Medicaid and CHIP regulations
• Validation of Network Adequacy
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Background (cont.) (Slide 3 of 3)
Summary of Activities Report is organized around the CMS Protocols for EQRO activities:
CMS Optional Protocols
• Validation of Encounter Data
• Administration/Validation of Quality of CareSurveys
• Calculation of Additional Performance Measures
• Conducting focus studies
• Assist with quality ratings
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Performance Improvement Projects (PIPs) (Slide 1 of 3)
The EQRO validated the following STAR Kids MCOs PIPs
• 2018: Potentially Preventable Emergency Department Visits (PPVs) for upper respiratory tract infection
• The MCOs completed their 2018 PIPs in December 2019 and submitted final PIP reports in November 2020.
• The EQRO will include final and overall results for the 2018 PIPs in the SFY 2021 SOA report.
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Performance Improvement Projects (PIPs) (cont.) (Slide 2 of 3)
The EQRO validated the following STAR Kids MCOs PIPs
• 2019: Beneficiaries with complex needs statewide PIP
• The EQRO evaluated the 2019 PIP Progress Report 2.
• The MCOs submitted the 2019 PIP Progress Report 2 in July 2020 and reported preliminary results and any changes to interventions between submission of Progress Report 1 in July 2019 and July 2020.
• 2020: Focus on behavioral health integration
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Performance Improvement Projects (PIPs) (Slide 3 of 3)
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Findings:• Some MCOs did not address previous EQRO
recommendations • Insufficient details regarding PIP modifications
2019 ProgressReport 2
2020 PIP Plan
2020 Progress Report 1
Minimum Score 0 82.6% 82.1%
Maximum Score 100 100% 100%
Average Score 78.6% 94% 94.1%
Network Adequacy (Slide 1 of 2)
Key Findings from STAR Kids Appointment Availability Studies
• Vision Study (No Referral Needed to obtain ophthalmology appointment)
• In 2020, STAR Kids program met 93.2% compliance; 2018 yielded 92.9% - difference of .3%
• Weekend appointments for vision study increased in 2020 by 23.5% compared to 2018.
Network Adequacy (cont.) (Slide 2 of 2)
Key Findings from STAR Kids Appointment Availability Studies
• Primary Care Provider (PCP) Study
• Urgent Care (appointment within 24 hours)–100% compliance for 2018 and 2020
• Routine Care (appointment within 14 days)–100% compliance for 2018 and 91.2% compliance for 2020; decrease of 8.8%
• Preventive Care (appointment within 90 days) –99.9% compliance for 2018 and 99.8% compliance for 2020; decrease of 0.1%
Quality of Care Surveys (Slide 1 of 5)
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Survey Question STAR Kids National Benchmarks
Experiences – (Positive Experience-Responses of “Always”)
Getting Needed Care 66.0% 61%
Getting Care Quickly 75% 73%
How Well Doctors Communicate
81.4% 81%
Customer Service 76.3% 68%
2020 CAHPS STAR Kids Child Member Caregiver Survey Results
Quality of Care Surveys (cont.) (Slide 2 of
5)
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Survey Question STAR Kids National Benchmarks
Ratings Caregiver Ratings of 9 or 10
Personal Doctor Rating 79.8% 78%
Specialist Rating 82.2% 74%
Health Plan Rating 74% 71%
Health Care Rating 77.4% 70%
2020 CAHPS STAR Kids Child Member Caregiver Survey Results
Quality of Care Surveys (cont.) (Slide 3 of
5)
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Survey Question STAR Kids National Benchmarks
Children with Chronic Conditions CCC Composites and Summary Ra
tes
Access to specialized Services 51.4% 53%
Personal Doctor Who Knows Child 90.6% 91%
Coordination of Care 80.4% 77%
Getting Needed Information 76.8% 76%
Access to Prescription Medicines 74.9% 69%
2020 CAHPS STAR Kids Child Member Caregiver Survey Results
Quality of Care Surveys (cont.) (Slide 4 of
5)
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Finding: Most STAR Kids composite scores increased from 2018 to 2020, except for the Getting Care Quickly composite which dropped slightly for STAR Kids.
1.80%
-0.70%
3.90%
0.80%
-15.00%
-10.00%
-5.00%
0.00%
5.00%
10.00%
15.00%
Getting Needed
Care
Getting Care
Quickly
How Well Doctors
Communicate
Customer ServiceRati
ng
s C
han
ge 2
01
8-2
02
0
Change in STAR Health Composite Scores from 2018 to 2020
Quality of Care Surveys (cont.) (Slide 5 of
5)
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Finding: All rating scores increased for STAR Kids from 2018 to 2020.
2.30% 3.30% 2.90% 3.50%
-10.00%
-5.00%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Personal Doctor
Rating
Specialist Rating Health Plan
Rating
Health Care
Rating
Rati
ng
Ch
an
ge 2
01
8 t
o 2
02
0
Change in STAR Kids Ratings from 2018 to 2020
Calculation of Additional Performance Measures
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The EQRO Calculates quality performance measures by MCO and program available on the Texas Healthcare Learning Collaborative Portal thlcportal.com.
A snapshot of STAR Kids MCO Performance v. national benchmarks is shown here.
HHSC Follow up to Recommendations / Key Findings
In response to key recommendations for the Summary of Activities Report:
• HHSC imposed corrective action plans (CAPs) and liquidated damages on plans for the 2020 Appointment Availability vision study
• HHSC gave direction during the Quality Forum in June 2021 to plans on the importance of addressing EQRO previous recommendations along with giving more information about PIP modification
HHSC Follow up to Recommendations / Key Findings (cont.)
In response to key recommendations for the Summary of Activities Report:
• HHSC is convening a social determinants of health (SDoH) workgroup to operationalize how HHSC should coordinate with MCOs to assess members’ SDoH needs and implement SDoH related interventions.
• HHSC Quality Assurance is working with a number of different departments and TMHP to improve the quality of provider directories to help member’s access to care.
Current Quality Initiatives with the EQRO
In addition to the activities outlined in the Summary of Activities Report, HHSC has the current quality initiatives with respect to STAR Kids:
• National Core Indicator - Child and Family Survey (NCI-CFS) (Summer/Fall 2021)
• STAR Kids Screening and Assessment Instrument Measures (Ongoing)
• Medically Dependent Children Program (MDCP) Focus groups (Summer 2021)
• Sharing results of SK-SAI measures with plans and publicly (Summer 2021)
