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The Health Management Agency (AHCA), which administers Florida’s Medicaid Managed Care (SMMC) program, received several recommendations to improve behavioral and women’s health care and other services as part of its federal requirements. External Quality Review (EKR).

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Health Services Advisory Group (HSAG), the EQR organization for Medicaid, evaluated the SMMC program for fiscal year 2020-2021 and released its technical report last month.

During AHCA’s most recent procurement cycle in 2017, contracts were awarded to several plans, including Sunshine Health, Simply Healthcare, and Aetna Better Health, which will continue until December 2024. These plans provide managed care (MMA), long term care (LTC) services. Programs, comprehensive plans MMA and LTC, Specialty and Dental Program. More than 5.2 million Florida residents are currently enrolled in Medicaid, according to the latest figures. data from AHKA.

HSAG used elements of the AHCA’s Comprehensive Quality Strategy (CQS) to measure agency performance. These include quality, timeliness and access to services.

In addition to the above performance indicator, HSAG also reviewed AHCA’s performance improvement projects and their compliance with the Health Performance Data and Information Set (HEDIS) measures.

Among MMA plans, the state, on average, achieved the minimum AHCA performance targets for 23 out of 38, or 60.5% of the scores. The performance indicators in the EQR were divided into six areas of care: pediatric care, women’s care, living with illness, behavioral health, care access/availability, and appropriate treatment and use.

Strengths of performance

Serious performance indicators include follow-up of children prescribed attention-deficit/hyperactivity disorder (ADHD) medications—the continuation and maintenance phase. The HEDIS performance indicator increased from 57.33% in 2020 to 62.67% in 2021, meeting or exceeding the performance target. According to the report, this means health care providers in Florida are monitoring children after they are diagnosed and treated for ADHD and ensure that drug levels are properly managed.

Other strengths include a reduction in the statewide average asthma medication intake rate among all participants. This rate has declined from 74.67% in 2020 to 73.94% in 2021, indicating that more Florida residents with asthma are receiving recommended care and are better able to manage their chronic disease.

The EQR noted that 7 out of 15 measurement metrics in the LTC program met or exceeded AHCA’s 2021 targets:

“The results show that plans have documentation of personal comprehensive assessments, comprehensive care plans, and shared care plans to promote coordination. [Long-Term Support Services]”, – the message says. “The results also show that health plans conduct assessments and create care plans with their members during [a] timeline of concrete measures”.

Performance Drawbacks

The report states that during the evaluation period, AHCA did not conduct due diligence every 3 years as required by the CMS Medicaid Managed Care Rule. However, the report notes that the AHCA has since “put in place a process to ensure future compliance.”

The report also warns that many of the negative performance figures may have been affected by temporary closures or reductions in non-urgent services due to the COVID pandemic.

According to the report, several indicators of women’s care fell below minimum targets. These include the timeliness of antenatal care visits (an 8 percentage point decrease from 2020 to 2021) and cervical cancer screening (a 4 percentage point decrease).

“Early detection of cancer and chlamydia reduces the risk of serious complications or death and can lead to a wider range of treatment options and lower healthcare costs,” the report says. “…Participants did not complete recommended screenings, which may indicate a lack of understanding of healthcare or recommended prevention and screening schedules.”

The report identified several shortcomings in relation to mental health interventions. For example, health care for smoking cessation and tobacco use fell by 3 percentage points. Follow-up treatment success rates after an emergency room visit for mental illness or substance abuse did not decrease significantly, and in some cases there was a slight increase, but generally remained below the AHCA effectiveness targets.

Some of the highest AHCA performance degradation rates have been associated with LTC services. The length of stay minimization rate has decreased by more than 21 percentage points from 2020 to 2021, while the transition success rate after a long stay in an institution has decreased by more than 11 percentage points. On average, the statewide treatment plan to prevent future patient injury from falls also dropped by more than 14 percentage points.

HSAG has set out several recommendations corresponding to each performance deficiency. It has generally been suggested that the AHCA study the social determinants of health that affect members’ access to services.

“Health plans should consider whether there are differences in their population that have contributed to reduced performance in a particular race or ethnicity, age group, zip code, etc.,” the report says. “Once the underlying cause is identified, health plans should implement appropriate interventions to improve utilization.”

The report continues to break down performance by plan and highlights some of AHCA’s ongoing efforts to improve service delivery. These include encouraging health plans to improve long-term care discharge plans, monitoring data reporting, and setting data reporting standards.

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