Welcome to the EQR Quarterly Meeting!

Wednesday, March 26, 20081:00 p.m. – 2:30 p.m. (EDT)

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External Quality Review Quarterly Meeting

Wednesday, March 26, 20081:00 p.m. – 2:30 p.m.

WELCOME!

EQR Quarterly Meeting

Welcome to all participantsOverview of agendaWebinar do’s and don’tsEvaluation Forms

Summary of Performance Improvement Projects Validation

FindingsWednesday, March 26, 2008

1:15 p.m. – 1:45 p.m.

Cheryl L. Neel, RN, MPH, CPHQ

Manager, Performance Improvement Projects

State & Corporate Services

Presentation Overview

• 2007-2008 PIP Validation Process• Summary of Findings• PIP Validation Summary Report Update• MCO Comment Process• Next Steps

2007-2008 PIP Validation Process

• “Statement of Intent” was completed by each MCO type and submitted to HSAG.

• PSNs were new to the PIP process this validation cycle.

• For 2007-2008, MCOs were to submit to HSAG two PIPs for validation:– Clinical and nonclinical– Collaborative topic and one other

2007-2008 PIP Process (cont.)

• HSAG selected two PIPs per MCO type.• One collaborative PIP was chosen.• One other PIP was chosen based on HSAG’s

selection criteria.– If an MCO 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.

111 PIPs Submitted

MCO-Type Collaborative Plan-specific

HMO 23 23

PSN 8 8

PMHP 12 11

NHDP 13 13

MCO-Type

Collaborative Topic

HMOWell-Child Visits in the First 15 Months of Life – Six or More Visits

PSNWell-Child Visits in the First 15 Months of Life – Six or More Visits

NHDP Retention Rate

PMHPFollow-up Within Seven Days after Acute Care Discharge for a Mental Health Diagnosis

Collaborative PIP Topics

Summary of Findings

• A total of 91 PIPs scored at least 80 percent compared to 21 PIPs in 2006-2007 (total of 81 PIPs for 2006-2007).

• A total of 20 PIPs scored below 80 percent compared to 60 PIPs in 2006-2007.

• For 2007-2008, Activities I-IV (study design) were assessed for all 111 PIPs.– 22 of the 111 PIPs had progressed to have

Activity VII assessed.– 3 progressed through Activity X.

2006-2007 Summary of PIP Validation Scores

% Score of Evaluation Elements Met

HMO NHDP PMHP Total

90% to 100% 2 0 0 2

80% to 89% 13 0 6 19

70% to 79% 13 1 0 14

60% to 69% 8 3 1 12

Less than 60% 17 16 1 34

Total 53 20 8 81

2007-2008 Summary of PIP Validation Scores

% Score of Evaluation Elements Met

HMO PSN NHDP PMHP Total

90% to 100% 32 10 14 14 70

80% to 89% 8 0 5 8 21

70% to 79% 2 1 0 0 3

60% to 69% 3 0 2 1 6

Less than 60% 1 5 5 0 11

Total 46 16 26 23 111

HMO Findings

• Total of 46 PIPs– 2 PIPs were assessed through Activity X.– Average score was 92 percent.

• Individual scores ranged from a low of 3 percent to a high of 100 percent.

– 88 percent of all the applicable evaluation elements assessed received a Met finding.

– 12 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

HMO PIP Overall Performance

HMO Summary of PIP Validation Scores

% Score of Evaluation Elements Met

2006-2007 2007-2008

90% to 100% 2 32

80% to 89% 13 8

70% to 79% 13 2

60% to 69% 8 3

Less than 60% 17 1

Total 53 46

PSN Findings

• Total of 16 PIPs– 1 PIP was assessed through Activity VI.– Average score was 79 percent.

• Individual scores ranged from a low of 6 percent to a high of 100 percent.

– 75 percent of all the applicable evaluation elements assessed received a Met finding.

– 25 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

PSN PIP Overall Performance

PSN Summary of PIP Validation Scores% Score of Evaluation

Elements Met2006-2007 2007-2008

90% to 100% 10

80% to 89% 0

70% to 79% 1

60% to 69% 0

Less than 60% 5

Total 16

NHDP Findings• Total of 26 PIPs

– Five PIPs were assessed through Activity IX.

– Average score was 80 percent.• Individual scores ranged from 24

percent to 100 percent.– 70 percent of all the applicable evaluation

elements assessed received a Met finding.– 30 percent of all the applicable evaluation

elements assessed received a Partially Met or Not Met.

