Administrator Meeting September 16, 2015 Kim Elliott, Ph.D., C.P.H.Q. Administrator, Clinical Quality Management

Performance Measures o Reviewing comments regarding data review that were received from Contractors o Anticipate finalizing 2013 Performance Measures in October, 2015 o Highlights:  Phoenix Health Plan has continued its Performance Measure improvements two years in a row  United Healthcare Community Plan showed significant improvement in the Well- Child, first 15 Months of Life Performance Measure  Almost every health plan showed significant improvement in the Adolescent Well Care Visit rate – we are moving much closer to the Minimum Performance Standard 2 Reaching across Arizona to provide comprehensive quality health care for those in need

2013 Performance Measure Aggregate Summary Performance Measures meeting the Minimum Performance Standard (MPS) 6 60% Performance Measures meeting the contractual Goal 2 20% Performance Measures meeting NCQA Medicaid Mean 571% Performance Measures meeting NCQA Commercial Mean 00% 3 Reaching across Arizona to provide comprehensive quality health care for those in need

Performance Measures: Minimum Performance Standard (MPS) Met Reaching across Arizona to provide comprehensive quality health care for those in need Contractor Number of Performance Measures MPS Met Percent of Minimum Performance Standard Met Phoenix Health Plan990% CMDP9100% Maricopa Health Plan880% Mercy Care Plan770% United Health Care Community Plan 770% Care 1st770% Bridgeway660% University Family Care550% Health Choice Arizona440%

5 National Committee for Quality Assurance Medicaid Means Reaching across Arizona to provide comprehensive quality health care for those in need Contractor Number of NCQA Medicaid Measure Means Met or Exceeded Percent of Medicaid Measure Means Met or Exceeded Phoenix Health Plan686% CMDP583% University Family Care571% United Healthcare Community Plan571% Mercy Care Plan571% Bridgeway457% Care 1 st 457% Maricopa Health Plan229% Health Choice114%

Aggregate Performance CYE 2013 Measurement Period (10/01/12-09/30/13), reported in CYE 2015 Performance Measure CYE 2012 Data (10/01/11-09/30/12) CYE 2013 Data (10/01/12-09/30/13) Relative Percent Change Statistical Significance AHCCCS Minimum Performance Standard AHCCCS Goal NCQA Medicaid Mean NCQA Commercial Mean Children's Access to PCPs: mo. 97.0% 97.4% 0.4% %97%96.1%98.0% Children's Access to PCPs: 25 mo.-6 yrs. 87.7% 89.2% 1.7%< %97%88.3%91.9% Children's Access to PCPs: yrs. 89.9% 91.4% 1.7%< %97%90.0%92.5% Children's Access to PCPs: yrs. 87.7% 89.4% 2.0%< %97%88.5%89.9% Well-Child Visits - First 15 mo. 67.8% 68.4% 0.8% %90%61.6%79.0% Well-Child Visits yrs.66.8% 65.5% -1.9%< %80%71.5%74.3% Adolescent Well Care38.0% 39.7% 4.3%< %50%50.0%44.5% Annual Dental Visits61.8% 59.9% -3.0%< % n/a EPSDT Participation65.7% 62.3% -5.2% 68%80%n/a EPSDT Dental Participation (Rate is reflective of combined Acute and ALTCS performance per CMS 416 programming requirements) 44.1% 45.5% 3.2%< %54%n/a 6 Reaching across Arizona to provide comprehensive quality health care for those in need

2014 Performance Measures Encounter, member and provider demographic data has been sent to Health Services Advisory Group to validate and to begin the Performance Measure process Hybrid data collection will be utilized for the following measures: o Prenatal and Postpartum Care o Diabetes o Influenza and Immunizations Contractors will collect data for the hybrid measures Anticipate receipt of data and rates back from HSAG before the end of 2015 As with the 2013 Performance Measure data, Contractors will be sent the files and provided an opportunity to review the results before they are determined final by AHCCCS 7 Reaching across Arizona to provide comprehensive quality health care for those in need

2015 Immunization Audit AHCCCS has collaborated with the Arizona Department of Health Services (ADHS), Vaccine For Children’s Program (VFC), to extract immunization data (beginning October 1, 2015) from the ASIIS system which will include immunization records for: o Immunizations for 2 year olds (CYE ) o Immunizations for 13 year olds (CYE ) o HPV (13 year old females) (CYE ) o Influenza age 50+ (CYE 2014) (already at VFC) 8 Reaching across Arizona to provide comprehensive quality health care for those in need

Immunization Audit 2015 When the data is received back from the Arizona Department of Health Services, Vaccine for Children’s Program, any missing records will be sent to Contractors to conduct a hybrid data collection process Hybrid collection files will be sent to Contractors in October (adults) and November (children) The final Immunization Audit report is due to the Legislature April 1, Reaching across Arizona to provide comprehensive quality health care for those in need

Performance Improvement Projects CSPMP (Opioid Use) o Increasing the number of providers that have registered with the CSPMP o Increasing the utilization of the CSPMP for narcotic prescribing  Methodology written  Baseline data – CYE 2015 Developmental Screening (Autism) o Increase the use of developmental screening at the 9, 18 and 24 month EPSDT visits o Increase treatment referrals for positive screening results  Methodology written  Baseline data – CYE 2015 E-prescribing o Baseline data has been calculated and shared with Contractors 10 Reaching across Arizona to provide comprehensive quality health care for those in need

Other CQM Updates The Health Plan Report Card was posted to the AHCCCS website on September 14, 2015 The CAHPS Survey for the SMI and CRS programs is underway – being conducted through Health Services Advisory Group Childhood Obesity Initiative has kicked off - most Contractors are participating 11 Reaching across Arizona to provide comprehensive quality health care for those in need

Questions? Thank You. 12 Reaching across Arizona to provide comprehensive quality health care for those in need