| FINGERTIP REPORT: D - EXTERNAL QUALITY REVIEW SUMMARY | ||||||||
| Period: FY09 (October 1, 2008 to September 30, 2009) | ||||||||
| An External Quality Review (EQR) of the 18 prepaid inpatient health plans (PIHPs) providing the managed behavioral health care benefit to Michigan Medicaid recipients was conducted by Health Services Advisory Group, Inc. (HSAG), as required by the federal Balanced Budget Act of 1997. HSAG performed two reviews of each of the 18 PIHPs covering the three federally mandated EQR-related activities—determination of compliance with federal and State standards, validation of performance measures, and validation of performance improvement projects (PIPs). A detailed summary of the EQR is available in the 2008–2009 External Quality Review Technical Report for Prepaid Inpatient Health Plans. | ||||||||
| Compliance with Federal and State Standards | Performance Measure Validation | |||||||
| PIHPs | Standard IX Subcontracts and Delegation | Standard X Provider Network | Standard X1 Credentialing |
Standard XII Access and Availability | Standard XIII Coordination of Care | Standard XIV Appeals | Monitoring Overall Compliance | |
| Access Alliance | 100% | 100% | 100% | 88% | 100% | 100% | 98% | 100% |
| CMH Affiliation of Mid-MI | 100% | 98% | 100% | 100% | 100% | 83% | 96% | 100% |
| CMH for Central MI | 100% | 100% | 100% | 100% | 100% | 97% | 99% | 83% |
| Southeast Partnership | 100% | 100% | 100% | 100% | 100% | 98% | 100% | 100% |
| Detroit-Wayne | 100% | 100% | 100% | 59% | 100% | 77% | 93% | 83% |
| Genesee County CMH | 100% | 100% | 100% | 97% | 100% | 100% | 100% | 100% |
| Lakeshore | 100% | 100% | 100% | 88% | 100% | 98% | 94% | 100% |
| LifeWays | 100% | 100% | 100% | 100% | 100% | 92% | 99% | 100% |
| Macomb | 100% | 100% | 100% | 82% | 100% | 97% | 98% | 100% |
| network180 | 100% | 100% | 96% | 85% | 100% | 98% | 98% | 100% |
| NorthCare | 100% | 100% | 100% | 85% | 100% | 83% | 96% | 100% |
| Northern Affiliation | 100% | 100% | 100% | 97% | 100% | 98% | 98% | 100% |
| Northwest | 100% | 100% | 100% | 88% | 100% | 98% | 97% | 100% |
| Oakland | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Saginaw | 100% | 100% | 100% | 76% | 100% | 95% | 95% | 100% |
| Southwest Affiliation * | 100% | 100% | 100% | 91% | 100% | 95% | 99% | 100% |
| Thumb Alliance * | 100% | 100% | 100% | 97% | 100% | 97% | 99% | 100% |
| Venture | 100% | 100% | 100% | 91% | 100% | 95% | 98% | 83% |
| Statewide Standard Score | 100% | 100% | 100% | 90% | 100% | 95% | 98% | 97% |
| Note: | Shaded cells show performance below the statewide score. | |||||||
| Source report: | HSAG (Health Services Advisory Group) 2008-2009 PIHP External Quality Review Technical Report | |||||||
| Version: | 1 | |||||||
| Date: | 03/15/10 | |||||||
| The Compliance Standard scores, each element within the six standards was evaluated and scored as Met, Substantially Met, Partially Met, Not Met, or Not Applicable, with the exception that Substantially Met was not applicable to the Access and Availability standard. The overall score for each of the six scored standards was determined by totaling the number of Met (value: 1 point), Substantially Met (0.75 points), Partially Met (0.50 points), Not Met (0.00 points), and Not Applicable (0.00 points) elements for the standard, then dividing the summed score by the total number of applicable elements for that standard. The same methodology, applied across all fourteen standards reviewed as part of the EQR, was used to determine the overall performance rating for each PIHP and the statewide scores, summing the values of the ratings and dividing that sum by the total number of applicable elements. | ||||||||
| The Performance Validation Measure scores are the percentage of twelve indicators that were graded as 'Fully Compliant'. | ||||||||
| The Monitoring Overall Compliance Scores are based on review of 14 Standards. | ||||||||