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Louisiana Medicaid Baseline Quality Data

Dr. Sandra BlakeEddy MyersUniversity of Louisiana at MonroeCollege of PharmacyOffice of Outcomes Research and Evaluation

• Louisiana Medicaid Baseline Quality Data

• Sources for Measure Specifications:

• HEDIS Technical Specifications Volume 2

• AHRQ Prevention Quality Indicators

• Children’s Health Insurance Program Reauthorization Act (CHIPRA)

• Question and Answer Session

Overview

• Located on the “Procurement Library” page of the “Making Medicaid Better” website:

http://new.dhh.louisiana.gov/index.cfm/page/270

• 2009 Measurement Year (2010 HEDIS Specification Year)

• Includes recipients enrolled in CommunityCARE at least 11 out of 12 months of the year who were also enrolled in last month of the year

• Dual-eligible recipients are excluded

Louisiana Medicaid Baseline Quality Data

• Measures are calculated using administrative claims data

• T1015 claims from FQHC/RHC settings are included

• Recipients enrolled in LaCHIP Affordable Plan for more than 1 month of the measurement year are excluded since their claims are processed through the Office of Group Benefits

• Measures are calculated after a 6-month claim lag to allow time for completion of claims

Louisiana Medicaid Baseline Quality Data, cont’d

• Healthcare Effectiveness Data and Information Set (HEDIS) by the National Committee for Quality Assurance (NCQA)

• Most measures are reported in the following way:Numerator (compliant population)/Denominator (eligible population) = Rate

• Specifications found in “HEDIS 2010 Technical Specifications, Volume 2”:

http://www.ncqa.org/tabid/75/Default.aspx

Sources for Baseline Data: HEDIS

Sources for Baseline Data: HEDIS, cont’d

• Adults’ Access to Preventive/Ambulatory Health Services $$

• Comprehensive Diabetes Care (HbA1c) $$

• Chlamydia Screening in Women $$

• Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life $$

• Adolescent Well-Care Visits $$

• Children and Adolescents’ Access to PCP

• Prenatal and Postpartum Care

• Childhood Immunization Status

• Immunization for Adolescents

• Lead Screening in Children

Sources for Baseline Data: HEDIS, cont’d

• Cervical Cancer Screening

• Weight Assessment and Counseling for Nutrition and Physical Activity in Children/Adolescents

• Use of Medication for People with Asthma

• Cholesterol Management for Patients with Cardiovascular Conditions*

*Results to be published May 20

• Comprehensive Diabetes Care

• Breast Cancer Screening

• Plan All-Cause Readmissions

• Well-Child Visits in the First 15 Months of Life

• Ambulatory Care (ER Utilization)

• PQI measures use hospital discharge data to identify quality of care for ambulatory care sensitive conditions.

• PQI measures are reported in the following way:Numerator (preventable hospitalizations)/Denominator (eligible

population) = Rate per 100,000

• PQI measures normally use the population in a geographic area for the denominator. The CommunityCARE sub-population has a restricted denominator and the rate is not comparable to published results or benchmarks.

• Specifications may be found on AHRQ’s website:• http://www.qualityindicators.ahrq.gov/Modules/PQI_TechSpec.aspx

Sources for Baseline Data:AHRQ Prevention Quality Indicators (PQI)

• Adult Asthma Admission Rate

• CHF Admission Rate

• Uncontrolled Diabetes Admission Rate

Sources for Baseline Data:AHRQ Prevention Quality Indicators (PQI), cont’d

• CHIPRA measures were created by the Children’s Health Insurance Program Reauthorization Act of 2009

• Most measures are reported in the following way:Numerator (compliant population)/Denominator

(population of interest) = Rate

• Specifications may be found on CHIPRA website:http://www.ahrq.gov/chipra/corebackground/corebacktab.htm

• Percent of Live Births Weighing Less than 2,500 Grams (TBD)

Sources for Baseline Data:CHIPRA

Q&A

Conclusion