Analysis of MAHP/Milliman HEDIS Data Report

1. Analysis of MAHP/Milliman HEDIS Data Report May 15, 2013

2. About Discern • Consulting firm focused on improving the health care system through measuring and rewarding performance and value. • Our goal is to create sustainable health delivery models that enhance patient health and lower overall cost. • We have directly supported value-based health care initiatives in more than 15 states. • Clients include national quality groups, trade associations, state government, and private health care organizations.

3. Objective of Analysis • Per MBHP’s request, Discern reviewed the following documents: • MassHealth HEDIS Reports for 2008-2012 • Milliman’s February 11, 2013 report “Comparison of HEDIS Results: MassHealth PCCP and Managed Care Plans” • MAHP Letter to Secretary of Administration and Finance Glen Shor dated February 12, 2013 • Discern analyzed whether conclusions in the Milliman report were supported by the data in the MassHealth reports and whether assertions in the MAHP letter were supported by the other documents.

4. Summary Findings The Milliman report offers little conclusive evidence of quality of care performance differences between Medicaid MCOs and the Primary Care Clinician Plan (PCCP). • Small performance differences. • Different populations. • Methodological uncertainty.

5. Small Differences in Performance • The composite MCO has only been 3.6% more successful than the PCCP on the average HEDIS measure from 2008 to 2012. • The average difference in performance between the PCCP and the MCOs on behavioral health measures was just 1.6%, yielding a statistical confidence in the difference between MCOs and PCCP of 68%. • This confidence level is well below the level typically required for statistically conclusive results, which is typically set at 90% confidence or higher. • Of the 12 behavioral health measures included in the Milliman Report, MCOs reliably outperformed the PCCP on only two.

6. Comparison of Dissimilar Populations

7. Comparison of Dissimilar Populations

8. Risk-Adjustment • NCQA does not risk-adjust HEDIS quality of care measure results. • NCQA segmentation of HEDIS by Medicaid, Commercial, and Medicare is evidence that population types do influence HEDIS results • HEDIS answers the question “To what extent did this patient population receive the recommended set of health services?” • HEDIS does not answer the question, “How well would another health plan have done managing this same population?”

9. Methodological Uncertainty • Milliman aggregates the performance of multiple plans over multiple years • Not all plans’ data available for all years • Not all measures available for all years • MassHealth reports themselves provide more detail • Individual plans’ performance varies widely • Against its closest comparator plan in terms of size and utilization, PCCP performance in 2011 and 2012 on the Behavioral Health measures was the same or better on all but one measure.

10. Summary Findings The Milliman report offers little conclusive evidence of quality of care performance differences between Medicaid MCOs and the Primary Care Clinician Plan (PCCP). • Small performance differences. • Different populations. • Methodological uncertainty.

11. Thank You! Guy D’Andrea gdandrea@discernconsulting.com Discern Consulting 1501 Sulgrave Ave., Suite 302 Baltimore, MD 21209 (410)542-4470 www.discernconsulting.com