1. PIP Quarterly Check-Ins State of Florida Agency for Health Care Administration Bureau of Medicaid Quality May 25, 2016 External Quality Review Quarterly Conference

2. PIP Check-In Planning Process Established teams- 4 teams (based on specific staff qualities and health plan/field staff location) Health plan assignments- PIP team assigned 3-4 health plans each (these teams will be with the same health plans permanently) First PIP check in- face to face, focusing on preventive dental PIP (unless they are a specialty plan) 2

3. 3 PIP Check-In Training Process Developed internal training All PIP teams attended the training PIP teams received binders with resources and check-in forms/templates to guide the discussions Role playing & practice Local health plan served as a pilot check-in

4. PIP Check-In Team Responsibilities Review and study all resources (including the preventive dental PIPs) Contact their assigned plans and coordinate meetings Scheduled 2-4 hours with each health plan, depending on assessment of need Coordinate travel approval (flights, hotels & rental cars) 4

5. Meeting Health Plan Quality Teams 5 Health plans expressed appreciation for the development of the teams and look forward to collaboration Many health plan QI staff said they were glad to “put a face to the name” in the emails that we exchange in our work Plans expressed the desire, willingness and interest to share ideas with other plans

6. Meeting Health Plan Quality Teams 6 Many plans have QI workgroups or teams that meet weekly/monthly Met team members and learned their roles Gained a better understanding for each health plan’s QI process

7. 7 Member LevelProvider LevelSystem Level Do not know they have dental benefits Lack of education, do not understand the importance of preventive dental procedures Cannot find a provider Office hours are not accommodating to their schedule Do not have transportation They have other more critical priorities (social determinants) Unaware of dental benefits Inaccurate billing Do not want to work with Medicaid Recipients Do not want the extra administrative burden Are not satisfied with reimbursements Inaccurate demographic information in the Medicaid system Challenges with billing in school based sealant programs Common Barriers reported by health plans

8. Barrier Prioritization Methods Health Plans are using: Strategy Grid-prioritizes barriers based on need and feasibility. Fishbone Diagram (Ishikawa)-causal diagrams. 5 Whys-determine the root cause of a defect or problem by repeating the question "Why?" Each question forms the basis of the next question. 8

9. 9 Member LevelProvider LevelSystem Level Educational materials (newsletters, flyers, handouts) Telephone contact (auto- dialer, text, reminder calls) Outreach programs (in-home training, hosting activities) Build and maintain an efficient and effective approach to address broken appointments Phone number printed on the medical/dental plan card. Educational materials (newsletters, handouts, guidelines) Provider Training Reports (gaps in care, service utilization) Meetings (discussions of results and improvement strategies) Incentives Ensure that each child has a dental home Health fairs Member outreach programs Provider outreach programs (case managers, liaisons) Online educational information (social media, websites) Co-communicate about oral health visits along with messaging about immunizations for young children. Common Interventions reported by health plans

10. 10 Unique Interventions learned at Check-Ins Online provider portals-identify gaps, provide training, etc. Phone system alerts customer service agent if the member on the call is not in compliance Partnership of PCP offices and mobile dental units Placing a dental provider in FQHCs Hosting Clinic Days in partnership with providers

11. 11 Unique Intervention learned at Check-Ins, contd. Utilizing pharmacy database to locate member phone numbers Use of Tracfone data to obtain member phone number Focus groups with members and primary care providers Adjustment of search filters for dental vendor website to include the search option to find a dentist for a specific time Placing pregnant mothers in dental homes, for easy transition for the child's dental home

12. QI Evaluation Methods Processes: Plan, Do, Study, Act (PDSA) Development of criteria for “successful phone calls” and follow up by reviewing encounter data Rapid Cycle Testing GEO-mapping/GEO-coding to identify members with dental care gaps in relation to the location of dental providers 12

13. 13 Agency Recommendations to Health Plans More frequent re-measuring outcomes and reevaluation of interventions More robust interventions (resource kit) Annual member newsletters and telephonic outreach (ROBO calls, On-Hold messaging) are more standard practice unless you are able to measure outcomes by hits on website where newsletter posted or mail return (still not very effective tool) Consumer engagement-Texting Campaign (80% Medicaid recipients have cell phones and 50% have smart phones) School based sealant programs – capturing claims (refer to map and CHD contact list)

14. 14 Agency Recommendations to Health Plans Build upon physician relations by forming provider focus group to better understand related barriers and needs of providers providing services to members (PCP and dental) Educate physicians to document in medical records referrals to dental homes or providers Use other venues such as Vendor Oversight Committee, Physician Advisory Group, Stakeholder Workgroups and Joint Operating Committees to gather provider and member feedback if there is clinical representation

15. Agency Follow Up Plan 15 Reviewed materials given to teams from health plans All PIP Teams met in April after all check-ins were completed Followed up with each health plan by providing a summary of initial visit and outline next steps Sent health plans resources or contacts discussed during check-ins

16. Impact of PIP Check-Ins Establishment of a firm working relationship. Health plan and AHCA quality staff now communicate more frequently Learned that plans are doing much more work than what is documented Plans are monitoring data more frequently (monthly and weekly) Stakeholder connections have been made More frequent utilization of school based sealant programs 16

17. Impact of PIP Check-Ins Sharing of ideas across health plans Discovered which plans are utilizing the plan do study act (PDSA) process, and which are not Introduction of QI tools to plans (i.e., barrier prioritization tools, etc.) Discussion of the importance of rapid cycle improvement 17

18. How will WE track our success? Tracking spreadsheet containing: –Any interim measures reported from the plans –Meeting dates/times (even if via phone or email) –Notes indicating discussions and follow up tasks –Any referrals, resources or contacts provided –Ongoing communication with HSAG to assess plan engagement 18

19. Additional Resources/Follow Up 19 Update on Medicaid Recipient App Text Messaging initiatives PCP’s incorporating dental into their practice SOHAP Consumer Engagement

20. PIP Check-Ins Next Steps 20

21. 21 Questions/Comments Thank you Health Plans!