hmo/psn quarterly meeting performance improvement projects
DESCRIPTION
HMO/PSN Quarterly Meeting Performance Improvement Projects. September 26 , 2011. Presenter: Christi Melendez, RN, CPHQ Project Manager, PIP Review Team. Presentation Topics. Discuss Well-Child Visits in the First 15 Months of Life—Six or More Visits Results Discuss Validation Results - PowerPoint PPT PresentationTRANSCRIPT
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HMO/PSN Quarterly MeetingPerformance Improvement Projects
September 26 , 2011
Presenter:
Christi Melendez, RN, CPHQProject Manager, PIP Review Team
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Slide 2
Presentation Topics
• Discuss Well-Child Visits in the First 15 Months of Life—Six or More Visits
• Results
• Discuss Validation Results
• Next Steps
• Important Dates
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HMO/PSN Non-Reform
Well-Child Visits in the First 15 Months of Life—
Six or More VisitsBaseline –
• Thirteen plans provided baseline results
• The overall rate for the Non-Reform HMOs was 34.0 percent
• The rates ranged from 11.1 to 80.0 percent
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HMO/PSN Non-Reform
Well-Child Visits in the First 15 Months of Life—
Six or More VisitsRemeasurement 1 –
• Twelve plans provided Remeasurement 1 results
• Seven plans reported improved rates from baseline to Remeasurement 1; all increases were statistically significant
• The overall rate increased from 34.0 percent to 37.1 percent
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HMO/PSN Non-Reform
Well-Child Visits in the First 15 Months of Life—
Six or More VisitsRemeasurement 2 –
• Ten plans provided Remeasurement 2 results
• Seven plans reported improved rates from Remeasurement 1 to Remeasurement 2; two of the increases were statistically significant
• The overall rate decreased from 37.1 percent to 30.0 percent
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HMO/PSN Non-Reform
Well-Child Visits in the First 15 Months of Life—
Six or More VisitsRemeasurement 3 –
• Five plans provided Remeasurement 3 results
• Two of the five plans reported improved rates from Remeasurement 2 to Remeasurement 3; none of the increases were statistically significant
• The overall rate decreased from 30.0 percent to 27.4 percentNOTE: Plans were not required to report Remeasurements 2 or 3 for
calendar year 2010
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HMO/PSN Non-Reform Baseline
Well-Child Visits in the First 15 Months of Life—Six or More Visits
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HMO/PSN Non-Reform Baseline to Remeasurement 1
Well-Child Visits in the First 15 Months of Life—Six or More Visits
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HMO/PSN Non-Reform Baseline to Remeasurement 2
Well-Child Visits in the First 15 Months of Life—Six or More Visits
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HMO/PSN Non-Reform Baseline to Remeasurement 3
Well-Child Visits in the First 15 Months of Life—Six or More Visits
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HMO/PSN Non-Reform Statistically Significant Improvement and
Sustained Improvement Validation Results for HMO PIPs Demonstrating Improvement
Well-Child Visits in the First 15 Months of Life—Six or More Visits
MCO MCO Type Statistically Significant Improvement
Sustained Improvement
Citrus Health Care, Inc. HMO Non-Reform Humana Family c/o Humana Medical Plan, Inc.
