External Quality Review Quarterly Meeting Wednesday, March 24, 2010 2:00 p.m. – 3:30 p.m. WELCOME!

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

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.

Summary of Performance Improvement Projects Validation Findings Wednesday, March 24, 2010 2:15 p.m. – 2:45 p.m. Presenter: Donald Grostic, MS Associate Director, Research and Analysis Team State & Corporate Services

Presentation Overview 2009–2010 PIP Validation Process Summary of Findings PIP Validation Summary Report Update Next Steps

2009–2010 PIP Validation Process “Statement of Intent” was completed by each MCO type and submitted to HSAG. For 2009–2010, MCOs were to submit to HSAG two PIPs for validation: Clinical and nonclinical Collaborative topic and one other

2009–2010 PIP Process (cont.) HSAG selected two PIPs per MCO type. One ongoing and one collaborative PIP were chosen. PIPs selected were chosen based on HSAG’s selection criteria. If an MCO did not have a nonclinical study in process and only had clinical studies, then two clinical PIPs were selected for this year’s validation cycle.

PIPs Submitted for 2009–2010 MCO-Type Collaborative Plan-specific HMO 2008–2009 2009–2010 HMO 24 22 26 28 PSN 8 6 PMHP 12 NHDP 15 14

Collaborative PIP Topics MCO-Type Collaborative Topic HMO Well-Child Visits in the First 15 Months of Life—Six or More Visits PSN NHDP Timeliness of Services PMHP Follow-up Within Seven Days after Acute Care Discharge for a Mental Health Diagnosis

Summary of Findings A total of 66 PIPs (56 percent) scored at least 80 percent compared to 73 PIPs (61 percent) in 2008–2009 (total of 119 PIPs for 2008–2009). For 2009–2010, Activities I–IV (study population) were assessed for all 118 PIPs. 111 PIPs (94.1 percent) progressed through Activity VI. 75 PIPs (63.6 percent) progressed through Activity VII. 77 PIPs (65.3 percent) progressed through Activity VIII. 51 PIPs (43.2 percent) progressed through Activity IX. 10 PIPs (8.5 percent) progressed through Activity X.

Summary of PIP Validation Scores % Score of Evaluation Elements Met HMO PSN NHDP PMHP Total 08–09 09–10 90% to 100% 21 20 4 10 3 7 18 1 46 38 80% to 89% 12 5 27 28 70% to 79% 14 2 6 24 60% to 69% 8 9 17 Less than 60% 16 11 50 29 30 119 118

Summary of Non-Collaborative vs. Collaborative PIP Validation Scores % Score of Evaluation Elements Met HMO PSN NHDP PMHP Total Non-Collab Collab 90% to 100% 10 5 2 1 21 17 80% to 89% 11 7 4 3 70% to 79% 9 14 60% to 69% 6 Less than 60% 28 22 8 15 12 63 55

HMO Findings Total of 50 PIPs (collaborative and non-collaborative) Seven PIPs (14 percent) were assessed through Activity X. Twenty-seven PIPs (54 percent) progressed through Activity IX. The average PIP score was 85 percent, the same as last year. Individual scores ranged from a low of 47 percent to a high of 100 percent. In general, as the PIPs progress through Activities VIII, IX and X, the PIP validation scores decrease. Fifty-six percent of the 36 PIPs that progressed though Activities VIII, IX, or X received a Met validation status.

HMO PIP Overall Performance 2008–2009 2009–2010

HMO Summary of PIP Validation Scores % Score of Evaluation Elements Met 2006–2007 2007–2008 2008–2009 2009–2010 90% to 100% 2 32 21 20 80% to 89% 13 8 10 18 70% to 79% 14 5 60% to 69% 3 4 Less than 60% 17 1 Total 53 46 50

HMO Findings for Collaborative PIPs Total of 22 PIPs Three PIPs (14 percent) were assessed through Activity X. Fifteen PIPs (68 percent) progressed through Activity IX. The average PIP score was 86 percent compared to 89 percent for last year. Individual scores ranged from a low of 56 percent to a high of 100 percent. Fifty-three percent of the 19 PIPs that progressed through Activities VIII, IX, or X received a Met validation status.

