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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
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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.
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Overall PIP Validation Performance
2009–2010 2010–2011
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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
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Study Indicator(s) Improvement
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Statistically Significant Study Indicator(s) Improvement
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Study Indicator(s) Sustained Improvement
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Overall Collaborative PIP Validation Performance
2009–2010 2010–2011
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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
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Collaborative Study Indicator Improvement
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Statistically Significant Collaborative Study Indicator Improvement
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Collaborative Study Indicator Sustained Improvement
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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.
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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 [email protected] 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
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Questions and Answerson PIP validation?
Page 18
Upcoming EQR Activities
Friday, March 25, 2011
Presenter:
Yolanda Strozier, MBA
Associate Director, State and Corporate Services
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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)
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Upcoming EQR activities
• Finalization of PIP Validation Reports (April 2011).
• Annual PIP Summary Report and Strategic Summary Report (April–June 2011).
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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.
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External Quality Review Quarterly Meeting
THANK YOU FOR YOUR PARTICIPATION!
