1. External Quality Review Quarterly Meeting Wednesday, September 23, 2009 2:00 p.m. – 3:30 p.m. WELCOME!

2. EQR Quarterly Meeting  Welcome to all participants  Overview of agenda  Webinar do’s and don’ts  Evaluation form

3. EQR Quarterly Meeting Note to all participants:  Please DO place your phone on mute during the call.  Please DO NOT place your phone on hold at any time during the meeting.

4. Questions?

5. Overview of EQR Technical Report for FY 2008–2009 Presenter: Gretchen Thompson, MBA, CPHQ Executive Director, State and Corporate Services

6. 2008-2009 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

7. 2008-2009 EQR Technical Report  Summarizes the activities and findings from the third year of the EQR contract  Includes summary findings by MCO type (HMO, PSN, PMHP/CWPMHP, and NHDP) as well as overall conclusions and recommendations

8. 2008-2009 EQR Technical Report Data used to evaluate MCO performance:  Validation of PIP results  Validation of performance measure results  HEDIS® results  HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

9. 2008-2009 EQR Technical Report Other EQR activities:  Technical assistance  Dissemination of education (quarterly meetings, website, trainings)  Focused reviews of compliance with access, structural, and operations standards

10. Validation of Performance Improvement Projects (PIPs)

11. Validation of PIPs HMOPSNNHDPPMHP Met Status Partially Met Status Not Met Status

12. PIP Conclusions  For the same PIPs submitted each year, the number of PIPs receiving a validation status of Met declined as the PIPs progressed to more challenging activities  For all PIPs submitted each year, the number of PIPs receiving a Met validation status improved from the first year to the third year

13. PIP Conclusions  For the Study Design Stage all MCO types addressed from 56 to 100 percent of Partially Met and Not Met evaluation elements  HMO PIPs received more Partially Met and Not Met validation status than Met  PSN PIPs with a Met validation status declined by 50 percent and more PIPs received a Partially Met and Not Met validation than in the previous year

14. PIP Conclusions  PMHP PIPs demonstrated a slight decline where more PIPs received a Not Met validation status in 2008-2009 than in the previous year. However, 16 PIPs received a Met validation status, which was the same as the previous year  NHDP PIPs with a Met validation status declined by 50 percent and more PIPs received a Partially Met and Not Met validation than in the previous year

15. Validation of 2007 Performance Measure Results

16. Validation of Performance Measures Evaluation of Performance Measure Reporting by Plan/Model Type Plan Type Model Type Are Standardized Performance Measures Reported? Are Performance Measures Eligible for Validation? Comments MCO HMO—Non- Reform Yes Standard HEDIS measures MCOHMO—ReformYes Standard HEDIS measures and Agency-defined measures PIHPPSN—Non-ReformYes Standard HEDIS measures PIHPPSN—ReformYes Standard HEDIS measures and Agency-defined measures PIHPPMHP/CWPMHPYes Agency-defined measures MCONHDPYes Agency/DOEA-defined measures

17. Validation of Performance Measures HMOs  Reform and Non-Reform HMOs report HEDIS performance measures.  Reform HMOs report on two Agency-defined measures.  Most HMOs received measure designations of Report for all performance measures  Three Non-Reform HMOs received Not Report for the Annual Dental Visits measure  Two Reform HMOs received a Not Report for the Use of Beta Agonist measure

18. Validation of Performance Measures PSNs  Reform and Non-Reform PSNs report HEDIS performance measures.  Reform PSNs report on two Agency- defined measures.  All PSNs received measure designations of Report for all performance measures  Many PSNs had very small populations for several required measures

19. Validation of Performance Measures PMHPs/CWPMHP  All PMHPs and the CWPMHP received a Fully Compliant [CMS] measure designation for two of the three required performance measures  Four of the PMHPs received a Substantially Compliant designation for Number of Enrollees Admitted to State Mental Health Treatment Facilities  One PMHP received a Not Valid designation because it did not have any valid data to report  For 2009-2010, AHCA eliminated the requirement to report the Number of Enrollees Admitted to State Mental Health Treatment Facilities measure

