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Administrator MeetingSeptember 16, 2015
Kim Elliott, Ph.D., C.P.H.Q.Administrator, Clinical Quality Management
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Performance Measures - 2013o Reviewing comments regarding data review that were received from
Contractorso Anticipate finalizing 2013 Performance Measures in October, 2015o 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
Reaching across Arizona to provide comprehensive quality health care for those in need
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2013 Performance Measure Aggregate Summary
Performance Measures meeting the Minimum Performance Standard (MPS)
660%
Performance Measures meeting the contractual Goal
220%
Performance Measures meeting NCQA Medicaid Mean
5 71%
Performance Measures meeting NCQA Commercial Mean
0 0%
Reaching across Arizona to provide comprehensive quality health care for those in need
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2013 Performance Measures: Minimum Performance Standard (MPS) Met
Reaching across Arizona to provide comprehensive quality health care for those in need
ContractorNumber of Performance Measures
MPS MetPercent of Minimum
Performance Standard MetPhoenix Health Plan 9 90%
CMDP 9 100%
Maricopa Health Plan 8 80%
Mercy Care Plan 7 70%
United Health Care Community Plan 7 70%
Care 1st 7 70%
Bridgeway 6 60%
University Family Care 5 50%
Health Choice Arizona 4 40%
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National Committee for Quality Assurance Medicaid Means
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Contractor
Number of NCQA Medicaid Measure
Means Met or Exceeded
Percent of Medicaid Measure
Means Met or Exceeded
Phoenix Health Plan 6 86%
CMDP 5 83%
University Family Care 5 71%
United Healthcare Community Plan 5 71%
Mercy Care Plan 5 71%
Bridgeway 4 57%
Care 1st 4 57%
Maricopa Health Plan 2 29%
Health Choice 1 14%
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Aggregate PerformanceCYE 2013 Measurement Period (10/01/12-09/30/13), reported in CYE 2015
Performance MeasureCYE 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: 12-24 mo. 97.0% 97.4% 0.4% 0.011 93% 97% 96.1% 98.0%
Children's Access to PCPs: 25 mo.-6 yrs. 87.7% 89.2% 1.7% <0.001 83% 97% 88.3% 91.9%
Children's Access to PCPs: 7-11 yrs. 89.9% 91.4% 1.7% <0.001 83% 97% 90.0% 92.5%
Children's Access to PCPs: 12-19 yrs. 87.7% 89.4% 2.0% <0.001 81% 97% 88.5% 89.9%
Well-Child Visits - First 15 mo. 67.8% 68.4% 0.8% 0.042 65% 90% 61.6% 79.0%
Well-Child Visits - 3-6 yrs. 66.8% 65.5% -1.9% <0.001 66% 80% 71.5% 74.3%
Adolescent Well Care 38.0% 39.7% 4.3% <0.001 42% 50% 50.0% 44.5%
Annual Dental Visits 61.8% 59.9% -3.0% <0.001 57% 57% n/a n/a
EPSDT Participation 65.7% 62.3% -5.2% 68% 80% n/a 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% <0.001 46% 54% n/a n/a
Reaching across Arizona to provide comprehensive quality health care for those in need
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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 Careo Diabeteso 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
Reaching across Arizona to provide comprehensive quality health care for those in need
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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 2013-2015)o Immunizations for 13 year olds (CYE 2013-2015)o HPV (13 year old females) (CYE 2013-2015)o Influenza age 50+ (CYE 2014) (already at VFC)
Reaching across Arizona to provide comprehensive quality health care for those in need
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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, 2016
Reaching across Arizona to provide comprehensive quality health care for those in need
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Performance Improvement Projects• CSPMP (Opioid Use)
o Increasing the number of providers that have registered with the CSPMPo 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-prescribingo Baseline data has been calculated and shared with Contractors
• Reaching across Arizona to provide comprehensive
quality health care for those in need
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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
Reaching across Arizona to provide comprehensive quality health care for those in need
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Questions?
Thank You.
Reaching across Arizona to provide comprehensive quality health care for those in need