HMO Non-Reform
Jackson Memorial Health Plan HMO Non-Reform Preferred Medical Plan, Inc. HMO Non-Reform United Healthcare of Florida, Inc.—AmeriChoice HMO Non-Reform Vista Healthplan, Inc.—Buena Vista Medicaid HMO Non-Reform Vista Healthplan, Inc.—Vista South Florida HMO Non-Reform Wellcare Health Plans, Inc.—Healthease of Florida, Inc. HMO Non-Reform Wellcare Health Plans, Inc.—Staywell of Florida, Inc. HMO Non-Reform
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HMO/PSN Reform
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Baseline –
• Seven plans provided baseline results
• The overall rate for the Reform HMO/PSNs was 37.5 percent
• The rates ranged from 10.3 percent to 60.0 percent
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HMO/PSN Reform
Well-Child Visits in the First 15 Months of Life—Six or More Visits
Remeasurement 1 –
• Three plans provided Remeasurement 1 results
• One of the three plans reported an improved rate from baseline to Remeasurement 1, the increase was not statistically significant
• The overall rate improved from 37.5 percent to 52.7 percent
Remeasurement 2 –
• One plan provided a Remeasurement 1 rate of 46.2 percent; the result was below the plan’s baseline rate of 48.7 percent
NOTE: Plans were not required to report Remeasurements 1 or 2 for calendar year 2010
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HMO/PSN Reform Baseline
Well-Child Visits in the First 15 Months of Life—Six or More Visits
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HMO/PSN Reform Baseline to Remeasurement 1
Well-Child Visits in the First 15 Months of Life—Six or More Visits
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HMO Validation Results Across All PIPs (Reform and Non-Reform)
Study Stage Activity
Percentage of Applicable Elements
Met Partially
Met Not Met
Design
I. Appropriate Study Topic 96%
(288/299) 2%
(6/299) 2%
(5/299)
II. Clearly Defined, Answerable Study Question(s) 87%
(90/104) 13%
(14/104) 0%
(0/104)
III. Clearly Defined Study Indicator(s) 92%
(283/307) 7%
(22/307) 1%
(2/307)
IV. Correctly Identified Study Population 89%
(136/153) 11%
(17/153) 0%
(0/153)
Design Total 92%
(797/863) 7%
(59/863) 1%
(7/863)
Implementation
V. Valid Sampling Techniques (if sampling was used) 100%
(59/59) 0%
(0/59) 0%
(0/59)
VI. Accurate/Complete Data Collection 89%
(319/358) 4%
(15/358) 7%
(24/358)
VII. Appropriate Improvement Strategies 89%
(108/121) 9%
(11/121) 2%
(2/121)
Implementation Total 90%
(486/538) 5%
(26/538) 5%
(26/538)
Outcomes
VIII. Sufficient Data Analysis and Interpretation 79%
(206/261) 10%
(26/261) 11%
(29/261)
IX. Real Improvement Achieved 66%
(66/100) 0%
(0/100) 34%
(34/100)
X. Sustained Improvement Achieved 56%
(9/16) 19%
(3/16) 25%
(4/16)
Outcomes Total* 75%
(281/377) 8%
(29/377) 18%
(67/377)
Overall Percentage of Applicable Evaluation Elements Scored Met 88%
(1564/1778) * The activity or stage total may not equal 100 percent due to rounding.
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PSN Validation Results Across All PIPs
Study Stage PSNs by Activity
Percentage of Applicable Elements
Met Partially
Met Not Met
Design
I. Appropriate Study Topic 100%
(94/94) 0%
(0/94) 0%
(0/94)
II. Clearly Defined, Answerable Study Question(s) 100%
(32/32) 0%
(0/32) 0%
(0/32)
III. Clearly Defined Study Indicator(s) 99%
(91/92) 1%
(1/92) 0%
(0/92)
IV. Correctly Identified Study Population 98%
(42/43) 2%
(1/43) 0%
(0/43)
Design Total 99%
(259/261) 1%
(2/261) 0%
(0/261)
Implementation
V. Valid Sampling Techniques (if sampling was used) Not
Applicable Not
Applicable Not
Applicable
VI. Accurate/Complete Data Collection 93%
(94/101) 6%
(6/101) 1%
(1/101)
VII. Appropriate Improvement Strategies 79%
(27/34) 21%
(7/34) 0%
(0/34)
Implementation Total* 90%
(121/135) 10%
(13/135) 1%
(1/135)
Outcomes
VIII. Sufficient Data Analysis and Interpretation 83%
(60/72) 17%
(12/72) 0%
(0/72)
IX. Real Improvement Achieved 50%
(14/28) 25%
(7/28) 25%
(7/28)
X. Sustained Improvement Achieved 100% (1/1)
0% (0/1)
0% (0/1)
Outcomes Total 74%
(75/101) 19%
(19/101) 7%
(7/101)
Overall Percentage of Applicable Evaluation Elements Scored Met 92%
(455/497) * The activity or stage total may not equal 100 percent due to rounding.
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Next Steps
What’s Next?• New Collaborative Intervention
• Work Group
• Develop Action Plan
• PIPs submitted to HSAG for validation Wednesday, December 14, 2011