welcome to the eqr quarterly meeting! wednesday, september 24, 2008 1:00 p.m. – 3:00 p.m. (edt) we...

Welcome to the EQR Quarterly Meeting!

Wednesday, September 24, 20081:00 p.m. – 3:00 p.m. (EDT)

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External Quality Review Quarterly Meeting

Wednesday, September 24, 20081:00 p.m. – 3:00 p.m.

WELCOME!

EQR Quarterly Meeting

Welcome to all participantsOverview of agendaWebinar do’s and don’tsEvaluation Forms

EQR Quarterly Meeting

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Overview of EQR Technical Report for 2007/2008

Presenter:

Peggy Ketterer, RN, BSN, CHCAExecutive Director, EQRO Services

2007-2008 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


• Summarizes the activities and findings from the second year of the EQR contract

• Includes summary findings by MCO type (HMO, PSN, PMHP/CWPMHP, and NHDP) as well as overall conclusions and recommendations


Data used to evaluate performance

included:

• Validation of PIP results

• Validation of performance measure results

• Consumer satisfaction survey data

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


Other EQR activities:• Technical assistance on enrollee race,

ethnicity, and primary household language

• Value-based purchasing methodologies

• Evaluation of AHCA quality strategy• Dissemination of education (quarterly

meetings, website, trainings)


Reform and Non-Reform:

• Most data that was available to evaluate performance (with the exception of PIPs) was limited to HMOs with a non-reform contract. The 2008-2009 EQR Technical Report will include additional data from reform plans.

HMO Findings

• Most objective data available to evaluate performance

• PIPs*–Nearly 70 percent received Met validation status, 15 percent received a Partially Met status, and 15 percent received a Not Met validation status

*Included both reform and non-reform submissions

HMO Findings

2006–2007 PIP Validation Status Met Partially Met Not Met Total

HMO

2

21

30

53


HMO

32

7

7

46

HMO Findings

• Performance Measures–Eight of the 12 HMOs were assigned an audit result of “Report, (“R”) for all of the performance measures required by AHCA, indicating there were no issues noted that resulted in a bias to any of the rates.

HMO Findings

• Performance Measures–Four HMOs received “Not Report,” (“NR”) findings for the Controlling High Blood Pressure measure, which led to those health plans not being able to report rates for this measure.

HMO Findings

• Consumer satisfaction surveys (CAHPS®)–Overall, statewide HMO performance on the composite and global measures for the adult and child surveys was average, although the child survey results were slightly better than the adult survey results.

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

HMO Findings

• One HMO (Vista Health Plan, Inc.—Vista South Florida) exceeded the statewide average for all four global ratings for the child Medicaid CAHPS survey.

HMO Findings

0

5

6

3

0

1

0

1

2

3

4

5

6

7

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

2006 National Medicaid Percentile Range

Nu

mb

er

of

We

igh

ted

Av

era

ge

Ra

tes

HMO Findings

• HEDIS Measures–results showed below average to average performance for the Women’s Care dimension which included Breast Cancer Screening, Chlamydia Screening in Women, and Timeliness of Prenatal Care measures.

Women’s CareRange of 2007 Rates

0%

10%

20%

30%

40%

50%

60%

70%

80%

Breast CancerScreening, 42-51

Years

Breast CancerScreening, 52-69

Years

Breast CancerScreening,Combined

Cervical CancerScreening

ChlamydiaScreening, 16-20

Years

ChlamydiaScreening, 21-25

Years

ChlamydiaScreening,Combined

Timeliness ofPrenatal Care

Highest Plan Rate FL Weighted Average Lowest Plan Rate

HMO Findings

• HEDIS Measures–results for most measures within the Living With Illness dimension ranked below average to average.

Living with Illness – Diabetes CareRange of 2007 Rates

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Diabetes Care-Eye Exam Diabetes Care-LDL Screening Diabetes Care-LDL level <100 Diabetes Care-Nephropathy


Living with IllnessRange of 2007 Rates, cont’d

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Asthma, 5-9Years

Asthma, 10-17Years

Asthma, 18-56Years

Asthma,Combined Rate

Controlling HighBlood Pressure,

16-45 Years


46-85 Years


Combined


PMHP Findings

• Limited objective data to evaluate• PIPs–Slightly more than 69 percent

received Met validation status, 22 percent received a Partially Met status, and 9 percent received a Not Met validation status

• Consumer satisfaction surveys–unable to use for comparison purposes

PMHP Findings


PMHP

0

7

1

8


PMHP

16

5

2

23

PSN Findings

Limited objective data to evaluate• Nearly 63 percent received Met

validation status, none received a Partially Met status, and slightly over 37 percent received a Not Met validation status


NHDP Findings

Limited objective data to evaluate• PIPs–62 percent received Met

validation status, 19 percent received a Partially Met status, and 19 percent received a Not Met validation status


NHDP Findings


NHDP

0

7

13

20


NHDP

16

5

5

26


Assessment of MCO Strengths and Weaknesses:

