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External Quality Review Quarterly Meeting Friday, March 30, 2012 3:00 p.m. – 4:00 p.m. WELCOME! Page 1 EQR Quarterly Meeting • Welcome to all participants • Overview of agenda • Webinar do’s and don’ts • Evaluation Forms Page 2 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 3 HMO/PSN HEDIS 2011 (CY 2010) HEDIS Results Friday, March 30, 2012 Presenter: Wendy Talbot, MPH, CHCA Associate Director, Audits (HSAG) State and Corporate Services Page 4 Performance Measures Related to Pediatric Care Page 5 Well-Child Visits—15 Months (Zero Visits) Well-Child Visits in the First 15 Months of Life—Zero Visits 10% 8% 6.2% 6% 4.3% 4% 2% 3.1% 3.0% 1.6% 3.0% 0.7% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Note: Lower rates are better for this measure. Page 6 Well-Child Visits—15 Months (Zero Visits) • Compared with the HEDIS 2010 results, both plan types increased in performance (their rates decreased). • The Reform weighted average exhibited a greater and statistically significant increase in performance. Page 7 Well-Child Visits—15 Months (6 Visits) Well-Child Visits in the First 15 Months of Life—6+ Visits 100% 80% 60% 64.4% 50.9% 49.2% 51.5% 46.5% 46.0% 40% 35.1% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 8 Well-Child Visits—15 Months (6 Visits) • The HEDIS 2011 weighted averages for both Non-Reform and Reform plans were at least 12 percentage points below the AHCA performance target. • Compared with HEDIS 2010 results, both plan types showed a statistically significant increase in HEDIS 2011 performance. Page 9 Well-Child Visits 3–6 Years Well-Child Visits in the 3rd-6th Years of Life 100% 74.9% 80% 72.5% 75.6% 74.9% 74.8% 72.7% 75.0% 60% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 10 Well-Child Visits 3–6 Years • Both the Reform and Non-Reform plans HEDIS 2011 weighted averages exceeded the AHCA performance target. Page 11 Adolescent Well Care Adolescent Well-Care Visits 100% 80% 51.4% 60% 49.2% 46.0% 46.4% 45.7% 46.3% 46.2% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 12 Adolescent Well Care • The HEDIS 2011 weighted averages for both Non-Reform and Reform plans were below AHCA’s performance target. • Compared with the HEDIS 2010 results, the weighted average for Non-Reform plans showed an increase of 3.5 percentage points. This increase was statistically significant. Page 13 Lead Screening in Children Lead Screening in Children 100% 76.5% 80% 55.2% 60% 53.1% 46.7% 52.5% 51.5% 54.1% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 14 Lead Screening in Children • The HEDIS 2011 weighted averages for both Non-Reform and Reform plans were more than 20 percentage points below AHCA’s performance target, with the Reform plans performing slightly better than the Non-Reform plans. Page 15 Annual Dental Visits Annual Dental Visit—Total 100% 80% 50.6% 60% 40% 34.0% 33.4% 27.9% 20% 18.5% 17.8% 16.1% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 16 Annual Dental Visits • The HEDIS 2011 Florida Medicaid weighted averages for both Non-Reform and Reform plans remained more than 15 percentage points below the AHCA performance target. Page 17 Childhood Immunization Status— Combo 2 Childhood Immunization Status—Combination 2 100% 80.0% 80% 71.3% 61.8% 72.8% 68.9% 72.6% 63.5% 60% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 18 Childhood Immunization Status— Combo 2 • Although the HEDIS 2011 weighted averages for both Non-Reform and Reform plans were below AHCA’s performance target, both plan types showed improvements over their HEDIS 2010 performance. Page 19 Childhood Immunization Status—Combo 3 Childhood Immunization Status—Combination 3 100% 74.3% 80% 63.6% 60% 52.0% 66.6% 61.8% 65.7% 53.7% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 20 Childhood Immunization Status—Combo 3 • Although the HEDIS 2011 weighted averages for both Non-Reform and Reform plans remained below AHCA’s performance target, both plan types showed improvement in their performance from HEDIS 2010. Page 21 Immunizations for Adolescents, Combination 1 Immunizations for Adolescents—Combination 1 100% 80% 60% 49.8% 43.9% 43.6% 43.4% 40% 20% 0% 2010 Weighted Average Non-Reform 2011 Weighted Average Reform Page 22 Immunizations for Adolescents, Combination 1 • Non-Reform and Reform plans