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Page 1
External Quality Review Quarterly Meeting
Monday, March 21, 20111:00 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/PSNHEDIS 2010 (CY 2009) HEDIS Results
Monday, March 21, 2011
1:25 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)
57.5
44.544.0
50.9
43.6
49.2
56.6
64.4 65.4
46.6
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
HEDIS 2008 HEDIS 2009
Non-Reform
Reform
HEDIS 50th Percentile
HEDIS 75th Percentile
HEDIS 25th Percentile
2.8% 3.0%
4.3%
5.3%
1.6%
6.2%
0.7%
0%
2%
4%
6%
8%
10%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Well-Child Visits in the First 15 Months of Life, Zero Visits
Non-Reform Reform Performance Target
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)
57.5
44.544.0
50.9
43.6
49.2
56.6
64.4 65.4
46.6
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
HEDIS 2008 HEDIS 2009
Non-Reform
Reform
HEDIS 50th Percentile
HEDIS 75th Percentile
HEDIS 25th Percentile
44.0%50.9%
46.0%43.6%49.2%
35.1%
64.4%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Well-Child Visits in the First 15 Months of Life, 6+ Visits
Non-Reform Reform Performance Target
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
71.172.5
71.4
75.6
67.668.2
74.9
74.0
60.0
65.0
70.0
75.0
80.0
HEDIS 2008 HEDIS 2009
Non-Reform
Reform
HEDIS 50thPercentile
HEDIS 75thPercentile
71.1% 72.5% 74.9%71.4%75.6% 72.7%
74.9%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Well-Child Visits in the 3rd-6th Years of Life
Non-Reform Reform Performance Target
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
41.7
46.044.2
46.4
42.442.1
51.4 51.4
35.0
40.0
45.0
50.0
55.0
HEDIS 2008 HEDIS 2009
Non-Reform
Reform
HEDIS 50thPercentile
HEDIS 75thPercentile
41.7% 46.0% 45.7%44.2% 46.4% 46.3%
51.4%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Adolescent Well-Care Visits
Non-Reform Reform Performance Target
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
17.8
11.3
17.7
27.9
42.8 45.1
50.6 51.3
27.9
27.5
0
10
20
30
40
50
60
HEDIS 2008 HEDIS 2009
Non-Reform
Reform
HEDIS 50th Percentile
HEDIS 75th Percentile
HEDIS 10th Percentile11.3%
17.8% 18.5%17.7%
27.9%33.4%
50.6%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Annual Dental Visit, Total
Non-Reform Reform Performance Target
46.7%53.1%55.2%
51.5%
76.5%
0%
20%
40%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Lead Screening in Children
Non-Reform Reform Performance Target
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
17.8
11.3
17.7
27.9
42.8 45.1
50.6 51.3
27.9
27.5
0
10
20
30
40
50
60
HEDIS 2008 HEDIS 2009
Non-Reform
Reform
HEDIS 50th Percentile
HEDIS 75th Percentile
HEDIS 10th Percentile11.3%
17.8% 18.5%17.7%
27.9%33.4%
50.6%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Annual Dental Visit, Total
Non-Reform Reform Performance Target
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
61.863.5
55
60
65
70
75
80
85
HEDIS 2009
Non-Reform
Reform
HEDIS 2008 50th percentile = 75.4%
HEDIS 75TH percentile = 80.0%
61.8%
71.3%
63.5%68.9%
80.0%
0%
20%
40%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Childhood Immunization Status, Combination 2
Non-Reform Reform Performance Target
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 250th percentile = 68.6%
52.0%
63.6%
53.7%
61.8%
74.3%
0%
20%
40%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Childhood Immunization Status, Combination 3
Non-Reform Reform Performance Target
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 2008 50th percentile = 65.9%
37.8%41.6%
42.2%
0%
20%
40%
60%
80%
100%
2010 Weighted Average
Follow-up Care for Children Prescribed ADHD Medication, Initiation
Non-Reform Reform Performance Target
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 2008 50th percentile = 65.9%
47.7%
67.2%
48.4%
0%
20%
40%
60%
80%
100%
2010 Weighted Average
Follow-up Care for Children Prescribed ADHD Medication, Continuation
Non-Reform Reform Performance Target
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 forPediatrics 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 forPediatrics 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
56.6% 53.8% 55.3%48.2%
52.2% 50.8%
72.0%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Cervical Cancer Screening
Non-Reform Reform Performance Target
Page 30
Cervical Cancer Screening
• Non-Reform plans continue to show better performance than the Reform plans.
