The Health Services Advisory Group (HSAG) produced the June 2018 report for Arizona Medicaid’s acute care and Comprehensive Medical and Dental Program (CMDP).
Overview of the CYE 2017 External Review included the following MCOs
- Care1st Health Plan Arizona, Inc. (Care1st)
- Health Choice Arizona (HCA)
- Health Net Access (Health Net)
- Maricopa Health Plan (MHP)
- Mercy Care Plan (MCP)
- Phoenix Health Plan, LLC (PHP)
- University Family Care (UFC)
- UnitedHealthcare Community Plan-Acute (UHCCP-Acute)
The report includes an assessment of the MCOs strengths and weaknesses for the quality of, timeliness of, and access to care. It also includes recommendations for improving the quality of care furnished by MCOs including how the state can target goals and objectives in the quality strategy, to better support improvement in the quality, timeliness, and access to healthcare services rendered to Medicaid members. The report also provides an assessment of the degree to which each MCO addressed effectively the recommendations for quality improvement made by HSAG in its external CYE 2016 quality review report.
AHCCCS conducted a comprehensive organizational review for the following MCOs
- Health Net
- Health Choice Arizona
- Care1st—during CYE 2017.
The CYE 2016 review (which includes CYE 2016 and CYE 2017 activities) was organized into 11 standard areas. For acute MCOs each standard area included several elements to measure the the MCO’s performance and compliance. The findings,
UHCCP-Acute, demonstrated scores of 95 percent and above for all eleven standard areas, which was the highest level of compliance, compared to the other three Contractors. Care1st demonstrated the second highest number of standard areas scored at 95 percent and above, with 10 of 11 standards. Health Net had eight of 11 standard areas scored at or above 95 percent. HCA had five of 11 standard areas scored at or above 95 percent, the lowest number of standard areas at 95 percent and above compared to the other three contractors.
11 areas of scoring:
- Corporate Compliance – five elements
- Claims and Information Systems – 12 elements
- Delivery Systems – nine elements
- General Administration – three elements
- Grievance Systems – 17 elements
- Adult; Early and Periodic Screening, Diagnostic and Treatment and Maternal Child Health – 15 elements
- Medical Management- 25 elements
- Member Information – nine elements
- Quality Management- 27 elements
- Reinsurance – four elements
- Third-Party Liability (TPL), seven elements
AHCCCS contracted with HSAG as its CMS-required external quality review organization to prepare this annual technical report.
Read the full report from AHCCCS
The Hertel Report will provide a full review of the HSAG report in its July newsletter.