Page 1 External Quality Review Quarterly Meeting Monday, March 21, 2011 1:00 p.m. –2:30 p.m....

External Quality Review Quarterly Meeting

Monday, March 21, 20111:00 p.m. –2:30 p.m.

WELCOME!

EQR Quarterly Meeting

• Welcome to all participants

• Overview of agenda

• Webinar do’s and don’ts

• Evaluation Forms

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.

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

Performance Measures Related to Pediatric Care

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



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.

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.

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


Non-Reform

Reform




44.0%50.9%

46.0%43.6%49.2%

35.1%

64.4%

0%

20%

40%

60%

80%

100%


Well-Child Visits in the First 15 Months of Life, 6+ Visits


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.

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


Non-Reform

Reform

HEDIS 50thPercentile


71.1% 72.5% 74.9%71.4%75.6% 72.7%

74.9%

0%

20%

40%

60%

80%

100%


Well-Child Visits in the 3rd-6th Years of Life


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.

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


Non-Reform

Reform



41.7% 46.0% 45.7%44.2% 46.4% 46.3%

51.4%

0%

20%

40%

60%

80%

100%


Adolescent Well-Care Visits


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.

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


Non-Reform

Reform



HEDIS 10th Percentile11.3%

17.8% 18.5%17.7%

27.9%33.4%

50.6%

0%

20%

40%

60%

80%

100%


Annual Dental Visit, Total


46.7%53.1%55.2%

51.5%

76.5%

0%

20%

40%

60%

80%

100%

2009 Weighted Average 2010 Weighted Average




• 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.

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


Non-Reform

Reform



HEDIS 10th Percentile11.3%

17.8% 18.5%17.7%

27.9%33.4%

50.6%

0%

20%

40%

60%

80%

100%


Annual Dental Visit, Total


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.

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%


Childhood Immunization Status, Combination 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.


HEDIS 250th percentile = 68.6%

52.0%

63.6%

53.7%

61.8%

74.3%

0%

20%

40%

60%

80%

100%


Childhood Immunization Status, Combination 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.

Follow-up Care for Children Prescribed ADHD Medication, Initiation


37.8%41.6%

42.2%

0%

20%

40%

60%

80%

100%

2010 Weighted Average



This was the first year this measure was included in the analysis; therefore, no comparison data were available.


• The rate for Reform plans was slightly below the performance target.

Follow-up Care for Children Prescribed ADHD Medication, Continuation and

Maintenance Phase


47.7%

67.2%

48.4%

0%

20%

40%

60%

80%

100%

2010 Weighted Average

Follow-up Care for Children Prescribed ADHD Medication, Continuation


This was the first year this measure was included in the analysis; therefore, no comparison data were available.

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.

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

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

Performance Measures Related to Women’s Care

Cervical Cancer Screening

56.6% 53.8% 55.3%48.2%

52.2% 50.8%

72.0%

0%

20%

40%

60%

80%

100%





• Non-Reform plans continue to show better performance than the Reform plans.

Breast Cancer Screening

47.5% 50.1%51.4%

56.8%56.4%

0%

20%

40%

60%

80%

100%





• 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.

Timeliness of Prenatal Care

71.6% 69.0% 69.4%66.2% 66.8%

75.1%

88.7%

0%

20%

40%

60%

80%

100%





• 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.

Postpartum Care

58.5%50.1% 52.6%52.8% 51.5% 52.3%

65.5%

0%

20%

40%

60%

80%

100%


Postpartum Care


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.

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

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.

Performance Measures Related to Living with Illness

Diabetes Care—HbA1c Testing

74.7% 75.1% 76.4%78.8%80.0% 82.9%

84.3%

0%

20%

40%

60%

80%

100%


Diabetes Care, HbA1c Testing


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.

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%


Diabetes Care, HbA1c Poor Control


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.

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%


Diabetes Care, LDL-C Screening


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.

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%


Diabetes Care, LDL-C Control (<100 mg/dL)


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.

Diabetes Care—Eye Exams

36.3%41.9%

48.2%

35.6%

43.9% 45.2%

62.7%

0%

20%

40%

60%

80%

100%


Diabetes Care, Eye Exam (Retinal) Performed


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.

Diabetes Care—Monitoring Nephropathy

77.1% 76.1% 77.1%79.2% 80.2% 81.8%

81.8%

0%

20%

40%

60%

80%

100%


Diabetes Care, Medical Attention for Nephropathy


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.

Controlling High Blood Pressure

52.7% 51.5% 53.0%46.2%

55.8% 53.5%

59.9%

0%

20%

40%

60%

80%

100%





• 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.

Use of Appropriate Medications for People with Asthma (Total)

86.9% 86.9%

83.6%

87.6%

90.6%

60%

80%

100%


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.

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.

Antidepressant Medication Management—Effective Acute Phase Treatment


45.4% 46.3%51.0% 48.9%

48.3%

0%

20%

40%

60%

80%

100%


Antidepressant Medication Management, Effective Acute Phase Treatment


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.

Antidepressant Medication Management—Effective Continuation Phase Treatment


31.2% 29.1%29.8%36.0% 31.3%

0%

20%

40%

60%

80%

100%


Antidepressant Medication Management, Effective Continuation Phase Treatment


Antidepressant Medication Management— Effective Continuation Phase Treatment

• For HEDIS 2010, Reform plans performed better than Non-Reform plans and exceeded the AHCA performance target.

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

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

Performance Measures Related to Access to Care

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%


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.


82.1% 81.2%84.7% 84.9%

88.3%

0%

20%

40%

60%

80%

100%


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.

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.

HMO/PSN HEDIS Results

Questions?

Upcoming EQR Activities

Monday, March 21, 2011

Presenter:

Yolanda Strozier, MBA

Associate Director, State and Corporate Services

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)


• Finalization of PIP Validation Reports (April 2011).

• Annual PIP Summary Report and Strategic Summary Report (April–June 2011).


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.

External Quality Review Quarterly Meeting

THANK YOU FOR YOUR PARTICIPATION!

Page 1 External Quality Review Quarterly Meeting Monday, March 21, 2011 1:00 p.m. –2:30 p.m....

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