Welcome to the EQR Quarterly Meeting! Wednesday, September 24, :00 p.m. – 3:00 p.m. (EDT) We will begin shortly. Call-in information is , Conference ID – Please place your phone on mute unless you are speaking. Thank you. As a Participant you can enter “F11” for Full Screen View and “Esc” to return to normal view *6 to Mute or *7 to Un-Mute

External Quality Review Quarterly Meeting Wednesday, September 24, :00 p.m. – 3:00 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.

Overview of EQR Technical Report for 2007/2008 Presenter: Peggy Ketterer, RN, BSN, CHCA Executive Director, EQRO Services

EQR Technical Report Required annually by the Balanced Budget Act of 1997 (BBA) Includes conclusions regarding the quality and timeliness of, and access to, care furnished by contracted MCOs and PIHPs

EQR Technical Report Summarizes the activities and findings from the second year of the EQR contract Includes summary findings by MCO type (HMO, PSN, PMHP/CWPMHP, and NHDP) as well as overall conclusions and recommendations

EQR Technical Report Data used to evaluate performance included: Validation of PIP results Validation of performance measure results Consumer satisfaction survey data HEDIS ® results HEDIS ® is a registered trademark of the National Committee for Quality Assurance (NCQA)

EQR Technical Report Other EQR activities: Technical assistance on enrollee race, ethnicity, and primary household language Value-based purchasing methodologies Evaluation of AHCA quality strategy Dissemination of education (quarterly meetings, website, trainings)

EQR Technical Report Reform and Non-Reform: Most data that was available to evaluate performance (with the exception of PIPs) was limited to HMOs with a non-reform contract. The EQR Technical Report will include additional data from reform plans.

HMO Findings Most objective data available to evaluate performance PIPs * –Nearly 70 percent received Met validation status, 15 percent received a Partially Met status, and 15 percent received a Not Met validation status *Included both reform and non-reform submissions

HMO Findings

Performance Measures–Eight of the 12 HMOs were assigned an audit result of “Report, (“R”) for all of the performance measures required by AHCA, indicating there were no issues noted that resulted in a bias to any of the rates.

HMO Findings Performance Measures–Four HMOs received “Not Report,” (“NR”) findings for the Controlling High Blood Pressure measure, which led to those health plans not being able to report rates for this measure.

HMO Findings Consumer satisfaction surveys (CAHPS ® )–Overall, statewide HMO performance on the composite and global measures for the adult and child surveys was average, although the child survey results were slightly better than the adult survey results. CAHPS ® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

HMO Findings One HMO (Vista Health Plan, Inc.—Vista South Florida) exceeded the statewide average for all four global ratings for the child Medicaid CAHPS survey.

HMO Findings

HEDIS Measures–results showed below average to average performance for the Women’s Care dimension which included Breast Cancer Screening, Chlamydia Screening in Women, and Timeliness of Prenatal Care measures.

Women’s Care Range of 2007 Rates

HMO Findings HEDIS Measures–results for most measures within the Living With Illness dimension ranked below average to average.

Living with Illness – Diabetes Care Range of 2007 Rates

Living with Illness Range of 2007 Rates, cont’d

PMHP Findings Limited objective data to evaluate PIPs–Slightly more than 69 percent received Met validation status, 22 percent received a Partially Met status, and 9 percent received a Not Met validation status Consumer satisfaction surveys– unable to use for comparison purposes

PMHP Findings

PSN Findings Limited objective data to evaluate Nearly 63 percent received Met validation status, none received a Partially Met status, and slightly over 37 percent received a Not Met validation status Consumer satisfaction surveys– unable to use for comparison purposes

NHDP Findings Limited objective data to evaluate PIPs–62 percent received Met validation status, 19 percent received a Partially Met status, and 19 percent received a Not Met validation status Consumer satisfaction surveys– unable to use for comparison purposes

NHDP Findings

EQR Technical Report Assessment of MCO Strengths and Weaknesses: HSAG developed a methodology to identify strengths and weaknesses in performance in key EQR areas Used objective data (PIPs, performance measure results, and consumer survey performance results)

EQR Technical Report Assessment of MCO Strengths and Weaknesses: HEDIS measures that exceeded the high performance level (national 90 th percentile) were considered a strength for the MCO HEDIS measures that fell below the low performance level (national 25 th percentile) were considered a weakness for the MCO

EQR Technical Report Assessment of MCO Strengths and Weaknesses: CAHPS measures that were statistically higher than the state average were considered a strength for the MCO CAHPS measures that were statistically lower than the state average were considered a weakness for the MCO

EQR Technical Report Assessment of MCO Strengths and Weaknesses: Within the technical report, HSAG prepared a set of tables displaying each MCO’s strengths and weakness based on the methodology Strengths and weaknesses were also grouped into categories of quality, timeliness, and access to care

High Performers High performers were identified as MCOs that demonstrated strengths in quality, access, and timeliness for every EQR activity that produced plan-specific results. Two MCOs met this criteria.