performed similarly during HEDIS 2010. • The increase of 5.9 percentage points from HEDIS 2010 to HEDIS 2011 among NonReform plans was statistically significant. Page 23 Follow-up Care for Children Prescribed ADHD Medication, Initiation Follow-up Care for Children Prescribed ADHD Medication—Initiation Phase 100% 80% 60% 44.5% 41.6% 40% 37.8% 42.2% 37.2% 20% 0% 2010 Weighted Average Non-Reform 2011 Weighted Average Reform Performance Target Page 24 Follow-up Care for Children Prescribed ADHD Medication, Initiation • The rate for Reform plans improved slightly from HEDIS 2010 and exceeded the performance target. • For the Non-Reform plans, there was a wide variation in rates between the highest- and lowest-performing plans of more than 25 percentage points. Page 25 Follow-up Care for Children Prescribed ADHD Medication, Continuation and Maintenance Phase Follow-up Care for Children Prescribed ADHD Medication— Continuation and Maintenance Phase 100% 80% 67.2% 64.4% 48.4% 60% 47.7% 46.9% 40% 20% 0% 2010 Weighted Average Non-Reform 2011 Weighted Average Reform Performance Target Page 26 Follow-up Care for Children Prescribed ADHD Medication, Continuation and Maintenance Phase • Though the rate for Reform plans decreased slightly, it remained 16 percentage points higher than the AHCA performance target. • However, caution should be used in interpreting this finding, as the total number of eligible Reform members was only 45 from one Reform plan. Page 27 Best Practices & Recommendations Page 28 Best Practices for Pediatric Measures Child & Adolescent Immunizations Lead Screening in Children Technology Link and Share Data Motivate/Educate Parents Establish Partnerships With Outside Entities Educate Staff & Enhance Administrative Protocols Identify Alternative Venues and Expand Access to Immunizations Alternative Screening Technologies Page 29 Best Practices for Pediatric Measures (Cont.) Well-Child Visits CWP Improve Access to Care and Services Parental Education Reminder Systems Decision Support Systems Physician Education Delayed Prescribing Practices Provider Education Page 30 Performance Measures Related to Women’s Care Page 31 Cervical Cancer Screening Cervical Cancer Screening 100% 72.0% 80% 60% 53.8% 52.2% 55.3% 55.6% 50.8% 53.2% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 32 Cervical Cancer Screening • Non-Reform and Reform plans showed improved weighted averages in HEDIS 2011 when compared to the HEDIS 2010 weighted averages, while still falling short of the performance target rate of 72.0 percent. Page 33 Chlamydia Screening Chlamydia Screening in Women—16-20 Years 100% 80% 60% 56.2% 55.5% 40% 20% 0% 2011 Weighted Average Non-Reform Reform This measure was recently added to the Medicaid reporting set; therefore, no comparison data were available. Page 34 Chlamydia Screening Chlamydia Screening in Women—21-24 Years 100% 80% 67.8% 64.9% 60% 40% 20% 0% 2011 Weighted Average Non-Reform Reform This measure was recently added to the Medicaid reporting set; therefore, no comparison data were available. Page 35 Chlamydia Screening Chlamydia Screening in Women—Total 100% 80% 60% 58.9% 60.2% 40% 20% 0% 2011 Weighted Average Non-Reform Reform This measure was recently added to the Medicaid reporting set; therefore, no comparison data were available. Page 36 Chlamydia Screening • There was a variation between the highest- and lowest-performing Non-Reform plans for all age ranges. • Variation among Reform plans (12.5 percentage points) was much smaller than the rate variation among Non-Reform plans (40.4 percentage points) for ages 21 through 24. Page 37 Breast Cancer Screening Breast Cancer Screening 100% 80% 59.2% 56.8% 60% 47.5% 51.4% 56.4% 50.4% 50.1% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 38 Breast Cancer Screening • Both the Non-Reform and Reform weighted averages showed an increase in performance during HEDIS 2011, though these increases were not statistically significant. • The Reform plans’ performance exceeded the State’s performance target for the second consecutive year. Page 39 Timeliness of Prenatal Care Timeliness of Prenatal Care 88.7% 100% 80% 75.1% 69.0% 66.8% 72.3% 69.4% 68.4% 60% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 40 Timeliness of Prenatal Care • Reform plans demonstrated a statistically significant decrease