Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
*Please see specs table and template sample on last two pages
The intent of the Dental QQRM is to collaborate on the shared goal of improving access to oral health care
and prevention of disease, driven by data analysis.
QQRM Instructions:
The first section of this template will focus on Data Driven Initiatives and the second section will focus on General
Initiatives. Exclusively report and discuss PH Medicaid members only (not multiple lines of business). Please be
prepared to discuss unexpected outcomes, barriers, or any new or additional opportunities that you find worth
exploring in future initiatives and what tools were used to access the information (e.g. surveys, reports, etc.)
Data Driven Initiatives:
• This section requires data and data collection must be part of the design of these initiatives.
• Be sure to answer all the following questions for each initiative:
a. Who was the specific audience or demographic?
b. How did you decide to member measure the outcomes of this section’s service(s) as stated in the heading above?
c. Total numbers of MEMBERS in the group.
d. Number of MEMBERS who received the service as stated in the heading above. (If needed, you may also include the members
reached in this box.)
e. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
f. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
• We are asking for TWO trending rate comparisons under each data driven topic of ADV, AADV, Tobacco Counseling for
the Control and Prevention of Oral Disease, Fluoride Varnish, Sealants*:
1. First is a Year Over Year (YOY) trending rates comparison, (located on the top of each topic section for ADV, AADV,
Tobacco Counseling for the Control and Prevention of Oral Disease, Fluoride Varnish and Sealants), using the following logic:
▪ Data collection is to be started on January 1
st
of each respective comparison year up to the date that
will be provided by the Department for each QQRM meeting. For example: If the date provided is
April 30
th
, provide the data starting from 1/1/xx through 4/30/xx.
▪ Please include Numerator (Num), Denominator (Den), and Rate.
Note: DHS understands that, given the short reporting period, this will not be a full reporting. The purpose of this trending is only to capture
a point in time comparison to see if the plan is on track for an increase in comparison to the previous year. This is not a rolling year
comparison.
2. The second is a separate data set for each initiative using the trending data of the two most recent quarters.
General Initiatives:
• This section is for other initiatives that may or may not be quantifiable on the following OPTIONAL topics (if they are
quantifiable please also include them in the “data driven” section):
Medical/Dental (Oral Health)/Behavioral Health Initiatives – Any medical related appointment or event that
leads to a dental service. Be sure to include any medical efforts for fluoride varnish in this area.
Tele-dentistry Initiatives – that follow PA-DHS policies and ADA policy on tele-dentistry.
Initiatives to Reach Populations with Oral Health Inequities/Social Determinants Of Health (SDOH) initiatives.
Some examples are populations that per CDC’s data suffers from oral health inequities or SUD populations,
etc.
Additional Initiatives- Please list any initiatives that do not fit in any of the other areas.
• Please update the information for all the sections in each quarter as follows:
• Please keep the written responses brief when possible. We are looking for high-level information that would quickly aid the
discussion for the meeting.
• Always use the previous quarter’s completed template to work on:
a. Make changes in red font.
b. Line out information that should be removed. An example is an initiative that is retired.
• Don’t forget to list your approved consumer/provider incentives in the appropriate sections.
