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External Quality Review Quarterly Meeting. Wednesday, September 26, 2007 1:00 p.m. – 3:00 p.m. WELCOME!. EQR Quarterly Meeting. Welcome to all participants Overview of agenda Webinar do’s and don’ts Evaluation Forms. PIP Validation Activities for Year Two. 1:15 p.m. – 1:30 p.m.

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external quality review quarterly meeting

External Quality Review Quarterly Meeting

Wednesday, September 26, 20071:00 p.m. – 3:00 p.m.

WELCOME!

eqr quarterly meeting
EQR Quarterly Meeting
  • Welcome to all participants
  • Overview of agenda
  • Webinar do’s and don’ts
  • Evaluation Forms
pip validation activities for year two

PIP Validation Activities for Year Two

1:15 p.m. – 1:30 p.m.

Presenter:

Cheryl Neel, RN, MPH, CPHQ

Manager, Performance Improvement Projects

overview
Overview
  • PIP Activities Completed
  • Important Dates
  • PIP Submission Tips
webinar pip trainings
Webinar PIP Trainings
  • PMHPs on August 21, 2007
  • NHDPs on August 22, 2007
  • HMOs/PSNs on August 22, 2007
purpose of pip webinar trainings
Purpose of PIP Webinar Trainings
  • Provided technical assistance for activities either Partially Met or Not Met overall for the 2006-2007 validation cycle
  • Instructed on how to submit PIPs
  • Provided resources
  • Addressed PIP questions and issues
pip statement of intent soi
PIP Statement of Intent (SOI)

HSAG received SOI submissions from:

  • 17 HMOs (Reform and Non-reform)
  • 6 PSNs
  • 8 PMHPs
  • 12 NHDPs
pip frequently asked questions
PIP Frequently Asked Questions
  • FAQ on myfloridaeqro.com
  • Updated for the 2007-2008 validation cycle
  • 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?
pip submission letters
PIP Submission Letters
  • Letters sent on September 6, 2007

Included:

  • 2007-2008 PIP validation timeline
  • PIP topics selected for validation
  • PIP study form for new PIPs
  • Completion instructions
pip topics selected
PIP Topics Selected

Examples:

HMO

  • Cultural & Linguistic
  • Member Satisfaction

PSN

  • Cultural and Linguistic
  • Dental Care
pip topics selected12
PIP Topics Selected

Examples:

PMHP

  • Encounters/Claims Lag
  • Readmissions

NHDP

  • Influenza Vaccination
  • Wound Care
pip submissions due to hsag
PIP Submissions Due to HSAG
  • All selected PIP submissions* are due Friday, October 5, 2007
  • *NHDP Collaborative PIPs due Friday, November 2, 2007
previously submitted pips
Previously Submitted PIPs
  • For ongoing PIPs, use the same PIP Study 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 Partially Met and Not Met evaluation elements from the previous validation cycle have been addressed in the documentation.
all pip submissions
All PIP Submissions
  • Complete demographic page of PIP Study Form.
  • Only complete the PIP Study Form as far as the PIP has progressed.
  • Be sure to include all attachments referenced in the PIP Study Form (e.g. manual data collection tool, instructions, etc.)
hsag contacts for pip questions
HSAG Contacts for PIP Questions
update on the collaborative pip initiatives

Update on the Collaborative PIP Initiatives

1:30 p.m. – 1:45 p.m.

Presenter:

Peggy Ketterer, RN, BSN, CHCA

Executive Director, EQRO Services

collaborative pips
Collaborative PIPs

EQRO Year 1 (FY 2006-2007)

  • HSAG validated 81 PIPs
  • HSAG identified potential collaborative topics within the Annual Strategic Report
collaborative pips21
Collaborative PIPs

EQRO Year 1 (FY 2006-2007)

HSAG recommended three topics:

  • Well-Child Visits (zero visits numerator) for HMOs/PSNs
  • Follow-Up After Hospitalization for Mental Illness for PMHPs
  • Fall Prevention for NHDPs
collaborative pips22
Collaborative PIPs

EQRO Year 2 (FY 2007-2008)

  • HSAG held collaborative PIP kick-off meetings in June with HMOs/PSNs, PMHPs, and NHDPs.
  • As a result of the kick-off meetings, the topics were modified or refined.
collaborative pips23
Collaborative PIPs

Final collaborative PIP topics:

  • Well-Child Visits (Six or More Visits numerator) for HMOs/PSNs
  • Follow-Up within Seven Days after Acute Care Discharge for a Mental Health Diagnosis for PMHPs
  • Retention Rate for NHDPs
collaborative pips24
Collaborative PIPs

Current status:

