Outline of 2007 Quality Affirmation Exercises.

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Diagram of 2007 Quality Confirmation Exercises Maryland Division of Wellbeing and Mental Cleanliness November 29, 2007 Outline 2007 Quality audit exercises: Frameworks Execution Survey Solid Children Quality Observing System Enrollee Fulfillment Review
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Outline of 2007 Quality Assurance Activities Maryland Department of Health and Mental Hygiene November 29, 2007

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Overview 2007 Quality audit exercises: Systems Performance Review Healthy Kids Quality Monitoring Program Enrollee Satisfaction Survey Healthcare Effectiveness Data and Information Set (HEDIS) Value-Based Purchasing Performance Measures Consumer Report Card Performance Improvement Projects 2

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Systems Performance Review Federal law obliges that all State Medicaid Programs utilize an External Quality Review Organization (EQRO) to direct a yearly Systems Performance Review (SPR) of all oversaw care associations (MCO). The Department contracts with Delmarva Foundation to direct the SPR. The 2006 SPR comprised of 9 guidelines. Each MCO is evaluated independently on consistence with every standard. Criteria utilized for every standard is explored and redesigned yearly by the Department in view of EQRO suggestions. 3

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System Performance Review (proceeded with) The Department pivoted two gauges for 2006, Outreach Plan and Health Education in light of the fact that the greater part of the MCOs had already met the base consistence rate (100%.) For 2006, the base consistence rate for all guidelines was 100% aside from Oversight of Delegated Entities at 90% and Fraud and Abuse at 70%. For any standard or any parts of a standard that don\'t meet the base consistence level, MCOs are in charge of actualizing an endorsed remedial activity arrangement. 4

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Systems Performance Review

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Healthy Kids Quality Monitoring Program Monitoring is performed by a group of medical caretakers who likewise audit and affirm suppliers for EPSDT administrations. Through restorative record surveys, the medical caretakers rate each MCO’s execution on consistence with the 5 noteworthy EPSDT segments: Health and Developmental History. Complete Physical Exam. Research center Tests. Vaccinations. Wellbeing Education. Information results are evaluated and approved by the EQRO and are incorporated in the SPR report. All MCOs surpassed the base composite consistence rate of 85%. All MCOs met or surpassed the 70% consistence rate for each of the 5 segments of the survey. 6

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Healthy Kids Audit Results

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Healthy Kids Audit Results

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Enrollee Satisfaction Surveys DHMH conducts an enrollee fulfillment review every year utilizing the Consumer Assessment of Healthcare Providers and Systems (CAHPS ®) overview instruments intended to assess members’ fulfillment with their wellbeing arrangements. DHMH utilizes a NCQA guaranteed CAHPS merchant to direct the study and accumulate the outcomes. Reviews incorporate inquiry sets covering: Enrollment and scope Access to and usage of medicinal services Communication and association with suppliers Interaction with MCO organization Self saw wellbeing status 9

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Enrollee Satisfaction Surveys (proceeded) In 2007 11,362 CAHPS Medicaid Adult Surveys and 13,958 CAHPS Medicaid Child with Chronic Care Condition (CCC) Surveys were sent. There were 2,850 grown-up reactions and 4,867 tyke reactions. Subsequent telephone calls were made to meeting individuals who did not react via mail. Reaction rates shifted by MCO extending from 21% to 35% for grown-ups and 15% to 29% for kids. Taking into account appraisals of 0 to 10 where 10 is the best, the most reduced MCO score in any evaluating is 7.4 for grown-ups and 6.4 for kids. 10

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Provider Satisfaction Surveys DHMH conducts a yearly supplier fulfillment review to evaluate supplier fulfillment with different parts of HealthChoice. DHMH utilizes a NCQA ensured HEDIS overview merchant to lead the review and order the outcomes. Truly, reaction rates have been low and it is trusted that a shorter review in mix with phone subsequent may help to expand supplier study interest starting in 2008.

