FLORIDA HEALTH CARE PLAN S QUALITY PROGRAM 1340 Ridgewood Ave., Holly Hill, FL 32117

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1 FLORIDA HEALTH CARE PLAN S QUALITY PROGRAM 1340 Ridgewood Ave., Holly Hill, FL POLICY/PURPOSE Florida Health Care Plan, Inc. (FHCP) has been providing health care benefits since 1974 in Volusia and Flagler Counties in Florida. Few organizations have been more active than FHCP in promoting good health and wellness for the members we serve. FHCP is a trusted name in the community, with a reputation for high quality care at affordable prices. FHCP offers a wide array of products to serve employer and member needs. We offer traditional HMO products, Point of Service with out of network benefits, Triple Option with expanded and out of network benefits, High Deductible Health Plans, Medicare Advantage with Medicare Advantage Part D, and Healthy Kids programs. FHCP s goal is to keep our members well. Members are encouraged to see their primary care physician, not only when they are sick, but for annual health assessments and preventive care. Members are also encouraged to participate in the many wellness programs offered by FHCP. Through FHCP, members gain access to a health care system designed to control medical costs without sacrificing the quality of care. We are continually expanding our network of providers to meet our members needs. In addition to our plan operated facilities and staff physicians, FHCP contracts with hundreds of providers throughout our community and by virtue of our affiliation with Florida Blue, our members now have access upon approval to thousands of providers throughout the State of Florida, the United States and also internationally. At Florida Health Care Plan we believe that it is our responsibility to positively impact the overall health and wellness of our members, and we have committed ourselves to create a health care system to do just that. Product Name Product Type # of Enrollees Initial Date of Operation Commercial Commercial HMO 31,527 June 1974 (include small group) Medicare MA PD 12,615 June 1974 Healthy Kids Individual 4,247 October 1990 Total 48,389 The active enrollment is current as of November 15, Page 1 of 16

2 FHCP s network is comprised of a total of 1462 providers, including 1132 specialists of which 34 are directly employed and 271 primary care physicians of which 23 are directly employed. FHCP contracts with 13 hospitals including every hospital in Volusia and Flagler counties. Major contract providers include: 1 home care agencies, 13 skilled facilities, and one national laboratory provider. FHCP operates our own pharmacies, retail, and mail order for members only and has one point of care pharmacy vendor when member needs are not met by the FHCP pharmacies. FHCP integrates behavioral health into its staff model medical system. We have three employed psychiatrists and five other behavioral health allied professionals as well as a contract network of behavioral health professionals. FHCP maintains two networks for our commercial membership: HMO and EPN. Our HMO network is a comprehensive network of providers to render all covered services. All commercial members enrolled in any FHCP benefit plan have access to FHCP s HMO network. Members that purchase the Triple Option Point of Service Rider have the FHCP HMO network as their first option, with FHCP s Expanded Physician Network (EPN) as their second option. The EPN is a network of physicians (PCP and specialists) only that provides additional physician choice to our Triple Option members. The EPN is comprised of physicians who contract directly with FHCP, and those that participate in the Blue Cross Blue Shield of Florida HMO network. According to 2013 CAHPS results for the commercial population, our commercial membership consists of 90.2 percent Caucasian, 6.9 percent Black, 5.6 percent Hispanic, 1.8 percent Asian, and 2.4 percent other. The 2013 Medicare CAHPS results show 18.6 percent of Medicare enrollees are under 70 years of age, 21.0 percent are between the age of and 60.4 percent are over the age of 75. According to the 2010 U.S. Census, about 92 percent of the local population speaks English. The non English speaking population is at 8 percent with the most common languages including Spanish, Russian and Polish. FHCP utilizes Language Line for support of other languages than English for all functions including Member Services and direct health care in the physician offices. During the last three years the major clinical conditions in the enrolled population were hypertension, diabetes and depression. SCOPE The QI program, which consists of a broad range of clinical and service issues relevant to its membership, includes all HMO, Medicare, Healthy Kids and Individual Health Plans. The program s scope, which is determined following an annual analysis of the population and its demographic and clinical characteristics, includes the monitoring and evaluation of high volume, high risk, problem prone clinical and service issues. Performance goals and thresholds are established for all measures, and are trended over time. The Performance Improvement Council (PIC) selects specific clinical and service areas and focuses resources to improve performance. At a minimum, the Quality Improvement program monitors and evaluates major Page 2 of 16

