1 Presentation to:Care Management Committee Presented by: Janice Carson, MD Deputy Director, PQO Date: 04/09/15 Performance Measurement

2 Mission The mission of the Department of Community Health is to provide access to affordable, quality health care to Georgians through effective planning, purchasing, and oversight. We are dedicated to A Healthy Georgia.

3 Overview Performance Measures –Overview of Purpose –Rate Generation Process –Populations Monitored CY 2013 Selected Performance Results Questions

4 Performance Measures  Tools to assess the performance of individual clinicians, clinical delivery teams, delivery organizations and health insurance plans in the provision of care to our Medicaid enrollees.  Our Measure Stewards include CMS and:  NCQA  Healthcare Effectiveness Data and Information Set (HEDIS)  Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surveys  Agency for Healthcare Research and Quality (AHRQ)  The Joint Commission

5 Performance Measurement Performance Measurement helps us: –Understand the healthcare delivery process –Identify quality of care issues –Increase the effectiveness of healthcare delivery

6 Performance Measure Rate Generation  HP - PM Generating Vendor  HEDIS ® software subcontractor  Medical Record Review subcontractor  HEDIS ® Certified Auditor

7 Performance Measure Rates Generation Specifications Claims-based (Administrative Rate) Medical Record Review (Hybrid Rates)

8 CY 2013 Populations Monitored ALL Medicaid Adult Only CCSP Fee for Service GA Families Foster Care

9 Performance Results

10 Performance Results

11 Performance Results

12 Performance Results

13 Performance Results

14 Performance Results Weight Assessment and Counseling for Children and Adolescents

15 Performance Results Georgia Families FFS Testing for Pharyngitis 76.50%72.75% Approp. Tx for URI 81.95%80.94% These measures describe care for sick children. One identifies whether providers are appropriately conducting strep tests for children diagnosed with pharyngitis and the other describes the percentage of practitioners who are not prescribing antibiotics for viral URIs. About 25% of practitioners are not performing strep tests and about 20% of providers are prescribing antibiotics for viral URIs.

16 Performance Results Georgia Families FFS Chlamydia Screening 50.11%43.42% Breast Cancer Screening 72.90%31.49% Cervical Cancer Screening 72.83% Hyb35.77% Hyb Women’s Health Measures

17 Performance Results CY 2013 Pregnancy Metrics –Most GF pregnant women enrolled in managed care during 2 nd trimester (62.35%). New process to improve this metric. –Most FFS pregnant women enrolled in Medicaid during 3 rd trimester (61.36%) –60.5% of GF pregnant women attended 81% or more of their projected prenatal visits. Only 28.71% of FFS pregnant women attended 81% or more of their projected prenatal visits.

18 Performance Results CY 2012CY 2013 GF LBW Rate8.59%8.92% FFS LBW Rate8.52%10.34% GF C-Sec Rate31.25%31.88% FFS C-Sec Rate27.48%31.08% GF C-Sec Rate for NSV19.07%18.02% FFS C-Sec Rate for NSV12.72%16.94% Pregnancy Outcomes NSV = Nulliparous Singleton Vertex presentations. Implemented Hard Stop Policy in October Awaiting CY 2014 data to determine the effectiveness of the policy.

19 Performance Results Asthma Care

20 Performance Results Diabetes Care

21 Performance Results Target % was 57.52

22 Performance Results

23 Performance Results

24 Performance Results In CY 2013: –Alcohol and other drug dependence % of GF members with a new episode of alcohol and other drug dependence initiated treatment within 14 days of diagnosis through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization. Only 7.65% who initiated treatment had two or more additional services within 30 days of the initiation visit. FFS members, 40.15% initiated treatment but only 4.72% had two or more additional services within 30 days of initiation. –ADHD % of GF 6 – 12 year olds newly prescribed treatment for ADHD came back for an appt within 30 days of their new prescription and 48.76% of those who remained on treatment for at least 7 months had at least two follow up visits within 9 months after the initiation phase ended. FFS % came back in 30 days and 45.32% who remained on treatment at least 7 months had two follow up visits within 9 months after the initiation phase.

25 Performance Results Georgia Families FFS ER Visits/1000 MM Antibiotics of Concern 41.17%43.89% Plan All Cause Readmissions 9.93%10.11%

26 Questions