• HSAG developed a methodology to identify strengths and weaknesses in performance in key EQR areas

• Used objective data (PIPs, performance measure results, and consumer survey performance results)

2007-2008 EQR Technical ReportAssessment of MCO Strengths andWeaknesses:• 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


Assessment of MCO Strengths andWeaknesses:• CAHPS measures that were statistically

higher than the state average were considered a strength for the MCO

• CAHPS measures that were statistically lower than the state average were considered a weakness for the MCO


Assessment of MCO Strengths andWeaknesses:• Within the technical report, HSAG

prepared a set of tables displaying each MCO’s strengths and weakness based on the methodology

• Strengths and weaknesses were also grouped into categories of quality, timeliness, and access to care

High Performers

• High performers were identified as MCOs that demonstrated strengths in quality, access, and timeliness for every EQR activity that produced plan-specific results. Two MCOs met this criteria.

High PerformersJackson Memorial Health Plan

• Both PIPs received a “Met” validation finding. One PIP addressed quality and access and the other addressed timeliness.

• JMH exceeded the 90th percentile for two HEDIS measures, both addressing quality.

• JMH exceeded the state average for two CAHPS measures, both addressing quality.

High Performers

Access Behavioral Health

• Both PIPs received a “Met” validation finding. One PIP addressed quality and timeliness and the other addressed access to care.

Conclusions and Recommendations

• Most objective data addressed only quality of services.

• Overall, the Florida Medicaid managed care programs demonstrated some improvements in performance during the second year of activities.


• All MCO types made great improvements in PIPs.

• HMO consumer satisfaction survey results also showed some areas of strength for a few HMOs, with one exceeding the statewide average across all four global ratings.


• HMO performance on certain HEDIS measures showed room for improvement.


• Recommendations included the need for MCOs to address all evaluation elements that received a Partially Met or Not Met validation finding on the next PIP submission.

• For performance measures, the MCOs should target low-performing measures for improvement efforts.


• MCOs may also consider conducting a PIP on consumer satisfaction.

• AHCA should continue efforts to implement a value-based purchasing initiative that includes incentives for improved performance on select HEDIS measures.


Questions?

Upcoming EQR Activities

Yolanda Strozier, MBAProject Manager, EQRO Services

Upcoming EQR activities

The next EQR Quarterly Meetings are scheduled for:

Wednesday, January 14, 2009 (AHCA Offices)One-on-One TA sessions Tuesday, January 13, 2009

Wednesday, March 25, 2009 (Webinar)


Validation of PIPs:

• Submission date for selected PIP forms and documentation is Monday, October 6, 2008


Collaborative PIPs:

• The next PMHP conference call is October 22nd at 11:00 a.m.


Validation of Performance Measures:

• Request for documentation for the HMOs/PSNs was sent out on September 10, 2008

• Documentation is due to HSAG on Monday, October 20th, 2008

• Requested items: HEDIS BAT, ISCAT questions, HEDIS data file, audit report


Validation of Performance Measures (NHDPs):

• Completed ISCAT and other requested documents are due to HSAG by September 26, 2008

• Site visits for NHDPs scheduled for October/November


Questions?

Florida’s Quality Strategy

Peggy Ketterer, RN, BSN, CHCAExecutive Director, EQRO ServicesDeborah McNamara, LCSW/PMPMedicaid Quality Coordinator

Quality Strategy

What is a quality strategy?

• A written strategy for assessing and improving the quality of managed care services offered by all MCOs and PIHPs

• Requirement within the Balanced Budget Act of 1997 (42 CFR §438.202)

Quality Strategy

Other BBA Requirements:

• Each state must obtain input of recipients and other stakeholders in the development of the strategy and make the document available for public comment before adopting it as final.

Quality Strategy

Other BBA Requirements:

• Each state must ensure that all MCOs comply with the standards established by the State

• Each state must conduct periodic reviews of the strategy to evaluate its effectiveness

Quality Strategy

Required elements must includeprocedures that:

• Assess the quality and appropriateness of care and services

• Identify race, ethnicity, and primary language of enrollees

• Regularly monitor and evaluate MCO compliance with standards

Quality Strategy

Required elements must includeprocedures that:• Identify performance measures and

levels for MCOs• Ensure arrangements for EQR • Ensure appropriate use of intermediate

sanctions• Ensure information systems that

support the quality strategy operations

Quality Strategy

Open discussion with meeting participants

Facilitator: Deborah McNamara

Quality Strategy

To access information on Florida’s Quality Assessment and Improvement Strategies

view:http://ahca.myflorida.com/Medicaid/

quality_mc/index.shtml

Facilitator: Deborah McNamara

Quality Strategy

Questions?

External Quality Review Quarterly Meeting

THANK YOU FOR YOUR PARTICIPATION!

welcome to the eqr quarterly meeting! wednesday, september 24, 2008 1:00 p.m. – 3:00 p.m. (edt) we...

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