3 primary care services, management of chronic care, use of preventive services, behavioral care services, the availability and accessibility of medical and behavioral health services and member satisfaction. A comprehensive summary of clinical and service measures and the specific objectives describing areas selected for focused improvement is located in the Performance Improvement Work Plan. PROGRAM GOALS AND OBJECTIVES 1. Demonstrate commitment to improving safe clinical practice. Distribute information to members that improves their knowledge about clinical safety in their own care. Questions to ask surgeons prior to surgery Questions to ask about drug drug interactions Research findings that facilitate decision making Collaborate with network providers and practitioners to perform the following activities. Conduct in service training focused on improving knowledge of safe practices (e.g., improving medical record legibility; establishing systems for timely followup of lab results) Combine data on adverse outcomes or poly pharmacy issues Incent safe clinical practice Develop incentives for achieving safer clinical practices Focus existing quality improvement activities on improving patient safety. Analyze and take action on complaint and satisfaction data that relate to clinical safety Implement comprehensive complex case management (CCM) programs and disease management (DM) programs that include follow up systems to ensure that care is received in a timely manner Evaluate clinical practices against aspects of practice guidelines that improve safe practices Improve continuity and coordination of care between practitioners to avoid miscommunication that can lead to poor outcomes Improve continuity and coordination between sites of care, such as hospitals and nursing homes, to ensure timely and accurate communication Implement pharmaceutical management practices that require safeguards to enhance patient safety Use site visit results from practitioner and provider credentialing to improve safe practices Page 3 of 16

4 Track and trend adverse event reporting to identify systems issues that contribute to poor safety Distribute information to members that facilitates informed decisions based on safety. Hospitals that use physicians specially trained in intensive care Pharmacies that provide patient counseling 2. Objectives for serving a culturally and linguistically diverse membership Provide disease management member materials in English and Spanish Provide information, training and tools to staff and practitioners to support culturally competent communication 3. Serving members with complex health needs The complex case management program description outlines the organization s approach to managing members with complex needs. Members with complex needs can include individuals with physical or developmental disabilities, multiple chronic conditions and those with frequent high intensity needs. 4. To optimize use of preventive and screening health services in order to facilitate early detection and treatment of high risk medical conditions. 5. To work collaboratively with behavioral care services to monitor, evaluate and improve process and outcomes of behavioral care, and coordination between behavioral care and general medical care. Focus on assessing the member s overall BH experience. 6. To support implementation of activities to improve patient safety in care delivery settings and promote delivery of culturally and linguistically appropriate services. 7. To monitor and evaluate multiple aspects of member satisfaction with care delivery and service. 8. To monitor, and improve when necessary, accessibility and availability of clinical care services. 9. To maintain an ongoing, up to date credentialing and recredentialing process. 10. To collaborate with the utilization management program and its impact on members and providers. 11. To provide appropriate oversight of all delegated relationships. DELEGATION Page 4 of 16

