Florida Agency for Health Care Administration (AHCA)

Collaborative PIP HMOs/PSNs Conference Call Minutes

Tuesday, February 14, 2012

MCOs Represented: Amerigroup, Better Health (Simply), Car Florida, CMS (PediCare), Coventry, First Coast Advantage, Freedom Health, Personal Health Plan (Healthy Palm Beaches), Humana, Integral Quality Care, Medica, Molina, Positive Health Care Partners, Preferred Medical, Prestige Health Choice, South Florida CCN, Sunshine State, United, Universal, PsychCare, United Public HealthTrust,

AHCA Representation: Diana LaCastro, Lakia Daniels, Kathy Wilson, Judith Roy, Darrell Floyd, Linda Mulhisen

HSAG Representation: Christi Melendez, Yolanda Strozier

Topic /

Discussion

/ Action / Responsible Person / Due
Date / Completed /
I. Introductions
and roll-call / Minutes from November 15th’s conference call were approved as submitted. / Completed
II.Historical
Data Update –
Sunshine State / AHCA will not share the claims with health plans stating information is not needed for day to day operations. Sunshine will forward the request and response to Florida Association of Health Plans (FAHP) under Mary Pat to ask them to approach AHCA for historical data. Sunshine’s own internal analysis is that the children/infant are members but do not show up on their enrollment for first through second month, thus missing those well-child visits (WCV). This can be anywhere from one to three visits. Those visits went to the state for fee for service (FFS) while awaiting enrollment into Sunshine. The availability of this information from AHCA’s historical data can improve administrative rates and mitigate need for medical record abstraction. Most of the plans voiced that they were in agreement and were experiencing the same issue.
Amerigroup mentioned that the issue goes beyond missing two or three appointments for WCV. There are other contractual requirements to assure children are getting immunizations, as well as other services. These other services may get paid up front to FFS and go beyond just WCV’s.
Pat from Medica asked if this historical data is being transmitted electronically and can it be used to support HEDIS? The data should be able to be uploaded to data warehouse and signed off by HEDIS auditors.
Based on the update today regarding historical data, this is the primary barrier which needs to be addressed. The recommendations from the group are to wait for FAHP’s involvement. / Forward the issue to Florida Association of Health Plans (FAHP) / Sunshine State / May 2012 / Pending
III. Data Mining Presentations / Freedom Health
For HEDIS 2011, Freedom had a small population for the non-reform side (43 members) and no reportable for Reform population; but did an analysis. They identified the following member barriers: 1) lack of awareness of member on periodicity schedule; 2) members receiving 3- 5 WCV but not returning for the 6th visit; 3) not making preventive care a priority (members get sick care but not preventive care). They identified the following Provider barriers: 1) noncompliant with recommended schedule or are unaware of this; 2) not documenting all components of visit-specifically related to anticipatory guidance.
Interventions included new member calls and auto-dialers. Freedom ensures members have ID cards, new member packets, know who their PCP is, and if transportation needs are identified. They offer a new member incentive for well-child visits within first 60 days of enrollment. Other data mining also identified members with no WCV in system. The plan will educate providers on documentation and billing standards, send reminder postcards and re-supply postcards to providers for distribution as well. They expect a higher population this year and have already seen an increase in administrative rates.
A question at the end was what gift card they used for the incentive. Debbie explained it is general retail gift card. / N/A / Completed
III. Data Mining Presentations cont. / PHP (Healthy Palm Beaches)
Their data mining yielded similar issues as other plans identified. Members are missing 1-2 visits which if getting the historical data from AHCA; this would help bring administrative rates into compliance with benchmark and goal.
The numerator noncompliant chart review indicated a lack of follow-up after sick visits (not giving priority to well care). PHP works with providers on those main components and some of the providers modified forms during the educational session. The providers using EMR are asked to align their systems to HEDIS specifications- some have done this but the results have not been measured yet. The provider who modified the sick visit forms had high HEDIS compliance.
PHP continues to educate provider and staff of importance of appointment scheduling prior to cut-off date. Some providers do not realize that one day out of specs did not count. It appears that if we speak with provider versus staff, that the Providers embrace the concept more. PHP is devoting more intense education on lower scoring providers.
Other data mining included a zip code analysis on who should have had the service to those who did and did not complete the service. The result is an even distribution on a pie chart; except for those very large provider groups with multiple offices within the service area. A supplemental data issue with lab items was identified and the plan is doing much more intense primary source verification (PSV) which should help bring measures closer to benchmark.
Humana
Humana stated are not conducting data mining for their Medicaid population. They are using outcomes from HEDIS to reach out to providers and do welcome calls, mailings, and reach out to providers. / N/A / Completed
IV. Status of
Previous
Collaborative
Intervention
Ideas / 1) Standardized Forms - many providers were already using the standardized forms in the CHCU Handbook. Many plans submitted suggestions for form revisions to AHCA. AHCA continues to work with these revisions. If providers are using the forms, have the changes been made? AHCA representatives, Diane LaCastro and Lakia Daniels will review the workgroup status with Debbie McNamara. A question was asked if plans using the forms have seen improvement or is the intervention retired. This was not developed into a collaborative intervention.
Many providers are going to EMR which is a barrier discussed at an on-site.
If providers are not using an EMR, should there be an outreach to use AHCA forms? We should cover both bases. 60% of providers are using the current CHCU form. If we ask them to use the forms in C & L we need to assure they are updated. / Standardized forms - AHCA staff will review with Debbie McNamara regarding if suggestions to forms were implemented or other status of the process and inform Christy Melendez. / AHCA Staff / May 2012 / Pending
2) Reminder Postcards – Christi from HSAG asked if any plans have received feedback on how the providers like this postcard. Sunshine stated providers and reps love the cards and have done a second distribution. They have also included the postcard in their postpartum mailings to mothers who have completed their postpartum visit. Another plan stated they are using the postcard as well as soon as they have been made aware of a baby being delivered. Integral mentioned positive feedback from providers and moms. / Postcards – continue intervention / Ongoing
3) PSA – It appears that the PSA was not aired on the radio as anticipated. The Wellcare representative with the Lear Channel radio and NBA player contact left the health plan. The current Wellcare staff went to Clear Channel radio who stated that plans would have to buy a communication plan to make sure the PSA was aired. This was not what was communicated to the HMO/PSN group. Stations stated they had no obligation to read the PSA. / None / Retired /Completed
4) Provider letter contains coding information sent out in 2010. This information was also included in the Postcard initiative in 2011 / None / Completed
V. Next
Collaborative
Intervention / Since there is a push for the EMRs, perhaps the plans can reach out to the vendors/developers to instruct what needs to be there for HEDIS compliance for all Medicaid measures- which will help the developers market the product. Positive Healthcare asked if potentially putting together an xml script to pull from wherever the data is stored in the EMR, i.e. correlated this to discharge summaries etc. from hospital EMRs.
Christi from HSAG asked if there would be a cost to the health plans. There was discussion and Christi recommended a workgroup on this issue noting that this is a busy time of year with HEDIS. PHP offered to go with the work group to poll providers and be lead for this. Freedom also volunteered. / Workgroup will convene within the next week. / Personal Health Plan and Freedom Health / May 2012 / Pending
VI. Next Steps / Next conference call will be on Tuesday, May 15th at 10:00 a.m. ET hosted by Coventry Health Plan. Data mining presentations will be presented by Integral, Jackson Memorial Health Plan, Molina, and Positive.

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