HMO Collaborative PIP Overall Performance 2008–2009 2009–2010

HMO Summary of Collaborative PIP Validation Scores % Score of Evaluation Elements Met 2008–2009 2009–2010 90% to 100% 12 10 80% to 89% 6 7 70% to 79% 5 2 60% to 69% 1 Less than 60% Total 24 22

PSN Findings Total of 14 PIPs (collaborative and non-collaborative) Ten PIPs (71 percent) were assessed through Activity VIII, Evaluation Element 5. The average PIP score was 88 percent compared to 73 percent for last year. Individual scores ranged from a low of 43 percent to a high of 100 percent. Ten percent of the 10 PIPs that progressed through Activity VIII, Evaluation Element 5, received a Met validation status. One of the 10 PIPs that progressed through Activity VIII, Evaluation Element 5, received a Met score for all critical evaluation elements. Nine of the 10 PIPs received a Partially Met for Activity VIII, Evaluation Element 1 (data analysis plan), which is a critical evaluation element.

PSN PIP Overall Performance 2008–2009 2009–2010

PSN Summary of PIP Validation Scores % Score of Evaluation Elements Met 2006–2007 2007–2008 2008–2009 2009–2010 90% to 100% NA 10 4 80% to 89% 1 70% to 79% 2 60% to 69% 3 Less than 60% 5 Total 16 14

PSN Findings for Collaborative PIPs Total of six PIPs Five PIPs were assessed through Activity VIII Evaluation Element 5. The average PIP score was 94 percent compared to 80 percent for last year. Individual scores ranged from a low of 71 percent to a high of 100 percent. One of the five PIPs that progressed through Activity VIII, Evaluation Element 5, received a Met validation score. Four of the five PIPs that progressed through Activity VIII, Evaluation Element 5, received a Partially Met score for the critical evaluation element 1 of Activity VIII (data analysis plan).

PSN Collaborative PIP Overall Performance 2008–2009 2009–2010

PSN Summary of Collaborative PIP Validation Scores % Score of Evaluation Elements Met 2008–2009 2009–2010 90% to 100% 2 5 80% to 89% 3 70% to 79% 1 60% to 69% Less than 60% Total 8 6

NHDP Findings Total of 30 PIPs (collaborative and non-collaborative) Nine PIPs were assessed through Activity IX and two of the nine PIPs through Activity X. The average PIP score was 70 percent, down from 74 percent last year. Individual scores ranged from 20 percent to 100 percent. Forty-four percent of the nine PIPs that progressed through Activity IX received a Met validation status. Eighty percent of the five PIPs that did not received a Met validation score and that progressed through Activity IX either scored a Partially Met or Not Met for Activity VIII, Evaluation Element 1 (data analysis plan), which is a critical evaluation element.

NHDP PIP Overall Performance 2008–2009 2009–2010

NHDP Summary of PIP Validation Scores % Score of Evaluation Elements Met 2006–2007 2007–2008 2008–2009 2009–2010 90% to 100% 14 3 7 80% to 89% 5 12 70% to 79% 1 6 60% to 69% 2 8 Less than 60% 16 Total 20 26 29 30

NHDP Findings for Collaborative PIPs Total of 15 PIPs All 15 PIPs were assessed through Activity VI. The average PIP score was 62 percent. Individual scores ranged from 20 percent to 100 percent. Two of the 15 PIPs received a Met validation status. Two of the 15 PIPs received a Met score for 100 percent of the critical evaluation elements.

NHDP Collaborative PIP Overall Performance 2008–2009 2009–2010

NHDP Summary of Collaborative PIP Validation Scores % Score of Evaluation Elements Met 2008–2009 2009–2010 90% to 100% 2 80% to 89% 6 1 70% to 79% 60% to 69% 5 Less than 60% 3 Total 15

PMHP Findings Total of 24 PIPs (collaborative and non-collaborative) 14 PIPs were assessed through Activity IX. The average PIP score was 75 percent, compared to 86 percent last year. Individual scores ranged from 64 percent to a high of 91 percent. Forty-three percent of the 14 PIPs that progressed through Activity IX received a Met validation status.

PMHP PIP Overall Performance 2008–2009 2009–2010

PMHP Summary of PIP Validation Scores % Score of Evaluation Elements Met 2006–2007 2007–2008 2008–2009 2009–2010 90% to 100% 14 18 1 80% to 89% 6 8 4 70% to 79% 60% to 69% 5 Less than 60% Total 23 24

PMHP Findings for Collaborative PIPs Total of 12 PIPs All 12 PIPs were assessed through Activity IX. The average PIP score was 78 percent, compared to 95 percent last year. Individual scores ranged from 73 percent to a high of 86 percent. Thirty-three percent of the 12 PIPs received a Met validation status. Forty-two percent of the 12 PIPs received a Met score for all critical evaluation elements.

