External Quality Review Quarterly Meeting Tuesday, September 26, p.m. – 3:30 p.m.

Welcome and Logistics  Introductions and roll-call  Webinar logistics  Do’s and don’ts

Welcome and Logistics  Today’s agenda  EQR activities and Medicaid Reform  Update on PIP validation activities  Update on validation of performance measures and HEDIS strategic reporting  Update on focused studies  Upcoming EQR activities  Questions and Answers

EQR Activities and Medicaid Reform  Balanced Budget Act of 1997  Applies to Medicaid managed care plans that have been in existence for one year  To prepare: begin required activities, including PIPs, performance measures, and ensuring compliance with BBA requirements

EQR Activities and Medicaid Reform To prepare for upcoming EQR review activities:  Visit myfloridaeqro.com  HSAG will send MCO mailings for informational purposes only, if requested  Participate in quarterly meetings, technical assistance activities

Performance Improvement Projects (PIPs) Update 1:15 p.m. – 1:45 p.m. Cheryl L. Neel, RN, MPH, CPHQ Manager, Performance Improvement Projects

Presentation Overview Statement of Intent –Purpose –Results Technical Assistance –Purpose –Results PIP Timeline

Statement of Intent Purpose: To gather pertinent data related to the PIP studies in progress To understand the technical assistance needs of the MCOs – ed 27 plans on August 11, 2006 –26 plans responded by the August 25, 2006 due date

Statement of Intent (continued) –15 HMOs responded with a total of 53 HMO study topics and 8 BHO study topics. Example of submitted studies: Asthma Cervical Cancer Screening for African- American Women Major Depressive Disorder Schizophrenia

Statement of Intent (continued) –12 NHDPs responded with a total of 25 study topics. Example of submitted studies: Access to Care Dementia Population Timeliness of Care Client Satisfaction Survey

Statement of Intent (continued) –4 PMHPs responded with a total of 8 study topics. Example of submitted studies: Inpatient Readmissions Data Integrity 14-Day Encounter Lag

Process of Review for Potential Validation Total of 94 PIP study topics submitted to HSAG HSAG PIP team met on August 30 th & September 5 th to ascertain current PIP study status and potential for validation. Reviewed responses to Statement of Intent questions to see –if the studies could be validated. –how far each study could be validated. Follow-up calls were made for clarification.

Technical Assistance (TA) Assessment Survey Purpose: To ascertain MCO specific and general PIP educational needs

Annual Technical Assistance Plan Report Based on Statement of Intent Technical Assessment Survey Draft of report to AHCA on September 15 th. –Includes assessment results –Includes HSAG strategies for TA

Timeline MCOs to receive PIP Submission letter and attachments electronically on Friday, October 6, PIP Submission documents due to HSAG by COB on Friday, November 3, 2006.

Questions and Answers on PIP activities?

Update on Validation of Performance Measures and HEDIS Strategic Analysis 1:45 p.m. – 2:15 p.m. Raj Shrestha, MBA, MPH, CHCA Director, Audits/Private Projects

Update on Validation of Performance Measures HSAG, in collaboration with AHCA, has determined which MCOs can undergo validation activities. MCOs that report standardized performance measures were determined to be eligible for validation activities.

Update on Validation of Performance Measures Technical assistance will be provided to AHCA, DOEA, and other MCOs to develop standardized performance measures as needed.

Update on Validation of Performance Measures On September 6, 2006, a document request letter was forwarded to the HMOs. The letter requested the following items: –MCO-completed 2006 Baseline Assessment Tool (BAT) – Final health plan quality indicator data file in AHCA-required format –Completion of additional questions on the information system capabilities assessment tool (ISCAT)

Update on Validation of Performance Measures These requested items are due to be submitted to HSAG on October 6, Upon receipt, HSAG will complete the following steps: –Step One: Review BAT and ISCAT additional questions to assess systems capabilities

Update on Validation of Performance Measures –Step Two: Review quality data indicator file for reasonability and evaluation of MCO performance –Step Three: Compile measure-specific validation findings based on CMS protocols –Step Four: Draft report of the results of the validation of performance measures activity

Update on Validation of Performance Measures The Draft report on the Validation of Performance Measures is due to AHCA in November, The report will be finalized in January, 2007.

Update on HEDIS Strategic Analysis HSAG will produce MCO-specific reports displaying HEDIS measures compared to national benchmarks, the statewide weighted average, and other MCOs. An assessment of the MCO strengths and areas for improvement will be identified, including conclusions and recommendations specific to the MCO.

Update on HEDIS Strategic Analysis MCO-specific reports will be provided to AHCA in December, 2007.

Update on HEDIS Strategic Analysis HSAG will prepare a HEDIS Strategic Analysis report of statewide data including: –Comparison to national benchmarks –Calculation of the state weighted average –Ranking of MCOs

Update on HEDIS Strategic Analysis Overall program strengths and areas for improvement will be identified. The draft report will be provided to AHCA in January, 2007.

Questions and Answers on Validation of Performance Measures or HEDIS Strategic Reporting activities

Update on Focused Study Activities 2:15 p.m. – 2:45 p.m. Thomas Miller, MA Director, State and Corporate Analysis

Update on Focused Study Activities HSAG will be conducting two focused studies on the following topics: Adolescent Well-Care Identification of Individuals with Special Health Care Needs

Update on Focused Study Activities – Adolescent Well-Care Adolescent Well-Care Status: –Study methodology developed –Study indicators identified –Medical record review tool and instructions under development

Update on Focused Study Activities – Adolescent Well-Care MCOs* included in the study: HMOs PSN MediPass *Will need to have members with months of continuous enrollment

Update on Focused Study Activities – Adolescent Well-Care MCOs not included in the study: PMHPs NHDPs

Update on Focused Study Activities What to expect? MCOs will be responsible for collecting the medical records for the selected sample cases for the adolescent well-care focused study Medical record collection period: Last quarter of 2006

Update on Focused Study Activities What to expect? HSAG will provide the list of sample cases and clear instructions on medical record collection Two submission dates will be identified (one in November, the final in December)

Update on Focused Study Activities –Special Health Care Needs Identification of Individuals with Special Health Care Needs: –Study methodology under review by AHCA –Study indicators being identified

Update on Focused Study Activities – Special Health Care Needs MCOs included in the study: HMOs PSN PMHPs NHDPs?

Update on Focused Study Activities – Special Health Care Needs MCOs not included in the study: MediPass NHDPs?

Update on Focused Study Activities – Special Health Care Needs What to expect? The study methodology calls for a survey to be completed by the MCOs indicating their process and policies for identifying individuals with special health care needs.

Update on Focused Study Activities – Special Health Care Needs What to expect? HSAG will request member-level data on individuals identified as having special health care needs. Conducted via the administrative method – anticipate no medical record review.

Update on Focused Study Activities – Special Health Care Needs What to expect? Proposed methodology involves MCOs “re-running” the population using a standardized approach to identify special health care needs

Update on Focused Study Activities General time frames: Analyze adolescent well-care data – March – April 2007 Prepare draft report for AHCA – May, 2007 Analyze identification of individuals with special health care needs data – March – April 2007 Prepare draft report for AHCA - May 2007

Upcoming EQR Activities 2:45 p.m. – 3:00 p.m. Peggy Ketterer, RN, BSN, CHCA Executive Director, EQRO Services

Upcoming EQR activities Website being remodeled – more user friendly, more functional PIP validation reports HMO HEDIS analysis reports Consumer satisfaction survey data requests and analysis

Questions and Answers

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