1. Summary of PMHP Performance Improvement Projects Validation Findings
Friday, March 25, 2011
3:00 p.m. – 4:00 p.m.
Presenter:
Donald Grostic, MS
Associate Director, State & Corporate Services

2. Presentation Overview
2010–2011 PIP Validation Process
Validation Findings
Study Indicator Results
Collaborative Validation Findings
Collaborative Study Indicator Results
Next Steps

3. 2010–2011 PIP Validation Process
“Statement of Intent” was completed by each MCO type and submitted to HSAG.
For 2010–2011, MCOs were to submit to HSAG two PIPs for validation:
Clinical and nonclinical
Collaborative topic and one other

4. 2010–2011 PIP Process (cont.) HSAG selected two PIPs.
One ongoing and one collaborative PIP were chosen.
PIPs selected were chosen based on HSAG’s selection criteria.
If a PMHP 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.

5. Overall PIP Validation Performance
2009–2010
2010–2011

6. Trending of PIP Validation Scores
% Score of Evaluation Elements Met
2006–2007
2007–2008
2008–2009
2009–2010
90% to 100% 14 18 1 2
80% to 89% 6 8 4
70% to 79% 3
60% to 69% 5
Less than 60%
Total 23 24

7. Study Indicator(s) Improvement

8. Statistically Significant Study Indicator(s) Improvement

9. Study Indicator(s) Sustained Improvement

10. Overall Collaborative PIP Validation Performance
2009–2010
2010–2011

11. Trending of Collaborative PIP Validation Scores
% Score of Evaluation Elements Met
2008–2009
2009–2010
90% to 100% 12 1
80% to 89% 3 8
70% to 79% 9
60% to 69%
Less than 60%
Total

12. Collaborative Study Indicator Improvement

13. Statistically Significant Collaborative Study Indicator Improvement

14. Collaborative Study Indicator Sustained Improvement

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

16. Process for Disputing Validation Score
The plan must submit its dispute via formal letter to HSAG and cc AHCA Contract Manager
The letter should outline the evaluation element/comment being disputed and the plan’s rationale for why the score should be changed
All responses should be ed to no later than April 1, 2011
The HSAG PIP Review Team will review the dispute and respond to the plan with a decision within seven (7) business days

17. Questions and Answers on PIP validation?

18. Upcoming EQR Activities
Friday, March 25, 2011
Presenter:
Yolanda Strozier, MBA
Associate Director,
State and Corporate Services

19. 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)

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

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

22. External Quality Review Quarterly Meeting
THANK YOU FOR YOUR PARTICIPATION!