of 6.7 percentage points from HEDIS 2010 to HEDIS 2011. • Non-Reform and Reform plan weighted averages continued to remain more than 16 percentage points below the State’s performance target. Page 41 Postpartum Care Postpartum Care 100% 80% 65.5% 60% 50.1% 51.5% 52.6% 54.8% 52.3% 49.2% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 42 Postpartum Care • Weighted averages among Non-Reform and Reform plans continued to remain at least 10 percentage points below the State’s performance target. Page 43 Best Practices for Women’s Care Measures The most effective interventions primarily addressed barriers related to access to care and lack of awareness. Page 44 Best Practices for Women’s Care Measures (Breast & Cervical Cancer Screenings) Physician Reminders Patient Reminders Improving Access & Awareness Physician Communication Physician Tools & Resources Collection of Data Note: Many of the same interventions used to increase breast and cervical cancer screening rates can be applied to chlamydia screening. Page 45 Best Practices for Women’s Care Measures (Prenatal and Postpartum Care) Education on Proper Coding Coordination of Care Educational Outreach Programs Resource Lists Provide Transportation Page 46 Performance Measures Related to Living with Illness Page 47 Diabetes Care—HbA1c Testing Diabetes Care—HbA1c Testing 100% 84.3% 82.9% 80.0% 80% 81.9% 79.6% 76.4% 75.1% 60% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 48 Diabetes Care—HbA1c Testing • While the HEDIS 2011 weighted average for Non-Reform plans showed steady improvement over the previous two years, the weighted average for Reform plans decreased slightly from HEDIS 2010. Page 49 Diabetes Care—Poor HbA1c Control Diabetes Care—HbA1c Poor Control 100% 80% 60% 51.7% 47.1% 46.5% 48.6% 45.4% 42.5% 39.7% 40% 20% 0% 2009 Weighted Average 2010 Weighted Average Non-Reform Reform 2011 Weighted Average Performance Target Note: Lower rates are better for this measure. Page 50 Diabetes Care—Poor HbA1c Control • While the Reform plans saw an increase of about 3 percentage points in their weighted average, the Non-Reform plans demonstrated a statistically significant decrease in their weighted average. Page 51 Diabetes Care—LDL-C Screening Diabetes Care—LDL-C Screening 100% 80% 76.3% 80.0% 83.3% 80.0% 77.8% 81.8% 77.9% 60% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 52 Diabetes Care—Care—LDL-C Screening • While Non-Reform and Reform plans exceeded the State’s performance target during HEDIS 2011, the weighted averages for NonReform plans showed an increase and the Reform plans showed a decrease. Page 53 Diabetes Care—LDL-C Level <100 Diabetes Care—LDL-C Control (<100 mg/dL) 100% 80% 60% 37.2% 35.3% 40% 33.8% 36.9% 35.8% 32.8% 29.4% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 54 Diabetes Care—LDL-C Level <100 • The weighted average for Reform plans continued to increase during HEDIS 2011, and the weighted average for Non-Reform plans decreased slightly. Page 55 Diabetes Care—Eye Exams Diabetes Care—Eye Exam (Retinal) Performed 100% 80% 62.7% 60% 41.9% 43.9% 48.2% 52.1% 45.2% 49.3% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 56 Diabetes Care—Eye Exams • Both Non-Reform and Reform weighted averages continued to increase during HEDIS 2011, with the Non-Reform plans showing a statistically significant improvement. Page 57 Diabetes Care—Monitoring Nephropathy Diabetes Care—Medical Attention for Nephropathy 100% 81.8% 80.2% 80% 79.0% 77.1% 76.1% 83.1% 81.8% 60% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 58 Diabetes Care—Monitoring Nephropathy • The weighted averages for both Non-Reform and Reform plans continued to improve during HEDIS 2011. • The Reform plans performed better than the Non-Reform plans by 4.1 percentage points and met the AHCA performance target for the second consecutive year. Page 59 Controlling High Blood Pressure Controlling High Blood Pressure 100% 80% 59.9% 60% 51.5% 55.8% 53.0% 54.7% 53.5% 46.3% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 60 Controlling High Blood Pressure • The HEDIS 2011 Non-Reform weighted average showed a slight improvement over 2010, whereas the Reform plans had a statistically significant decline of 7.2 percentage points. Page 61 Use of Appropriate Medications for People with Asthma (Total) Use of Appropriate