High Performers Jackson Memorial Health Plan Both PIPs received a “Met” validation finding. One PIP addressed quality and access and the other addressed timeliness. JMH exceeded the 90 th percentile for two HEDIS measures, both addressing quality. JMH exceeded the state average for two CAHPS measures, both addressing quality.

High Performers Access Behavioral Health Both PIPs received a “Met” validation finding. One PIP addressed quality and timeliness and the other addressed access to care.

Conclusions and Recommendations Most objective data addressed only quality of services. Overall, the Florida Medicaid managed care programs demonstrated some improvements in performance during the second year of activities.

Conclusions and Recommendations All MCO types made great improvements in PIPs. HMO consumer satisfaction survey results also showed some areas of strength for a few HMOs, with one exceeding the statewide average across all four global ratings.

Conclusions and Recommendations HMO performance on certain HEDIS measures showed room for improvement.

Conclusions and Recommendations Recommendations included the need for MCOs to address all evaluation elements that received a Partially Met or Not Met validation finding on the next PIP submission. For performance measures, the MCOs should target low-performing measures for improvement efforts.

Conclusions and Recommendations MCOs may also consider conducting a PIP on consumer satisfaction. AHCA should continue efforts to implement a value-based purchasing initiative that includes incentives for improved performance on select HEDIS measures.

EQR Technical Report Questions?

Upcoming EQR Activities Yolanda Strozier, MBA Project Manager, EQRO Services

Upcoming EQR activities The next EQR Quarterly Meetings are scheduled for: Wednesday, January 14, 2009 (AHCA Offices) One-on-One TA sessions Tuesday, January 13, 2009 Wednesday, March 25, 2009 (Webinar)

Upcoming EQR activities Validation of PIPs: Submission date for selected PIP forms and documentation is Monday, October 6, 2008

Upcoming EQR activities Collaborative PIPs: The next PMHP conference call is October 22nd at 11:00 a.m.

Upcoming EQR activities Validation of Performance Measures: Request for documentation for the HMOs/PSNs was sent out on September 10, 2008 Documentation is due to HSAG on Monday, October 20th, 2008 Requested items: HEDIS BAT, ISCAT questions, HEDIS data file, audit report

Upcoming EQR activities Validation of Performance Measures (NHDPs): Completed ISCAT and other requested documents are due to HSAG by September 26, 2008 Site visits for NHDPs scheduled for October/November

Upcoming EQR activities Questions?

Florida’s Quality Strategy Peggy Ketterer, RN, BSN, CHCA Executive Director, EQRO Services Deborah McNamara, LCSW/PMP Medicaid Quality Coordinator

Quality Strategy What is a quality strategy? A written strategy for assessing and improving the quality of managed care services offered by all MCOs and PIHPs Requirement within the Balanced Budget Act of 1997 ( 42 CFR § )

Quality Strategy Other BBA Requirements: Each state must obtain input of recipients and other stakeholders in the development of the strategy and make the document available for public comment before adopting it as final.

Quality Strategy Other BBA Requirements: Each state must ensure that all MCOs comply with the standards established by the State Each state must conduct periodic reviews of the strategy to evaluate its effectiveness

Quality Strategy Required elements must include procedures that: Assess the quality and appropriateness of care and services Identify race, ethnicity, and primary language of enrollees Regularly monitor and evaluate MCO compliance with standards

Quality Strategy Required elements must include procedures that: Identify performance measures and levels for MCOs Ensure arrangements for EQR Ensure appropriate use of intermediate sanctions Ensure information systems that support the quality strategy operations

Quality Strategy Open discussion with meeting participants Facilitator: Deborah McNamara

Quality Strategy To access information on Florida’s Quality Assessment and Improvement Strategies view: _mc/index.shtml Facilitator: Deborah McNamara

Quality Strategy Questions?

External Quality Review Quarterly Meeting THANK YOU FOR YOUR PARTICIPATION!