overview of 2007 quality assurance activities
Download
Skip this Video
Download Presentation
Overview of 2007 Quality Assurance Activities

Loading in 2 Seconds...

play fullscreen
1 / 26

Overview of 2007 Quality Assurance Activities - PowerPoint PPT Presentation


  • 355 Views
  • Uploaded on

Overview of 2007 Quality Assurance Activities Maryland Department of Health and Mental Hygiene November 29, 2007 Overview 2007 Quality review activities: Systems Performance Review Healthy Kids Quality Monitoring Program Enrollee Satisfaction Survey

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Overview of 2007 Quality Assurance Activities' - emily


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
overview of 2007 quality assurance activities

Overview of 2007 Quality Assurance Activities

Maryland Department of

Health and Mental Hygiene

November 29, 2007

slide2
Overview
  • 2007 Quality review activities:
    • Systems Performance Review
    • Healthy Kids Quality Monitoring Program
    • Enrollee Satisfaction Survey
    • Healthcare Effectiveness Data and Information Set (HEDIS)
    • Value-Based Purchasing Performance Measures
    • Consumer Report Card
    • Performance Improvement Projects

2

slide3
Systems Performance Review
  • Federal law requires that all State Medicaid Programs use an External Quality Review Organization (EQRO) to conduct an annual Systems Performance Review (SPR) of all managed care organizations (MCO).
  • The Department contracts with Delmarva Foundation to conduct the SPR.
  • The 2006 SPR consisted of 9 standards.
  • Each MCO is rated separately on compliance with each standard.
  • Criteria used for each standard is reviewed and updated annually by the Department based on EQRO recommendations.

3

slide4
System Performance Review (continued)
  • The Department rotated two standards for 2006, Outreach Plan and Health Education because all of the MCOs had previously met the minimum compliance rate (100%.)
  • For 2006, the minimum compliance rate for all standards was 100% except Oversight of Delegated Entities at 90% and Fraud and Abuse at 70%.
  • For any standard or any components of a standard that do not meet the minimum compliance level, MCOs are responsible for implementing an approved corrective action plan.

4

healthy kids quality monitoring program
Healthy Kids Quality Monitoring Program
  • Monitoring is performed by a team of nurses who also review and certify providers for EPSDT services.
  • Through medical record reviews, the nurses rate each MCO’s performance on compliance with the 5 major EPSDT components:
          • Health and Developmental History.
          • Comprehensive Physical Exam.
          • Laboratory Tests.
          • Immunizations.
          • Health Education.
  • Data results are reviewed and validated by the EQRO and are included in the SPR report.
  • All MCOs exceeded the minimum composite compliance rate of 85%.
  • All MCOs met or exceeded the 70% compliance rate for each of the 5 components of the review.

6

slide9
Enrollee Satisfaction Surveys
  • DHMH conducts an enrollee satisfaction survey annually using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey instruments designed to evaluate members’ satisfaction with their health plans.
  • DHMH uses an NCQA certified CAHPS vendor to conduct the survey and compile the results.
  • Surveys include question sets covering:
        • Enrollment and coverage
        • Access to and utilization of healthcare
        • Communication and interaction with providers
        • Interaction with MCO administration
        • Self perceived health status

9

slide10
Enrollee Satisfaction Surveys (continued)
  • In 2007
    • 11,362 CAHPS Medicaid Adult Surveys and 13,958 CAHPS Medicaid Child with Chronic Care Condition (CCC) Surveys were mailed. There were 2,850 adult responses and 4,867child responses.
    • Follow-up phone calls were made to interview members who did not respond by mail.
  • Response rates varied by MCO ranging from 21% to 35% for adults and 15% to 29% for children.
  • Based on ratings of 0 to 10 where 10 is the best, the lowest MCO score in any rating is 7.4 for adults and 6.4 for children.

10

provider satisfaction surveys
Provider Satisfaction Surveys
  • DHMH conducts an annual provider satisfaction survey to assess provider satisfaction with various aspects of HealthChoice.
  • DHMH uses an NCQA certified HEDIS survey vendor to conduct the survey and compile the results.
  • Historically, response rates have been low and it is believed that a shorter survey in combination with telephone follow-up may help to increase provider survey participation beginning in 2008.
provider satisfaction surveys continued
Provider Satisfaction Surveys (continued)
  • Survey topics include:
      • Finance Issues
      • Customer Service/Provider Relations
      • No-Show HealthChoice Appointments
      • Coordination of Care and Case Management
      • Utilization Management
      • Overall Satisfaction
  • In 2007
      • A mail-only survey administration methodology was utilized to survey a random sample of Primary Care Providers (PCPs) from each of the seven MCOs. From a total aggregate of 5,309 PCPs, 248 responses were received yielding a total aggregate response rate of 6.1%
slide13
HEDIS Performance Measures
  • The Healthcare Effectiveness Data and Information Set is a standardized set of performance measures developed by NCQA and CMS to measure managed care performance and assess opportunities for improvements in quality of care.
  • Each year NCQA updates the measurement set based on the latest information available.
  • The Department contracts with an NCQA certified HEDIS vendor to audit and report the MCOs’ scores.
  • MCOs use claim and encounter data to produce each measure. However, for some measures, MCOs are allowed to supplement incomplete data with medical record reviews.