Medications for People with Asthma—Total 100% 90.6% 86.9% 86.9% 87.6% 86.6% 86.0% 83.6% 80% 60% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target 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 and HEDIS 2011 (5–50 years of age), caution should be used when interpreting the trending results. Page 62 Use of Appropriate Medications for People with Asthma (Total) • Weighted averages among Non-Reform and Reform plan types were very similar during HEDIS 2011. • While both plan types reported slight decreases in their weighted averages from HEDIS 2010, they were still within 5 percentage points of the State’s performance target. Page 63 Antidepressant Medication Management— Effective Acute Phase Treatment Antidepressant Medication Management—Effective Acute Phase Treatment 100% 80% 60% 51.0% 45.4% 56.3% 48.3% 46.3% 48.9% 47.3% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 64 Antidepressant Medication Management— Effective Acute Phase Treatment • Reform plans continued to meet the AHCA performance target and outperform NonReform plans during HEDIS 2011. Page 65 Antidepressant Medication Management— Effective Continuation Phase Treatment Antidepressant Medication Management—Effective Continuation Phase Treatment 100% 80% 60% 44.0% 40% 31.2% 31.3% 36.0% 29.8% 31.9% 29.1% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 66 Antidepressant Medication Management— Effective Continuation Phase Treatment • Weighted averages for both Non-Reform and Reform plans improved during HEDIS 2011 and surpassed the State’s performance target. • The weighted average for Reform plans outperformed the weighted average NonReform plans by more than 12 percentage points during HEDIS 2011. Page 67 Adult BMI Assessment Adult BMI Assessment 100% 80% 60% 52.7% 47.9% 41.8% 37.2% 40% 31.2% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform Performance Target Page 68 Adult BMI Assessment • The weighted averages for both Non-Reform and Reform plan types increased substantially during HEDIS 2011. Page 69 Best Practices for Living With Illness Measures Peer Support and Support Groups Healthy Eating & Weight-Loss Programs Computerized Prompting Provider Education Patient Outreach Improve Patient Education Practitioner Tool Kit Easy Prescription Refills Collaborative Care Model Identify Members for Targeted Interventions Incentivize Providers and Members Assign Quality Managers to High Volume Providers Provider/Physician Interventions Page 70 Performance Measures Related to Access to Care Page 71 Adults’ Access to Preventive/Ambulatory Health Services, 20-44 Years Adults' Access to Preventive/Ambulatory Health Services—20-44 Years 100% 84.8% 80% 69.1% 71.8% 67.9% 71.2% 68.1% 71.2% 60% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 72 Adults’ Access to Preventive/Ambulatory Health Services, 20-44 Years • The HEDIS 2011 Non-Reform weighted average increased slightly from the HEDIS 2010 average, while the weighted average among HEDIS 2011 Reform plans remained the same from HEDIS 2010. • In HEDIS 2011, both plan types were at least 10 percentage points below the AHCA performance target. Page 73 Adults’ Access to Preventive/Ambulatory Health Services, 45-64 Years Adults' Access to Preventive/Ambulatory Health Services—45-64 Years 88.3% 100% 80% 82.1% 85.5% 84.9% 84.7% 81.5% 81.2% 60% 40% 20% 0% 2009 Weighted Average Non-Reform 2010 Weighted Average Reform 2011 Weighted Average Performance Target Page 74 Adults’ Access to Preventive/Ambulatory Health Services, 45-64 Years • Compared with HEDIS 2010 performance, both plan types exhibited slight but not statistically significant increases in performance during HEDIS 2011. Page 75 Best Practices for Access to Care Measures Page 76 Questions? Wendy Talbot, MPH, CHCA Associate Director, Audits 602.801.6846 [email protected] Upcoming EQR Activities Friday, March 30, 2012 Presenter: Yolanda Strozier, MBA Associate Director, State and Corporate Services Page 78 Upcoming EQR activities • PIP Validation Reports will be finalized in May 2012. • PIPs are submitted to AHCA in August 2012 Page 79 Upcoming EQR activities The next EQR Quarterly Meeting: – Wednesday, June 13, 2012 (AHCA Offices) One-on-one TA sessions Tuesday, June 12, 2012 Page 80 External Quality Review Quarterly Meeting THANK YOU FOR YOUR PARTICIPATION! Page 81