  • Monthly conference calls are held with all participants
  • Documentation requirements for each PIP activity are discussed
  • Host MCOs are responsible for facilitating the meeting and preparing meeting minutes
collaborative pips25
Collaborative PIPs

Current status:

  • The study question has been identified for each collaborative
  • Study indicators have been identified for the HMO/PSN and PMHP PIPs
  • All MCOs are responsible for completing customized PIP forms
collaborative pips26
Collaborative PIPs

Validation activities:

  • HSAG is validating two PIPs per MCO
  • Collaborative PIPs will be validated (as one of the two selected PIPs per MCO)
  • If an MCO is not participating in the collaborative, two other PIPs will be selected for validation
collaborative pips27
Collaborative PIPs

Validation activities:

  • Collaborative PIPs will be validated as far as they have progressed to date. Additional evaluation elements will be considered “not applicable” for this validation cycle.
collaborative pips28
Collaborative PIPs

Validation activities:

  • HSAG will produce a report for each PIP selected for validation, including the collaborative PIPs.
  • The reports have been streamlined to be more concise and less repetitive.
collaborative pips29
Collaborative PIPs

Collaborative PIP Report:

  • HSAG prepared the draft Statewide Collaborative Methodology Report for PIPs in August, 2007
  • The report describes the background, purpose, and status of the collaborative, as well as HSAG’s role in facilitating the progression of the PIPs
collaborative pips30
Collaborative PIPs

Collaborative PIP Information:

  • HSAG has posted the meeting minutes, agendas, conference call schedules, and FAQs on www.myfloridaeqro.com
slide32
Validation of Performance Measures and HEDIS Strategic

AnalysisFY 2007/2008

Wendy Talbot, MPH

Project Leader, State and Corporate Services

performance measure validation process
Performance Measure Validation Process
  • HSAG, in collaboration with AHCA, has determined which MCOs can undergo validation activities
    • Non-reform populations only for Year 2
  • To be eligible for validation activities, an MCO must report standardized performance measures
performance measure validation process34
Objectives

Evaluate accuracy of data collected

Determine the extent to which each measure calculated followed established specifications

Utilize process consistent with CMS protocol

Performance Measure Validation Process
performance measure validation process35
Performance Measure Validation Process
  • On September 10, 2007, a document request letter was forwarded to the HMOs. The letter requested the following items:
    • HMO-completed 2007 Baseline Assessment Tool (BAT) or updates to their 2006 BAT
    • Final health plan quality indicator data file in AHCA-required format
    • Completion of additional questions on the information system capabilities assessment tool (ISCAT)
  • Requested items are due to HSAG on or before October 19, 2007
performance measure validation process36
Performance Measure Validation Process
  • Step One: Review BAT and ISCAT additional questions to assess systems capabilities
  • Step Two: Review quality data indicator file for reasonability and evaluation of HMO performance
  • Step Three: Compile measure-specific validation findings based on CMS protocols
  • Step Four: Draft report of the results of the validation of performance measures activity
performance measure validation process37
Performance Measure Validation Process
  • Validation of Performance Measure report
    • Draft to AHCA November 30, 2007
    • Final to AHCA January 11, 2008
hedis strategic analysis
Objectives

Verify that the HMO’s HEDIS production processes conform with technical specifications

Measure the HMO’s Information Systems capabilities

Evaluate the HMO’s ability to process medical, member, and provider data in order to accurately report HEDIS data

Ensure accurate and reliable publicly reported data

HEDIS Strategic Analysis
hedis strategic analysis39
HEDIS Strategic Analysis
  • No HMO-specific reports in Year 2, only Statewide Aggregate
  • Statewide Aggregate report will include:
    • Comparisons to national benchmarks
    • Comparisons to 2006 rates
    • Calculation of the state weighted average
    • Ranking of HMOs
    • Identification of overall program strengths and areas for improvement
reported measures
Reported Measures
  • Dimensions of Care
    • Women’s Care
      • Breast Cancer Screening
      • Cervical Cancer Screening
      • Chlamydia Screening in Women
      • Timeliness of Prenatal Care
    • Living With Illness
      • Use of Appropriate Medication for People with Asthma
      • Comprehensive Diabetes Care
      • Controlling High Blood Pressure
hedis strategic analysis41
HEDIS Strategic Analysis
  • Strategic Aggregate report
    • Draft to AHCA January 30, 2008
    • Final to AHCA March 5, 2008
2007 2008 focused study

2007/2008 Focused Study

1:55 p.m. – 2:05 p.m.

