Quality StrategyQuality Strategy

June 10, 2009June 10, 2009

Presented by:Debby McNamara, LCSW, PMPQuality Coordinator, AHCA

Performance Improvement ProjectsPerformance Improvement ProjectsQuestion & Answer SessionQuestion & Answer Session

Wednesday, June 10, 2009Wednesday, June 10, 2009

Did you know…? The Frequently Asked Questions for PIPs on the

myfloridaeqro.com Web site has been updated as of May, 2009.

Your final 2008-9 PIP Validation Reports have been posted to your folder on the HSAG FTP site.

You can schedule technical assistance by contacting Denise Driscoll at ddriscoll@hsag.com.

Did you know…? The same process from the past two years will

be used for the submission of PIPs for 2009-2010.

CMS is reviewing all the protocols over the next six months and changes may be occurring.

HSAG is investigating the feasibility of moving the PIP Summary Forms to a Web based submission process for 2010-2011.

The collaborative call schedule has been posted.

Any Questions?

EQR Quarterly MeetingEQR Quarterly Meeting

Overview of Current Activities and Overview of Current Activities and Upcoming EQR ActivitiesUpcoming EQR Activities

June 10, 2009June 10, 2009

Presented by:Gretchen Thompson, MBA, CPHQExecutive Director, State & Corporate Services

Current EQR Activities

Overview of activities

conducted during

state fiscal year 2008-2009

Current EQR Activities

Performance Improvement Projects (PIPs) Completed validation of two PIPs per MCO Produced the Annual PIP Validation

Summary Report Draft Annual Strategic Report for

Performance Improvement Projects is due to AHCA on June 30, 2009

Technical assistance activities with MCOs, AHCA, and DOEA - ongoing

Current EQR Activities

Validation of Performance Measures Completed validation of performance

measures reported by HMOs and PSNs (Reform and Non-Reform), PMHPs, CWPMHP and NHDPs

Produced and finalized Annual Validation of Performance Measures report and MCO specific findings

Produced and finalized MCO-specific Validation of Performance Measure reports for PMHPs and NHDPs

Current EQR Activities

Validation of Performance Measures PMHP initial validation activities are

underway for the new cycle

Current EQR Activities

Monitoring of MCO Contract Compliance

Working with AHCA and DOEA to finalize monitoring tools and database

– PMHP database tool operational (includes CW-PMHP)

– Tool development to occur for NHDP, PSN, and HMOs once FY 2010 contracts are finalized

Focused reviews continuing

Current EQR Activities

Strategic HEDIS® Analysis

Produced and finalized HEDIS 2008 Strategic Analysis Report on Reform and Non-reform HMOs and PSNs

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)

Current EQR Activities

Technical Assistance in Other Areas Provided technical assistance as

needed Produced quarterly reports on

technical assistance activities provided during the year and status of recommendations

Current EQR Activities

Dissemination and Education Conducted four quarterly meetings during

the fiscal year Conducted one-on-one technical assistance

sessions Maintained myfloridaeqro.com website Weekly communications with AHCA,

monthly progress reports

Current EQR Activities

EQR Technical Report Internal analysis underway Draft report due to AHCA in July, 2009

Year Four EQR Activities

Overview of activities to be

conducted during

state fiscal year 2009-2010

Year Four EQR Activities

Validation of PIPsValidation of performance measuresReview of compliance with access, structural, and operations standardsStrategic HEDIS® analysis reportsTechnical assistanceDissemination of EQR informationEQRO Technical Report

Year Four EQR Activities

MARK YOUR CALENDARS!!!!

