plugging the quality holes in medicaid: quality measurement in pa as it applies to managed care...
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Plugging The Quality Holes in Medicaid: Quality Measurement in PA as it applies
to Managed Care
Carol SmolijVice President, Quality, Healthcare ManagementHealth Partners of Philadelphia
Association for Community Affiliated Plans
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About Health Partners
Now in our 25th year, Health Partners continues to be a community force, helping historically underserved residents lead healthier lives through equal access to care. We are a not-for-profit health plan owned by seven hospitals that provides healthcare coverage to residents of the five counties of Southeastern Pennsylvania (including Philadelphia). Our plan has been recognized as a national model for Medicaid managed care.
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•Albert Einstein Medical Center
•Aria Health
•Episcopal Hospital
•Hahnemann University Hospital
•Hospital of the University of Pennsylvania
•St. Christopher’s Hospital for Children
•Temple University Hospital
Owner Hospitals
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Our Mission• To manage our
business to exceed expectations.
• To operate with respect and dignity in all relationships.
• To continually improve the health outcomes of our Members.
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Making a Difference Every Day
• More than 450 employees
• More than 150,000 members
• Ranked #1 in member satisfaction in our market for six years
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•Churning Effect
•Member Centric Barriers
•Reporting Inequity
•Continuous Enrollment
Challenges
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•HEDIS
•Monthly YTD
•Member Level Detail
•Quarterly Focused Rates
•State Specific Measures
Current PA MCO Quality Reporting
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•Diabetes
•Pregnancy
•Hypertension
•Lead / EPSDT
PA Focused Areas
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•BMI
•Pregnancy - Depression
•Pregnancy – Smoking / ETS
•High Lead Levels - referral
PA EQR Measures
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•Improved Care Across Delivery Systems
•Same to same measures
•Analysis of membership
•Study of demographics
Quality Measurement in PA
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•Continued – Improved Care Across Delivery Systems
•Identification of commonalities statewide – i.e. dental care
•Convergence of ideas
•Shared decision making
•Quarterly meetings / shared agenda items
Quality Measurement in PA
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•Comparison
•Changes over time
•Collaboration
Access Plus (FFS) & Primary Care Case Management (PCCM)
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•Data Sharing
•Member Transfers
•Plan Collaboration
•Reporting Equity
•Better Benchmarking
Looking Ahead
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•Medicaid Accreditation Advisory Committee (MAAC)
•Medicaid Health Plans of America (MHPA)
•Reporting differences between Commercial & Medicaid
•Negative Impact of Enrollment Churn
•Role of States in Determining COC
NCQA MAAC
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Questions
???
Thank you!