Florida Agency for Health Care Administration (AHCA)

Collaborative PIP HMOs/PSNs Conference Call Minutes

12/11/2007

MCOs Represented : Access Health Solutions, Children’s Medical Services, Humana Family, Jackson Memorial Health Plan, Ped-I-Care, Pediatric Associates, Preferred Medical Plan, Total Health Choice, United Healthcare of Florida, Universal Health Care, Vista Healthplan, Well Care of Florida, Citrus Health Care, Health Systems One, South Florida Community Care Network.

MCOs Not Represented: Healthy Palm Beaches Personal Health Plan, United Health Care of Florida –Evercare

Topic /

Discussion

/ Action / Responsible Person / Due
Date / Completed /
Opening Comments / Conference call was hosted by Preferred Medical Plan, Inc (PMP).
After introductions and roll call, PMP asked if there were any changes to the minutes from the previous call. No changes were identified.
Jackson Memorial Health Plan and Vista Health Plan stated not having received the Agenda or previous minutes. / Cheryl Neel will forward the agenda and minutes to the two health plans.
The website where minutes and agendas are located:
www.myfloridaeqro.com / C. Neel / ASAP / 12/12/07
PMP reviewed objectives for the conference call:
1.  To discuss status of completion of documentation for Activity 6 (non-reform plans)
2.  To discuss documentation requirements for Activity 7 (non-reform plans)
3.  To discuss preparation for data collection and reporting (reform plans)
To eliminate confusion, the first half of the call addresses only non-reform plans, the second addresses reform plans.
10:00 -10:30 AM – Non Reform Medicaid.
10:30/11:00 AM –Rreform Medicaid
Current Status of Collaborative PIP - Non Reform Medicaid / Activities 1-4 submitted by each Health Plan are currently being reviewed by the HSAG Review Team. There will be a PIP’s Validation report to AHCA on February 2008.
Baseline data (HEDIS 2007 Well-Child Visits in the First 15 Months of Life) has been collected.
Cheryl discussed in detail the Documentation of Activities 6a and 6b (Data Completion & Collection) and what they were looking for; mainly data accuracy, reliability, completeness and back up documentation.
Discussion of Activity 6c - data analysis and other pertinent methodological features. HSAG will be reviewing the following elements:
·  What is the systemic process used for data collection, that includes your baseline and re-measurement data.
·  Your timeline for data collection
·  Defined data elements to be collected
·  Source of the data must be clear (internal, vendor, who are the vendors, how often oversight.
·  What is your audit process (HEDIS) what is your process?
·  An estimated degree of automated data completeness (100%-99 %?).
·  Automated data algorithms
·  Steps for data analysis, and how you follow these steps.
·  What you do with missing data, your interventions and plan should be documented, what is being done about it, what is your plan and interventions you should address this issue.
·  Manual data collection tool that support interrater reliability.
/ HSAG completing validation of PIP activities one through four.
Health Plans were encouraged to be thorough in their documentation and data sources, to input any additional information and data; to expand and attach any relevant documentation, tools, policies, workflow etc. / HSAG
All plans / 03/15/08
Ongoing as PIP progresses. The next official submission of the PIP for validation is scheduled for October, 2008.
Discussion of Documentation Requirements for Activity 7-Non Reform Medicaid / Activity 7 – Improvement Strategies – was discussed in detail. HSAG evaluation elements :
·  Planned/implemented strategies for improvement are related to causes/barriers identified through data analysis and QI process. Causal barrier analysis and implementation of interventions were already implemented. Must document through your QI processes, QI Committee Minutes, the Barriers identified and the interventions designed to improve them.
·  Planned /implemented strategies for improvement are system changes that are likely to induce permanent change. Indicate the reasons for how interactions may bring changes. What interventions you have in place to change, are changes likely to persuade permanent changes? Use any analysis tool such as flow charts, fishbone, and consult with your Medical Director, consultants, etc.
Planned /implemented strategies for improvement are revised if original interventions are not successful. Make sure interventions are successful or re-formulate them
·  Planned /implemented strategies for improvement are standardized and monitored if interventions are successful. It was clarified that interventions from previous years may be used as long as they can prove to have brought improvements/positive changes to overcome identified barriers. / Attach any policies or interventions proven effective and successful, such as member mailings, education programs, newsletters.
During re-measurement we need to show how the interventions have brought improvements since implemented. / All plans / Ongoing as PIP progresses.
Current status of Collaborative PIP - Reform Medicaid / Activities 1 – 4 completed have been completed. Reform plans will be using HEDIS 2008 data (measurement period 1/1/07 – 12/31/07).
Discussion of documentation for Activities 5 (Sampling methods ) and 6 (Manual Data Collection) completed
Preparation for Data Collection and Reporting –Reform Medicaid / Wendy Talbot from HSAG explained in detail the processes for preparation for data collection and reporting:
·  Preparing a data repository
·  Developing source code or contracting with a certified software vendor, codes should be written appropriately , what exclusion and the inclusion codes
·  Extracting/freezing data into repository
·  Calculating an administrative rate, initially and with scheduled data refreshes
·  Systematic sampling (if necessary)
·  Medical record data collection process (tools, training materials, inter-relater reliability)
·  Combining administrative and hybrid data
·  Validating results, through auditing process, compare previous year data, benchmarks. / Plans were encouraged to use their contracted HEDIS auditor to guide Plans through these steps.
Many Plans already had their HEDIS audits during 2007. / All Reform Plans / Ongoing as PIP progresses.
Next steps / January conference call will be canceled due to EQRO Quarterly Meeting to be held in Tallahassee on January 16th, 2007.
Next Conference Call: / Next conference call is scheduled for Tuesday February 12th at 10:00 a.m. ET, hosted by United Health Care of Florida.
Preferred Medical Plan, Inc will distribute the minutes from this conference call within two weeks.

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