Upcoming EQR ActivitiesContract Year Two

1:45 p.m. – 2:30 p.m.

Peggy Ketterer, RN, BSN, CHCAExecutive Director, EQRO Services

Upcoming EQR activities

MARK YOUR CALENDARS!!!!The Contract Year 2 EQR Quarterly

Meetings are being scheduled as follows:Wednesday, September 26, 2007 (Webinar)

Wednesday, January 16, 2008 (AHCA Offices)

Wednesday, March 26, 2008 (Webinar)

Wednesday, June 18, 2008 (AHCA Offices)

Year Two EQR Activities

•Validation of PIPs

•Validation of performance measures

•Review of compliance with access, structural, and operations standards

•Strategic reports on consumer-reported surveys

•Strategic HEDIS® analysis reportsHEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

Year Two EQR Activities

•Technical assistance

•Value-based purchasing methodologies

•Evaluation of AHCA quality strategy

•Focused studies

•Dissemination of EQR information

•EQRO Technical Report

MCO Roles and Responsibilities related to Year Two EQR Activities

MCO Roles and Responsibilities

Validation of Performance Improvement Projects

Validation of PIPsMCO Roles and Responsibilities

• Provide basic information on the PIPs that are currently underway

• Complete the PIP form and provide supportive documentation for each PIP selected for validation

• Review HSAG’s completed PIP tool and summary grid, providing feedback and comments

Validation of PIPsMCO Roles and Responsibilities

• Participate in the Collaborative PIP activities– Attend Kick-Off Meeting (June 20th, 2007)– Fill out and maintain individual PIP Form– Participate in monthly conference calls– Facilitate one monthly conference call (with

HSAG support)

Validation of PIPsMCO Roles and Responsibilities

• Participate in the Collaborative PIP activities– Conduct key activities of the PIP following the

study design– Implement interventions– Collect and analysis two re-measurements

Project Activity by MonthValidation of Performance Improvement Projects (PIPs)

Task May Jun Jul Aug Sep Oct Nov Dec Jan 07

Feb Mar Apr May Jun

PIPs 7/07 – 8/07PIP Documentation

Requested

10/07 – 12/07Perform individual

PIP Analysis

12/07 – 2/08Prepare Annual

Validation Summary Report

1/08 – 4/08Prepare Annual Strategic Report

OngoingCollaborative PIP Activities

9/07MCO Submit PIP Forms

MCO Roles and Responsibilities

Validation of Performance Measures

Validation of Performance MeasuresMCO Roles and Responsibilities

• HMOs and PSN provide 2007 HEDIS® Baseline Assessment Tool (BAT), Data Submission Tool (DST), and Final Audit Report to HSAG

• HMOs and PSN complete and forward supplemental questions document to HSAG

• Establish a contact person if questions arise from the HSAG review team

Validation of Performance MeasuresMCO Roles and Responsibilities

PMHPs and NHDPs:• HSAG is working with AHCA and the

DOEA (for the NHDPs) to identify and define performance measures to be collected.

• Once performance measure data has been collected and reported by the PMHPs and NHDPs, HSAG will conduct the validation activities. The time frame for validation activities is yet to be determined.

Project Activity by MonthValidation of Performance Measures (PMVs)

Task May Jun Jul Aug Sep Oct Nov Dec Jan 07

Feb Mar Apr May

PMVs

11/07 – 1/08Prepare Report

10/07-11/07Receive MCO documentation

9/07

Request Documentation

Ongoing TA to AHCA/DOEAfor Performance Measure Development

MCO Roles and Responsibilities

Focused Studies

Focused StudiesMCO Roles and Responsibilities

Collect medical records• Receive list of sample cases • Identify appropriate providers• Collect medical records• Forward medical records to Tampa office • Provide status reports of medical record pursuit

• Provide data/information as requested

Project Activity by Month Focused Studies

Task Jun Jul Aug Sep Oct Nov Dec Jan 07

Feb Mar Apr May Jun

Focused Studies

7/07 –9/07Develop Study

Criteria for study(s)

9/07 – 10/07 Identify Study

Populations and Select Samples

10/07 – 12/07MCOs Collect Medical

Records

01/08 – 3/08Abstract Medical

Records

3/08 – 4/08Perform Data

Analysis

4/08 – 6/08Prepare

Report(s)

Upcoming EQR activities

•Quarterly EQR meetings (webinar and onsite at AHCA offices)

•Other meetings (including Collaborative PIP meetings and technical assistance sessions) will be scheduled in conjunction with the quarterly meetings

THANK YOU FOR YOUR PARTICIPATION!