Carol L. Stanley, MS, CPHQ

1
Medicaid QUALITY No Great
Thing is Created Suddenly Epictetus, c. 55-135
C.E.

• Presented by
• Carol L. Stanley, MS, CPHQ
• Quality Improvement Analyst
• Department of Medical Assistance Services,
  Virginia
• [phone] Carol.Stanley_at_DMAS.Virginia.Gov
  
  
  
• 
  
  
  Today is September
  11, 2008
• 
  We
  Remember

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Where is Medicaid Quality _at_ DMAS?

• Department of Medical Assistance Services
• Division of Health Care Services
• Systems and Reporting Unit
• Quality Improvement

NEW
External Quality Review Organization (EQRO)
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Key Features of Virginias Medicaid Quality
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Requirement for Accreditation Supports the DMAS
Mission Statement

• Virginia is one of only a few states that
  requires Medicaid MCOs to be NCQA accredited!
  This bold quality standard reflects DMAS mission
  statement

To provide a system of high quality and cost
effective health care services to qualifying
Virginians and their families.
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NCQA Accreditation Status

• Excellent (the highest status achievable!)
• Anthem HealthKeepers Plus
• CareNET Southern Health
• Optima Family Care
• Virginia Premier Health Plan
• New Health Plan Accreditation
• AMERIGROUP Community Care

MCO is listed in the U.S. News and World Reports
top 100 Medicaid MCOs in the country! (2007).
2008 rankings will be released in November.
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Coming Soon

• Through a competitive RFP process, a new EQR
  contract will begin by the end of this calendar
  year
• Key opinion leaders (nationally) are exploring
  the possibility of aligning SCHIP quality
  requirements with Medicaid MCO requirements
• Quality Compass 2008 will be released in October
  by NCQA
• Focused Studies 2008 reports
• expected to be released by January 2009

7
CMS Mandated (external quality review) Activities
Partially Overlap with NCQA Requirements
A state may deem NCQA accreditation as evidence
of partially meeting duplicative CMS EQR
requirements. Going forward, DMAS will eliminate
duplicative EQR activities!
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Look to HEDIS to help Benchmark

• Benchmark A continuous process of measuring
  products, services and/or practices against the
  competition in order to find and implement the
  best practices - National Association for
  Healthcare Quality
• How are we doing as a state?
• How are we doing in comparison to states with
  similar demographics and/or similar Medicaid
  delivery systems?
• How are our MCOs doing in comparison to each
  other, the state average, and the national
  average?
• Which states and MCOs are significantly above the
  mean? What programs, policies, or benefit
  designs are used by these states that have
  positioned them as a best practice? Can it be
  replicated in our state?

Virginia Medicaid MCO HEDIS Scores Include FAMIS
Medicaid Enrollees in the Populations Studied
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MCOs Aim to Increase the Use of Childhood
Immunizations

• Direct mail prompts to members
• Coding and billing guidelines mailed to
  physicians
• MD office receive list (from MCOs) of patients
  needing immunizations
• Establishing data exchange link with Virginia
  Immunization Registry
• visits Retail gift card for parents who send
  proof of well-child (card signed by physician)
• Social marketing through signage on MCO vans
• Newsletter articles to providers and members
• Pay-for-performance (to physicians for increasing
  immunization rates)

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MCOs Aim to Increase the Use ofWell-Child Visits

• Direct mail prompts to members
• Coding and billing guidelines mailed to
  physicians
• MD office receive direct mail information about
  EPSDT
• Physicians receive list of children due for
  visits
• Newsletter articles to providers and members
• Missed-appointment reminders
• Reminders through happy-birthday cards
• Yearly calendars provided to moms with well-child
  reminders on it

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2008 HEDIS Numbers

• Hot-Off-the-Press

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Childhood Immunization rates improved (from HEDIS
2007) among all MCOsin Virginia
Coming Soon!
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3/5 MCOs Well-child visits increased, with one
of the plans reporting an increase of 17
percentage points
Coming Soon!
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Other Well-Child
Coming Soon!
Coming Soon!
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Rates for the control of asthma with medications
improved for all MCOs
Coming Soon!
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Dance with the Data But dont let it trip you!

• As with all data, HEDIS data has limitations.
  The technical specifications for each measure is
  comprehensive, rigorous, and subject to change
  each year. This limits the ability to trend data
  over time.
• First-time measures should be viewed with caution
  as change takes time.
• May be more useful to see how Virginia compares
  with other states and its percentiles.

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Other Data

• Annual Focused Studies Since 2004
• Immunizations
• Well-Child Visits
• Asthma
• Pre-Natal Care

• Currently in a transition year
• 2008 Focused Studies
• Immunizations
• Well-Child Visits
• Asthma
• Pre-Natal Care
• NEW for 2008- Further stratification by race
  and,
• The data analysis is more aligned with meeting
  FAMIS and Medicaid reporting requirements
• Anticipated release date of 2008 Focused Studies
  is January, 2009

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The Future of Focused Studies

• Improving Birth Outcomes through Adequate
  Prenatal Care
• Well-Child (immunizations, asthma, PCP visits
  will also be a component of the well-child
  focused study)
• Blood Pressure and Cholesterol Management

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Collaborating

• Partner with Purpose!
• State Agencies
• and
• MCOs

• Focus on common opportunities for improvement
• Conduct barrier analysis as a group
• Identify potential solutions to removing barriers
  as a group
• Implement and assess progress along the way
  

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More Information

• www.NCQA.org
• www.cms.gov
• www.DMAS.Virginia.Gov
• www.IHI.org