Page 1 External Quality Review Quarterly Meeting Monday, March 21, :00 p.m. –2:30 p.m. WELCOME!

Page 2 EQR Quarterly Meeting Welcome to all participants Overview of agenda Webinar do’s and don’ts Evaluation Forms

Page 3 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.

Page 4 HMO/PSN HEDIS 2010 (CY 2009) HEDIS Results Monday, March 21, :25 p.m. – 2:20 p.m. Presenter: Melissa Brashear, MBA, CPA Executive Director, Audits (HSAG) State and Corporate Services

Page 5 Performance Measures Related to Pediatric Care

Page 6 Well-Child Visits—15 Months (Zero Visits) Note: Lower rates are better for this measure.

Page 7 Well-Child Visits—15 Months (Zero Visits) Compared with the HEDIS 2009 results, both plan types declined in performance (their rates increased). The Reform weighted average exhibited a greater and statistically significant decline.

Page 8 Well-Child Visits—15 Months (6 Visits)

Page 9 Well-Child Visits—15 Months (6 Visits) Compared with the HEDIS 2009 results, both plan types showed a statistically significant decline in HEDIS 2010 performance and were at least 18 percentage points below AHCA’s performance target.

Page 10 Well-Child Visits 3–6 Years

Page 11 Well-Child Visits 3–6 Years The HEDIS 2010 Non-Reform plan weighted average reached AHCA’s performance target and exceeded the Reform plan weighted average by approximately 2 percentage points.

Page 12 Adolescent Well Care

Page 13 Adolescent Well Care The HEDIS 2010 weighted averages for both Non-Reform and Reform plans were below AHCA’s performance target, with the Reform plans performing slightly better than the Non- Reform plans.

Page 14 Lead Screening in Children

Page 15 Lead Screening in Children The HEDIS 2010 weighted averages for both Non-Reform and Reform plans were at least 20 percentage points below AHCA’s performance target. However, the Non-Reform plans showed a statistically significant improvement in their performance in HEDIS 2010 of 6.4 percentage points.

Page 16 Annual Dental Visits

Page 17 Annual Dental Visits Although the HEDIS 2010 weighted averages for both Non-Reform and Reform plans were at least 15 percentage points below the AHCA performance target, the HEDIS 2010 performance demonstrated an improvement over HEDIS 2009.

Page 18 Childhood Immunization Status— Combo 2 HEDIS th percentile = 75.4% HEDIS 75 TH percentile = 80.0%

Page 19 Childhood Immunization Status— Combo 2 Although the HEDIS 2010 weighted averages for both Non-Reform and Reform plans were below AHCA’s performance target, both plan types showed statistically significant improvements over their HEDIS 2009 performance.

Page 20 Childhood Immunization Status—Combo 3 HEDIS 250 th percentile = 68.6%

Page 21 Childhood Immunization Status—Combo 3 Although the HEDIS 2010 weighted averages for both Non-Reform and Reform plans were about 10 percentage points below AHCA’s performance target, both plan types showed statistically significant improvement in their performance from HEDIS 2009.

Page 22 Follow-up Care for Children Prescribed ADHD Medication, Initiation HEDIS th percentile = 65.9% This was the first year this measure was included in the analysis; therefore, no comparison data were available.

Page 23 Follow-up Care for Children Prescribed ADHD Medication, Initiation The rate for Reform plans was slightly below the performance target.

Page 24 Follow-up Care for Children Prescribed ADHD Medication, Continuation and Maintenance Phase HEDIS th percentile = 65.9% This was the first year this measure was included in the analysis; therefore, no comparison data were available.

Page 25 Follow-up Care for Children Prescribed ADHD Medication, Continuation and Maintenance Phase Although the figure shows that the Reform plans performed better than the Non-Reform plans and AHCA’s performance target by almost 20 percentage points, the total sum of eligible Reform members was 61. Therefore, caution should be used in interpreting the results.

Page 26 Best Practices for Pediatrics Care Measures The most effective interventions were those that targeted specific barriers. Member interventions conducted in conjunction with provider interventions Electronic tracking tools and provider prompts Multicomponent and stepped interventions Improve access to care and transportation

Page 27 Best Practices for Pediatrics Care Measures, continued Partnerships with outside entities Alternative testing strategies Immunization registries Systematic Follow-up for Children With ADHD Repeat information/emphasize common message

Page 28 Performance Measures Related to Women’s Care

Page 29 Cervical Cancer Screening

Page 30 Cervical Cancer Screening Non-Reform plans continue to show better performance than the Reform plans.

Page 31 Breast Cancer Screening

Page 32 Breast Cancer Screening Both the Non-Reform and Reform weighted averages showed a statistically significant improvement in performance in The Reform plans’ HEDIS 2010 performance exceeded the performance target.

Page 33 Timeliness of Prenatal Care

Page 34 Timeliness of Prenatal Care Reform plans demonstrated a statistically significant increase of 8.3 percentage points from HEDIS 2009 to HEDIS 2010 and performed better than the Non-Reform plans.

Page 35 Postpartum Care

Page 36 Postpartum Care Although the HEDIS 2010 weighted averages for both plan types showed an improvement from HEDIS 2009, the performance was still below the HEDIS 2008 weighted averages.

Page 37 Best Practices for Women’s Care Measures The most effective interventions primarily addressed barriers related to access and lack of awareness. Physician and patient reminders Alternative types of providers Train practitioners in communication skills Improving access and awareness Physician tools and resources

Page 38 Best Practices for Women’s Care Measures, continued Chlamydia educational materials developed and distributed separately Implementing standard interventions for cervical cancer screening Continually modify interventions Note: Many of the same interventions used to increase cervical cancer screening rates can be applied to chlamydia screening.