PMHP Collaborative PIP Overall Performance 2008–2009 2009–2010

PMHP Summary of Collaborative PIP Validation Scores % Score of Evaluation Elements Met 2008–2009 2009–2010 90% to 100% 12 80% to 89% 3 70% to 79% 9 60% to 69% Less than 60% Total

PIP Validation Summary Reports HMOs, PSNs, PMHPs, and NHDPs received PIP Validation Summary Reports on Monday, March 15, 2010.

Next Steps for MCOs MCOs need to address all Points of Clarification and all Partially Met and Not Met evaluation elements. HSAG has provided the MCOs with the Word version of the study submitted. MCOs should use the same study document to continue working on the PIPs. MCOs should date, bold, and strike-through any sections in which revisions are made to the study document.

PIP Validation Annual Summary Report First draft of the 2009–2010 PIP Annual Summary Report will be sent to AHCA and DOEA on Friday, March 26, 2010. Includes compilation of all the MCO findings. Includes conclusions and recommendations.

Questions and Answers on PIP validation?

March Quarterly Meeting Performance Measure and HEDIS Results Wednesday, March 24, 2010 2:45 p.m. – 3:20 p.m. Presenter: Wendy Talbot, MPH, CHCA Project Manager, State and Corporate Services

Nursing Home Diversion Program (NHDP) CY 2008 Performance Measure Results

Understanding the Distribution Graphs Highest Rate Average Lowest Rate

NHDP Performance Measures Disenrollment Rate Retention Rate Voluntary Disenrollment Rate Average Length of Enrollment Before Voluntary Disenrollment (months)

NHDP Performance Measure Results

Findings Calendar Year (CY) 2008 was the first year the NHDPs reported validated performance measures. Retention Rate performance ranged from a high of 98.6 percent to a low of 88.9 percent.

Findings (continued) For the Disenrollment Rate and Voluntary Disenrollment Rate, a lower rate is better. Disenrollment Rate ranged from 26.3 percent to 6.6 percent and Voluntary Disenrollment Rate ranged from 10.3 percent to 2.3 percent.

Prepaid Mental Health Plans (PMHPs) & Child Welfare Prepaid Mental Health Plan (CWPMHP) CY 2008 Performance Measure Results

PMHPs & CWPMHP Performance Measures Follow-up Within Seven Days After Acute Care Discharge for a Mental Health Diagnosis With a Mental Health Practitioner (7-day follow-up with MHP) With a Case Manager (7-day follow-up with CM) Follow-up Within 30 Days After Acute Care Discharge for a Mental Health Diagnosis With a Mental Health Practitioner (30-day follow-up with MHP) With a Case Manager (30-day follow-up with CM) Thirty-day Readmission Rate

PMHP & CWPMHP Performance Measure Results

Findings Range of rates represents all of the areas covered by the PMHPs and CWPMHP. Fewer plans are using case managers for follow-up care. A lower rate is better for the readmission rate. Performance across all measures showed a wide range from the highest-performing plan to the lowest performing plan.

HMO/PSN HEDIS 2009 (CY 2008) HEDIS Results

Performance Measures Related to Pediatric Care

Well-Child Visits—15 Months (6 Visits)

Well-Child Visits—15 Months (6 Visits) Both plan types improved by at least 5 percentage points from 2008 to 2009. For HEDIS 2009, the Non-Reform plans performed 1.7 percentage points better than the Reform plans. Both plan types continued to perform below the 50th percentile.

Well-Child Visits 3–6 Years

Well-Child Visits 3–6 Years Both plan types showed improvement from 2008 to 2009. The Reform plans performed slightly better than the Non-Reform plans. Both plan types performed above the national 50th percentile for both 2008 and 2009. The Reform plans’ performance exceeded the 2009 HEDIS 75th percentile.

Adolescent Well Care

Adolescent Well Care The Non-Reform and Reform plans improved performance from 2008 to 2009. HEDIS 2009 rates for both plan types were above the national 50th percentile. Neither plan type met the 75th percentile.

