{ Louisiana Medicaid Baseline Quality Data Dr. Sandra Blake Eddy Myers University of Louisiana at Monroe College of Pharmacy Office of Outcomes Research and Evaluation

Louisiana Medicaid Baseline Quality Data Louisiana Medicaid Baseline Quality Data Sources for Measure Specifications: Sources for Measure Specifications: HEDIS Technical Specifications Volume 2 HEDIS Technical Specifications Volume 2 AHRQ Prevention Quality Indicators AHRQ Prevention Quality Indicators Children’s Health Insurance Program Reauthorization Act (CHIPRA) Children’s Health Insurance Program Reauthorization Act (CHIPRA) Question and Answer Session Question and Answer Session Overview

Located on the “Procurement Library” page of the “Making Medicaid Better” website: Located on the “Procurement Library” page of the “Making Medicaid Better” website: Measurement Year (2010 HEDIS Specification Year) Includes recipients enrolled in CommunityCARE at least 11 out of 12 months of the year who were also enrolled in last month of the year Dual-eligible recipients are excluded Dual-eligible recipients are excluded Louisiana Medicaid Baseline Quality Data

Measures are calculated using administrative claims data T1015 claims from FQHC/RHC settings are included Recipients enrolled in LaCHIP Affordable Plan for more than 1 month of the measurement year are excluded since their claims are processed through the Office of Group Benefits Measures are calculated after a 6-month claim lag to allow time for completion of claims Louisiana Medicaid Baseline Quality Data, cont’d

Healthcare Effectiveness Data and Information Set (HEDIS) by the National Committee for Quality Assurance (NCQA) Most measures are reported in the following way: Numerator (compliant population)/Denominator (eligible population) = Rate Specifications found in “HEDIS 2010 Technical Specifications, Volume 2”: Sources for Baseline Data: HEDIS

Sources for Baseline Data: HEDIS, cont’d Adults’ Access to Preventive/Ambulatory Health Services $$ Adults’ Access to Preventive/Ambulatory Health Services $$ Comprehensive Diabetes Care (HbA1c) $$ Comprehensive Diabetes Care (HbA1c) $$ Chlamydia Screening in Women $$ Chlamydia Screening in Women $$ Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life $$ Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life $$ Adolescent Well-Care Visits $$ Adolescent Well-Care Visits $$ Children and Adolescents’ Access to PCP Children and Adolescents’ Access to PCP Prenatal and Postpartum Care Prenatal and Postpartum Care Childhood Immunization Status Childhood Immunization Status Immunization for Adolescents Immunization for Adolescents Lead Screening in Children Lead Screening in Children

Sources for Baseline Data: HEDIS, cont’d Cervical Cancer Screening Cervical Cancer Screening Weight Assessment and Counseling for Nutrition and Physical Activity in Children/Adolescents Weight Assessment and Counseling for Nutrition and Physical Activity in Children/Adolescents Use of Medication for People with Asthma Use of Medication for People with Asthma Cholesterol Management for Patients with Cardiovascular Conditions* Cholesterol Management for Patients with Cardiovascular Conditions* * Results to be published May 20 Comprehensive Diabetes Care Comprehensive Diabetes Care Breast Cancer Screening Breast Cancer Screening Plan All-Cause Readmissions Plan All-Cause Readmissions Well-Child Visits in the First 15 Months of Life Well-Child Visits in the First 15 Months of Life Ambulatory Care (ER Utilization) Ambulatory Care (ER Utilization)

PQI measures use hospital discharge data to identify quality of care for ambulatory care sensitive conditions. PQI measures are reported in the following way: Numerator (preventable hospitalizations)/Denominator (eligible population) = Rate per 100,000 PQI measures normally use the population in a geographic area for the denominator. The CommunityCARE sub-population has a restricted denominator and the rate is not comparable to published results or benchmarks. Specifications may be found on AHRQ’s website: Sources for Baseline Data: AHRQ Prevention Quality Indicators (PQI)

Adult Asthma Admission Rate CHF Admission Rate Uncontrolled Diabetes Admission Rate Sources for Baseline Data: AHRQ Prevention Quality Indicators (PQI), cont’d

CHIPRA measures were created by the Children’s Health Insurance Program Reauthorization Act of 2009 Most measures are reported in the following way: Numerator (compliant population)/Denominator (population of interest) = Rate Specifications may be found on CHIPRA website: Percent of Live Births Weighing Less than 2,500 Grams (TBD) Sources for Baseline Data: CHIPRA

Q&A Conclusion