Marilea Rose, RN, BA

Associate Director, State and Corporate Services

slide44
HSAG will be conducting one focused study on the following topic:

To what extent do the outpatient behavioral health authorization processes, medical necessity criterion, and timeliness of authorizations vary across MCOs and by service category.

the purpose of the study is to determine
The purpose of the study is to determine:
  • how behavioral health authorization processes vary between MCOs.
  • how medical necessity criterion vary between MCOs.
  • how timeliness of authorizations vary across MCOs.
focused study activities what are the project steps
Focused Study ActivitiesWhat are the project steps?

Step 1: Procure MCO information via survey method

Step 2: Conduct desk review of survey responses and supporting documentation (policies and procedures)

Step 3: Evaluate MCO self reported timeliness of authorizations

Step 4: Prepare report

a survey will be sent to the mcos to collect study information
A survey will be sent to the MCOs to collect study information
  • Survey will be similar to the Special Health Care Needs survey used for the 2006/2007 focused study
  • Tentative timeframe to send the survey to the MCOs is mid-November
  • Tentative timeframe for returning the survey to HSAG is mid-December
what types of information will the survey collect from the mcos
What types of information will the survey collect from the MCOs?
  • Authorization policies and procedures
  • What initiates a request for authorization
  • Staff credentials required to authorize various services
  • Number of units authorized for initial requests for services
  • Process to obtain continued authorization
  • Timeliness standards for authorizations
  • Medical necessity criterion
overview of eqr technical report for 2006 2007

Overview of EQR Technical Report for 2006/2007

2:05 p.m. – 2:25 p.m.

Presenter:

Peggy Ketterer, RN, BSN, CHCA

Executive Director, EQRO Services

2006 2007 eqr technical report
2006-2007 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
2006 2007 eqr technical report53
2006-2007 EQR Technical Report
  • Summarizes the activities and findings from the first year of the EQR contract
  • Includes summary findings by MCO type (HMO, PSN, PMHP, and NHDP) as well as overall conclusions and recommendations
2006 2007 eqr technical report54
2006-2007 EQR Technical Report

Data used to evaluate performance included:

  • Validation of PIP results
  • Validation of performance measure results
  • Consumer satisfaction survey data
2006 2007 eqr technical report55
2006-2007 EQR Technical Report

Data used to evaluate performance (cont’d):

  • HEDIS® results
  • Results of Adolescent Well-Care Focused Study

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

2006 2007 eqr technical report56
2006-2007 EQR Technical Report

Other EQR activities:

  • There were several EQR activities that were not intended to produce findings that could be used for comparisons
  • A summary of these activities, along with the final outcome, was addressed in the report
2006 2007 eqr technical report57
2006-2007 EQR Technical Report

Other EQR activities:

  • Technical assistance on enrollee race, ethnicity, and primary household language
  • Value-based purchasing methodologies
  • Evaluation of AHCA quality strategy
  • Dissemination of education (quarterly meetings, website, trainings)
2006 2007 eqr technical report58
2006-2007 EQR Technical Report

HMO Findings:

  • Most objective data available to evaluate performance
  • PIPs–Nine percent received Met validation status, 43 percent received a Partially Met status, and 47 percent received a Not Met validation status
2006 2007 eqr technical report59
2006-2007 EQR Technical Report

HMO Findings (cont’d):

  • Performance Measures–above average performance on asthma measures, average performance on breast cancer and Chlamydia screening measures, and below average performance on well-child care measures.
2006 2007 eqr technical report60
2006-2007 EQR Technical Report

HMO Findings (cont’d):

  • Consumer satisfaction surveys (CAHPS®)–mixed results, no observable patterns seen
  • Focused Study (Adolescent Well-Care)–generally low performance statewide

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

2006 2007 eqr technical report61
2006-2007 EQR Technical Report

PMHP Findings:

  • Limited objective data to evaluate
  • PIPs–Most PIPs received a Partially Met validation status, with one receiving a Not Met status
  • Consumer satisfaction surveys–unable to use for comparison purposes
2006 2007 eqr technical report62
2006-2007 EQR Technical Report

PSN Findings:

  • Limited objective data to evaluate
  • Consumer satisfaction surveys–unable to use for comparison purposes
  • Focused Study (Adolescent Well-Care)–performance generally consistent with statewide average
2006 2007 eqr technical report63
2006-2007 EQR Technical Report

NHDP Findings:

  • Limited objective data to evaluate
  • PIPs–Most PIPs received a Not Met validation status, with two PIPs receiving a Partially Met status
  • Consumer satisfaction surveys–unable to use for comparison purposes
2006 2007 eqr technical report64
2006-2007 EQR Technical Report

Assessment of MCO Strengths and Weaknesses:

