TITLE PAGE - Georgia Department of Community Health

TITLE PAGE - Georgia Department of Community Health

Performance Measurement Presentation to: Care Management Committee Presented by: Janice Carson, MD Deputy Director, PQO 1 Date: 04/09/15 Mission The mission of the Department of Community Health is to provide access to affordable, quality health care to Georgians through effective planning, purchasing, and oversight. We are dedicated to A Healthy Georgia. 2 Overview Performance Measures

Overview of Purpose Rate Generation Process Populations Monitored CY 2013 Selected Performance Results Questions 3 Performance Measures Tools to assess the performance of individual clinicians, clinical delivery teams, delivery organizations and health insurance plans in the provision of care to our Medicaid enrollees. Our Measure Stewards include CMS and: NCQA Healthcare Effectiveness Data and Information Set (HEDIS) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surveys Agency for Healthcare Research and Quality (AHRQ)

The Joint Commission 4 Performance Measurement Performance Measurement helps us: Understand the healthcare delivery process Identify quality of care issues Increase the effectiveness of healthcare delivery 5 Performance Measure Rate Generation HP - PM Generating Vendor HEDIS software subcontractor Medical Record Review subcontractor

HEDIS Certified Auditor 6 Performance Measure Rates Generation Specifications Claims-based (Administrative Rate) Medical Record Review (Hybrid Rates) 7 CY 2013 Populations Monitored

GA Families Foster Care Fee for Service 8 Performance Results % Accessing Care Child and Adolescent Access to PCPs 94.00% 92.00% 90.00% 88.00% 86.00% 84.00%

82.00% 80.00% 78.00% 76.00% 74.00% CY 2011 CY 2012 CY 2013 9 Performance Results Well Child Visits in first 15 months 6 or more visits 80.00% % with Six or More Visits 70.00% 60.00%

50.00% 40.00% 30.00% 20.00% 10.00% 0.00% CY 2011 CY 2012 CY 2013 10 Performance Results Well Child Visits Ages 3-6 80.00% 70.00% % of visits

60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% CY 2011 CY 2012 CY 2013 11 Performance Results Adolescent Well Care Visits 60.00% % with visits

50.00% 40.00% 30.00% 20.00% 10.00% 0.00% CY 2011 CY 2012 CY 2013 12 Performance Results Developmental Screening 120.00% % of Children screened 100.00%

80.00% 60.00% 40.00% 20.00% 0.00% CY 2012 CY 2013 13 Performance Results 70.00% Weight Assessment and Counseling for Children and Adolescents 60.00% 50.00% 40.00% 30.00% 20.00%

CY 2011 CY 2012 CY 2013 Target 10.00% 0.00% 14 Performance Results Georgia Families FFS Testing for Pharyngitis

76.50% 72.75% Approp. Tx for URI 81.95% 80.94% These measures describe care for sick children. One identifies whether providers are appropriately conducting strep tests for children diagnosed with pharyngitis and the other describes the percentage of practitioners who are not prescribing antibiotics for viral URIs. About 25% of practitioners are not performing strep tests and about 20% of providers are prescribing antibiotics for viral URIs. 15

Performance Results Womens Health Measures Georgia Families FFS 50.11% 43.42% Breast Cancer 72.90% Screening 31.49% Cervical Cancer Screening

35.77% Hyb Chlamydia Screening 72.83% Hyb 16 Performance Results CY 2013 Pregnancy Metrics Most GF pregnant women enrolled in managed care during 2nd trimester (62.35%). New process to improve this metric. Most FFS pregnant women enrolled in Medicaid during 3rd trimester (61.36%) 60.5% of GF pregnant women attended 81% or more of their projected prenatal

visits. Only 28.71% of FFS pregnant women attended 81% or more of their projected prenatal visits. 17 Performance Results Pregnancy Outcomes CY 2012 CY 2013 GF LBW Rate 8.59% 8.92% FFS LBW Rate 8.52%

10.34% GF C-Sec Rate 31.25% 31.88% FFS C-Sec Rate 27.48% 31.08% GF C-Sec Rate for NSV 19.07% 18.02%

FFS C-Sec Rate for NSV 12.72% 16.94% NSV = Nulliparous Singleton Vertex presentations. Implemented Hard Stop Policy in October 2013. Awaiting CY 2014 data to determine the effectiveness of the policy. 18 Performance Results 100.00% Asthma Care 80.00% 60.00% 40.00%

20.00% 0.00% CY 2012 CY 2013 Target 19 Performance Results Diabetes Care 80.00% 70.00% 60.00% 50.00% CY 2011 CY 2012

CY 2013 40.00% 30.00% 20.00% 10.00% 0.00% HbA1c Testing GF HbA1c Testing FFS HbA1c >9 GF HbA1c>9 FFS 20

Performance Results Controlling High Blood Pressure 50.00% 45.00% 40.00% % of Members Controlled 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% CY 2012 CY 2013

Target % was 57.52 21 Performance Results Follow Up after Hospitalization for Mental Illness 90.00% 80.00% % of members with f/u visit 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00%

Follow Up 7 day GF Follow Up 7 day FFS Follow Up 30 day GF Follow Up 30 day FFS 22 % o f m e m be rs w ith an nu al visit Performance Results Annual Dental Visits 80.00% 70.00% 60.00%

50.00% 40.00% 30.00% 20.00% 10.00% 0.00% CY 2011 CY 2012 CY 2013 23

Performance Results In CY 2013: Alcohol and other drug dependence - 35.62% of GF members with a new episode of alcohol and other drug dependence initiated treatment within 14 days of diagnosis through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization. Only 7.65% who initiated treatment had two or more additional services within 30 days of the initiation visit. FFS members, 40.15% initiated treatment but only 4.72% had two or more additional services within 30 days of initiation. ADHD - 35.74% of GF 6 12 year olds newly prescribed treatment for ADHD came back for an appt within 30 days of their new prescription and 48.76% of those who remained on treatment for at least 7 months had at least two follow up visits within 9 months after the initiation phase ended. FFS - 33.58% came back in 30 days and 45.32% who remained on treatment at least 7 months had two follow up visits within 9 months after the initiation phase. 24 Performance Results

ER Visits/1000 MM Antibiotics of Concern Plan All Cause Readmissions Georgia Families 58.12 FFS 41.17% 43.89% 9.93% 10.11%

91.38 25 Questions 26

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