20. PMHP/CWPMHP Agency-Defined Performance Measure Results Florida Medicaid PMHP/CWPMHP Performance Summary: Follow-Up After Hospitalization for Mental Health Performance Measure Performance Measure Rate Highest RateMedianLowest Rate Follow-Up with Mental Health Practitioner 31.2%17.8%11.0% Follow-Up with Mental Health Practitioner and/or Case Manager 55.2%29.6%15.5% Follow-Up with a Case Manager42.8%14.7%4.0% Readmission Rate30.2%22.9%15.7% Number of Enrollees Admitted to State Mental Health Treatment Facilities 0.12%0.09%0.00%

21. Validation of Performance Measures NHDPs  All 14 NHDPs, who reported performance measures, were able to report valid results  All performance measures were based on enrollment  Four NHDPs received a Substantially Compliant measure designation for one or more of the four performance measures  None of the issues resulted in a significant bias to the final reported performance measure rates

22. NHDP Agency-Defined Performance Measure Results Florida Medicaid NHDP Rates for Agency-Defined Performance Measures Performance Measure Performance Measure Rate Highest RateMedianLowest Rate Disenrollment Rate26.3%18.4%6.6% Retention Rate98.6%94.9%88.9% Voluntary Disenrollment Rate 10.3%4.2%2.1% Average Length of Enrollment (Months) 32.8316.085.09

23. HEDIS Measure Results

24. Non-Reform and Reform HEDIS Results 1 5 8 4 00 3 7 3 4 1 0 0 1 2 3 4 5 6 7 8 9 0 TO 1010 TO 2525 TO 5050 TO 7575 TO 9090 TO 100 2007 National Medicaid Percentile Range Number of Weighted Average Rates Non-ReformReform Health Plan Performance Compared to National Medicaid Percentiles

25. Pediatric Non-Reform HEDIS Measures HEDIS measures results showed below average to average performance for the Pediatric Care dimension There were no MCOs who performed above the high performance level (HPL) Eight plans did not provide the benefit required for Annual Dental Visits

26. Pediatric Reform HEDIS Measures

27. Women’s Care Non-Reform HEDIS Measures There were no MCOs who performed above the high performance level (HPL)

28. Women’s Care Reform HEDIS Measures There were no MCOs who performed above the high performance level (HPL)

29. Living With Illness (Part 1) Non-Reform HEDIS Measures

30. Living With Illness (Part 2) Non-Reform HEDIS Measures One plan did not offer the health benefits required for the following measures: Follow-Up After Hospitalization After 30 Days and for Follow-Up After Hospitalization After 7 Days

31. Living With Illness (Part 1) Reform HEDIS Measures

32. Living With Illness (Part 2) Reform HEDIS Measures One Reform plan was not required to report the Controlling High Blood Pressure measure.

33. 2008-2009 EQR Technical Report Assessment of MCO Strengths and Weaknesses:  HSAG developed a methodology to identify strengths and weaknesses in performance in key EQR areas  A set of tables displaying objective data (PIPs and performance measure results) highlights each MCO’s strengths and weakness based on the methodology  Strengths and weaknesses were grouped into categories of quality, timeliness, and access to care

34. 2008-2009 EQR Technical Report Assessment of MCO Strengths and Weaknesses:  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

35. Overall Conclusions for PIPs and Performance Measures  Overall, the Florida Medicaid managed care programs demonstrated some improvements in performance during the third year of activities, and some areas that need continued improvement  All MCOs demonstrated challenges with PIPs –Of the PIPs that achieved a Met validation status, most addressed quality and some addressed access  Statewide performance measure results demonstrated some strengths, but more opportunities for improvement

36. Recommendations for PIPs  PIP recommendations include the need for: –MCOs to address all evaluation elements that received a Partially Met or Not Met validation finding on the next PIP submission –MCOs to select PIP topics that address access and timeliness of services –Statewide interventions, or future collaboratives, that target low performing performance measures, such as: prenatal care, cervical cancer screening, and follow-up after hospitalization for mental illness

37. Recommendations for Performance Measures  Performance measure recommendations include the need for: –Targeted improvement efforts toward performance measures that fall below the LPL –Consider implementing performance measures that address access to and timeliness of services  AHCA should continue efforts to implement performance-based purchasing initiatives to improve performance on select HEDIS measures

38. Compliance Update  HSAG working closely with AHCA to develop Access databases for use in monitoring MCO compliance with access, structural, and operations standards  AHCA staff have implemented use of the database for monitoring PMHPs  HSAG/AHCA/DOEA revising monitoring tools to reflect new contract provisions for HMOs, PSNs, NHDPs  Access database testing and implementation will occur for HMOs, PSNs, NHDPs during FY 2009- 2010

39. 2008-2009 EQR Technical Report Questions?

