The Health and Human Services Commission (HHSC) launched a new initiative to conduct individual calls with MCOs starting in June 2015. These calls are initiated by staff from the Quality Oversight Unit in the Quality and Program Improvement Section. Participation from HHSC also includes staff from Quality Assurance, Healthcare Transformation Waiver and Health Plan Management, with representation from the state’s External Quality Review Organization.
The purpose of these quality calls is to maintain an interactive dialogue with MCOs on priority areas related to quality improvement and efficiency in the context of value-based purchasing roadmap designed by HHSC. The central paradigm of the dialogue is focused on measuring the value of healthcare provided to the state beneficiaries, within the healthcare delivery and payment reform led by HHSC.
The priority areas for these calls are the following:
- Discussion of MCO's overall initiatives towards value-based purchasing contracts with providers (moving away from strict volume based reimbursement models toward payment models that link greater amounts of provider payment to value).
- Discussion of MCO's efforts towards identification of high value Delivery System Reform Incentive Payment (DSRIP) projects and the steps the MCOs take towards integration of these projects into an MCO value based purchasing model.
- Discussion of MCO's intervention strategies targeting special populations (beneficiaries with high costs and complex needs including superutilizers, those with substance use disorders, and those who need behavioral health services). These strategies could include value based purchasing models as means to finance the interventions.
- Focused discussion on a specific MCO quality measure. The measures of interest are either proposed by the MCOs or are selected by the Quality Oversight Unit. HHSC may provide analyses of the quality measure(s) to be discussed prior to the call based on the following criteria:
- Data is publicly available on HHSC’s Data and Reports quality webpage
- Measure has high frequency or high cost
- There is a significant trend from year to year.
Below are documents discussed during the quality improvement calls by MCO:
- Aetna Better Health (PDF)
- Amerigroup (PDF)
- Blue Cross Blue Shield of Texas (PDF)
- CHRISTUS Health Plan (PDF)
- Cigna-HealthSpring (PDF)
- Community First Health Plans (PDF)
- Community Health Choice (PDF)
- Cook Children’s Health Plan (PDF)
- Driscoll Health Plan (PDF)
- El Paso First Health Plans (PDF)
- FirstCare (PDF)
- Molina Healthcare of Texas (PDF)
- Parkland Community Health Plan (PDF)
- RightCare from Scott & White Health Plan (PDF)
- Sendero Health Plans (PDF)
- Dell Children's Health Plan (formerly Seton) (PDF)
- Superior HealthPlan (PDF)
- Texas Children’s Health Plan (PDF)
- UnitedHealthCare Community Plan (PDF)
These interactions with MCOs are a vital component of HHSC's comprehensive and data driven quality improvement process. It is an opportunity for various HHSC units that have intersections with quality, to engage more regularly counterparts from individual MCOs in proactive discussions in these priority areas. Through this open dialogue, centered on publicly available data, HHSC will be able to more effectively assess each MCO's progress, identify barriers, and generally support MCOs in their efforts to improve quality.
For more information, please email HHSC Quality.