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Provider Satisfaction Surveys (proceeded with) Survey themes include: Finance Issues Customer Service/Provider Relations No-Show HealthChoice Appointments Coordination of Care and Case Management Utilization Management Overall Satisfaction In 2007 A mail-just study organization strategy was used to study an arbitrary example of Primary Care Providers (PCPs) from each of the seven MCOs. From an aggregate total of 5,309 PCPs, 248 reactions were gotten yielding an aggregate total reaction rate of 6.1%

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HEDIS Performance Measures The Healthcare Effectiveness Data and Information Set is an institutionalized arrangement of execution measures created by NCQA and CMS to quantify oversaw care execution and survey open doors for enhancements in nature of consideration. Every year NCQA upgrades the estimation set in view of the most recent data accessible . The Department contracts with a NCQA guaranteed HEDIS seller to review and report the MCOs’ scores. MCOs utilization claim and experience information to create every measure. Be that as it may, for a few measures, MCOs are permitted to supplement deficient information with restorative record surveys. 13

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HEDIS Performance Measures For 2007, MCOs were obliged to report their execution on 20 HEDIS measures. Access/Availability of Care Children and Adolescents’ Access to Primary Care Practitioners Adults’ Access to Preventive/Ambulatory Health Services Prenatal and Postpartum Care Call Answer Timeliness Call Abandonment Effectiveness of Care Childhood Immunization Status Adolescent Immunization Status Breast Cancer Screening Cervical Cancer Screening Comprehensive Diabetes Care Use of Appropriate Medications for People with Asthma Appropriate Treatment for Children with Upper Respiratory Infection ( NEW ) Appropriate Testing for Children with Pharyngitis ( NEW ) Chlamydia Screening in Women ( NEW ) Use Of Services Frequency of Ongoing Prenatal Care Well-Child Visits in the First 15 Months of Life Well-Child Visits in the Third, Fourth, Fifth and Sixth Year of Life Adolescent Well-care Visits Discharge and Average Length of Stay-Maternity Care Births and Average Length of Stay, Newborns 14

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HEDIS Performance Measures (proceeded with) The 2007 HEDIS reviews had an increment in the quantity of DHMH measures that must be accounted for. Three measures included gave data protection administrations gave to HealthChoice individuals. These measures were: Chlamydia Screening in ladies, Appropriate Testing for Children with Pharyngitis, Appropriate Treatment for Children with Upper Respiratory Infection. By and large, the MCOs keep on showwing change in their HEDIS scores in the course of the most recent 4 years. 15

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Department of Health and Mental Hygiene

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MCOs: Benchmarks: AGM = AMERIGROUP Maryland, Inc. NMH = National Medicaid HEDIS Mean HFC = Helix Family Choice, Inc. MARR = Maryland Average Reportable Rate DIA = Diamond Plan - the Medicaid product offering of Coventry Health Care MMA = Maryland MCO Average JMS = Jai Medical Systems Managed Care Organization, Inc MPC = Maryland Physicians Care PP = Priority Partners UHC = UnitedHealthcare of the Mid-Atlantic, Inc. Report Indicators : NR = Not Reportable NA = Not Applicable

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Value-Based Purchasing Value Based Purchasing is an arrangement of execution measures taking into account current HealthChoice observing exercises. The objective of our Value Based Providing so as to purchase technique is to enhance MCO execution money related motivating forces and disincentives. These 10 measures cover exceedingly essential measurements of MCO execution: Access to Care Quality of Care Administration (MCO structure and operations) 5 of the 10 measures are HEDIS measures and 5 are Maryland particular. 20

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Value-Based Purchasing (proceeded with) Targets for every measure have been built up taking into account 3 levels of execution: Disincentive: For any measure that the MCO does not meet the base focus on, a disincentive of 1/9 of 1/2 percent of the aggregate capitation paid to the MCO amid the estimation year will be gathered. Nonpartisan Incentive: For any measure that the MCO surpasses the base focus on, the MCO might be paid an impetus installment of up to 1/9 of 1/2 percent of the aggregate capitation sum paid to the MCO amid the estimation year. 21

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Value-Based Purchasing (proceeded)

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Consumer Report Card This is the fifth year that we have created a HealthChoice Consumer Report Card. Since its origin, the Department has been contracting with the NCQA (through the EQRO contract) to build up the approach and compute the MCOs’ scores. The 6 execution regions appraised in the Report Card are figured aggregating 30-40 measures from HEDIS, Value Based Purchasing, and the Satisfaction Survey. The Consumer Report Card is incorporated in all enlistment parcels. 23

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Performance Improvement Projects Currently have 2 Performance Improvement Projects continuous that MCOs are obliged to direct: Improve Screening for Chronic Kidney Disease Improve Cervical Cancer Screening (Began July 2007) Improving the Delivery of Prenatal/Postpartum Care was finished in 2007. PIPs comprise of: Submission of information accumulation and examination arrangement Baseline estimation of information Intervention advancement and execution Re-estimation of information 24

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Performance Improvement Projects For Prenatal/Postpartum: All MCOs enhanced their scores from pattern in 2004 to last in 2007. For CKD Measure 1 “HEDIS, Kidney Disease Monitored Rate

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