1. Quality Strategy June 10, 2009 Presented by: Debby McNamara, LCSW, PMP Quality Coordinator, AHCA

2. Performance Improvement Projects Question & Answer Session Wednesday, June 10, 2009

3. Did you know…?  The Frequently Asked Questions for PIPs on the myfloridaeqro.com Web site has been updated as of May, 2009.  Your final 2008-9 PIP Validation Reports have been posted to your folder on the HSAG FTP site.  You can schedule technical assistance by contacting Denise Driscoll at ddriscoll@hsag.com. ddriscoll@hsag.com

4. Did you know…?  The same process from the past two years will be used for the submission of PIPs for 2009- 2010.  CMS is reviewing all the protocols over the next six months and changes may be occurring.  HSAG is investigating the feasibility of moving the PIP Summary Forms to a Web based submission process for 2010-2011.  The collaborative call schedule has been posted.

5. Any Questions?

6. EQR Quarterly Meeting Overview of Current Activities and Upcoming EQR Activities June 10, 2009 Presented by: Gretchen Thompson, MBA, CPHQ Executive Director, State & Corporate Services

7. Current EQR Activities Overview of activities conducted during state fiscal year 2008-2009

8. Current EQR Activities Performance Improvement Projects (PIPs)  Completed validation of two PIPs per MCO  Produced the Annual PIP Validation Summary Report  Draft Annual Strategic Report for Performance Improvement Projects is due to AHCA on June 30, 2009  Technical assistance activities with MCOs, AHCA, and DOEA - ongoing

9. Current EQR Activities Validation of Performance Measures  Completed validation of performance measures reported by HMOs and PSNs (Reform and Non-Reform), PMHPs, CWPMHP and NHDPs  Produced and finalized Annual Validation of Performance Measures report and MCO specific findings  Produced and finalized MCO-specific Validation of Performance Measure reports for PMHPs and NHDPs

10. Current EQR Activities Validation of Performance Measures  PMHP initial validation activities are underway for the new cycle

11. Current EQR Activities Monitoring of MCO Contract Compliance  Working with AHCA and DOEA to finalize monitoring tools and database –PMHP database tool operational (includes CW-PMHP) –Tool development to occur for NHDP, PSN, and HMOs once FY 2010 contracts are finalized  Focused reviews continuing

12. Current EQR Activities Strategic HEDIS ® Analysis  Produced and finalized HEDIS 2008 Strategic Analysis Report on Reform and Non-reform HMOs and PSNs HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)

13. Current EQR Activities Technical Assistance in Other Areas  Provided technical assistance as needed  Produced quarterly reports on technical assistance activities provided during the year and status of recommendations

14. 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

15. Current EQR Activities EQR Technical Report  Internal analysis underway  Draft report due to AHCA in July, 2009

16. Year Four EQR Activities Overview of activities to be conducted during state fiscal year 2009-2010

17. Year Four EQR Activities  Validation of PIPs  Validation of performance measures  Review of compliance with access, structural, and operations standards  Strategic HEDIS ® analysis reports  Technical assistance  Dissemination of EQR information  EQRO Technical Report

18. Year Four EQR Activities MARK YOUR CALENDARS!!!! The next EQR Quarterly Meetings are scheduled for:  Wednesday, September 23, 2009 (Webinar)  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

19. MCO Roles and Responsibilities related to Year Four EQR Activities (FY 09-10)

20. MCO Roles and Responsibilities Validation of Performance Improvement Projects

21. Validation of PIPs MCO Roles and Responsibilities  Provide basic information on the PIPs that are currently underway (Statement of Intent)  Complete the PIP Summary Form and provide supportive documentation for each PIP selected for validation  Review HSAG’s completed PIP Validation Tool and address any Points of Clarification, Partially Met and Not Met evaluation elements

22. Validation of PIPs MCO Roles and Responsibilities  Continuing Collaborative PIP activities –Participate in quarterly conference calls –Facilitate at least one quarterly conference call (with HSAG support)  New Collaborative PIP activities (for NHDPs) –Monthly conference calls –Facilitate at least one monthly conference call (with HSAG support)

23. 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 annual re- measurements

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

25. MCO Roles and Responsibilities Validation of Performance Measures

26. Validation of Performance Measures MCO Roles and Responsibilities  Both non-reform and reform HMOs and PSNs provide 2009 HEDIS ® RoadMap (HEDIS Record of Administration, Data Management and Processes)  HMOs and PSNs complete and forward supplemental questions document to HSAG  Establish a contact person if questions arise from the HSAG review team

27. 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.

28. 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.

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

30. Project Activity by Month Validation of Performance Measures (PMVs) PMHPs Task MayJunJulAugSepOctNovDecJan 10 FebMarAprMay PMVs PMHPs 6/09 – 7/09 Prepare Report, Review Final Rates 08/09 Finalize PMV Reports 5/09-6/09 Site Visits Ongoing TA to AHCA/DOEA for Performance Measures 03/10 Request ISCAT documentation 05/10 Receive ISCAT documentation

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

32. THANK YOU FOR YOUR PARTICIPATION!