5 FHCP delegates responsibilities to Carenet, Staywell, and Community Health Partners Collier County Network Management. Carenet is a 24 hour nurse advice line which also provides members with access to an audio health library and web nurse capabilities. This service provides an option for patient after hour nurse assessment with the capability of clinical triage. Staywell is an NCQA accredited vendor who provides online self empowerment and wellness information (health risk assessment and health education tools and resources). There is a separate health risk assessment for teenagers that addresses their specific age related concerns. Community Health Partners Collier County Network Management supports the Healthy Kids Program in Collier County and performs network management and credentialing. Each delegated program is monitored for compliance and quality. Network management, credentialing, member satisfaction/complaints, utilization management and quality management all play a key component in the annual assessment. Assessment related to compliance is reviewed by the Accreditation Committee and reported to the Performance Improvement Council. Name of QI Delegate(s) and Type of Service Month and Year Originally Delegated Delegated Functions Providers (number/ percent) Members (number/ percent) Carenet Nov 2010 Health information line 100% 48,389 Staywell Jan 2011 Online health risk 100% 48,389 appraisal and online tools Community Health Partners Oct 2008 Network management and credentialing for 10% 4,247 Collier Country Healthy Kids product Network only Management DentaQuest Jan 1, 2014 PROGRAM OPERATIONS Governing Body Pediatric patients from the Exchange <1% 0 The FHCP board of directors is the Governing Body for the QI program. FHCP s Chief Medical Officer is responsible for reporting Quality Improvement activities to the Governing Body and providing feedback to the Performance Improvement Council. The Governing Body meets quarterly. Membership includes: Secretary, Florida Blue, Assistant General Counsel Chairperson, Florida Blue, SVP, Business Operations Florida Blue, EVP Chief Admin Officer & CFO Page 5 of 16

6 Florida Blue, SVP Sales & Marketing Florida Blue, GVP Chief Accounting Officer Florida Blue, VP Chief Investment Officer & Treasurer FHCP, President & Chief Executive Officer FHCP Chief Financial Officer, Associate CEO Governing Body Quality Improvement (QI) responsibilities include: Allocate resources; Review, evaluate, and approve the QI program description, QI work plans, and the QI evaluation annually; Designate the Performance Improvement Committee to perform oversight of the Quality Improvement program; Review of regular reports from the QI program delineating actions taken and improvements made (not less than annually); Ensure that the QI program and work plan are implemented effectively and result in improvements in care and service; Designate the peer review body responsible for reviewing credentialing and recredentialing files to recommend and/or approve practitioners for participation. Performance Improvement Committee (PIC) FHCP s PIC establishes strategic direction and monitors and supports the implementation of the QI program and work plans throughout the organization. The PIC is a multidisciplinary committee, whose membership includes the Chief Executive Officer, Chief Medical Officer, Chief Information Officer, Contract Services Administrator, Pharmacy Administrator, Clinical Services and Utilization Management Administrator, Practice Management Administrator, Quality Management Administrator, Clinical Measurement and Analysis Reporting Director, Director of Wellness, Director of Membership Growth & Maintenance, and Disease Management Manager. The PIC meets monthly and reports to the Board of Directors. Those members who supplement the council on an ad hoc basis depending on the topic include: Chief Financial Officer, Administrator of Actuarial Services, Administrator of Financial Services, Human Resources Director, Government Relations and Compliance Officer, Operations and Planning Administrator, and others as necessary. The Chief Executive Officer chairs the PIC. Responsibilities of the PIC are: Review/approve the QI program description and QI work plan; Select clinical and service indicators and studies and establish priorities; Evaluate and approve the work plans, including providing feedback and recommendations; Page 6 of 16

