WELCOME! External Quality Review Quarterly Meeting Wednesday, June 18, :00 a.m. – 3:30 p.m. WELCOME!

EQR Quarterly Meeting Welcome to all participants Overview of agenda Refreshments

Health Services Advisory Group, Inc. EQR Quarterly Meeting Overview of Current Activities and Upcoming EQR Activities June 18, 2008 Presented by: Peggy Ketterer, RN, BSN, CHCA Executive Director, EQR Services

Current EQR Activities Overview of activities conducted during state fiscal year

Current EQR Activities Performance Improvement Projects (PIPs) Completed validation of two PIPs per MCO Produced and finalized the Annual PIP Validation Summary Report Produced and finalized the Annual PIP Strategic Summary Report

Current EQR Activities Performance Improvement Projects (PIPs) Facilitated three collaborative PIPs (still in process) Draft Annual Statewide Collaborative PIP Methodology Report is due to AHCA in early July, 2008 Technical assistance activities with MCOs, AHCA, and DOEA - ongoing

Current EQR Activities Validation of Performance Measures Completed validation of performance measures reported by non-reform HMOs Produced and finalized Annual Validation of Performance Measures report Conducting validation of performance measures reported by PMHPs (in process)

Current EQR Activities Validation of Performance Measures Developed specifications for PMHPs/NHDPs

Current EQR Activities Monitoring of MCO Contract Compliance Working with AHCA and DOEA on monitoring tools and potential areas of standardization within and across each MCO type Working on ensuring that the monitoring process meets all Balanced Budget Act of 1997 (BBA) requirements Conducting validation audits of AHCA’s monitoring of fraud and abuse

Current EQR Activities Strategic HEDIS ® Analysis Produced and finalized HEDIS 2007 Strategic Analysis Report on non-reform HMOs HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)

Current EQR Activities Technical Assistance – Enrollee Race, Ethnicity, and Primary Language Provided technical assistance as needed Awaiting implementation of new FMMIS system for improvements in collecting and reporting Produced a draft report on technical assistance activities provided during the year

Current EQR Activities Value-Based Purchasing Provided technical assistance as needed Participated in conference calls with Brady Augustine and Tom Warring Provided literature review results related to auto- assignment algorithms, encounter data submission, and return on investments Produced a draft report on technical assistance activities provided during the year

Current EQR Activities Evaluation of AHCA Quality Strategy Completed review of updated Quality Strategy Participated in monthly calls with AHCA Quality Strategy lead, Deborah McNamara Produced a draft report on the findings from the review of the updated Quality Strategy

Current EQR Activities Focused Study – Behavioral Health Prior Authorization Process Produced a draft report on the Behavioral Health Prior Authorization Focused Study

Current EQR Activities Dissemination and Education Conducted four quarterly meetings during the fiscal year Conducted one-on-one technical assistance sessions Maintained myfloridaeqro.com website Weekly communications with AHCA, monthly progress reports

Current EQR Activities EQR Technical Report Completed analysis of 2007 CAHPS ® data Internal analysis underway Draft report due to AHCA in July, 2008 CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)

Current EQR Activities Technical Assistance to AHCA (as needed) Consumer-reported satisfaction surveys Quality Strategy Validation of PIPs

Year Three EQR Activities Overview of activities to be conducted during state fiscal year

Year Three EQR Activities MARK YOUR CALENDARS!!!! The next EQR Quarterly Meetings are scheduled for: Wednesday, September 24, 2008 (Forum TBD) Wednesday, January 14, 2009 (AHCA Offices) One-on-One TA sessions Tuesday, January 13, 2009 Wednesday, March 25, 2009 (Webinar) Wednesday, June 10, 2009 (AHCA Offices)

Year Three EQR Activities Validation of PIPs Validation of performance measures Review of compliance with access, structural, and operations standards Strategic HEDIS ® analysis reports Technical assistance on enrollee race, ethnicity, and primary language

Year Three EQR Activities Value-based purchasing methodologies Evaluation of AHCA quality strategy Focused study (Topic TBD) Dissemination of EQR information EQRO Technical Report Technical Assistance (consumer surveys, validation of PIPs, quality strategy, and other areas)

