Medicare Advantage and Prescription Drug and Health Plan Quality Strategy Overview

1. Medicare Advantage and Prescription Drug and Health Plan Quality Strategy Overview Marsha Davenport, MD MPHCAPT, USPHS Chief Medical Officer Medicare Drug and Health Plan Contract Administration Group April 11, 2012

2. Overview Purpose Background of Quality Improvement (QI) Requirements Quality Strategy Future Directions Resources Summary

3. PURPOSE

4. Purpose Share our current and future vision and directions of the Medicare Advantage (MA) Quality Improvement (QI) Program Describe our new Quality Strategy for the MA and Prescription Drug Plan (PDP) Program Provide a framework for you to revise and align your QI Program with our new Quality Strategy

5. BACKGROUND: Quality Improvement (QI) Program Overview

6. Background: Medicare Advantage Quality Improvement (QI) Program 42 Code of Federal Regulations (CFR) � 422.152 Applies to all MAOs, including SNPs Development of a Quality Improvement (QI) Program Seven components of the QI Program Serves to integrate and coordinate all of the assessment tools and reporting requirements

7. QI Program -2- Chronic care improvement program (CCIP) Meet the requirements of 42CFR �422.152(c) Addresses populations identified by CMS based on review of current quality performance Quality improvement projects (QIPs) Meet the requirements of 42CFR �422.152(d) Expected to have a favorable effect on health outcomes and enrollee satisfaction Address areas identified by CMS

8. QI Program -3- Develop and maintain a health information system Encourage providers to participate in CMS and Health & Human Services (HHS) QI initiatives Contract with an approved Medicare CAHPS vendor to conduct the Medicare CAHPS satisfaction survey

9. QI Program -4- Include a program review process for the formal evaluation of the QI Program that addresses at least the following areas on an annual basis: Impact Effectiveness Take remedial action to correct problems identified using ongoing quality improvement

10. Foundations of the MA and PDP Quality Strategy The foundation of our Quality Strategy includes: 42 Code of Federal Regulations (CFR) � 422.152 2001 Institute of Medicine Report Triple AIM Health and Human Services (HHS) National Strategy for Quality Improvement in Health Care 2011 HHS National Prevention Strategy (NPS) 2011

11. Quality Strategy: Our Goals for MA and PDP We want the Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs) to compete on quality We want MAOs and PDPs to provide leadership and innovation in delivering quality health care Our Quality Strategy is the framework to guide the MA and PDP program

12. Defining Quality

Medicare Advantage and Prescription Drug and Health Plan Quality Strategy Overview

Medicare Advantage and Prescription Drug and Health Plan Quality Strategy Overview

Presentation Transcript

Medicare D Prescription Drug Benefit

Medicare health plan quality and performance ratings

Medicare Prescription Drug Benefits

Medicare Part D Prescription Drug Plan Medicare Blue Rx OSU

Medicare Prescription Drug Coverage

Quality Measurement and Improvement Under the New Medicare Prescription Drug Benefit

Medicare Prescription Drug Coverage

Medical and Prescription Drug Plan Choices

Let’s Learn Medicare! Medicare Prescription Drug Benefit

Comparing Quality in Medicare FFS and Medicare Advantage

Understanding Medicare Prescription Drug Coverage

Understanding Medicare Prescription Drug Coverage

Medicare and the New Prescription Drug Benefit

Navigating the Medicare Prescription Drug Plan Finder

Medicare Prescription Drug Coverage

Medicare Prescription Drug Coverage

Medicare Prescription Drug Coverage

Medicare Advantage Overview

MEDICARE PRESCRIPTION DRUG BENEFIT

Medicare Part D Prescription Drug Plan

Medicare Prescription Drug Coverage

Medicare Advantage Overview