Performance Based Auto Assignment

1
Performance Based Auto Assignment

• Susan Moran
• Michigan Department of Community Health
• October 12, 2004

2
Program Highlights

• Medicaid Managed care implemented 1997 (1915(b)
  waiver)
• 17 contracted plans provide coverage in 82 of the
  83 counties
• 61 counties mandatory (includes 15 rural
  exception counties) 21 voluntary
• 1.4 million Medicaid beneficiaries
• 882,552 enrolled beneficiaries (as of 9-1-04)
• 962,749 total beneficiaries eligible for managed
  care

3
Contracting History

• Contracts awarded through competitive bid process
• Initial bid 1997-1998, focused on price
• Price (rate) re-bid 2000
• New FY 05-06 contracts recently issued as result
  of performance based competitive bid

4
Performance Monitoring

• Annual site visits
• Monthly encounter timeliness/volume, claims
  payment, complaint rate monitoring
• Audited HEDIS report
• Adult and child CAHPS

5
AA History

• 1997-1999
• Since inception, Medicaid contract included
  language that establishes states authority to
  distribute auto assignments
• Initial AA process based on technical score and
  bid rate
• Technical score considered relationships with
  community based entities, network features
• Lower bid rate higher score

6
FY 2000 AA Process

• AA criteria expands to include clinical and
  administrative criteria
• Clinical cervical cancer, breast cancer
  screening
• Administrative reporting timeliness
• Financial Bid rate by region

7
FY 04 AA Process

• 3 Performance categories
• Administrative, clinical, financial
• Equally weighted
• Three auto assignment tiers
• Proportionately more AAs in tier 1 than tier 2,
  and proportionately more AAs in tier 2 that tier 3

8
FY 04 Auto Assignment Criteria
9
FY 05 AA Process

• Network/Access capacity
• Considers strength of PCP network and enrollment
  capacity by region (100 pts.)
• Quality of Care
• HEDIS 2004 score compared to NCQA 50th and 75th
  percentiles (100 pts)
• Plans rank ordered within region
• Top half placed in upper AA tier lower half in
  bottom tier

10
Quality of Care

• Childhood immunization combo 1
• Well child visits zero visit rate
• Well child visits 3-6
• Timeliness of prenatal and postpartum care
• Diabetes HbA1c testing
• Getting needed care getting care quickly
  temporarily excluded

11
AA Enrollment Highlights

• Beneficiaries who fail to make a plan choice
  within 26 days of receiving an enrollment packet
  are auto assigned
• Percent auto assigned averages 40
• Enrollment broker administers the auto assignment
  process

12
Decision/Design Process

• Establish Objective
• Reviewed variety of performance measures
• State workgroup (internal) recommended initial
  set of measures
• Measures have evolved over time as available data
  has evolved

13
Measure Selection

• Valid and reliable data
• Timing and availability of data
• Absolute vs. relative measures of performance
• Variable levels of performance
• Align with strategic initiatives/goals

14
Incentive Strategies

• Financial
• Contractor Performance Bonus (Medicaid managed
  care)
• Auto assignment process
• Non Financial
• Consumer guide
• Performance reports
• Sanctions (financial and non financial)
• Corrective action plan
• Mandated performance improvement project
• Enrollment freeze

15
Summary

• Auto assignment can be an effective incentive
  strategy
• Keep it simple
• Select measures from different performance
  domains and data sets
• Its a work in progress