40. PIP Validation Activities for 2009-2010 2:50 p.m. – 3:05 p.m. Presenter: Christi Melendez, RN, CPHQ EQRO Project Manager, PIPs

41. Overview  PIP Activities –Completed –Scheduled  Important Dates  PIP Submission Tips

42. PIP Activities Completed

43. Completed Statement of Intent (SOI)  August 14 th : Notification sent to MCOs  August 28 th : MCOs submitted SOI information PIP Submission Letter  September 9 th : Submission letter distributed to MCOs with study topics identified for validation

44. Statement of Intent (SOI)  103 SOIs received from 26 HMOs  23 SOIs received from 7 PSNs  24 SOIs received from 12 PMHPs  35 SOIs received from 15 NHDPs 185 SOIs submitted 120 PIPs to be validated

45. PIP Submission Letters  Letters sent on September 9, 2009 Included:  2009-2010 PIP validation timeline  PIP topics selected for validation  PIP Summary Form for new PIPs  Completion instructions

46. PIP Frequently Asked Questions  FAQ on www.myfloridaeqro.comwww.myfloridaeqro.com  Includes FAQs for collaborative PIPs  Examples of FAQs –What are some resources I can use in conducting my PIP? –Where can I find benchmarking information for Medicaid programs? –What is a collaborative PIP?  When are PIP forms and documentation due? October 9, 2009

47. PIP Submission Tips

48. Previously Submitted PIPs  For ongoing PIPs, use the same PIP Summary Form that was submitted for previous year’s validation cycle.  Highlight, bold, or add text in a different color, and date any new information that is added to the existing PIP Study Form.  Strikethrough and date any information that no longer applies to the PIP study submission.  Ensure all Points of Clarification, Partially Met and Not Met evaluation elements from the previous validation cycle have been addressed in the documentation.

49. All PIP Submissions  Complete/update demographic page of PIP Summary Form.  Only complete the PIP Summary Form as far as the PIP has progressed.  Be sure to include all attachments referenced in the PIP Summary Form (e.g. HEDIS final audit reports, manual data collection tool, instructions, etc.)

50. HSAG Contacts for PIP Questions  Denise Driscoll –ddriscoll@hsag.comddriscoll@hsag.com –602.745.6260  Christi Melendez –cmelendez@hsag.comcmelendez@hsag.com –602.745.6339

51. Questions?

52. Upcoming EQR Activities Presenter: Yolanda Strozier, MBA EQRO Project Manager

53. Upcoming EQR activities The next EQR Quarterly Meetings are scheduled for:  Wednesday, January 13, 2010 (AHCA Offices) One-on-One TA sessions Tuesday, January 12, 2010  Wednesday, March 24, 2010 (Webinar)  Wednesday, June 9, 2010 (AHCA Offices) One-on-One TA sessions Tuesday, June 8, 2010

54. Upcoming EQR activities Validation of PIPs: Submission date for selected PIP forms and documentation is Friday, October 9, 2009

55. Upcoming EQR activities Collaborative PIPs:  The next PMHP conference call is Tuesday, October 27th at 11:00 a.m.  The next HMO/PSN conference call is November 16 th at 10:00 a.m.  The next NHDP conference call is December 16 th at 2 p.m.

56. Upcoming EQR activities Validation of Performance Measures (HMOs/PSNs):  Request for documentation for the HMOs/PSNs was sent out on September 11th, 2009  Documentation is due to HSAG on Friday, October 16th, 2009  Requested items: HEDIS BAT, ISCAT questions, HEDIS data file, audit report

57. Upcoming EQR activities Validation of Performance Measures (NHDPs):  Completed ISCAT and other requested documents are due to HSAG by September 25, 2009  Site visits for NHDPs scheduled for October/November

58. Upcoming EQR activities Validation of Performance Measures (PMHPS/CWPMHP):  Completed ISCAT and other requested documents are due to HSAG by April 16, 2010  Site visits for PMHPS/CWPMHP will occur in May, 2010

59. Upcoming EQR activities Questions?