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Slide 1
HMO/PSN Quarterly MeetingPerformance Improvement Projects
September 26 , 2011
Presenter:
Christi Melendez, RN, CPHQProject Manager, PIP Review Team
Slide 2
Presentation Topics
• Discuss Well-Child Visits in the First 15 Months of Life—Six or More Visits
• Results
• Discuss Validation Results
• Next Steps
• Important Dates
Slide 3
HMO/PSN Non-Reform
Well-Child Visits in the First 15 Months of Life—
Six or More VisitsBaseline –
• Thirteen plans provided baseline results
• The overall rate for the Non-Reform HMOs was 34.0 percent
• The rates ranged from 11.1 to 80.0 percent
Slide 4
HMO/PSN Non-Reform
Well-Child Visits in the First 15 Months of Life—
Six or More VisitsRemeasurement 1 –
• Twelve plans provided Remeasurement 1 results
• Seven plans reported improved rates from baseline to Remeasurement 1; all increases were statistically significant
• The overall rate increased from 34.0 percent to 37.1 percent
Slide 5
HMO/PSN Non-Reform
Well-Child Visits in the First 15 Months of Life—
Six or More VisitsRemeasurement 2 –
• Ten plans provided Remeasurement 2 results
• Seven plans reported improved rates from Remeasurement 1 to Remeasurement 2; two of the increases were statistically significant
• The overall rate decreased from 37.1 percent to 30.0 percent
Slide 6
HMO/PSN Non-Reform
Well-Child Visits in the First 15 Months of Life—
Six or More VisitsRemeasurement 3 –
• Five plans provided Remeasurement 3 results
• Two of the five plans reported improved rates from Remeasurement 2 to Remeasurement 3; none of the increases were statistically significant
• The overall rate decreased from 30.0 percent to 27.4 percentNOTE: Plans were not required to report Remeasurements 2 or 3 for
calendar year 2010
Slide 7
HMO/PSN Non-Reform Baseline
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Slide 8
HMO/PSN Non-Reform Baseline to Remeasurement 1
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Slide 9
HMO/PSN Non-Reform Baseline to Remeasurement 2
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Slide 10
HMO/PSN Non-Reform Baseline to Remeasurement 3
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Slide 11
HMO/PSN Non-Reform Statistically Significant Improvement and
Sustained Improvement Validation Results for HMO PIPs Demonstrating Improvement
Well-Child Visits in the First 15 Months of Life—Six or More Visits
MCO MCO Type Statistically Significant Improvement
Sustained Improvement
Citrus Health Care, Inc. HMO Non-Reform Humana Family c/o Humana Medical Plan, Inc.
HMO Non-Reform
Jackson Memorial Health Plan HMO Non-Reform Preferred Medical Plan, Inc. HMO Non-Reform United Healthcare of Florida, Inc.—AmeriChoice HMO Non-Reform Vista Healthplan, Inc.—Buena Vista Medicaid HMO Non-Reform Vista Healthplan, Inc.—Vista South Florida HMO Non-Reform Wellcare Health Plans, Inc.—Healthease of Florida, Inc. HMO Non-Reform Wellcare Health Plans, Inc.—Staywell of Florida, Inc. HMO Non-Reform
Slide 12
HMO/PSN Reform
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Baseline –
• Seven plans provided baseline results
• The overall rate for the Reform HMO/PSNs was 37.5 percent
• The rates ranged from 10.3 percent to 60.0 percent
Slide 13
HMO/PSN Reform
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Remeasurement 1 –
• Three plans provided Remeasurement 1 results
• One of the three plans reported an improved rate from baseline to Remeasurement 1, the increase was not statistically significant
• The overall rate improved from 37.5 percent to 52.7 percent
Remeasurement 2 –
• One plan provided a Remeasurement 1 rate of 46.2 percent; the result was below the plan’s baseline rate of 48.7 percent
NOTE: Plans were not required to report Remeasurements 1 or 2 for calendar year 2010
Slide 14
HMO/PSN Reform Baseline
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Slide 15
HMO/PSN Reform Baseline to Remeasurement 1
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Slide 16
HMO Validation Results Across All PIPs (Reform and Non-Reform)
Study Stage Activity
Percentage of Applicable Elements
Met Partially
Met Not Met
Design
I. Appropriate Study Topic 96%
(288/299) 2%
(6/299) 2%
(5/299)
II. Clearly Defined, Answerable Study Question(s) 87%
(90/104) 13%
(14/104) 0%
(0/104)
III. Clearly Defined Study Indicator(s) 92%
(283/307) 7%
(22/307) 1%
(2/307)
IV. Correctly Identified Study Population 89%
(136/153) 11%
(17/153) 0%
(0/153)
Design Total 92%
(797/863) 7%
(59/863) 1%
(7/863)
Implementation
V. Valid Sampling Techniques (if sampling was used) 100%
(59/59) 0%
(0/59) 0%
(0/59)
VI. Accurate/Complete Data Collection 89%
(319/358) 4%
(15/358) 7%
(24/358)
VII. Appropriate Improvement Strategies 89%
(108/121) 9%
(11/121) 2%
(2/121)
Implementation Total 90%
(486/538) 5%
(26/538) 5%
(26/538)
Outcomes
VIII. Sufficient Data Analysis and Interpretation 79%
(206/261) 10%
(26/261) 11%
(29/261)
IX. Real Improvement Achieved 66%
(66/100) 0%
(0/100) 34%
(34/100)
X. Sustained Improvement Achieved 56%
(9/16) 19%
(3/16) 25%
(4/16)
Outcomes Total* 75%
(281/377) 8%
(29/377) 18%
(67/377)
Overall Percentage of Applicable Evaluation Elements Scored Met 88%
(1564/1778) * The activity or stage total may not equal 100 percent due to rounding.
Slide 17
PSN Validation Results Across All PIPs
Study Stage PSNs by Activity
Percentage of Applicable Elements
Met Partially
Met Not Met
Design
I. Appropriate Study Topic 100%
(94/94) 0%
(0/94) 0%
(0/94)
II. Clearly Defined, Answerable Study Question(s) 100%
(32/32) 0%
(0/32) 0%
(0/32)
III. Clearly Defined Study Indicator(s) 99%
(91/92) 1%
(1/92) 0%
(0/92)
IV. Correctly Identified Study Population 98%
(42/43) 2%
(1/43) 0%
(0/43)
Design Total 99%
(259/261) 1%
(2/261) 0%
(0/261)
Implementation
V. Valid Sampling Techniques (if sampling was used) Not
Applicable Not
Applicable Not
Applicable
VI. Accurate/Complete Data Collection 93%
(94/101) 6%
(6/101) 1%
(1/101)
VII. Appropriate Improvement Strategies 79%
(27/34) 21%
(7/34) 0%
(0/34)
Implementation Total* 90%
(121/135) 10%
(13/135) 1%
(1/135)
Outcomes
VIII. Sufficient Data Analysis and Interpretation 83%
(60/72) 17%
(12/72) 0%
(0/72)
IX. Real Improvement Achieved 50%
(14/28) 25%
(7/28) 25%
(7/28)
X. Sustained Improvement Achieved 100% (1/1)
0% (0/1)
0% (0/1)
Outcomes Total 74%
(75/101) 19%
(19/101) 7%
(7/101)
Overall Percentage of Applicable Evaluation Elements Scored Met 92%
(455/497) * The activity or stage total may not equal 100 percent due to rounding.
Slide 18
Next Steps
What’s Next?• New Collaborative Intervention
• Work Group
• Develop Action Plan
• PIPs submitted to HSAG for validation Wednesday, December 14, 2011
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