Welcome to the EQR Quarterly Meeting! Wednesday, March 26, 2008 1:00 p.m. – 2:30 p.m. (EDT)

1. Welcome to the EQR Quarterly Meeting!Wednesday, March 26, 20081:00 p.m. – 2:30 p.m. (EDT) We will begin shortly. Call-in information is 888.742.8686, Conference ID – 2087716. Please place your phone on mute unless you are speaking. Thank you. As a Participant you can enter “F11” for Full Screen View and “Esc” to return to normal view *6 to Mute or *7 to Un-Mute

2. External Quality Review Quarterly Meeting Wednesday, March 26, 20081:00 p.m. – 2:30 p.m. WELCOME!

3. EQR Quarterly Meeting • Welcome to all participants • Overview of agenda • Webinar do’s and don’ts • Evaluation Forms

4. Summary of Performance Improvement Projects Validation FindingsWednesday, March 26, 20081:15 p.m. – 1:45 p.m. Cheryl L. Neel, RN, MPH, CPHQ Manager, Performance Improvement Projects State & Corporate Services

5. Presentation Overview • 2007-2008 PIP Validation Process • Summary of Findings • PIP Validation Summary Report Update • MCO Comment Process • Next Steps

6. 2007-2008 PIP Validation Process • “Statement of Intent” was completed by each MCO type and submitted to HSAG. • PSNs were new to the PIP process this validation cycle. • For 2007-2008, MCOs were to submit to HSAG two PIPs for validation: • Clinical and nonclinical • Collaborative topic and one other

7. 2007-2008 PIP Process (cont.) • HSAG selected two PIPs per MCO type. • One collaborative PIP was chosen. • One other PIP was chosen based on HSAG’s selection criteria. • If an MCO did not have a nonclinical study in process and only had clinical studies, then two clinical PIPs were selected for this year’s validation cycle.

8. 111 PIPs Submitted

9. Collaborative PIP Topics

10. Summary of Findings • A total of 91 PIPs scored at least 80 percent compared to 21 PIPs in 2006-2007 (total of 81 PIPs for 2006-2007). • A total of 20 PIPs scored below 80 percent compared to 60 PIPs in 2006-2007. • For 2007-2008, Activities I-IV (study design) were assessed for all 111 PIPs. • 22 of the 111 PIPs had progressed to have Activity VII assessed. • 3 progressed through Activity X.

11. 2006-2007 Summary of PIP Validation Scores

12. 2007-2008 Summary of PIP Validation Scores

13. HMO Findings • Total of 46 PIPs • 2 PIPs were assessed through Activity X. • Average score was 92 percent. • Individual scores ranged from a low of 3 percent to a high of 100 percent. • 88 percent of all the applicable evaluation elements assessed received a Met finding. • 12 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

14. HMO PIP Overall Performance

15. HMO Summary of PIP Validation Scores

16. PSN Findings • Total of 16 PIPs • 1 PIP was assessed through Activity VI. • Average score was 79 percent. • Individual scores ranged from a low of 6 percent to a high of 100 percent. • 75 percent of all the applicable evaluation elements assessed received a Met finding. • 25 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

17. PSN PIP Overall Performance

18. PSN Summary of PIP Validation Scores

19. NHDP Findings • Total of 26 PIPs • Five PIPs were assessed through Activity IX. • Average score was 80 percent. • Individual scores ranged from 24 percent to 100 percent. • 70 percent of all the applicable evaluation elements assessed received a Met finding. • 30 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

20. NHDP PIP Overall Performance

21. NHDP Summary of PIP Validation Scores

22. PMHP Findings • Total of 23 PIPs • 1 PIP was assessed through Activity X. • Average score was 93 percent. • Individual scores ranged from 64 percent to a high of 100 percent. • 92 percent of all the applicable evaluation elements assessed received a Met finding. • 8 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

23. PMHP PIP Overall Performance

24. PMHP Summary of PIP Validation Scores

25. PIP Validation Summary Reports • PMHPs received PIP Validation Summary Reports on Friday, March 14, 2008. • HMOs, PSNs, and NHDPs received PIP Validation Summary Reports on Monday, March 24, 2008.

26. MCO Comment Process • The MCOs were provided with five business days from the receipt of their PIPs to contact HSAG if an error had occurred (No revisions or additional documents were accepted). • HSAG’s PIP Review Team will review all comments and questions, and respond to the MCOs within five business days from receipt of the inquiry.

27. Next Steps for MCOs • MCOs need to address all points of clarification, Partially Met, and Not Met evaluation elements. • HSAG has provided to the MCOs the Word version of the study submitted. • Use the same study document to continue working on the PIPs. Date, bold, strike-through any sections in which revisions are made to the study document.

28. PIP Validation Annual Summary Report • First draft of the 2007-2008 PIP Annual Summary Report will be sent to AHCA and DOEA on Friday, March 28, 2008. • Compilation of all the MCO findings. • Two year comparison for Activities I through IV. • Includes conclusions and recommendations.

29. Questions and Answerson PIP validation?

30. Open Discussion on Collaborative PIPs 1:45 p.m. – 2:05 p.m. Presenter: Peggy Ketterer, RN, BSN, CHCA Executive Director, EQRO Services

31. Collaborative PIPs Current status: • Monthly conference calls are held with all participants. • Documentation requirements for each PIP activity are discussed. • Host MCOs are responsible for facilitating the meeting and preparing meeting minutes.

32. Collaborative PIPs Current status – cont’d: • HMOs/PSNs: • Non-reform plans have collected baseline data and are currently identifying interventions. • Reform plans are collecting baseline data, which will officially be reported in July, 2008.

33. Collaborative PIPs Current status – cont’d: • PMHPs: • Plans are collecting baseline data which will be reported in July, 2008. • NHDPs: • Plans are collecting baseline data on a quarterly basis, with an annual rate calculated for calendar year 2008.

34. Collaborative PIPs Open Discussion: Collaborative approach – what is working well, what could be improved?

35. Collaborative PIPs Open Discussion: Collaborative approach – time frame for completion of PIP activities.

36. Collaborative PIPs Open Discussion: Collaborative approach – what are the challenges being faced?

37. Collaborative PIPs Next steps: • Continue monthly or bi-monthly conference calls • Continue to document on PIP study form • Submit PIP study form to HSAG for validation in October, 2008

38. Upcoming EQR Activities 2:05 p.m. – 2:20 p.m. Presenter: Peggy Ketterer, RN, BSN, CHCA Executive Director, EQRO Services

39. Upcoming EQR activities The next EQR Quarterly Meetings are scheduled for: • Wednesday, June 18, 2008 (AHCA Offices) One-on-One TA sessions Tuesday, June 17, 2008 • Wednesday, September 24, 2008 (Webinar)

40. Upcoming EQR activities The next EQR Quarterly Meetings are scheduled for: • Wednesday, January 14, 2009 (AHCA Offices) One-on-One TA sessions Tuesday, January 13, 2009 • Wednesday, March 25, 2009 (Webinar)

41. Upcoming EQR activities • Finalization of PIP Validation Reports (April 2008). • Annual PIP summary report and strategic summary report (May – June 2008).

42. Upcoming EQR activities • Behavioral health authorizations focused study report (June 2008). • EQR Technical Report (August 2008). • Site visits for the validation of PMHP performance measures will occur in May – June 2008.

43. Upcoming EQR Activities Questions?

44. External Quality Review Quarterly Meeting THANK YOU FOR YOUR PARTICIPATION!