Floridaexternal Quality Review Organization (EQRO)

FloridaExternal Quality Review Organization (EQRO)

Strategic Summary of External Quality Review (EQR) Quarterly Meeting

September 26, 2007

Meeting Summary

HSAG Florida EQRO team conducted the EQR Quarterly Meeting on September 26, 2007. The meeting was held via Webinar. Representatives from various Agency for Health Care Administration (AHCA) and Department of Elder Affairs (DOEA) units, reform and non-reform plans, and other interested parties participated in the meeting. There were 63 attendees. The meeting time was 1:00 p.m. to 3:00 p.m. The following items were presented:

Introductions, Welcome and Logistics–Ms. Peggy Ketterer, Executive Director, EQRO Services (HSAG), welcomed the participants and discussed basic meeting logistics. Ms. Carol Burch, MPA, Contract Manager, Medicaid Division (AHCA)also welcomed the attendees. Ms. Burch discussed briefly the role of AHCA as the oversight and approval body for all Managed Care Organization (MCO) related contractual functions [and DOEA for NHDP contractual functions]. HSAG’s role as the external quality review organization for Florida’s Medicaid managed care program is to evaluate MCO compliance and performance as required by the Centers for Medicare and Medicaid Services (CMS), including feedback, recommendations and technical assistance.

Performance Improvement Project (PIP) Validation Activities for Year Two –Ms. Cheryl Neel, PIP Manager (HSAG),provided a summary of the PIP-related activities that had been completed, upcoming key dates related to PIP validation, and PIP submission tips. Ms. Neel provided the dates and focus of the previous PIP technical assistance training sessions, which were conducted during August of 2007. Ms. Neel summarized the number of PIP “Statement of Intent” documents received, which are completed by the MCOs and indicate what PIPs are currently being conducted. Ms. Neel informed the participants that the frequently asked questions (FAQ) document had been updated on HSAG’s website and encouraged participants to visit the website for further information. Ms. Neel described the process used by HSAG to request the PIPs for the validation activities, and covered key dates for submissions. Finally, Ms. Neel provided some PIP completion tips, which will assist the participants in preparing for their PIP documents for submission.

Update on the Collaborative PIP Initiatives – Ms. Peggy Ketterer described the previous EQRO activities that resulted in recommended topics for the collaborative PIPs. Ms. Ketterer identified the final collaborative PIP topics and described the current status of each collaborative PIP. Ms. Ketterer discussed HSAG’s validation approach for the collaborative PIPs as well as the final validation report which will describe the overall validation findings. Finally, Ms. Ketterer informed the participants that documents including meeting minutes, agendas, conference call schedules, and FAQs related to the collaborative are all available at

Update on the Validation of Performance Measures and HEDIS[®] Strategic Reporting – Ms. Wendy Talbot, MPH, Project Leader, (HSAG) provided a summary of the validation of performance measures for the Year Two EQR activities, which will focus on the non-reform population [since the reform plans will not yet have a full year of data collected to report]. Ms. Talbot reviewed the activity objectives, key steps, and timeframes for the validation process. Ms. Talbot also described the objectives for the HEDIS strategic reporting tasks, HSAG’s approach to the analysis of the data, and key dates for deliverables.

Focused Study for 2007/2008 – Ms. Marilea Rose, RN, BSN, Associate Director (HSAG), provided an overview of the selected focused study for fiscal year 2007-2008. The focus of the study was identified as outpatient behavioral health authorization processes currently used by health maintenance organizations (HMOs), provider service networks (PSNs), and prepaid mental health plans (PMHPs). The purpose of the study was discussed, as well as an overview of each step in the focused study process. Ms. Rose described the survey document that will be sent to the managed care organizations (MCOs) who will be participating in the focused study, and identified the targeted dates for submission of the information.

Overview of EQR Technical Report for 2006/2007 – Ms. Ketterer provided an overview of the purpose and high level findings from the 2006/2007 EQR technical report. High level findings by MCO type (including HMOs, PSNs, PMHPs, and NHDPs) were also presented. Finally, Ms. Ketterer described the approach used by HSAG to identify MCO-specific strengths and weaknesses across the key EQR activities evaluated during the fiscal year.

Florida’s Medicaid Quality Strategy –Linda Macdonald, Senior Management Analyst II (AHCA),provided an overview of the background and purpose for the development of the state’s quality strategy. Margaret DeHesse, RN, BSN, Executive Director (HSAG), then presented a summary of the overall findings and recommendations made from HSAG’s evaluation of AHCA’s quality strategy, one of the activities conducted during the first year of the EQR contract.

Upcoming EQR Activities – Ms. Ketterer provided an overview of the upcoming EQR activities for the second year of the contract, which included the date for the next EQR quarterly meeting, upcoming PIP validation activities, collaborative PIP conference calls, the request and submission of documentation related to validation of performance measures, and the focused study activities. Ms. Ketterer closed the session with a brief question and answer period, and thanked all participants for attending.

Implications to AHCA Quality Strategy

Although there was no anticipated impact to the AHCA quality strategy related to the September 2007 EQR Quarterly Meeting, an overview and discussion of the quality strategy occurred during the meeting, which should result in increased awareness and attention.

Implications to MCO Contracts

There was no anticipated impact to the MCO contracts related to the September 2007 EQR Quarterly Meeting.

Meeting Evaluation Summary

Eleven of the 63 attendees completed a feedback form, which was emailed to all participants following the close of the meeting. Of the eleven respondents, ten noted that the meeting achieved their needs/objectives. Please refer to Attachment A for a complete display of the meeting evaluation results.

Next Steps

HSAG posted the handouts and presentations on the HSAG website.
The next EQR Quarterly Meeting will be held on Wednesday, January 16, 2008 onsite at the AHCA offices.

Strategic Summary_Sept_26_2007 Florida EQRO

State of FloridaFL07-08_Strategic Summary_1107_F1

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