April 5 2017 Felicia F Norwood Director Robert Mendonsa Deputy Administrator Managed Care Care Coordination Timeline HFSs Quality Measurement Tools Realigned and streamlined previous performance measures ID: 671453
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Slide1
Managed Care Oversight Committee
April 5, 2017Felicia F. Norwood, DirectorRobert Mendonsa, Deputy Administrator, Managed CareSlide2
Care Coordination TimelineSlide3
HFS’s Quality Measurement Tools
Realigned and streamlined previous performance measuresReviewed and incorporated multiple data sources to ensure key medical and behavioral health services were coveredAnalyzed other states/ measures and the Centers for Medicare & Medicaid Services Adult and Child Core Sets
As a result, the number of measures were reduced from over 100 to 23 evidence-based measures
Using national benchmark data--Healthcare Effectiveness Data and Information Set (HEDIS)-- to draw national comparisons and compare MCO health plan performance
Overall goal:
Improve quality and performance as well as drive accountabilitySlide4
measure focus
key measure name/ description
HFS PROGRAM
Access/Utilization of Care
Adults' Access to Preventive/Ambulatory Health Services
FHP/ACA, ICP, MMAI
Ambulatory Care
FHP/ACA, ICP, MMAI
Well-Child Visits in the First 15 Months of Life
FHP/ACAWell-Child Visits in the Third, Fourth, Fifth, and Sixth Years of LifeFHP/ACAPreventive/ Screening ServicesChildhood Immunization Status (All Combos)FHP/ACABreast Cancer ScreeningFHP/ACA, ICP, MMAICervical Cancer ScreeningFHP/ACA, ICPChlamydia Screening in WomenFHP/ACA, ICPMaternity CareTimeliness of Prenatal Care and Postpartum CareFHP/ACA, ICPTimeliness of Postpartum CareFHP/ACA, ICPAppropriate CareWeight Assessment and Counseling for Nutrition and Physical Activity for Children/AdolescentsFHP/ACAHuman Papillomavirus Vaccine for Female AdolescentsFHP/ACAControlling High Blood PressureFHP/ACA, ICP, MMAIComprehensive Diabetes CareFHP/ACA, ICP, MMAIStatin Therapy for Patients with DiabetesFHP/ACA, ICP, MMAIAdult BMI AssessmentFHP/ACA, ICP, MMAIMedication Management for People with AsthmaFHP/ACA, ICP
Evidence-Based Quality Measures (1 of 2)Slide5
measure focus
key measure name/ description
HFS PROGRAM
Behavioral Health
Follow-Up After Hospitalization for Mental Illness
FHP/ACA, ICP, MMAI
Metabolic Monitoring for Children and Adolescents on Antipsychotics
FHP/ACA
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
FHP/ACA, ICP, MMAILong Term CareCare for Older AdultsMMAIAnnual Monitoring for Patients on Persistent MedicationsFHP/ACA, ICP, MMAIUse of High-Risk Medications in the ElderlyMMAIEvidence-Based Quality Measures (2 of 2)Slide6
2015 Consumer Report CardJanuary 2017, HFS posted first consumer report cardReport card combines calendar year 2015 HEDIS data and Consumer Assessment of Healthcare Providers and Systems (CAHPS) data
Measures organized into 4 distinct categories:Doctor’s Communication and ServiceGetting CareBehavioral HealthKeeping Kids HealthyReport card will be updated and revised annually; next version will be in interactive online tool
To view the report card, visit hfs.illinois.gov (“Health Plan Comparison Tool” on home page)Slide7Slide8Slide9
MCO Provider Complaint Portal HFS designed a MCO Provider Complaint PortalRolled out in February 2017
In collaboration with the University of Illinois Office of Medicaid Innovation The secure, electronic web-based portal assists providers
with resolving issues with
MCOs,
after the provider has been unsuccessful with the
MCO
https
://
www.illinois.gov/
hfs/MedicalProviders/cc/Pages/ManagedCareComplaints.aspx.