Department of Medical Assistance Services, Virginia

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Quality The Land of Opportunity

• Presented by
• Department of Medical Assistance Services,
  Virginia

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Leap into the Land of Opportunity
Well-Balanced
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National Committee for Quality Assurance (NCQA)
Accreditation Standards
Virginia was the first state to require all
Medicaid MCOs to be NCQA accredited. The
rigorous accreditation and re-accreditation
process enables the plans to meet a significant
portion of CMS and state quality review
requirements
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CMS Mandated Activities Partially Overlap with
NCQA Requirements
A state may deem NCQA accreditation as evidence
of partially meeting duplicative CMS EQR
requirements, this results in a smarter use of
quality improvement resources
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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?

When benchmarking leads to actionable
recommendations, it is well worth the resources
used to answer these questions
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• Average for Virginia Medicaid MCO 46
• Lower than national mean, which is 49
• MCO 2 Was there a change in program, policy, or
  benefit design that may have resulted in a
  reduction from 2006 to 2007? If so, should it be
  re-introduced, and possibly replicated by the
  other MCOs? What is MCO 2 doing that
  consistently has them outperforming the other
  MCOs with this measure? Can it be replicated?

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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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All Virginia Medicaid Managed Care Partners are
NCQA Accredited Four of five are on the U.S.
News and World Report list of the top 100
Medicaid MCOs in the country!

• AMERIGROUP Community
  Care
• Anthem HealthKeepers Plus
• CareNET Southern Health
• Optima Family Care
• Virginia Premier Health
  Plan

New Health Plan Accreditation
33
Excellent
41
Excellent
22
Excellent
68
Excellent
Combined, Virginias Medicaid MCOs serve nearly
50 of the Medicaid population
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Administrative Data

• Partnering with the MCOs to streamline data
  collection, analysis, and reporting is well worth
  the investment of resources.
• Partnering in order to continuously improve
  information system processes requires a
  high-level of trust between the payer (the state)
  and the plans.

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Administrative Data Improvement

• In anticipation of using encounter data for rate
  setting with MCOs, DMAS hired a consultant to
  evaluate the validity of encounter data
• The consultant identified opportunities for
  improvement- trends in missing and incomplete
  claims data and invalid diagnosis codes
• DMAS, the MCOs and subcontractors have partnered
  to make system changes to strengthen the validity
  of the encounter data
• The consultant has re-examined the validity of
  the encounter data now that the fixes have been
  made
• DMAS will continue to monitor and evaluate the
  processes and data as we begin to use encounters
  for rate setting

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Resource Efficiencies

• When CMS quality review requirements duplicate
  NCQA requirements for accreditation, states may
  deem the CMS requirements as being met.
• Using HEDIS and CAHPS measures for benchmarking
  is a smart use of resources
• The collaborative approach to quality improvement
  enables plans to share best practices, conduct
  barrier analysis, and share resources

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Leap into Quality with your Balanced Portfolio
in Hand
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Next..

• A Best Practice Optima Health,
• a Virginia
  Medicaid MCO
• Ranked 22 Best Medicaid MCO in the U.S.