Page 39 Performance Measures Related to Living with Illness

Page 40 Diabetes Care—HbA1c Testing

Page 41 Diabetes Care—HbA1c Testing The HEDIS 2010 weighted averages for both Non-Reform and Reform plans showed steady improvement over the previous two years, with the Reform plans nearly meeting the AHCA target.

Page 42 Diabetes Care—Poor HbA1c Control Note: Lower rates are better for this measure.

Page 43 Diabetes Care—Poor HbA1c Control The HEDIS 2010 weighted averages for both the Non-Reform and Reform plans performed better than HEDIS 2009, with Non-Reform plans showing a statistically significant improvement. Nonetheless, both plan types were still below the AHCA performance target by more than 5 percentage points.

Page 44 Diabetes Care—LDL-C Screening

Page 45 Diabetes Care—Care—LDL-C Screening The HEDIS 2010 weighted averages for both plan types showed continual improvement from previous years, although the changes were not statistically significant. For HEDIS 2010, the weighted average for the Reform plans exceeded the AHCA target, while the weighted average for the Non- Reform plans was only 0.1 percentage point below the target.

Page 46 Diabetes Care—LDL-C Level <100

Page 47 Diabetes Care—LDL-C Level <100 Both the Non-Reform and Reform weighted averages in HEDIS 2010 increased from HEDIS 2009, with the Non-Reform plans showing a statistically significant improvement.

Page 48 Diabetes Care—Eye Exams

Page 49 Diabetes Care—Eye Exams Both the Non-Reform and Reform weighted averages continued to increase for HEDIS 2010, with the Non-Reform plans showing a statistically significant improvement.

Page 50 Diabetes Care—Monitoring Nephropathy

Page 51 Diabetes Care—Monitoring Nephropathy The weighted averages for the Reform plans showed improvement each year, and also met the AHCA performance target for HEDIS 2010.

Page 52 Controlling High Blood Pressure

Page 53 Controlling High Blood Pressure Compared with the HEDIS 2009 weighted averages, the HEDIS 2010 Non-Reform weighted average showed a slight improvement, whereas the Reform plans had a slight decline.

Page 54 Use of Appropriate Medications for People with Asthma (Total) Note: Since the age range used for this measure for HEDIS 2009 (5–56 years of age) was different from the range used for HEDIS 2010 (5–50 years of age), caution should be used when interpreting the trending results.

Page 55 Use of Appropriate Medications for People with Asthma (Total) The Reform plans are approaching the performance target and performed slightly better than the Non-Reform plans in HEDIS 2010.

Page 56 Antidepressant Medication Management— Effective Acute Phase Treatment HEDIS th percentile = 45.1%

Page 57 Antidepressant Medication Management— Effective Acute Phase Treatment Reform plans performed better than Non- Reform plans and exceeded the performance target during HEDIS 2009 and HEDIS 2010.

Page 58 Antidepressant Medication Management— Effective Continuation Phase Treatment HEDIS th percentile = 28.3%

Page 59 Antidepressant Medication Management— Effective Continuation Phase Treatment For HEDIS 2010, Reform plans performed better than Non-Reform plans and exceeded the AHCA performance target.

Page 60 Best Practices for Living with Illness Measures Comprehensive Diabetes Care –Support groups –Diabetic Health Management Program –Patient outreach Controlling Blood Pressure –Reminder systems for preventive care –Stepped care approach to antihypertensive drug therapy

Page 61 Best Practices for Living with Illness Measures, Continued Asthma Management –Asthma registry –Assign quality managers to high-volume providers –Incentive program for providers and members Antidepressant Medication Management –Collaborative care model –Self-care tip sheets –Practitioner tool kit

Page 62 Performance Measures Related to Access to Care

Page 63 Adults’ Access to Preventive/Ambulatory Health Services, Years

Page 64 Adults’ Access to Preventive/Ambulatory Health Services, Years The HEDIS 2010 Non-Reform and Reform weighted averages declined from the HEDIS 2009 averages, with the Non-Reform plans showing a slightly greater decline than the Reform plans.

Page 65 Adults’ Access to Preventive/Ambulatory Health Services, Years

Page 66 Adults’ Access to Preventive/Ambulatory Health Services, Years Compared with HEDIS 2009 performance, the Non-Reform plans exhibited a slight but statistically significant decline in performance in HEDIS 2010, whereas the Reform plans had a small but not statistically significant increase in performance.

Page 67 Best Practices for Access to Care Measures Educating patients on health care navigation Establishing a member awards program Coordinating transportation Participating in health fairs Providing a “medical home” Convenient service hours A patient-centered care model can also improve screening and chronic disease management HEDIS measures.

Page 68 HMO/PSN HEDIS Results Questions?

Page 69 Upcoming EQR Activities Monday, March 21, 2011 Presenter: Yolanda Strozier, MBA Associate Director, State and Corporate Services

Page 70 Upcoming EQR activities The next EQR Quarterly Meetings: –Wednesday, June 8, 2011 (AHCA Offices) One-on-one TA sessions Tuesday, June 7, 2011 –Week of September 26, 2011 (Webinar) –Wednesday, January 11, 2012 (AHCA Offices) One-on-one TA sessions Tuesday, January 10, 2012 –Week of March 19, 2012 (Webinar)

Page 71 Upcoming EQR activities Finalization of PIP Validation Reports (April 2011). Annual PIP Summary Report and Strategic Summary Report (April–June 2011).

Page 72 Upcoming EQR activities Next Steps PIPs are submitted to AHCA/DOEA— August 2011 MCOs will receive HSAG’s “Statement of Intent” (SOI) survey on Wednesday, August 10, Completed SOI’s due to HSAG on Monday, August 29 th.

Page 73 External Quality Review Quarterly Meeting THANK YOU FOR YOUR PARTICIPATION!