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External Quality Review Quarterly Meeting

External Quality Review Quarterly Meeting. Monday, March 21, 2011 1:00 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:

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External Quality Review Quarterly Meeting

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  1. External Quality Review Quarterly Meeting Monday, March 21, 20111:00 p.m. –2:30 p.m. WELCOME!

  2. EQR Quarterly Meeting • Welcome to all participants • Overview of agenda • Webinar do’s and don’ts • Evaluation Forms

  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.

  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

  5. Performance Measures Related to Pediatric Care

  6. Well-Child Visits—15 Months (Zero Visits) Note: Lower rates are better for this measure.

  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.

  8. Well-Child Visits—15 Months (6 Visits)

  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.

  10. Well-Child Visits 3–6 Years

  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.

  12. Adolescent Well Care

  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.

  14. Lead Screening in Children

  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.

  16. Annual Dental Visits

  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.

  18. Childhood Immunization Status—Combo 2 HEDIS 75THpercentile = 80.0% HEDIS 2008 50th percentile = 75.4%

  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.

  20. Childhood Immunization Status—Combo 3 HEDIS 250th percentile = 68.6%

  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.

  22. Follow-up Care for Children Prescribed ADHD Medication, Initiation HEDIS 2008 50th percentile = 65.9% This was the first year this measure was included in the analysis; therefore, no comparison data were available.

  23. Follow-up Care for Children Prescribed ADHD Medication, Initiation • The rate for Reform plans was slightly below the performance target.

  24. Follow-up Care for Children Prescribed ADHD Medication, Continuation and Maintenance Phase HEDIS 2008 50th percentile = 65.9% This was the first year this measure was included in the analysis; therefore, no comparison data were available.

  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.

  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

  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

  28. Performance Measures Related to Women’s Care

  29. Cervical Cancer Screening

  30. Cervical Cancer Screening • Non-Reform plans continue to show better performance than the Reform plans.

  31. Breast Cancer Screening

  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.

  33. Timeliness of Prenatal Care

  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.

  35. Postpartum Care

  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.

  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

  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.

  39. Performance Measures Related to Living with Illness

  40. Diabetes Care—HbA1c Testing

  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.

  42. Diabetes Care—Poor HbA1c Control Note: Lower rates are better for this measure.

  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.

  44. Diabetes Care—LDL-C Screening

  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.

  46. Diabetes Care—LDL-C Level <100

  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.

  48. Diabetes Care—Eye Exams

  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.

  50. Diabetes Care—Monitoring Nephropathy

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