Page 31
Breast Cancer Screening
47.5% 50.1%51.4%
56.8%56.4%
0%
20%
40%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Breast Cancer Screening
Non-Reform Reform Performance Target
Page 32
Breast Cancer Screening
• Both the Non-Reform and Reform weighted averages showed a statistically significant improvement in performance in 2010.
• The Reform plans’ HEDIS 2010 performance exceeded the performance target.
Page 33
Timeliness of Prenatal Care
71.6% 69.0% 69.4%66.2% 66.8%
75.1%
88.7%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Timeliness of Prenatal Care
Non-Reform Reform Performance Target
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
58.5%50.1% 52.6%52.8% 51.5% 52.3%
65.5%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Postpartum Care
Non-Reform Reform Performance Target
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 forWomen’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 forWomen’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
74.7% 75.1% 76.4%78.8%80.0% 82.9%
84.3%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Diabetes Care, HbA1c Testing
Non-Reform Reform Performance Target
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.
48.5%51.7%
46.5%48.3% 47.1% 45.4% 39.7%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Diabetes Care, HbA1c Poor Control
Non-Reform Reform Performance Target
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
75.6% 76.3% 77.8%79.9% 80.0%83.3% 77.9%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Diabetes Care, LDL-C Screening
Non-Reform Reform Performance Target
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
29.5% 29.4%33.8%
29.3%35.3% 35.8%
37.2%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Diabetes Care, LDL-C Control (<100 mg/dL)
Non-Reform Reform Performance Target
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
36.3%41.9%
48.2%
35.6%
43.9% 45.2%
62.7%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Diabetes Care, Eye Exam (Retinal) Performed
Non-Reform Reform Performance Target
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
77.1% 76.1% 77.1%79.2% 80.2% 81.8%
81.8%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Diabetes Care, Medical Attention for Nephropathy
Non-Reform Reform Performance Target
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
52.7% 51.5% 53.0%46.2%
55.8% 53.5%
59.9%
0%
20%
40%
60%
80%
100%
2008 Weighted Average 2009 Weighted Average 2010 Weighted Average
Controlling High Blood Pressure
Non-Reform Reform Performance Target
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)
86.9% 86.9%
83.6%
87.6%
90.6%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Use of Appropriate Medications for People with Asthma, Total
Non-Reform Reform 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 (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 2008 50th percentile = 45.1%
45.4% 46.3%51.0% 48.9%
48.3%
0%
20%
40%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Antidepressant Medication Management, Effective Acute Phase Treatment
Non-Reform Reform Performance Target
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 2008 50th percentile = 28.3%
31.2% 29.1%29.8%36.0% 31.3%
0%
20%
40%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Antidepressant Medication Management, Effective Continuation Phase Treatment
Non-Reform Reform Performance Target
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 forLiving 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 forLiving 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, 20-44 Years
69.1% 67.9%71.8% 71.2%
84.8%
0%
20%
40%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Adults' Access to Preventive/Ambulatory Health Services, 20-44 Years
Non-Reform Reform Performance Target
Page 64
Adults’ Access to Preventive/Ambulatory Health Services, 20-44 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, 45-64 Years
82.1% 81.2%84.7% 84.9%
88.3%
0%
20%
40%
60%
80%
100%
2009 Weighted Average 2010 Weighted Average
Adults' Access to Preventive/Ambulatory Health Services, 45-64 Years
Non-Reform Reform Performance Target
Page 66
Adults’ Access to Preventive/Ambulatory Health Services, 45-64 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 forAccess 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, 2011.
• Completed SOI’s due to HSAG on Monday, August 29th.
Page 73
External Quality Review Quarterly Meeting
THANK YOU FOR YOUR PARTICIPATION!