Florida Medicaid Quality in Managed Care
Florida Medicaid is committed to ensuring that health care services delivered through managed care plans are held to high standards of quality and excellence. All vendors contracted with the Agency to provide managed care services must meet specific requirements for ensuring quality both in services provided and in administrative processes involved in oversight of the plan's operations.
By accessing the information below, you may learn about the Agency's overall quality strategy and you will find additional information sources to learn more about Florida's quality initiatives.
Quality Assessment and Improvement Strategies – Initial Quality Strategy
The Federal Centers for Medicare and Medicaid Services require that each state have a written strategy for assessing and improving the quality of managed care services. Florida completed its initial quality strategy in 2006. The Quality Assessment and Improvement Strategy will be updated annually and will include input from recipients and interested stakeholders. Please follow the link below to access Florida's Initial Quality Assessment and Improvement Strategy.
Quality Assessment & Improvement Strategies,
Florida Medicaid
Managed Care Programs [395KB PDF]
The 2007 update to the Quality Assessment and Improvement Strategy was submitted to the CMS in January 2008 and can be viewed by clicking on the link below.
Florida Medicaid Managed Care Quality Assessment & Improvement Strategies Annual Update December 2007 [1.13KB PDF]  6/23/08
Cultural Competency
The Agency for Health Care Administration supports ongoing training for cultural competency in the delivery of services for all its health plans and providers. Georgetown University's National Center for Cultural Competence offers a valuable resource to organizations and individuals developing, implementing and/or evaluating a cultural competency plan.
http://www11.georgetown.edu/research/gucchd/nccc/index.html
Medicaid Reform Performance Measures
As part of Florida's Medicaid Reform initiative, the Agency sought to review and amend the performance measures historically required for HMOs contracting with the Agency to better assess the quality and effectiveness of the health care services. Public input was sought and received from interested parties, including health care advocates, providers, and State of Florida sister agencies, culminating in the final list of adopted measures.
Medicaid Reform Performance Measures Policy Transmittal [493KB PDF]
The links below provide documents distributed at public workshops held on October 6, 2006, and October 26, 2006. Also provided is a compilation of stakeholder comments the Agency received during the performance measures development process.
October 6, 2006 Medicaid Reform Performance Measures Presentation [126KB PDF]
Stakeholder Comments (as of 10/25/06)
October 26, 2006 Medicaid Reform Performance Measures Workshop Presentations [100KB PDF]
Medicaid Reform Performance Measures 10/26/06 [47KB PDF]
Pfizer Health Solutions Reporting Overview 10/26/06 [471KB PDF]
External Quality Review
In compliance with federal requirements, Florida contracts with an external quality review organization to provide a quality review of its Medicaid managed care programs. The purpose of External Quality Review is to assess and improve managed care organizations and prepaid inpatient health plans' strengths and weaknesses with respect to the quality, timeliness, and access to Medicaid health care services.
Health Systems Advisory Group, Inc. (HSAG), Florida's contracted External Quality Review vendor, provides 11 categories of activity that include:
- validation of performance improvement projects;
- validation of performance measures;
- review of compliance with access, structural and operations standards;
- strategic reports on consumer-reported satisfaction surveys;
- strategic reports of HEDIS Analysis;
- technical assistance on enrollee race/ethnicity and primary household language information;
- value-based purchasing methodologies;
- evaluation of AHCA's quality strategy;
- implementation of focused studies (such as adolescent well-care and identification of special health care needs);
- dissimination of information to keep key stakeholders within and outside of Medicaid involved and informed of External Quality Review work projects and tasks; and
- development of an annual technical report for submittal to the Federal Centers for Medicare and Medicaid.
These activities impact HMOs, Provider Service Networks, Prepaid Mental Health Plans, the Child Welfare Prepaid Mental Health Plan, and Nursing Home Diversion Plans.
For more information about HSAG and external quality review activities, see HSAG's Florida website at: www.myfloridaeqro.com
The Florida Health Finder
On this website you can find information to help you compare the quality and cost performance of hospitals, ambulatory surgery centers, health plans, nursing homes, and prescription drugs. The website also lists Florida health care facilities; information on health insurance; medical care resources for the uninsured; resources for seniors; and much more.
The main topic areas to view on the Florida Health Finder website include:
Health Plans: Compare health plans on quality of care, member satisfaction, coverage areas by county, accreditation status, and claims payment performance. You can also compare monthly health plan premium rate options and find additional resources on many health insurance topics.
Hospitals and Ambulatory Surgery Centers: View performance and outcome data on selected medical conditions and procedures in these types of health care facilities.
Emergency Room Care: Read educational information about when and how to use an emergency room, what to do in a medical crisis, alternatives to emergency room care and other helpful information.
Prescription Drugs: View comparative prices at Florida pharmacies for the top 100 most prescribed drugs in Florida. You choose the county where you live and a drug you want to price. The website displays the current price for most pharmacies in your county.
For more information about Florida Health Finder, please visit the website at: http://www.floridahealthfinder.gov.
Related Links
Choice Counseling
Florida's Medicaid Reform
Medicaid Health Maintenance Organization (HMO)
Managed Integrated Care (MIC)
Nursing Home Diversion Program (Department of Elder Affairs)
Provider Service Network (PSN)
For more information on Florida Medicaid Quality in Managed Care, please contact:
Debby McNamara, LCSW, PMP
Senior Management Analyst II
mcnamard@ahca.myflorida.com
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