The table below depicts trended PPV performance by MCO. The performance trend line and the 2017 NCQA Medicaid Quality Compass percentile ranking are included for comparison purposes. Exhibit 52: Trended MCO PPV HEDIS HEDIS HEDIS Trend 2017 QC 2013 2014 2015 2016 2017 Line Percentile Ranking 90th 73.83% 74.03% 72.43% 73.61% 73.67% BMCHP 67.71% 69.58% 71.55% 66.94% 72.59% 75th 90th ↑ – (%) Fallon 76.63% 76.63% 64.92% 73.39% 71.88% 75th 90th ↓ – HNE - 76.03% 79.92% 72.27% 70.15% 75th 90th ↓ – NHP 67.65% 65.85% 67.29% 68.19% 65.79% 50th 66th PPV – Tufts 76.64% 75.61% 70.31% 73.85% 66.67% 50th 66th ↓ – KEPRO evaluates a MCO’s performance against a set of pre-determined criteria. The Technical Reviewer assigns a score to each individual rating criterion. The Reviewer rates individual standards as either 1 (does not meet item criteria); 2 (partially meets item criteria); or 3 (meets item criteria). A rating score is calculated by dividing the sum of all available points by the sum of all points received. This ratio is presented as a percentage. MCO rating scores follow. Exhibit 53: PPV PIP Rating Scores by MCO Discussion We can observe when comparing Exhibit 51 (2017 MCO Postpartum Visit Rates) to Exhibit 50 (2016 PPV Intervention Type by MCO), that the breadth of interventions do not necessarily correlate to improved performance. For example, BMCHP reports one intervention, yet is the highest performing plan and it is the only plan whose performance is trending up. The Performance Improvement Project Reporting Template asks plans for an assessment of intervention effectiveness. Few plans, however, completed such an analysis. This makes it difficult to identify best practices and while some interventions are intriguing, e.g., THPP’s Doula by My Side” program, without a formal analysis, KEPRO is not able to endorse this or any other intervention. This represents an opportunity for KEPRO to provide technical training. All MassHealth MCOs conducted PIPs targeted at improving AMM performance.
The table below depicts trended PPV performance by MCO. The performance trend line and the 2017 NCQA Medicaid Quality Compass percentile ranking are included for comparison purposes. Exhibit 52: Trended MCO PPV HEDIS 2013 HEDIS 2014 2015 2016 HEDIS 2017 Trend Line 2017 QC Percentile Ranking PPV (%) 90th 73.83% 74.03% 72.43% 73.61% 73.67% BMCHP 67.71% 69.58% 71.55% 66.94% 72.59% ↑ 75th – 90th Fallon 76.63% 76.63% 64.92% 73.39% 71.88% ↓ 75th – 90th HNE - 76.03% 79.92% 72.27% 70.15% ↓ 75th – 90th NHP 67.65% 65.85% 67.29% 68.19% 65.79% 50th – 66th Tufts 76.64% 75.61% 70.31% 73.85% 66.67% ↓ 50th – 66th KEPRO evaluates a MCO’s performance against a set of pre-determined criteria. The Technical Reviewer assigns a score to each individual rating criterion. The Reviewer rates individual standards as either 1 (does not meet item criteria); 2 (partially meets item criteria); or 3 (meets item criteria). A rating score is calculated by dividing the sum of all available points by the sum of all points received. This ratio is presented as a percentage. MCO rating scores follow. Exhibit 53: PPV PIP Rating Scores by MCO Discussion We can observe when comparing Exhibit 51 (2017 MCO Postpartum Visit Rates) to Exhibit 50 (2016 PPV Intervention Type by MCO), that the breadth of interventions do not necessarily correlate to improved performance. For example, BMCHP reports one intervention, yet is the highest performing plan and it is the only plan whose performance is trending up. The Performance Improvement Project Reporting Template asks plans for an assessment of intervention effectiveness. Few plans, however, completed such an analysis. This makes it difficult to identify best practices and while some interventions are intriguing, e.g., THPP’s Doula by My Side” program, without a formal analysis, KEPRO is not able to endorse this or any other intervention. This represents an opportunity for KEPRO to provide technical training. All MassHealth MCOs conducted PIPs targeted at improving AMM performance.