Annual Dental Visits

Annual Dental Visits Most Non-Reform plans do not offer dental care as a covered benefit. The performance of both plan types improved by least 6 percentage points from 2008. Performance remained well below the national 50th percentile.

Childhood Immunization Status— Combo 2 HEDIS 75TH percentile = 80.0% HEDIS 2008 50th percentile = 75.4%

Childhood Immunization Status— Combo 2 The Reform plans performed slightly better than the Non-Reform plans. Performance for both plan types was well below the 50th percentile (by at least 12 percentage points) and the 75th percentile (by at least 16 percentage points).

Childhood Immunization Status—Combo 3 HEDIS 75TH percentile =74.3% HEDIS 2008 50th percentile = 68.6%

Childhood Immunization Status—Combo 3 The Reform plans performed slightly better than the Non-Reform plans. Both rates were well below both the 50th percentile.

Lead Screening in Children HEDIS 75TH percentile =76.5% HEDIS 2008 50th percentile = 65.9%

Lead Screening in Children The Reform plans outperformed the Non-Reform plans by nearly 10 percentage points. Both rates ranked below the 50th percentile (by at least 10 percentage points) and the 75th percentile (by at least 20 percentage points).

Overall Comments on Pediatrics Care Measures For HEDIS 2009, the Reform plans performed equal to or better than the Non-Reform plans for all measures except the well-child in the first 15 months (six visits) measure. For measures with more than one year of data, both plan types had improvement from HEDIS 2008 to HEDIS 2009. Well-child visits (3–6 years) and adolescent well care measures were the only two measures where both plan types performed above the 50th percentiles. Both plan types have room for improvement on all the other measures to reach the 50th percentiles and the 75th percentiles.

Performance Measures Related to Women’s Care

Cervical Cancer Screening

Cervical Cancer Screening Performance was well below the national 50th percentile. The Non-Reform rate improved in 2008, then showed a decline in 2009. The Reform rate improved by 4 percentage points.

Breast Cancer Screening

Breast Cancer Screening Only the Non-Reform plans collected Breast Cancer Screening data in HEDIS 2007, and showed a 5.5 percentage point increase in HEDIS 2009. For HEDIS 2009, the Reform plans performed nearly 4 percentage points above the Non-Reform plans and were also higher than the 50th percentile.

Timeliness of Prenatal Care

Timeliness of Prenatal Care The Reform plans showed a slight improvement from 2008 to 2009 but remained below the national 50th percentile. The Non-Reform plans have performed slightly better than the national 10th percentile since 2007.

Postpartum Care

Postpartum Care Neither plan type met the national 50th percentile in 2008 or 2009. The Non-Reform rate dropped by 8.4 percentage points from 2008 to 2009 and dropped below the national 25th percentile. The Reform rate showed a slight decline and also performed below the 25th percentile.

Overall Comments on Women’s Care Measures For HEDIS 2009, the Reform plans performed better than the Non-Reform plans for Breast Cancer Screening and Postpartum Care. The HEDIS 2009 performance of both plan types when compared to national percentiles was generally low: Except for the Breast Cancer Screening measure, both plan types were below the 50th percentile. Both plan types’ performance on the Postpartum Care measures was below the 25th percentile.

Overall Comments on Women’s Care Measures (continued) Performance trends varied: Both plan types showed a decline in the Postpartum Care rates. Non-Reform plans’ performance declined for the Timeliness to Prenatal Care measure and the Cervical Cancer Screening measure, but the Reform plans’ performance improved.

Performance Measures Related to Living with Illness

Diabetes Care—HbA1c Testing

Diabetes Care—HbA1c Testing The Reform plans performed about 5 percentage points higher than the Non-Reform plans for HEDIS 2009. The Reform plans performed around the 50th percentile and the Non-Reform plans performed slightly above the 25th percentile for both years.

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

Diabetes Care—Poor HbA1c Control A lower rate indicates better performance for this measure. The Reform plans performed better than the Non-Reform plans. Neither plan type performed better than the national average.

Diabetes Care—Good HbA1c Control

Diabetes Care—Good HbA1c Control The performance of both plan types improved from 2008 to 2009. The 2009 rates for both the Reform and Non-Reform plans exceeded the HEDIS 75th percentile.

