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Presentation to: Care Management Committee

Presented by: Janice Carson, MDDeputy Director, PQO

Date: 04/09/15

Performance Measurement

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Mission The mission of the Department of Community Health is to

provide access to affordable, quality health care to Georgians through effective planning, purchasing,

and oversight.

We are dedicated to A Healthy Georgia.

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Overview

• Performance Measures– Overview of Purpose– Rate Generation Process– Populations Monitored

• CY 2013 Selected Performance Results • Questions

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Performance Measures

Tools to assess the performance of individual clinicians, clinical delivery teams, delivery organizations and health insurance plans in the provision of care to our Medicaid enrollees.

Our Measure Stewards include CMS and: NCQA

Healthcare Effectiveness Data and Information Set (HEDIS) Consumer Assessment of Healthcare Providers and Systems

(CAHPS) Surveys

Agency for Healthcare Research and Quality (AHRQ) The Joint Commission

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Performance Measurement

Performance Measurement helps us:– Understand the healthcare delivery process– Identify quality of care issues– Increase the effectiveness of healthcare delivery

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Performance Measure Rate Generation

HP - PM Generating Vendor HEDIS® software

subcontractor Medical Record

Review subcontractor

HEDIS® Certified Auditor

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Performance Measure Rates Generation

SpecificationsClaims-based

(Administrative Rate)

Medical Record Review (Hybrid Rates)

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CY 2013 Populations Monitored

ALL

CCSP

Fee for Service

GA Families

FosterCare

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Performance Results

CY 2011

CY 2012

CY 2013

Georgia Families

0.869

0.872

0.8781

FFSState Target

HEDIS 50th %tile 75.00%

77.00%79.00%

Child and Adolescent Access to PCPs

% A

cces

sing

Car

e

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Performance Results

CY 2011

CY 2012

CY 2013

Georgia Families

0.587

0.6266

0.6432

FFSState Target

HEDIS 50th Percentile

5.00%15.00%25.00%

Well Child Visits in first 15 months 6 or more visits

% w

ith S

ix o

r M

ore

Vis

its

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Performance Results

CY 2011

CY 2012

CY 2013

Georgia Families

0.681

0.6817

0.6964

FFSState Target

HEDIS 50th Percentile

5.00%15.00%25.00%

Well Child Visits Ages 3-6

% o

f vis

its

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Performance Results

CY 2011

CY 2012

CY 2013

Georgia Families

0.412

0.4997

0.4624

FFSState Target

HEDIS 50th %tile 5.00%

15.00%25.00%

Adolescent Well Care Visits

% w

ith v

isits

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Performance Results

CY 2012

CY 2013

Georgia Families

0.224

0.3436

FFSState Target

10.00%30.00%50.00%

Developmental Screening

% o

f Chi

ldre

n sc

reen

ed

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Performance Results

GF BMI GF Nutr Couns

GF Phy Act Couns

FFS BMI FFS Nutr Couns

FFS Phy Act Couns

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

CY 2011CY 2012CY 2013Target

Weight Assessment and Counseling for Children and Adolescents

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Performance Results

Georgia Families

FFS

Testing for Pharyngitis

76.50% 72.75%

Approp. Tx for URI

81.95% 80.94%

These measures describe care for sick children. One identifies whether providers are appropriately conducting strep tests for children diagnosed with pharyngitis and the other describes the percentage of practitioners who are not prescribing antibiotics for viral URIs. About 25% of practitioners are not performing strep tests and about 20% of providers are prescribing antibiotics for viral URIs.

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Performance Results

Georgia Families

FFS

Chlamydia Screening

50.11% 43.42%

Breast Cancer Screening

72.90% 31.49%

Cervical Cancer Screening

72.83% Hyb 35.77% Hyb

Women’s Health Measures

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Performance Results

• CY 2013 Pregnancy Metrics– Most GF pregnant women enrolled in

managed care during 2nd trimester (62.35%). New process to improve this metric.

– Most FFS pregnant women enrolled in Medicaid during 3rd trimester (61.36%)

– 60.5% of GF pregnant women attended 81% or more of their projected prenatal visits. Only 28.71% of FFS pregnant women attended 81% or more of their projected prenatal visits.

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Performance Results

CY 2012 CY 2013

GF LBW Rate 8.59% 8.92%

FFS LBW Rate 8.52% 10.34%

GF C-Sec Rate 31.25% 31.88%

FFS C-Sec Rate 27.48% 31.08%

GF C-Sec Rate for NSV 19.07% 18.02%

FFS C-Sec Rate for NSV 12.72% 16.94%

Pregnancy Outcomes

NSV = Nulliparous Singleton Vertex presentations.Implemented Hard Stop Policy in October 2013. Awaiting CY 2014 data to determine the effectiveness of the policy.

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Performance Results

Asthma Approp

Meds GF

Asthma Approp

Meds FFS

Asthma Meds 50% Comp GF

Asthma Meds 50% Comp FFS

Asthma Meds 75% Comp GF

Asthma Meds 75% Comp FFS

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

CY 2012CY 2013Target

Asthma Care

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Performance Results

HbA1c Testing GF HbA1c Testing FFS HbA1c >9 GF HbA1c>9 FFS0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

CY 2011CY 2012CY 2013

Diabetes Care

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Performance Results

CY 2012 CY 2013

Georgia Families 0.4719 0.4692

FFS 0.3893 0.2774

2.50%

7.50%

12.50%

17.50%

22.50%

27.50%

32.50%

37.50%

42.50%

47.50%

Controlling High Blood Pressure

% o

f Mem

bers

Con

trol

led

Target % was 57.52

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Performance Results

Follow Up 7 day GF Follow Up 7 day FFS Follow Up 30 day GF Follow Up 30 day FFS

CY 2011 0.459 0.371 0.676 0.591

CY 2012 0.4704 0.4017 0.6511 0.6126

CY 2013 0.4759 0.4069 0.6889 0.6054

Target 0.6957 0.6957 0.8428 0.8428

5.00%

15.00%

25.00%

35.00%

45.00%

55.00%

65.00%

75.00%

85.00%

Follow Up after Hospitalization for Mental Illness

% o

f mem

bers

with

f/u

visit

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Performance Results

CY 2011

CY 2012

CY 2013

Georgia Families

0.688

0.6977

0.6947

FFSTarget 90th %tile

5.00%

15.00%

25.00%

Annual Dental Visits

% o

f mem

bers

with

ann

ual

visit

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Performance Results

• In CY 2013: – Alcohol and other drug dependence - 35.62% of GF members with a new

episode of alcohol and other drug dependence initiated treatment within 14 days of diagnosis through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization. Only 7.65% who initiated treatment had two or more additional services within 30 days of the initiation visit. FFS members, 40.15% initiated treatment but only 4.72% had two or more additional services within 30 days of initiation.

– ADHD - 35.74% of GF 6 – 12 year olds newly prescribed treatment for ADHD came back for an appt within 30 days of their new prescription and 48.76% of those who remained on treatment for at least 7 months had at least two follow up visits within 9 months after the initiation phase ended. FFS - 33.58% came back in 30 days and 45.32% who remained on treatment at least 7 months had two follow up visits within 9 months after the initiation phase.

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Performance Results

Georgia Families

FFS

ER Visits/1000 MM

58.12 91.38

Antibiotics of Concern

41.17% 43.89%

Plan All Cause Readmissions

9.93% 10.11%

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Questions