administrator meeting september 16, 2015 kim elliott, ph.d., c.p.h.q. administrator, clinical...

Administrator MeetingSeptember 16, 2015

Kim Elliott, Ph.D., C.P.H.Q.Administrator, Clinical Quality Management

2

Performance Measures - 2013o Reviewing comments regarding data review that were received from

Contractorso Anticipate finalizing 2013 Performance Measures in October, 2015o Highlights:

Phoenix Health Plan has continued its Performance Measure improvements two years in a row

United Healthcare Community Plan showed significant improvement in the Well-Child, first 15 Months of Life Performance Measure

Almost every health plan showed significant improvement in the Adolescent Well Care Visit rate – we are moving much closer to the Minimum Performance Standard

Reaching across Arizona to provide comprehensive quality health care for those in need

3

2013 Performance Measure Aggregate Summary

Performance Measures meeting the Minimum Performance Standard (MPS)

660%

Performance Measures meeting the contractual Goal

220%

Performance Measures meeting NCQA Medicaid Mean

5 71%

Performance Measures meeting NCQA Commercial Mean

0 0%


4

2013 Performance Measures: Minimum Performance Standard (MPS) Met


ContractorNumber of Performance Measures

MPS MetPercent of Minimum

Performance Standard MetPhoenix Health Plan 9 90%

CMDP 9 100%

Maricopa Health Plan 8 80%

Mercy Care Plan 7 70%

United Health Care Community Plan 7 70%

Care 1st 7 70%

Bridgeway 6 60%

University Family Care 5 50%

Health Choice Arizona 4 40%

5

National Committee for Quality Assurance Medicaid Means


Contractor

Number of NCQA Medicaid Measure

Means Met or Exceeded

Percent of Medicaid Measure

Means Met or Exceeded

Phoenix Health Plan 6 86%

CMDP 5 83%

University Family Care 5 71%

United Healthcare Community Plan 5 71%

Mercy Care Plan 5 71%

Bridgeway 4 57%

Care 1st 4 57%

Maricopa Health Plan 2 29%

Health Choice 1 14%

6

Aggregate PerformanceCYE 2013 Measurement Period (10/01/12-09/30/13), reported in CYE 2015

Performance MeasureCYE 2012 Data (10/01/11-

09/30/12)

CYE 2013 Data

(10/01/12-09/30/13)

Relative Percent Change

Statistical Significance

AHCCCS Minimum

Performance Standard

AHCCCS Goal

NCQA Medicaid

Mean

NCQA Commercial

Mean

Children's Access to PCPs: 12-24 mo. 97.0% 97.4% 0.4% 0.011 93% 97% 96.1% 98.0%

Children's Access to PCPs: 25 mo.-6 yrs. 87.7% 89.2% 1.7% <0.001 83% 97% 88.3% 91.9%

Children's Access to PCPs: 7-11 yrs. 89.9% 91.4% 1.7% <0.001 83% 97% 90.0% 92.5%

Children's Access to PCPs: 12-19 yrs. 87.7% 89.4% 2.0% <0.001 81% 97% 88.5% 89.9%

Well-Child Visits - First 15 mo. 67.8% 68.4% 0.8% 0.042 65% 90% 61.6% 79.0%

Well-Child Visits - 3-6 yrs. 66.8% 65.5% -1.9% <0.001 66% 80% 71.5% 74.3%

Adolescent Well Care 38.0% 39.7% 4.3% <0.001 42% 50% 50.0% 44.5%

Annual Dental Visits 61.8% 59.9% -3.0% <0.001 57% 57% n/a n/a

EPSDT Participation 65.7% 62.3% -5.2% 68% 80% n/a n/a

EPSDT Dental Participation (Rate is reflective of combined Acute and ALTCS performance per CMS 416 programming requirements)

44.1% 45.5% 3.2% <0.001 46% 54% n/a n/a


7

2014 Performance Measures• Encounter, member and provider demographic data has been sent to Health

Services Advisory Group to validate and to begin the Performance Measure process

• Hybrid data collection will be utilized for the following measures:o Prenatal and Postpartum Careo Diabeteso Influenza and Immunizations

• Contractors will collect data for the hybrid measures

• Anticipate receipt of data and rates back from HSAG before the end of 2015

• As with the 2013 Performance Measure data, Contractors will be sent the files and provided an opportunity to review the results before they are determined final by AHCCCS


8

2015 Immunization Audit• AHCCCS has collaborated with the Arizona

Department of Health Services (ADHS), Vaccine For Children’s Program (VFC), to extract immunization data (beginning October 1, 2015) from the ASIIS system which will include immunization records for: o Immunizations for 2 year olds (CYE 2013-2015)o Immunizations for 13 year olds (CYE 2013-2015)o HPV (13 year old females) (CYE 2013-2015)o Influenza age 50+ (CYE 2014) (already at VFC)


9

Immunization Audit 2015• When the data is received back from the Arizona Department of

Health Services, Vaccine for Children’s Program, any missing records will be sent to Contractors to conduct a hybrid data collection process

• Hybrid collection files will be sent to Contractors in October (adults) and November (children)

• The final Immunization Audit report is due to the Legislature April 1, 2016


10

Performance Improvement Projects• CSPMP (Opioid Use)

o Increasing the number of providers that have registered with the CSPMPo Increasing the utilization of the CSPMP for narcotic prescribing

Methodology written Baseline data – CYE 2015

• Developmental Screening (Autism)o Increase the use of developmental screening at the 9, 18 and 24 month EPSDT

visits o Increase treatment referrals for positive screening results

Methodology written Baseline data – CYE 2015

• E-prescribingo Baseline data has been calculated and shared with Contractors

• Reaching across Arizona to provide comprehensive

quality health care for those in need

11

Other CQM Updates• The Health Plan Report Card was posted to the AHCCCS

website on September 14, 2015

• The CAHPS Survey for the SMI and CRS programs is underway – being conducted through Health Services Advisory Group

• Childhood Obesity Initiative has kicked off - most Contractors are participating


12

Questions?

Thank You.


administrator meeting september 16, 2015 kim elliott, ph.d., c.p.h.q. administrator, clinical...

Documents

performance measurecye

need42013 performance

health choice114

maricopa health plan880

maricopa health plan229

health choice arizona440

exceededphoenix health

mercy care plan571