• Use this Key to label an initiative’s population and grouped them sequentially:
(M) – Member-focused, (P) – Provider-focused, (C) – Community engagement/collaboration-focused, (O) – Other
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
2
D A T A D R I V E N I N I T I A T I V E S
Find below a template to be used for each MCO initiative/incentive (Two templates are provided, feel free to add more
if needed):
1. ADV-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
2. ADV-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
Annual Dental Visit (Ages 2-20) (ADV) - PeopleStat Targeted Measure
Trending HEDIS Rates Comparison
1/31/2021
1/31/2022
Annual Dental Visit (ADV)
Num
Den
Num
Den
Rate
Initiative Discussion
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
e. Rate-
7/1/21-9/30/21
10/1/21-12/31/21
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
3
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
e. Rate-
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
4
Find below a template to be used for each MCO initiative/incentive (Two templates are provided, feel free to add more
if needed):
1. AADV (including any maternity population)-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
2. AADV (including any maternity population)-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
Adult Annual Dental Visit ≥ 21 Years (AADV)
Trending rates comparison
1/31/2021
1/31/2022
Adult Annual Dental Visit (AADV)
Num
Den
Num
Den
Rate
Maternity AADV
Num
Den
Num
Den
Rate
Initiative Discussion
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
e. Rate-
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
5
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
e. Rate-
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
6
Find below a template to be used for each MCO initiative/incentive (Two templates are provided, feel free to add more
if needed):
1. D1320-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
2. D1320-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
Tobacco Counseling for the Control and Prevention of Oral Disease (D1320)
*provider must be certified as a Tobacco Cessation Counselor (TCC) through DOH
Trending rates comparison
1/31/2021-Total # of services provided
1/31/2022-Total # of services provided
Tobacco Counseling (D1320)
Initiative Discussion
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
e. Rate-
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
7
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
e. Rate-
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
8
Find below a template to be used for each MCO initiative/incentive (Two templates are provided, feel free to add more
if needed):
1. D1206-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
2. D1206-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
Fluoride Varnish by a Dental Provider (D1206)
Trending rates comparison
1/31/2021-Total # of services provided
1/31/2022-Total # of services provided
Fluoride Varnish in a Dental Setting (D1206)
Initiative Discussion
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
e. Rate-
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
e. Rate-
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
9
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
10
Find below a template to be used for each MCO initiative/incentive (Two templates are provided, feel free to add more
if needed):
1. Dental Sealants-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
2. Dental Sealants-Initiative/Incentive’s Name (Population key: M, P, C, O):
Description of Initiative/Incentive:
a. Who was the specific audience or demographic?
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above (Please define the
numerator and denominator in this area)?
Dental Sealants
Trending rates comparison
1/31/2021
1/31/2022
Num
Den
Rate
Num
Den
Rate
Numerator 1: At least one sealant
Numerator 2: Sealants on all four molars
Initiative Discussion
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
e. Rate-
7/1/21-9/30/21
10/1/21-12/31/21
c. Denominator- Total number of MEMBERS
in the group:
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
11
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
e. Rate-
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
12
G E N E R A L I N I T I A T I V E S
Medical/Dental (Oral Health)/Behavioral Health Initiatives
1st Quarter Discussion
Please list the initiatives in this area with only high-level descriptions to provide the foundation for discussion during the meeting. And
please be prepared to discuss to unexcepted outcomes, barriers, or any new or additional opportunities that you find worth exploring in
future initiatives. And what tools were used to access the information (e.g. surveys, reports, etc.)
• Initiative #1 (initiative’s population Key: M, P, C, O)
• Initiative #2 (initiative’s population Key: M, P, C, O)
•
•
Tele-dentistry Initiatives
1st Quarter Discussion
Please list the initiatives in this area with only high-level descriptions to provide the foundation for discussion during the meeting. And
please be prepared to discuss to unexcepted outcomes, barriers, or any new or additional opportunities that you find worth exploring in
future initiatives. And what tools were used to access the information (e.g. surveys, reports, etc.)
• Initiative #1 (initiative’s population Key: M, P, C, O)
• Initiative #2 (initiative’s population Key: M, P, C, O)
•
•
Outreaching Populations with Oral Health Inequities/SDOH initiatives
1st Quarter Discussion
Please list the initiatives in this area with only high-level descriptions to provide the foundation for discussion during the meeting. And
please be prepared to discuss to unexcepted outcomes, barriers, or any new or additional opportunities that you find worth exploring in
future initiatives. And what tools were used to access the information (e.g. surveys, reports, etc.)
• Initiative #1 (initiative’s population Key: M, P, C, O)
• Initiative #2 (initiative’s population Key: M, P, C, O)
•
•
Additional Initiatives
1st Quarter Discussion
Please list the initiatives in this area with only high-level descriptions to provide the foundation for discussion during the meeting. And
please be prepared to discuss to unexcepted outcomes, barriers, or any new or additional opportunities that you find worth exploring in
future initiatives. And what tools were used to access the information (e.g. surveys, reports, etc.)