13

slide14
HEDIS Performance Measures
  • For 2007, MCOs were required to report their performance on 20 HEDIS measures.

Access/Availability of Care

  • Children and Adolescents’ Access to Primary Care Practitioners
  • Adults’ Access to Preventive/Ambulatory Health Services
  • Prenatal and Postpartum Care
  • Call Answer Timeliness
  • Call Abandonment

Effectiveness of Care

  • Childhood Immunization Status
  • Adolescent Immunization Status
  • Breast Cancer Screening
  • Cervical Cancer Screening
  • Comprehensive Diabetes Care
  • Use of Appropriate Medications for People with Asthma
  • Appropriate Treatment for Children with Upper Respiratory Infection (NEW)
  • Appropriate Testing for Children with Pharyngitis (NEW)
  • Chlamydia Screening in Women (NEW)

Use Of Services

  • Frequency of Ongoing Prenatal Care
  • Well-Child Visits in the First 15 Months of Life
  • Well-Child Visits in the Third, Fourth, Fifth and Sixth Year of Life
  • Adolescent Well-care Visits
  • Discharge and Average Length of Stay- Maternity Care
  • Births and Average Length of Stay, Newborns

14

slide15
HEDIS Performance Measures (continued)
  • The 2007 HEDIS audits had an increase in the number of DHMH measures that had to be reported. Three measures added provided information on preventative services provided to HealthChoice members.
    • These measures were:
      • Chlamydia Screening in women,
      • Appropriate Testing for Children with Pharyngitis,
      • Appropriate Treatment for Children with Upper Respiratory Infection.
  • Overall, the MCOs continue to show improvement in their HEDIS scores over the last 4 years.

15

slide17
MCOs:Benchmarks:

AGM = AMERIGROUP Maryland, Inc. NMH = National Medicaid HEDIS Mean

HFC = Helix Family Choice, Inc. MARR = Maryland Average Reportable Rate DIA = Diamond Plan - the Medicaid product line of Coventry Health Care MMA = Maryland MCO Average

JMS = Jai Medical Systems Managed Care Organization, Inc

MPC = Maryland Physicians Care

PP = Priority Partners

UHC = UnitedHealthcare of the Mid-Atlantic, Inc. Report Indicators: NR = Not Reportable NA = Not Applicable

slide20
Value-Based Purchasing
  • Value Based Purchasing is a set of performance measures based on current HealthChoice monitoring activities.
  • The goal of our Value Based Purchasing strategy is to improve MCO performance by providing monetary incentives and disincentives.
  • These 10 measures cover all important dimensions of MCO performance:
      • Access to Care
      • Quality of Care
      • Administration (MCO structure and operations)
  • 5 of the 10 measures are HEDIS measures and 5 are Maryland specific.

20

slide21
Value-Based Purchasing (continued)
  • Targets for each measure have been established based on 3 levels of performance:
        • Disincentive:

For any measure that the MCO does not meet the minimum target, a disincentive of 1/9 of 1/2 percent of the total capitation paid to the MCO during the measurement year will be collected.

        • Neutral
        • Incentive:

For any measure that the MCO exceeds the minimum target, the MCO shall be paid an incentive payment of up to 1/9 of 1/2 percent of the total capitation amount paid to the MCO during the measurement year.

21

consumer report card
Consumer Report Card
  • This is the fifth year that we have produced a HealthChoice Consumer Report Card.
  • Since its inception, the Department has been contracting with the NCQA (through the EQRO contract) to develop the methodology and calculate the MCOs’ scores.
  • The 6 performance areas rated in the Report Card are calculated compiling 30-40 measures from HEDIS, Value Based Purchasing, and the Satisfaction Survey.
  • The Consumer Report Card is included in all enrollment packets.

23

performance improvement projects
Performance Improvement Projects
  • Currently have 2 Performance Improvement Projects ongoing that MCOs are required to conduct:
        • Improve Screening for Chronic Kidney Disease
        • Improve Cervical Cancer Screening (Began July 2007)

Improving the Delivery of Prenatal/Postpartum Care was completed in 2007.

  • PIPs consist of:
        • Submission of data collection and analysis plan
        • Baseline measurement of data
        • Intervention development and implementation
        • Re-measurement of data

24

performance improvement projects25
Performance Improvement Projects
  • For Prenatal/Postpartum: All MCOs improved their scores from baseline in 2004 to final in 2007.
  • For CKD Measure 1 “HEDIS, Kidney Disease Monitored Rate”: All MCOs improved their scores from 2005-2006. (Diamond Plan was not required to participate in 2006 due to insufficient membership size).
  • For CKD Measure 2 “Hypertensive members receiving at least one serum creatinine”: 2 MCOs improved their scores, 3 MCOs remained relatively the same, and 1 MCO had a small score decrease from 2005-2006. (Diamond Plan was not required to participate in 2006 due to insufficient membership size).

25

where to find complete information
Where to find complete information ?

DEPARTMENT OF HEALTH AND MENTAL HYGIENE

WEBPAGE

http://www.dhmh.state.md.us/

Select “Medical Care Programs”, “HealthChoice Managed Care”, “HealthChoice Quality Assurance Activities”

26

ad