7 Annually evaluate the effectiveness of the QI program with input from the appropriate staff; Receive, review, and analyze status reports from each functional area on the progress of implementation of work plans, including aggregate trend reports and analysis of clinical and service indicators, including: Are scheduled time commitments met or behind schedule? Are committees meeting as scheduled? What is their output? Do reports submitted include quantitative data, comparison of results to threshold and performance goals, the identification of causes limiting desired performance, recommendations, and a plan of action? Are action plans implemented effectively? Establish or assure that benchmarks and/or performance goals are established for each indicator; Evaluate clinical and service indicators performance; Review summary reports on the status of delegation; Approve, rescind or modify delegation following the review of delegate audit results; Identify and/or assure that system wide trends are identified and analyzed and that focused interventions are implemented to improve performance issues; Assure that quality improvement efforts are prioritized, resources are appropriate, and that resolution occurs; and Submit reports to the Board of Directors (not less than annually). Quality and Patient Safety Committee The Quality and Patient Safety committee membership includes staff and community physicians with an interest in improving the quality and safety of FHCP members. The Quality and Patient Safety Committee include family practitioners, internists, Hospitalist, one psychiatrist, one endocrinologist, Quality Management Administrator, Practice Management Administrator, Clinical Service and Utilization Review Administrator, Chief Executive Officer, and Chief Medical Officer. The committee meets at least quarterly, is chaired by the Chief Medical Officer and reports to the PI Council. Responsibilities include: Develop draft standards, including practice guidelines, medical record standards, etc. and distribute to affected practitioners for review and feedback; Review new clinical technology and make recommendation on incorporation into the benefit plan to the health plan; Provide input on design of QI studies, barriers to improvement and action plans to reduce or remove the barriers to improvement; Review results of clinical QI studies, and measures of access to clinical care; and Provide feedback and suggestions on activities the health plan implements to promote patient safety in the care delivery setting. Page 7 of 16

8 Accreditation and Delegation Team The Accreditation and Delegation Team is comprised of Administrator of Quality Management, Administrator of Clinical Services and Utilization Management, Contract Service Administrator and ad hoc members as appropriate. The Accreditation and Delegation Committee meets a minimum of at least quarterly, is chaired by Administrator of Quality Management, and reports to the PI Council. Responsibilities include: Review of all accreditation monitoring activities; Referral of any monitoring concerns to the UM or Quality Committee; and Review all delegates for compliance. Customer Satisfaction Committee The Customer Satisfaction Committee is comprised of the Chief Medical Officer, Quality Management Administrator, Practice Management Administrator, marketing representation, Clinical Services and Utilization Review Administrator, Contract Service Administrator, Clinical Pharmacist, and Member Service and Complex Case Management Manager. The Customer Satisfaction Team is chaired by the Administrator of Quality Management and meets a minimum of quarterly and reports actionable items to the PIC. The responsibilities of the Customer Satisfaction subcommittee: Continuously assess all accreditation Member Relations standards for compliance; Ensure that all complaints are aggregated and analyzed for use in improvement projects; Monitor and analyze customer satisfaction data and information recommend improved programs, processes, and services to Administration and the PI Council; Recommend methods to build positive customer relationships to acquire and satisfy customers and to increase business and positive referrals; Assess and make recommendations for improvements in the methods by which customers seek information, conduct business, and make complaints; and Explore improved methods to determine customer satisfaction throughout FHCP and its provider network Clinical Solutions The Clinical Solutions Team is comprised of the Director of Clinical Solutions Applications, Clinical Services and Utilization Review Administrator, Practice Management Administrator, Quality Management Administrator, Contract Services Administrator, and ad hoc member participation as indicated. The Clinical Solutions Committee is chaired by the Director of Clinical Solutions, and meets Quarterly and reports recommendations to the PI Council. The responsibilities of the Clinical Solutions subcommittee: Periodically review and integrate Information Systems (IS) strategic direction with Strategic Business Plan/Goals; Page 8 of 16

