Florida’s Medicaid Program

The Agency for Health Care Administration (Agency) today announced that the Statewide Medicaid Managed Care (SMMC) quality scores for calendar year 2016 are the highest in the Florida Medicaid program’s history. This is the second full year of Healthcare Effectiveness Data and Information Set (HEDIS) quality scores for the SMMC program, and the results show an improvement in the overwhelming majority of these nationally recognized quality measures. Florida’s Medicaid program is one of the most efficient programs in the country, and our implementation to Managed Care stands as a national model. In calendar year 2016, Florida’s Medicaid health plans performed as well as or better than the national average on 59 percent of HEDIS measures.
Agency Secretary Justin Senior said, “What these scores really reflect is that managed care is working, and the program is providing even better quality care every year for the families we serve. In 2014 we transitioned the Florida Medicaid program to a Managed Care system, this roll out now stands as a national model for managed care and has made our program a more efficient Medicaid program. Our Agency’s goal is to provide better health care for all Floridians, and we are proud of how successful the program has been. We will continue to work with the health plans and providers to ensure that recipients are receiving the care that they need.”
The National Committee for Quality Assurance (NCQA) uses HEDIS to measure health plans on their levels of care and service. With Florida’s Medicaid health plans performing at or above the national average on 59 percent of HEDIS measures, Florida Medicaid has had an overall improvement of six percentage points over its 2015 scores and an 18 percentage point increase over plan ratings prior to the SMMC program.
31 reported measures showed improvement over last year’s scores, including:

• Adult BMI Assessment
• Adults’ Access to Preventive Care – 65+ years
• Annual Dental Visit
• Annual Monitoring for Patients on Persistent Medications – ACEs/ARBs
• Annual Monitoring for Patients on Persistent Medications – Digoxin
• Annual Monitoring for Patients on Persistent Medications – Diuretics
• Annual Monitoring for Patients on Persistent Medications – Total
• Call Answer Timeliness
• Cervical Cancer Screening
• Childhood Immunization Status – Combination 2
• Childhood Immunization Status – Combination 3
• Chlamydia Screening in Women – 16-20 years
• Chlamydia Screening in Women – Total
• Comprehensive Diabetes Care – Eye Exam
• Comprehensive Diabetes Care – HbA1c Good Control
• Comprehensive Diabetes Care – HbA1c Poor Control
• Comprehensive Diabetes Care – HbA1c Testing
• Controlling High Blood Pressure
• Engagement of Alcohol and Other Drug Dependence Treatment – 13-17 years
• Engagement of Alcohol and Other Drug Dependence Treatment – 18+ years
• Engagement of Alcohol and Other Drug Dependence Treatment – Total
• Follow-up After Hospitalization for Mental Illness – 30 Day
• Follow-up After Hospitalization for Mental Illness – 7 Day
• Follow-up Care for Children Prescribed ADHD Medication – Continuation and Maintenance
• Immunizations for Adolescents – Combination 1
• Initiation of Alcohol and Other Drug Dependence Treatment – 13-17 years
• Lead Screening in Children
• Postpartum Care
• Prenatal Care
• Well-Child Visits in the First 15 Months – 6+ visits
• Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life

For more information on the SMMC program, please visit our website.