The next EQR Quarterly Meetings are scheduled for:

Wednesday, September 23, 2009 (Webinar)Wednesday, January 13, 2010 (AHCA Offices)

One-on-One TA sessions Tuesday, January 12, 2010Wednesday, March 24, 2010 (Webinar)Wednesday, June 9, 2010 (AHCA Offices)

One-on-One TA sessions Tuesday, June 8, 2010

MCO Roles and Responsibilities related to Year Four EQR

Activities (FY 09-10)

MCO Roles and Responsibilities

Validation of Performance Improvement Projects

Validation of PIPsMCO Roles and Responsibilities

Provide basic information on the PIPs that are currently underway (Statement of Intent)

Complete the PIP Summary Form and provide supportive documentation for each PIP selected for validation

Review HSAG’s completed PIP Validation Tool and address any Points of Clarification, Partially Met and Not Met evaluation elements

Validation of PIPsMCO Roles and Responsibilities

Continuing Collaborative PIP activities– Participate in quarterly conference calls– Facilitate at least one quarterly conference call

(with HSAG support)

New Collaborative PIP activities (for NHDPs)– Monthly conference calls– Facilitate at least one monthly conference call

(with HSAG support)

Validation of PIPsMCO Roles and Responsibilities

Participate in the Collaborative PIP activities– Conduct key activities of the PIP following

the study design– Implement interventions– Collect and analyze two annual re-

measurements

Project Activity by MonthValidation of Performance Improvement Projects (PIPs)

Task May Jun Jul Aug Sep Oct Nov Dec Jan 10

Feb Mar Apr May Jun

PIPs 7/09 – 9/09Statement of Intent

Requested

10/09 – 12/09Perform Individual

PIP Reviews

01/10 – 2/10Prepare Annual

Validation Summary Report

03/10 – 04/10Prepare Annual Strategic Report

OngoingCollaborative PIP Activities and Technical Assistance

10/09MCOs Submit

PIP Forms

MCO Roles and Responsibilities

Validation of Performance Measures

Validation of Performance MeasuresMCO Roles and Responsibilities

Both non-reform and reform HMOs and PSNs provide 2009 HEDIS® RoadMap (HEDIS Record of Administration, Data Management and Processes)

HMOs and PSNs complete and forward supplemental questions document to HSAG

Establish a contact person if questions arise from the HSAG review team

Validation of Performance MeasuresMCO Roles and Responsibilities

PMHPs complete Information Systems Capabilities Assessment Tool (ISCAT), source code, and when produced, performance measure rates for selected measures.

Prepare for and participate in HSAG’s site visit (May – June annually) and post onsite audit activities.

Validation of Performance MeasuresMCO Roles and Responsibilities

NHDPs complete Information Systems Capabilities Assessment Tool (ISCAT), source code, and when produced, performance measure rates for selected measures.

Prepare for and participate in HSAG’s site visit (Oct – Nov annually) and post onsite audit activities.

Project Activity by MonthValidation of Performance Measures (PMVs)

HMOs/PSNs (Reform and Non-Reform)

Task May Jun Jul Aug Sep Oct Nov Dec Jan 10

Feb Mar Apr May

PMVs

HMOs &

PSNs

11/09 – 1/10Prepare Report

10/09-11/09Receive MCO documentation

9/09

Request Documentation

Ongoing TA to AHCA/DOEAfor Performance Measures

Project Activity by MonthValidation of Performance Measures (PMVs)

PMHPs

Task May Jun Jul Aug Sep Oct Nov Dec Jan 10

Feb Mar Apr May

PMVs

PMHPs

6/09 – 7/09Prepare Report,

Review Final Rates

08/09Finalize PMV

Reports

5/09-6/09

Site Visits

Ongoing TA to AHCA/DOEAfor Performance Measures

03/10Request ISCAT documentation

05/10

Receive ISCAT documentation

Project Activity by MonthValidation of Performance Measures (PMVs)

NHDPs

Task May Jun Jul Aug Sep Oct Nov Dec Jan 10

Feb Mar Apr May

PMVs

NHDPs

12/09 – 1/10Prepare Report,

Review Final Rates 02/10Finalize PMV

Reports

10/09-11/09

Site Visits

Ongoing TA to AHCA/DOEAfor Performance Measures

08/09Request ISCAT documentation

09/09

Receive ISCAT documentation

THANK YOU FOR YOUR PARTICIPATION!