9 Review status of clinical IS projects and prioritization; Review proposed IS initiatives in light of FHCP Strategic Business Plan/Goals; and Make recommendations to the PIC, as appropriate. Disease Management Team The Disease Management Team is comprised of Disease Management manager, Clinical Services and Utilization Review Administrator, Practice Management Administrator, Quality Management Administrator, Clinical Quality Specialists, Clinical Measurement and Analysis Reports Director, Clinical Pharmacist, Accreditation Coordinator and Chief Medical Officer. The Disease Management Team is chaired by the manager of Disease Management, meets monthly, and reports to the PI Council. The responsibilities of Disease Management team: Design and coordinate health care intervention and communications for populations with condition in which patients self care efforts are significant; Utilize evidence based guidelines, protocols and algorithms to direct the formulation of any program supporting the physician or practitioner/ patient relationship and plan of care; Assess each program for patient education focus that is aimed at self management, involving the family in the care process, emphasizing prevention of exacerbation and promoting communication between patients and physicians, and specialists; Provide practice guidelines to physicians and other providers; Measure baseline data for patient identification and for comparison at re measure; Analyze process and program outcome measures; and Provide feedback to all involved when intervention outcomes are measured. Pharmacy and Therapeutics (P&T) The P&T subcommittee membership includes three clinical pharmacists, three Family Physicians, two Internists, one Cardiologist, one Neurologist, one Hospitalist, one Psychiatrist, one Oncologist, one Geriatrician, one Ophthalmologist, Administrator of Pharmacy, Quality Management Administrator, and Chief Medical Officer. The P&T committee meets quarterly and is chaired by the Chief Medical Officer or designee. Responsibilities of the P&T subcommittee include: Submit a quarterly report to the PIC of the status of activities; Review and recommend appropriate additions and deletions for the formulary that provides for clinical effectiveness, safety, efficiency and cost effectiveness; Assess medication errors and recommend solutions to FHCP s Performance Improvement Council; Use scientific and economic considerations when making formulary decisions; Annually reviews drugs in therapeutic classes for formulary; Recommend protocols and procedures for the timely use of and access to both formulary and non formulary drug products; Comply with Medicare D regulations; Page 9 of 16

10 Assess new medications and makes a recommendation for inclusion or exclusion of the formulary; and Review new clinical technology or current technology with a new indication and make recommendations on incorporation into the benefit plan to the health plan. Utilization Management Committee (UM) The UM Committee membership includes, Chief Medical Officer, Director of Psychiatry, Quality Management Administrator, Clinical Services and Utilization Management Administrator, Manager of Case management Utilization Review, Manager of Central Referrals Department, Manager of Member Services and Complex Case Management, Supervisor of Central Referrals, Accreditation Coordinator, and Referral Specialist Team Leader. The UM committee meets a minimum of quarterly, is chaired by the Administrator of Clinical Services and Utilization Management, and reports to the PI Council. The responsibilities of the UM Committee includes: Develops, reviews, revises, and assesses all components of the program on an ongoing basis; Develop work plans to implement Standards; Review and approve medical and behavioral health quarterly reports and annual QI program evaluations, work plans, and program descriptions and Standards, state, and federal rules and regulations; Ensures ongoing monitoring of all denials, overutilization and underutilization of medical and behavioral health services; Submit quarterly reports to the PIC; Adopt the clinical review criteria; Analyze clinical and service indicators, establish performance goals. Healthy Kid Quality Committee The HK Quality Committee is comprised of a pediatritian, the Chief Medical Officer, Administrator of Quality, representation from Community Health Partners (CHP), and additional representation from the health plan quality and network management division. The Administrator of Quality Chairs the committee, and the committee meets on a quarterly schedule. The responsibilities include: * Design and coordinate health care intervention and communications for populations with condition in which patients self care efforts are significant; * Utilize evidence based guidelines, protocols and algorithms to direct the formulation of any program supporting the physician or practitioner/ patient relationship and plan of care; * Assess each program for patient education focus that is aimed at selfmanagement, involving the family in the care process, emphasizing prevention of exacerbation and promoting communication between patients and physicians, and specialists; Page 10 of 16