NHDP PIP Overall Performance

NHDP Summary of PIP Validation Scores

% Score of Evaluation Elements Met

2006-2007 2007-2008

90% to 100% 0 14

80% to 89% 0 5

70% to 79% 1 0

60% to 69% 3 2

Less than 60% 16 5

Total 20 26

PMHP Findings

• Total of 23 PIPs– 1 PIP was assessed through Activity X.– Average score was 93 percent.

• Individual scores ranged from 64 percent to a high of 100 percent.

– 92 percent of all the applicable evaluation elements assessed received a Met finding.

– 8 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

PMHP PIP Overall Performance

PMHP Summary of PIP Validation Scores

% Score of Evaluation Elements Met

2006-2007 2007-2008

90% to 100% 0 14

80% to 89% 6 8

70% to 79% 0 0

60% to 69% 1 1

Less than 60% 1 0

Total 8 23

PIP Validation Summary Reports

• PMHPs received PIP Validation Summary Reports on Friday, March 14, 2008.

• HMOs, PSNs, and NHDPs received PIP Validation Summary Reports on Monday, March 24, 2008.

MCO Comment Process

• The MCOs were provided with five business days from the receipt of their PIPs to contact HSAG if an error had occurred (No revisions or additional documents were accepted).

• HSAG’s PIP Review Team will review all comments and questions, and respond to the MCOs within five business days from receipt of the inquiry.

Next Steps for MCOs

• MCOs need to address all points of clarification, Partially Met, and Not Met evaluation elements.

• HSAG has provided to the MCOs the Word version of the study submitted.

• Use the same study document to continue working on the PIPs. Date, bold, strike-through any sections in which revisions are made to the study document.

PIP Validation Annual Summary Report

• First draft of the 2007-2008 PIP Annual Summary Report will be sent to AHCA and DOEA on Friday, March 28, 2008.– Compilation of all the MCO findings.– Two year comparison for Activities I

through IV.– Includes conclusions and

recommendations.

Questions and Answerson PIP validation?

Open Discussion on Collaborative PIPs

1:45 p.m. – 2:05 p.m.

Presenter:

Peggy Ketterer, RN, BSN, CHCAExecutive Director, EQRO Services

Collaborative PIPs

Current status:– Monthly conference calls are held with

all participants.

– Documentation requirements for each PIP activity are discussed.

– Host MCOs are responsible for facilitating the meeting and preparing meeting minutes.

Collaborative PIPs

Current status – cont’d:– HMOs/PSNs:

• Non-reform plans have collected baseline data and are currently identifying interventions.

• Reform plans are collecting baseline data, which will officially be reported in July, 2008.

Collaborative PIPs

Current status – cont’d:– PMHPs:

• Plans are collecting baseline data which will be reported in July, 2008.

– NHDPs:• Plans are collecting baseline data on a

quarterly basis, with an annual rate calculated for calendar year 2008.

Collaborative PIPs

Open Discussion:

Collaborative approach – what is working well, what could be improved?

Collaborative PIPs

Open Discussion:

Collaborative approach – time frame for completion of PIP activities.

Collaborative PIPs

Open Discussion:

Collaborative approach – what are the challenges being faced?

Collaborative PIPs

Next steps:– Continue monthly or bi-monthly

conference calls

– Continue to document on PIP study form

– Submit PIP study form to HSAG for validation in October, 2008

Upcoming EQR Activities

2:05 p.m. – 2:20 p.m.

Presenter:

Peggy Ketterer, RN, BSN, CHCAExecutive Director, EQRO Services

Upcoming EQR activities

The next EQR Quarterly Meetings are scheduled for:

•Wednesday, June 18, 2008 (AHCA Offices)One-on-One TA sessions Tuesday, June 17, 2008

•Wednesday, September 24, 2008 (Webinar)

Upcoming EQR activities

The next EQR Quarterly Meetings are scheduled for:

•Wednesday, January 14, 2009 (AHCA Offices)One-on-One TA sessions Tuesday, January 13, 2009

•Wednesday, March 25, 2009 (Webinar)

Upcoming EQR activities

• Finalization of PIP Validation Reports (April 2008).

• Annual PIP summary report and strategic summary report (May – June 2008).

Upcoming EQR activities

• Behavioral health authorizations focused study report (June 2008).

• EQR Technical Report (August 2008).

• Site visits for the validation of PMHP performance measures will occur in May – June 2008.

Upcoming EQR Activities

Questions?

External Quality Review Quarterly Meeting

THANK YOU FOR YOUR PARTICIPATION!