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Summary of PMHP Performance Improvement Projects Validation Findings. Friday, March 25, 2011 3:00 p.m. – 4:00 p.m. Presenter: Donald Grostic, MS Associate Director, State & Corporate Services. Presentation Overview. 2010–2011 PIP Validation Process Validation Findings - PowerPoint PPT Presentation
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Page 1
Summary of PMHP Performance Improvement Projects Validation Findings
Presenter: Donald Grostic, MSAssociate Director, State & Corporate Services
Friday, March 25, 2011
3:00 p.m. – 4:00 p.m.
Page 2
Presentation Overview
• 2010–2011 PIP Validation Process• Validation Findings• Study Indicator Results• Collaborative Validation Findings• Collaborative Study Indicator Results• Next Steps
Page 3
2010–2011 PIP Validation Process
• “Statement of Intent” was completed by each MCO type and submitted to HSAG.
• For 2010–2011, MCOs were to submit to HSAG two PIPs for validation:– Clinical and nonclinical– Collaborative topic and one other
Page 4
2010–2011 PIP Process (cont.)
• HSAG selected two PIPs.• One ongoing and one collaborative PIP were
chosen.• PIPs selected were chosen based on HSAG’s
selection criteria.– If a PMHP did not have a nonclinical study in
process and only had clinical studies, then two clinical PIPs were selected for this year’s validation cycle.
Page 5
Overall PIP Validation Performance
2009–2010 2010–2011
Page 6
Trending of PIP Validation Scores
% Score of Evaluation
Elements Met
2006–2007
2007–2008
2008–2009
2009–2010
2010-2011
90% to 100% 0 14 18 1 2
80% to 89% 6 8 1 4 14
70% to 79% 0 0 0 14 3
60% to 69% 1 1 0 5 2
Less than 60% 1 0 5 0 3
Total 8 23 24 24 24
Page 7
Study Indicator(s) Improvement
Page 8
Statistically Significant Study Indicator(s) Improvement
Page 9
Study Indicator(s) Sustained Improvement
Page 10
Overall Collaborative PIP Validation Performance
2009–2010 2010–2011
Page 11
Trending of Collaborative PIP Validation Scores
% Score of Evaluation
Elements Met
2008–2009
2009–2010
2010-2011
90% to 100% 12 0 1
80% to 89% 0 3 8
70% to 79% 0 9 3
60% to 69% 0 0 0
Less than 60% 0 0 0
Total 12 12 12
Page 12
Collaborative Study Indicator Improvement
Page 13
Statistically Significant Collaborative Study Indicator Improvement
Page 14
Collaborative Study Indicator Sustained Improvement
Page 15
Next Steps for PMHPs
• PMHPs need to address all Points of Clarification and all Partially Met and Not Met evaluation elements.
• HSAG has provided the PMHPs with the Word version of the study submitted.
• PMHPs should use the same study document to continue working on the PIPs. PMHPs should date, bold, and strike-through any sections in which revisions are made to the study document.
Page 16
Process for Disputing Validation Score
• The plan must submit its dispute via formal letter to HSAG and cc AHCA Contract Manager
• The letter should outline the evaluation element/comment being disputed and the plan’s rationale for why the score should be changed
• All responses should be e-mailed to ddriscoll@hsag.com no later than April 1, 2011
• The HSAG PIP Review Team will review the dispute and respond to the plan with a decision within seven (7) business days
Page 17
Questions and Answerson PIP validation?
Page 18
Upcoming EQR Activities
Friday, March 25, 2011
Presenter:
Yolanda Strozier, MBA
Associate Director, State and Corporate Services
Page 19
Upcoming EQR activities
• The next EQR Quarterly Meetings:– Wednesday, June 8, 2011 (AHCA Offices)
One-on-one TA sessions Tuesday, June 7, 2011
– Week of September 26, 2011 (Webinar)– Wednesday, January 11, 2012 (AHCA
Offices)One-on-one TA sessions Tuesday, January 10, 2012– Week of March 19, 2012 (Webinar)
Page 20
Upcoming EQR activities
• Finalization of PIP Validation Reports (April 2011).
• Annual PIP Summary Report and Strategic Summary Report (April–June 2011).
Page 21
Upcoming EQR activities
Next Steps• PIPs are submitted to AHCA/DOEA— August
2011• MCOs will receive HSAG’s “Statement of
Intent” (SOI) survey on Wednesday, August 10, 2011.
• Completed SOI’s due to HSAG on Monday, August 29th.
Page 22
External Quality Review Quarterly Meeting
THANK YOU FOR YOUR PARTICIPATION!
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