• Initiative #1 (initiative’s population Key: M, P, C, O)
• Initiative #2 (initiative’s population Key: M, P, C, O)
•
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
13
Dental Measures
Specifications
ADV
Annual Dental Visit measures the percentage of members 2-20 years of age
who had at least one dental visit during the measurement year. Please contact
your Quality/HEDIS area for the technical specifications for this measure.
AADV/Maternity AADV
Adult Annual Dental Visit/ Maternity AADV both measure the percentage of
members 21+ years of age who had at least one dental visit during the
measurement year.
For the latest and most complete list of the specifications, please refer to your
assigned File Transfer Protocol (FTP) IPRO site.
Tobacco Counseling for the Control and
Prevention of Oral Disease
Tobacco Counseling for the Control and Prevention of Oral Disease measures
the number of D1320 services provided during the measurement year by PA-
DOH certified Tobacco Cessation Counselor (TCC) Dental Providers.
Fluoride Varnish
Fluoride Varnish measures the number of D1206 services provided during the
measurement year.
Sealants
The Sealant performance measure assesses the percentage of enrolled
children ages 6-9 years at elevated risk of dental caries who received a sealant
on a permanent first molar tooth within the measurement year. For the latest
and most complete list of the specifications, please refer to your assigned File
Transfer Protocol (FTP) IPRO site.
Q1 2022 Dental Quarterly Quality Review Meeting (QQRM) to Evaluate Performance Measures and Initiatives
HEDIS and Pennsylvania Performance Measure Outliers Below 75
th
Percentile and PeopleStat Targeted Measures
(Managed Care Organization Name)
14
DENTAL SERVICE DATA-DRIVEN QQRM TEMPLATE
SAMPLE
Tobacco Counseling for the Control and Prevention of Oral Disease (D1320)
*provider must be certified as a Tobacco Cessation Counselor (TCC) through DOH
Trending rates comparison
2/29/2020- Total # of services provided
2/28/2021 – Total # of services provided
Tobacco Counseling (D1320)
Initiative Discussion
1. D1320-Initiative/Incentive’s Name (Population key: M, P, C, O): Tobacco Cessation Initiative (P):
Description of Initiative/Incentive:
To increase DOH TCC dental provider counselors and their utilization of D1320 in collaboration with FQHCs. Provided
continuing Education (CE) course on motivational interviewing for tobacco cessation counseling and included instructions to
become DOH TCC provider. Also encouraged the use of tele-dentistry for providing D1320 and provided a toolkit. Made follow
up outreach to those providers who had not completed DOH certification after 90 days from initial outreach/invite.
a. Who was the specific audience or demographic? Members who are not currently receiving D1320 by DOH TCC certified providers.
b. How did you decide to measure the member outcomes of this section’s service(s) as stated in the heading above? Compared the
total number of members on the FQHC medical panel who are diagnosed with tobacco use, to how many members received D1320 by
DOH TCC certified providers.
1/1/21-3/31/21
4/1/21-6/30/21
c. Denominator- Total number of MEMBERS
in the group:
8,342
8,950
d. Numerator- Number of MEMBERS who
received the service as stated in the
heading above:
3
100
e. Rate-
f. If the data is not favorable, how is the information used to make improvements to the particular initiative or is it too early to tell?
Too early to tell. Will continue to repeat quarterly outreach/invites for a minimum of 1 year before analyzing the data/initiative
favorability.
g. Any unexpected outcomes or barriers? Have any new or additional opportunities been discovered?
Providers are not registering for the CEs, even though it’s complimentary. Plan to send out surveys to dental providers as well as the
staff to determine what the barriers might be (prefer differ dates/times, prefer pre-recorded video to be completed at any time, prefer
in-person training by their medical counterparts, etc.) Pending the survey response, will consider adjusting the availability/format of
the training and might consider incentives for medical or dental providers to collaborate together.