  • HSAG developed a methodology to identify strengths and weaknesses in performance in key EQR areas
  • Used objective data (PIPs, performance measure results, consumer survey performance, and focused study results)
2006 2007 eqr technical report65
2006-2007 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
2006 2007 eqr technical report66
2006-2007 EQR Technical Report

Assessment of MCO Strengths and Weaknesses:

  • CAHPS® measures that were statistically higher than the state mean were considered a strength for the MCO
  • CAHPS® measures that were statistically lower than the state mean were considered a weakness for the MCO

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)

2006 2007 eqr technical report67
2006-2007 EQR Technical Report

Assessment of MCO Strengths and Weaknesses:

  • Adolescent well-care clinical indicators that were statistically higher than the overall MCO aggregate rate were considered a strength for the MCO
  • Adolescent well-care clinical indicators that were statistically lower than the overall MCO aggregate rate were considered a weakness for the MCO
2006 2007 eqr technical report68
2006-2007 EQR Technical Report

Assessment of MCO Strengths and Weaknesses:

  • Within the technical report, HSAG prepared a set of tables displaying each MCO’s strengths and weakness based on the methodology
  • Strengths and weaknesses were also grouped into categories of quality, timeliness, and access to care
2006 2007 eqr technical report69
2006-2007 EQR Technical Report

Overall Conclusions and Recommendations:

  • Most objective data addressed only quality of services
  • Unable to draw overall conclusions based on the first year of data
  • Expect more objective data and the ability to compare performance in FY 2007-2008
2006 2007 eqr technical report70
2006-2007 EQR Technical Report

Overall Conclusions and Recommendations:

  • Recommendations included introducing standardized performance measures and consumer satisfaction surveys for all MCO types
  • Need to add indicators or measures that address timeliness and access to care.
florida medicaid quality strategy

Florida Medicaid Quality Strategy

2:25 p.m. – 2:40 p.m.

Linda Macdonald, MS

Senior Management Analyst II

AHCA

Margaret deHesse, RN, BSN

Executive Director, State and Corporate Services

HSAG

quality strategy
Quality Strategy

AHCA Development

  • Background
  • Goals and Objectives

EQRO Review

  • Findings
  • Recommendations
quality strategy74
Quality Strategy

EQR Findings:

  • The Quality Strategy was generally compliant with the CMS requirements and toolkit
  • High level of detail was included
  • The Quality Strategy should be further enhanced to better align with federal regulations and to improve its overall effectiveness
quality strategy75
Quality Strategy

Recommendations

  • Enhance methods/process for gathering enrollee/stakeholder feedback
  • Add details/methodology regarding conducting annual quality review
  • Explicitly state the term of the EQRO contract
  • List the standards and activities that will be monitored through Medicare or an accreditation review
quality strategy76
Quality Strategy

Recommendations Continued

  • Describe the work being done in the area of race/ethnicity and primary language
  • Include statements about vision, values, and guiding principles
  • Set performance measurement benchmarks and improvement goals
upcoming eqr activities

Upcoming EQR Activities

2:40 p.m. – 2:50 p.m.

Peggy Ketterer, RN, BSN, CHCA

Executive Director, EQRO Services

upcoming eqr activities79
Upcoming EQR activities

MARK YOUR CALENDARS!!!!

Next quarterly meeting is scheduled for Wednesday, January 16, 2008.

The meeting will be a full day, onsite at the AHCA offices.

upcoming eqr activities80
Upcoming EQR activities

Validation of PIPs:

  • Submission date for selected PIP forms and documentation is Friday, October 5, 2007
  • For NHDPs only, collaborative PIP form is due to HSAG by Friday, November 2, 2007
upcoming eqr activities81
Upcoming EQR activities

Collaborative PIPs:

  • HMO/PSN conference call is Tuesday, October 16th at 10:00 a.m.
  • PMHP conference call is Thursday, October 25th at 11:00 a.m.
  • NHDP conference call is Thursday, October 18th at 2:00 p.m.
upcoming eqr activities82
Upcoming EQR activities

Validation of Performance Measures:

  • Request for documentation for HMOs was sent out on September 10, 2007
  • Documentation is due to HSAG on Friday, October 19th, 2007
  • Requested items: HEDIS BAT, ISCAT questions, HEDIS data file, audit report
upcoming eqr activities83
Upcoming EQR activities

Focused Study–Behavioral Health Authorizations:

  • Document request will be sent to all participating HMOs, PSNs, and PMHPs
  • Requested documentation will include completion of a questionnaire, policies and procedures, and authorization forms
external quality review quarterly meeting85
External Quality Review Quarterly Meeting

THANK YOU FOR YOUR PARTICIPATION!

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