PIP VALIDATION REPORT 2014 YEAR 3 UPDATE: 2013-2014 EVALUATION PERIOD Prepared for: the Florida Healthy Kids Corporation Prepared by: the Institute for Child Health Policy, University of Florida Timeline and Context for FHK PIPs HEDIS® W34 for FHKP: 64% HEDIS® W34 for FHKP: 63% Preventive Dental Services FHKP: 50% Preventive Dental Services FHKP: 46% October 2010 FHKP selects well-child visits (W34) for the health plans and preventive dental services for dental plans PIPs based on quality of care results from '08-09' May '11 - April '12 Plans implement PIPs after submission, revision, and resubmission of PIP proposals with the ICHP EQR team May '12 - April '13 Plans submit Year 1 report and enter into 2nd year of PIP implementation. Plans adjust PIPs to accommodate the impact of state-wide rebids May '13 - April '14 Plans submit Year 2 report and enter into 3nd year of PIP. Health plans submit proposals for 2nd PIP of their choice and receive feedback from the ICHP EQR team May 2014 Plans submit Year 3 report and enter into 4th year of PIP. Health Plans are given approval to begin 2nd PIPs in Jan. 2015 Summary of FHKP Goals and Performance 2013-2014 MCO FHKP Health Plans Performance Goals Improve Well-Child (W34) Visits [Reach: All FHK 5-6] For plans performing 10 or more percentage points below the FHKP mean – improve to the FHKP mean For plans within 10 percentage points of the FHKP mean – improve to the national mean For plans within 10 percentage points of the national Medicaid HEDIS® mean – improve performance to the national mean or to 110% of current rate, whichever is greater 2013-2014 PIP Performance FHKP W34 was static, remaining below the 25% HEDIS® Medicaid benchmark Real improvement was not achieved for Amerigroup, FHCP, United, or WellCare Real improvement was reported by Coventry and Florida Blue FHKP Dental Plans Improve use of Preventive Dental Services [Reach: All FHK] Improve percentage of children using any preventive dental services (CDT codes D1000D1999) by at least 6 percentage points Increase the percentage of children in each age category receiving age-appropriate preventive services by at least six percentage points. FHKP preventive dental services increased by 1% in 2013 and has increased 3% since 2011 (members enrolled ≥6 months continually) Real improvement was reported by MCNA Other gains are reported by ICHP5 Reporting Key: = goal met; = goal partially met; = goal not met Evaluation of Health Plan’s W34 PIP Amerigroup Coventry FL Blue FHCP Sunshine United WellCare Study Topic M M M M M M M Study Question M M M M M M M Study Indicator M M M M M M M Identify Population M M M M M M M Sampling Methods PM M Data Collection M PM M M PM M PM Interventions NM M M PM PM PM PM Data Analysis PM PM PM PM PM M PM Real Improvement NM PM NA* NM NA* NM NM Sustained Improvement NA NA NA NA NA NA NA NA NA NA *Note: Fl Blue and Sunshine could not report statistical significance due to small sample size or lack of data for measurement year Reporting Key: = goal met; = goal partially met; = goal not met M NA HEDIS® W34 Rates FHKP HEDIS® W34 Rates by Year HEDIS® W34 Rates by Plan for MY 2013 100% Sunshine 80% 62.8% 64.7% 64.4% 75.9% Staywell (WellCare) 68.8% Amerigroup 63.6% FHCP 62.9% UHC 62.7% HealthEase (WellCare) 60.5% Coventry 59.2% Plan Rate 60% 40% 20% 0% 2011 2012 2013 Year HEDIS® 50th Percentile MY 2013 = 72.3% 0% 20% 40% 60% Rate 80% 100% Evaluation of Dental PIPs MCO Argus Note: Argus is new to the FHKP and does not have sufficient data for MY 2013 DentaQuest Note: DQ is revising PIP and did not have any interventions in place for MY 2013 MCNA Preventive Service (1) Preventive dental services (specifying measures for members enrolled ≥one month and those enrolled ≥three months) (1) Preventive dental services (2) Topical fluoride service (1) Preventive dental services (2) Sealants Argus DentaQuest MCNA Study Topic NA M M Study Question NA M M Study Indicator NA PM M Identify Population NA M M Sampling Methods NA Data Collection NA M M Interventions NA NM PM Data Analysis NA Real Improvement NA Sustained Improvement NA Reporting Key: = goal met; NA NA NM NA = goal partially met; NA PM M NA = goal not met Preventive Dental Services FHK MY 2010-2013 Preventive Dental Services FHKP MY 2013 100% 80% Rate 60% 40% 38.6% 38.0% 38.1% (+0.1) (+1.2) (-0.5) 44.2% 43.5% 43.8% (+0.6) (+1.5) (-0.3) 50.0% 49.3% 49.8% (+1.5) (+2.1) (+0.7) 55.2% 54.6% 55.2% (+1.5) (+1.8) (+1.3) 20% FHKP DQ MCNA FHKP DQ MCNA FHKP DQ MCNA FHKP DQ MCNA 0% Any Enrollment Length At Least 3 Months At Least 6 Months 11-12 Months Enrollment Length and Program/Plan Note: Numbers in parentheses indicate the change from MY 2013 2nd PIP Proposals for Health Plans Implementation January 2015 MCO PIP Topic and Indicator PIP Reach Amerigroup Topic: Improving Mental Health Follow-up within 7 days Post Hospitalization Indicator: HEDIS® 373 out of 58,398 FHK members Coventry Topic: Immunizations for Adolescents Indicator: HEDIS® 658 out of 21,056 FHK members Florida Blue Topic: Adolescent Well-Care Visits Indicator: HEDIS® 159 out of 330 FHK members FHCP Topic: Appropriate testing for Children with Pharyngitis Indicator: HEDIS® number not provided – (all FHK who qualify) out of 4057 Sunshine Topic: Adolescent Well-Care Reach: Indicator: HEDIS® 239 out of 1075 FHK members United Topic: Adolescent Well-Care Indicator: HEDIS® 11,816 out of 52,207 FHK members WellCare Topic: Improving Follow-Up After Hospitalization for Mental Illness Indicator: HEDIS® 303 out of 82,897 FHK members Next Steps and Recommendations Summary • There has been little change in the overall HEDIS® W34 rates for the FHKP from baseline to the completion of the 3rd year of FHKP PIP implementation • There have been steady gains made for FHKP in overall use of preventive dental services from baseline to the completion of the 3rd year PIP implementation Next Steps: Program-Level Response 1) Focus upcoming site visits and phone interviews with providers on QA/QI processes 2) Focus upcoming QAPI interviews with plans on PIPs 3) Perform a deep-dive analysis for HEDIS® W34 rates for FHKP members so as to identify specific recommendations for more targeted interventions 4) Summarize findings of the above listed (1-3) in a final report delivered in December 2014 Next-Steps: Plan-Level Recommendations • W34 Interventions must be readdressed by plans that have not experienced any change in their PIP indicators
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