MCO Roles and Responsibilities related to Year Three EQR Activities (FY 08-09)

MCO Roles and Responsibilities Validation of Performance Improvement Projects

Validation of PIPs MCO Roles and Responsibilities Provide basic information on the PIPs that are currently underway (Letter of Intent) Complete the PIP form and provide supportive documentation for each PIP selected for validation Review HSAG’s completed PIP tool and summary grid, providing feedback and comments

Validation of PIPs MCO Roles and Responsibilities Participate in the Collaborative PIP activities –Participate in monthly conference calls –Facilitate at least one monthly conference call (with HSAG support)

Validation of PIPs MCO Roles and Responsibilities Participate in the Collaborative PIP activities –Conduct key activities of the PIP following the study design –Implement interventions –Collect and analyze two re-measurements

Project Activity by Month Validation of Performance Improvement Projects (PIPs) Task MayJunJulAugSepOctNovDecJan 09 FebMarAprMayJun PIPs 7/08 – 9/08 Statement of Intent Requested 10/08 – 12/08 Perform Individual PIP Reviews 01/09 – 2/09 Prepare Annual Validation Summary Report 03/09 – 04/09 Prepare Annual Strategic Report Ongoing Collaborative PIP Activities and Technical Assistance 10/08 MCOs Submit PIP Forms

MCO Roles and Responsibilities Validation of Performance Measures

Validation of Performance Measures MCO Roles and Responsibilities Both non-reform and reform HMOs and PSNs provide 2008 HEDIS ® Baseline Assessment Tool (BAT), Interactive Data Submission System (IDSS), and Final Audit Report to HSAG HMOs and PSNs complete and forward supplemental questions document to HSAG Establish a contact person if questions arise from the HSAG review team

Validation of Performance Measures MCO Roles and Responsibilities PMHPs complete Information Systems Capabilities Assessment Tool (ISCAT), source code, and when produced, performance measure rates for selected measures. Prepare for and participate in HSAG’s site visit (May – June annually) and post onsite audit activities.

Validation of Performance Measures MCO Roles and Responsibilities NHDPs complete Information Systems Capabilities Assessment Tool (ISCAT), source code, and when produced, performance measure rates for selected measures. Prepare for and participate in HSAG’s site visit (Oct – Nov annually) and post onsite audit activities.

Project Activity by Month Validation of Performance Measures (PMVs) HMOs/PSNs (Reform and Non-Reform) Task MayJunJulAugSepOctNovDecJan 09 FebMarAprMay PMVs HMOs & PSNs 11/08 – 1/09 Prepare Report 10/08-11/08 Receive MCO documentation 9/08 Request Documentation Ongoing TA to AHCA/DOEA for Performance Measure Development

Project Activity by Month Validation of Performance Measures (PMVs) PMHPs Task MayJunJulAugSepOctNovDecJan 09 FebMarAprMay PMVs PMHPs 6/08 – 7/08 Prepare Report, Review Final Rates 08/08 Finalize PMV Reports 5/08-6/08 Site Visits Ongoing TA to AHCA/DOEA for Performance Measure Development 03/09 Request ISCAT documentation 05/09 Receive ISCAT documentation

Project Activity by Month Validation of Performance Measures (PMVs) NHDPs Task MayJunJulAugSepOctNovDecJan 09 FebMarAprMay PMVs NHDPs 12/08 – 1/09 Prepare Report, Review Final Rates 02/09 Finalize PMV Reports 10/08-11/08 Site Visits Ongoing TA to AHCA/DOEA for Performance Measure Development 08/08 Request ISCAT documentation 09/09 Receive ISCAT documentation

MCO Roles and Responsibilities Focused Study

Focused Study MCO Roles and Responsibilities Topic of focused study is yet to be determined by AHCA. Upon identification of topic, MCOs will be responsible for collecting necessary medical records (if required by the methodology).

Upcoming EQR activities Quarterly EQR meetings (webinar and onsite at AHCA offices) Other meetings (including Collaborative PIP meetings and technical assistance sessions) will be scheduled in conjunction with the quarterly meetings

THANK YOU FOR YOUR PARTICIPATION!