Welcome to the EQR Quarterly Meeting! Wednesday, March 25, 2009 1:00 p.m. – 2:30 p.m. (EDT)

1. Welcome to the EQR Quarterly Meeting!Wednesday, March 25, 20091:00 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 [DO NOT USE HOLD]. 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 25, 20091:00 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 Findings Wednesday, March 25, 2009 1:15p.m. – 1:45 p.m. Presenter: Donald Grostic, MS Associate Director, Research and Analysis Team State & Corporate Services

5. Presentation Overview • 2008-2009 PIP Validation Process • Summary of Findings • PIP Validation Summary Report Update • MCO Comment Process • Next Steps

6. 2008-2009 PIP Validation Process • “Statement of Intent” was completed by each MCO type and submitted to HSAG. • For 2008-2009, MCOs were to submit to HSAG two PIPs for validation: • Clinical and nonclinical • Collaborative topic and one other

7. 2008-2009 PIP Process (cont.) • HSAG selected two PIPs per MCO based on prior-approved selection criteria. • One collaborative and one plan-specific PIP. • One clinical and one nonclinical, unless all PIPs were one type or the other in which case both were clinical or nonclinical for this year’s validation cycle.

8. 119 PIPs Submitted for 2008-2009

9. Collaborative PIP Topics

10. Summary of Findings • A total of 73 PIPs scored at least 80 percent compared to 91 PIPs in 2007-2008 (total of 111 PIPs for 2007-2008). • A total of 46 PIPs scored below 80 percent compared to 20 PIPs in 2007-2008. • For 2008-2009, Activities I-V (sampling) were assessed for all 119 PIPs. • 18 of the 119 PIPs had progressed to have Activity IX assessed. • 3 progressed through Activity X.

11. Summary of PIP Validation Scores

12. HMO Findings • Total of 50 PIPs • Three PIPs were assessed through Activity X. • The average PIP score was 85 percent. • Individual scores ranged from a low of 50 percent to a high of 100 percent. • 86 percent of all the applicable evaluation elements assessed received a Met finding. • 14 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

13. HMO PIP Overall Performance 2007-2008 2008-2009

14. HMO Summary of PIP Validation Scores

15. HMO Findings for Collaborative PIPs • Total of 24 PIPs • Nine PIPs were assessed through Activity IX. • The average PIP score was 89 percent. • Individual scores ranged from a low of 68 percent to a high of 100 percent. • 89 percent of all the applicable evaluation elements assessed received a Met finding. • 11 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

16. HMO Collaborative PIP Overall Performance 2008-2009

17. HMO Summary of Collaborative PIP Validation Scores

18. PSN Findings • Total of 16 PIPs • Nine PIPs were assessed through Activity VIII Evaluation Element 5. • The average PIP score was 73 percent. • Individual scores ranged from a low of 23 percent to a high of 100 percent. • 72 percent of all the applicable evaluation elements assessed received a Met finding. • 28 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

19. PSN PIP Overall Performance 2007-2008 2008-2009

20. PSN Summary of PIP Validation Scores

21. PSN Findings for Collaborative PIPs • Total of 8 PIPs • Four PIPs were assessed through Activity VIII Evaluation Element 5. • The average PIP score was 80 percent. • Individual scores ranged from a low of 57 percent to a high of 100 percent. • 80 percent of all the applicable evaluation elements assessed received a Met finding. • 20 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

22. PSN Collaborative PIP Overall Performance 2008-2009

23. PSN Summary of Collaborative PIP Validation Scores

24. NHDP Findings • Total of 29 PIPs • Two PIPs were assessed through Activity IX. • The average PIP score was 74 percent. • Individual scores ranged from 46 percent to 91 percent. • 74 percent of all the applicable evaluation elements assessed received a Met finding. • 26 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

25. NHDP PIP Overall Performance 2007-2008 2008-2009

26. NHDP Summary of PIP Validation Scores

27. NHDP Findings for Collaborative PIPs • Total of 15 PIPs • Fourteen PIPs were assessed through Activity VIII Evaluation Element 5. • The average PIP score was 74 percent. • Individual scores ranged from 46 percent to 91 percent. • 73 percent of all the applicable evaluation elements assessed received a Met finding. • 27 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

28. NHDP Collaborative PIP Overall Performance 2008-2009

29. NHDP Summary of Collaborative PIP Validation Scores

30. PMHP Findings • Total of 24 PIPs • One PIP was assessed through Activity IX. • The average PIP score was 86 percent. • Individual scores ranged from 53 percent to a high of 100 percent. • 85 percent of all the applicable evaluation elements assessed received a Met finding. • 15 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

31. PMHP PIP Overall Performance 2007-2008 2008-2009

32. PMHP Summary of PIP Validation Scores

33. PMHP Findings for Collaborative PIPs • Total of 12 PIPs • Seven PIPs were assessed through Activity VIII Evaluation Element 5. • The average PIP score was 95 percent. • Individual scores ranged from 90 percent to a high of 97 percent. • 95 percent of all the applicable evaluation elements assessed received a Met finding. • 5 percent of all the applicable evaluation elements assessed received a Partially Met or Not Met.

34. PMHP Collaborative PIP Overall Performance 2008-2009

35. PMHP Summary of Collaborative PIP Validation Scores

36. PIP Validation Summary Reports • PIP Validation Summary Reports were sent to HMOs, PSNs, PMHPs and NHDPs the week of March 16th, 2009.

37. 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.

38. PIP Validation Annual Summary Report • First draft of the 2008-2009 PIP Annual Summary Report will be sent to AHCA and DOEA on Friday, March 27, 2009. • Compilation of all the MCO findings. • Includes conclusions and recommendations.

39. 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.

40. Questions and Answerson PIP validation?

41. Upcoming EQR Activities 1:45 p.m. – 1:55 p.m. Presenter: Yolanda Strozier, MBA Project Manager, EQRO Services

42. Upcoming EQR activities The next EQR Quarterly Meetings are scheduled for: • Wednesday, June 10, 2009 (AHCA Offices) One-on-One TA sessions Tuesday, June 9, 2009 • Wednesday, September 23, 2009 (Webinar)

43. Upcoming EQR activities The next EQR Quarterly Meetings (cont.) are scheduled for: • Wednesday, January 13, 2010 (AHCA Offices) One-on-One TA sessions Tuesday, January 12, 2010 • Wednesday, March 24, 2010 (Webinar)

44. Upcoming EQR activities • Finalization of PIP Validation Reports (April 2009). • Annual PIP summary report and strategic summary report (April – June 2009).

45. Upcoming EQR activities • EQR Technical Report (August 2009). • Site visits for the validation of PMHP performance measures will occur in May – June 2009.

46. Upcoming EQR Activities Questions?

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