Diabetes Care—LDL-C Screening

Diabetes Care—LDL-C Screening Performance from 2008 to 2009 remained fairly stable, with a slight improvement. Both plan types performed above the national 50th percentile for HEDIS 2009. The Reform plans performed above the 75th percentile.

Diabetes Care—LDL-C Level <100

Diabetes Care—LDL-C Level <100 The Reform rate increased from 2008 to 2009 and performed above the 50th percentile. The Non-Reform rate has decreased slightly since HEDIS 2007, and remains below the 50th percentile and the Reform rate.

Diabetes Care—Eye Exams

Diabetes Care—Eye Exams The rates for both Reform and Non-Reform plans increased from 2008 to 2009 by at least 5 percentage points. The Reform plan rate was slightly higher than the Non-Reform rate for 2009. The 2009 rates were slightly above the 25th percentile, but were below the 50th percentile.

Diabetes Care—Monitoring Nephropathy

Diabetes Care—Monitoring Nephropathy The Reform plans outperformed the Non-Reform plans in both 2008 and 2009. While the Non-Reform rate declined from 2008 to 2009, the rate equaled the 50th percentile in 2009. The Reform rate improved from 2008 to 2009, and was 0.3 of a percentage point below the 75th percentile.

Controlling High Blood Pressure

Controlling High Blood Pressure The Reform rate improved from 2008 to 2009 by almost 10 percentage points and ranked above the 50th percentile. The Non-Reform rate ranked between the 25th and the 50th percentile.

Use of Appropriate Medications for People with Asthma (Total)

Use of Appropriate Medications for People with Asthma (Total) Only the Non-Reform plans collected Asthma data in HEDIS 2007, and showed a slight improvement from 2007 to 2009. The Non-Reform plans performed better than the Reform plans in 2009. Both plan types performed below the 50th percentile.

Follow-up After Hospitalization for Mental Illness (30 days)

Follow-up After Hospitalization for Mental Illness (30 days) Both plan types showed improvement from 2008 to 2009. The Non-Reform and Reform plans performed below the 50th percentile.

Follow-up After Hospitalization for Mental Illness (7 days)

Follow-up After Hospitalization for Mental Illness (7 days) Both plan types demonstrated improvement from 2008. The 2009 rates for the Non-Reform and Reform plans ranked between the 25th and the 50th percentile.

Antidepressant Medication Management—Effective Acute Phase Treatment HEDIS 75TH percentile = 48.3% HEDIS 2008 50th percentile = 45.1%

Antidepressant Medication Management—Effective Acute Phase Treatment Both plan types performed better than the national 50th percentile. The Reform plans outperformed the Non-Reform plans and exceeded the 75th percentile.

Antidepressant Medication Management—Effective Continuation Phase Treatment HEDIS 75TH percentile = 31.3% HEDIS 2008 50th percentile = 28.3%

Antidepressant Medication Management— Effective Continuation Phase Treatment Both plan types performed better than the national 50th percentile. The Non-Reform plans outperformed the Reform plans and were only 0.1 of a percentage point below the 75th percentile.

Overall Comments on Living with Illness Measures The performance for the Living with Illness measures saw more plans reaching and exceeding the 75th percentile than measures in other domains. During HEDIS 2009, the Reform plans performed either the same as or better than the Non-Reform plans on all but three measures (the measure on follow-up after hospitalization, seven days and 30 days; and the Antidepressant Medication Management—Effective Continuation Phase Treatment measure).

Upcoming EQR Activities Wednesday, March 24, 2010 3:20 p.m. – 3:25 p.m. Presenter: Yolanda Strozier, MBA Project Manager, EQRO Services

Upcoming EQR activities The next EQR Quarterly Meetings: Wednesday, June 9, 2010 (AHCA Offices) One-on-one TA sessions Tuesday, June 8, 2010 Wednesday, September 22, 2010 (Webinar) Wednesday, January 12, 2011 (AHCA Offices) One-on-one TA sessions Tuesday, January 11, 2011 Wednesday, March 23, 2011 (Webinar)

Upcoming EQR activities Finalization of PIP Validation Reports (April 2010). Annual PIP Summary Report and Strategic Summary Report (April–June 2010).

Upcoming EQR activities Site visits for the validation of PMHP performance measures will occur in May 2010. EQR Technical Report (August 2010).

Upcoming EQR Activities Questions?

External Quality Review Quarterly Meeting THANK YOU FOR YOUR PARTICIPATION!