Transcript Overview of 2004-2005 External Quality Review (EQR) Activities

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