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Quality Work Group

This report provides an update on the progress of the Quality Work Group, including the development of core and emerging quality measures. It also reviews the response to issues raised to date and outlines the next steps for moving forward.

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Quality Work Group

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  1. Quality Work Group Report to Members and Stakeholders 2.18.11

  2. Purpose of Today’s Report • Update on Quality Work Group • Review Quality Measures • Review DHHS Response to Issues Raised to Date • Next Steps/Process for Moving Forward

  3. Update Finalized core quality standards for inclusion in RFP. Met with program leads to identify supplemental quality measures for RFP. Developed preliminary list of core quality measures Developed preliminary list of emerging measures Identified potential measures for quality incentives

  4. Types of Quality Measures Core Quality Measures Emerging Quality Measures Incentive Measures

  5. Core Measures • Known to be tied to quality of care or outcomes • Nationally recognized, standardized and tested • Already in use in Maine and/or required under MCO accreditation • Ease of data collection • Actionable by the MCO • Broadly represent the domains and range of services/populations served by the MCO

  6. Emerging Measures • Require further definition/refinement • Not in general use nationally or in Maine • Pertain to populations or services not included in Year 01

  7. Incentive Measures • Weak performance under PCCM program (as shown in MaineCare UR reports) • Areas where return-on-investment to MCO is longer term but critical to quality outcomes • Areas where MCO has major role in implementing improvement interventions. • Areas with reliable data source

  8. Domains of Interest • Prevention and Health Promotion • Management of Chronic Conditions • Management of Acute Conditions • Functional Status and Symptomotology • Member Experience [TBD based on member survey] • Service Use and Cost

  9. Outstanding Issues • Determine if standard measure exists for: • BMI percent • Lipid screening • Develop stratifications for analyzing each measure by population group, age, program, etc. • Determine steward for data collection and analysis (e.g., MCO, DHHS, etc.) • Critically review number and types of incentives and relationship to current PIP. • Develop benchmarks for incentives.

  10. Responses to Issues Raised to Date SEE HANDOUT

  11. Next Steps • Staff review of measures • Final review and recommendations by Quality Work Group • Financial review by DHHS and consultants to assess implications of incentive measures

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