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Quality—I’ll know it when I see it!!!

Quality—I’ll know it when I see it!!!. November 12, 2012. Introduction. History of Passport Historical perspective of Quality M easures Current status Prediction for the future. Passport’s Story. Founded in 1997 with the mission to “Improve the Health and Quality of Life of our Members”

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Quality—I’ll know it when I see it!!!

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  1. Quality—I’ll know it when I see it!!! November 12, 2012

  2. Introduction • History of Passport • Historical perspective of Quality Measures • Current status • Prediction for the future

  3. Passport’s Story • Founded in 1997 with the mission to “Improve the Health and Quality of Life of our Members” • Administer Managed Care Medicaid benefits for non-exempt members in Region 3

  4. Passport’s Story • Partnership between the Commonwealth, Passport’s sponsors, and the community (the Partnership Council) • The aim was to maintain/improve access to care, slow the rate of increase in medical expenses, and improve health outcomes

  5. Quality Defined • Mirriam-Webster®- “a degree of excellence” • Robert Wood Johnson Foundation- “a distinct management process and set of tools and techniques that are coordinated to ensure that departments consistently meet the health needs of their communities”

  6. Quality Defined • Institute of Medicine ‘01- “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”

  7. Quality Defined • Is it simply a system that promotes both precision and accuracy in a cost-effective manner?

  8. Historical Quality Measures • Easy to obtain • Comparable • Applicable across regions • As a result ADMINISTRATIVE • Claims • Encounters

  9. Quality Measures • EPSDT (Early Periodic Screening Detection and Treatment) • Federal and State program • System of reimbursement as well as measurement and reporting • Specific expected services for children and adolescents based on age

  10. Quality Measure (EPSDT)

  11. Quality Measures • NCQA (National Committee for Quality Assurance) • Provides accreditation for health plans and other health care related organizations • Developed and maintains a common set of measures

  12. Quality Measures • HEDIS® (Health Effectiveness Data and Information Set) • Developed and maintained by NCQA • Defines inclusion and exclusion criteria and specifications(continuous enrollment, etc.) • Used by >90% of US health plans • 75 measures across 8 domains

  13. Quality Measures • Quality Compass® • Allows comparison of health plan performance by measure The source for data contained in this publication is Quality Compass® 2011 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2011 contains certain CAHPS® data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

  14. Quality Measures

  15. Quality Measures

  16. Quality Measures

  17. Quality Measures (Diabetes) • HEDIS Diabetes Measures • 2000 6 measures • HbA1C testing, Poor HbA1C control (>9.0), eye exam, LDL-C screen, LDL-C <130, monitoring for nephropathy (kidney disease)

  18. Quality Measures (Diabetes) • 2012 11 measures • All of 2000’s measures except LDL-C 130 • Also includes • HbA1C <9.0, <8.0, and <7.0 as separate measures • LDL-C <100 • BP <140/80 • BP <140/90

  19. Quality Measures (Diabetes)

  20. Quality Measures (Diabetes)

  21. Quality Measures (Diabetes)

  22. Quality Measures (Diabetes)

  23. Quality Measures (Diabetes)

  24. Quality Measures • Healthy Kentuckian 2010 Measures • Healthy People 2020 Measures

  25. The Future • Increasing emphasis on outcomes • Payments tied to performance • Shared savings

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