External Quality Review Quarterly Meeting

1. External Quality Review Quarterly Meeting Friday, March 30, 20123:00 p.m. – 4:00 p.m. WELCOME!

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

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. HMO/PSNHEDIS 2011 (CY 2010) HEDIS Results Friday, March 30, 2012 Presenter: Wendy Talbot, MPH, CHCA Associate Director, Audits (HSAG) State and Corporate Services

5. Performance Measures Related to Pediatric Care

6. Well-Child Visits—15 Months (Zero Visits) Note: Lower rates are better for this measure.

7. Well-Child Visits—15 Months (Zero Visits) • Compared with the HEDIS 2010 results, both plan types increased in performance (their rates decreased). • The Reform weighted average exhibited a greater and statistically significant increase in performance.

8. Well-Child Visits—15 Months (6 Visits)

9. Well-Child Visits—15 Months (6 Visits) • The HEDIS 2011 weighted averages for both Non-Reform and Reform plans were at least 12 percentage points below the AHCA performance target. • Compared with HEDIS 2010 results, both plan types showed a statistically significant increase in HEDIS 2011 performance.

10. Well-Child Visits 3–6 Years

11. Well-Child Visits 3–6 Years • Both the Reform and Non-Reform plans HEDIS 2011 weighted averages exceeded the AHCA performance target.

12. Adolescent Well Care

13. Adolescent Well Care • The HEDIS 2011 weighted averages for both Non-Reform and Reform plans were below AHCA’s performance target. • Compared with the HEDIS 2010 results, the weighted average for Non-Reform plans showed an increase of 3.5 percentage points. This increase was statistically significant.

14. Lead Screening in Children

15. Lead Screening in Children • The HEDIS 2011 weighted averages for both Non-Reform and Reform plans were more than 20 percentage points below AHCA’s performance target, with the Reform plans performing slightly better than the Non-Reform plans.

16. Annual Dental Visits

17. Annual Dental Visits • The HEDIS 2011 Florida Medicaid weighted averages for both Non-Reform and Reform plans remained more than 15 percentage points below the AHCA performance target.

18. Childhood Immunization Status—Combo 2

19. Childhood Immunization Status—Combo 2 • Although the HEDIS 2011 weighted averages for both Non-Reform and Reform plans were below AHCA’s performance target, both plan types showed improvements over their HEDIS 2010 performance.

20. Childhood Immunization Status—Combo 3

21. Childhood Immunization Status—Combo 3 • Although the HEDIS 2011 weighted averages for both Non-Reform and Reform plans remained below AHCA’s performance target, both plan types showed improvement in their performance from HEDIS 2010.

22. Immunizations for Adolescents, Combination 1

23. Immunizations for Adolescents, Combination 1 • Non-Reform and Reform plans performed similarly during HEDIS 2010. • The increase of 5.9 percentage points from HEDIS 2010 to HEDIS 2011 among Non-Reform plans was statistically significant.

24. Follow-up Care for Children Prescribed ADHD Medication, Initiation

25. Follow-up Care for Children Prescribed ADHD Medication, Initiation • The rate for Reform plans improved slightly from HEDIS 2010 and exceeded the performance target. • For the Non-Reform plans, there was a wide variation in rates between the highest- and lowest-performing plans of more than 25 percentage points.

26. Follow-up Care for Children Prescribed ADHD Medication, Continuation and Maintenance Phase

27. Follow-up Care for Children Prescribed ADHD Medication, Continuation and Maintenance Phase • Though the rate for Reform plans decreased slightly, it remained 16 percentage points higher than the AHCA performance target. • However, caution should be used in interpreting this finding, as the total number of eligible Reform members was only 45 from one Reform plan.

28. Best Practices & Recommendations

29. Best Practices for Pediatric Measures Child & Adolescent Immunizations Lead Screening in Children • Technology • Motivate/Educate Parents • Educate Staff & Enhance Administrative Protocols • Identify Alternative Venues and Expand Access to Immunizations • Link and Share Data • Establish Partnerships With Outside Entities • Alternative Screening Technologies

30. Best Practices for Pediatric Measures (Cont.) Well-Child Visits CWP • Improve Access to Care and Services • Reminder Systems • Physician Education • Parental Education • Provider Education • Decision Support Systems • Delayed Prescribing Practices

31. Performance Measures Related to Women’s Care

32. Cervical Cancer Screening

33. Cervical Cancer Screening • Non-Reform and Reform plans showed improved weighted averages in HEDIS 2011 when compared to the HEDIS 2010 weighted averages, while still falling short of the performance target rate of 72.0 percent.

34. Chlamydia Screening This measure was recently added to the Medicaid reporting set; therefore, no comparison data were available.

35. Chlamydia Screening This measure was recently added to the Medicaid reporting set; therefore, no comparison data were available.

36. Chlamydia Screening This measure was recently added to the Medicaid reporting set; therefore, no comparison data were available.

37. Chlamydia Screening • There was a variation between the highest- and lowest-performing Non-Reform plans for all age ranges. • Variation among Reform plans (12.5 percentage points) was much smaller than the rate variation among Non-Reform plans (40.4 percentage points) for ages 21 through 24.

38. Breast Cancer Screening

39. Breast Cancer Screening • Both the Non-Reform and Reform weighted averages showed an increase in performance during HEDIS 2011, though these increases were not statistically significant. • The Reform plans’ performance exceeded the State’s performance target for the second consecutive year.

40. Timeliness of Prenatal Care

41. Timeliness of Prenatal Care • Reform plans demonstrated a statistically significant decrease of 6.7 percentage points from HEDIS 2010 to HEDIS 2011. • Non-Reform and Reform plan weighted averages continued to remain more than 16 percentage points below the State’s performance target.

42. Postpartum Care

43. Postpartum Care • Weighted averages among Non-Reform and Reform plans continued to remain at least 10 percentage points below the State’s performance target.

44. Best Practices forWomen’s Care Measures The most effective interventions primarily addressed barriers related to access to care and lack of awareness.

45. Best Practices forWomen’s Care Measures (Breast & Cervical Cancer Screenings) • Physician Reminders • Patient Reminders • Improving Access & Awareness • Physician Communication • Physician Tools & Resources • Collection of Data Note: Many of the same interventions used to increase breast and cervical cancer screening rates can be applied to chlamydia screening.

46. Best Practices forWomen’s Care Measures (Prenatal and Postpartum Care) • Education on Proper Coding • Coordination of Care • Educational Outreach Programs • Resource Lists • Provide Transportation

47. Performance Measures Related to Living with Illness

48. Diabetes Care—HbA1c Testing

49. Diabetes Care—HbA1c Testing • While the HEDIS 2011 weighted average for Non-Reform plans showed steady improvement over the previous two years, the weighted average for Reform plans decreased slightly from HEDIS 2010.

50. Diabetes Care—Poor HbA1c Control Note: Lower rates are better for this measure.