1. Plugging The Quality Holes in Medicaid: Quality Measurement in PA as it applies to Managed Care Carol Smolij Vice President, Quality, Healthcare Management Health Partners of Philadelphia Association for Community Affiliated Plans

2. About Health Partners Now in our 25th year, Health Partners continues to be a community force, helping historically underserved residents lead healthier lives through equal access to care. We are a not-for-profit health plan owned by seven hospitals that provides healthcare coverage to residents of the five counties of Southeastern Pennsylvania (including Philadelphia). Our plan has been recognized as a national model for Medicaid managed care.

3. Albert Einstein Medical Center Aria Health Episcopal Hospital Hahnemann University Hospital Hospital of the University of Pennsylvania St. Christopher’s Hospital for Children Temple University Hospital Owner Hospitals

4. Our Mission To manage our business to exceed expectations. To operate with respect and dignity in all relationships. To continually improve the health outcomes of our Members.

5. Making a Difference Every Day More than 450 employees More than 150,000 members Ranked #1 in member satisfaction in our market for six years

6. Churning Effect Member Centric Barriers Reporting Inequity Continuous Enrollment Challenges

7. HEDIS Monthly YTD Member Level Detail Quarterly Focused Rates State Specific Measures Current PA MCO Quality Reporting

8. Diabetes Pregnancy Hypertension Lead / EPSDT PA Focused Areas

9. BMI Pregnancy - Depression Pregnancy – Smoking / ETS High Lead Levels - referral PA EQR Measures

10. Improved Care Across Delivery Systems Same to same measures Analysis of membership Study of demographics Quality Measurement in PA

11. Continued – Improved Care Across Delivery Systems Identification of commonalities statewide – i.e. dental care Convergence of ideas Shared decision making Quarterly meetings / shared agenda items Quality Measurement in PA

12. Comparison Changes over time Collaboration Access Plus (FFS) & Primary Care Case Management (PCCM)

13. Data Sharing Member Transfers Plan Collaboration Reporting Equity Better Benchmarking Looking Ahead

14. Medicaid Accreditation Advisory Committee (MAAC) Medicaid Health Plans of America (MHPA) Reporting differences between Commercial & Medicaid Negative Impact of Enrollment Churn Role of States in Determining COC NCQA MAAC

15. Questions ??? Thank you!