11 * Provide practice guidelines to physicians and other providers; * Measure baseline data for patient identification and for comparison at remeasure; * Analyze process and program outcome measures; and * Provide feedback to all involved when intervention outcomes are measured. Credentialing / Peer Review Committee The credentialing committee membership includes nine participating physicians representing the specialties of Family Medicine, Internal Medicine, General Surgery, OB/GYN, and ad hoc representation as indicated for the type of physician and provider reviewed. The committee is comprised of staff and contracted practitioners. The staff includes the Chief Medical Officer and Quality Management Administrator, credentialing coordinator and the peer review coordinator. The committee is chaired by a contracted physician or Chief Medical Officer, or designee, meets a minimum of quarterly and reports to the PI Council. The credentialing committee responsibilities include: * Review, modify and approve standards and policies and procedures for the credentialing and recredentialing of practitioners and health delivery organizations; * Evaluate practitioners credentialing files which include the results of primary verification, queries to monitoring organizations and a office site visit assessment (PCP, OB/GYNs) and approve or deny practitioners and providers for participation in the health plan; * Evaluate all practitioner and provider recredentialing files, including performance data, and approve or deny continued participation with the health plan. QI Resources Information Systems and Analytic Resources QI data comes from multiple sources within the organization. The table below illustrates the variety of data sources used in QI. Data resources Claims Encounter data Enrollment Other, specify: CAHPS, HOS Incident reporting information Complaints UM statistics HEDIS data Medical records data Serious reportable adverse events (SRAE) Analytic resources are another critical component to the QI process. The table below lists the Page 11 of 16

12 analytic resources used for quantitative analysis and root cause, or barrier analysis. Organizational Structure Analytical Resources Position/Advisor Location Credentials Local Page 12 of 16 Corporate Chief Medical Officer X MD Quality Management Admin X RN, BSN, CHCQM Clinical Services & UM, Admin x RN, BSN Practice Management, Admin X RN, MSN Clinical Measurement Director X BS Clinical Risk Manager X RN, LHRM Health & Disease Management X RN Assistant Administrator Quality X BSN Clinical Pharmacist X Rph Special Project Manager X RN, BS FHCP s Chief Medical Officer is responsible for implementation of the QI program. The Director of Psychiatry is responsible for the behavioral health aspects of the QI program. The Quality Management, Administrator is responsible for managing day to day operations. Quality Improvement is a multidivisional endeavor including Medical Informatics/Clinical Measurement and Analysis, Disease Management and Clinical Services. The QI responsibility consists of 24 FTEs, and Clinical Measurement Analysis and Reporting consists of 6 FTEs. Responsibilities include: * Provide staff support to QI committees; * Develop initial drafts of program documents for review and approval by the PIC; * Formulate quarterly reports to the Governing Body and PIC, reflecting the status of program implementation; * Oversee and manage QI delegation, including conducting initial evaluation of potential delegates, reviewing and evaluating delegate s reports, and communicating an annual review of the delegates; * Formulate scheduled reports for external review agencies; * Annually update the FHCP population analysis; * Draft initial work plan for review and approval by the PIC; * Formulate initial draft QI study design; * Implement QI studies, including data collection methods; * Facilitate implementation of the QI work plan across the organization;

13 * Implementing the DM and CM programs; * Oversight of the UM program including appeals; * Implementing the credentialing program; * Oversight of the network including access; * Oversight of member satisfaction; and * Formulate practice guidelines and health management programs for submission to the PIC. Accountability of Quality Committees Participating providers serve in the Quality Improvement process and all standing subcommittees. Participating providers provide feedback to the PIC by representing the standards of care in the community and the community resources available. Participating providers also use their medical knowledge to assist the health plan to identify high risk, problem prone areas, most important aspects of care, and to recommend clinical priorities for monitoring and evaluation. Other responsibilities include: * Review, evaluate, and make recommendations for credentialing and recredentialing files; * Review individual medical records reflecting adverse occurrences; * Review proposed practice guidelines and clinical protocols; * Review proposed QI study designs; and * Participate in the development of action plans to improve levels of care and service. The Quality Management department is responsible for developing all policies, procedures, and forms used in the credentialing and recredentialing of practitioners and health delivery organizations. The credentialing staff implements the policies and procedures, including gathering all applications, primary source verification, and presenting a completed file to the credentialing committee for review and determinations. All credentialing and recredentialing files are maintained in secure locked confidential files. The credentialing department provides quarterly reports to the PIC on the status of credentialing and recredentialing activities. QM is responsible for gathering of sentinel event monitors and adverse occurrence screens. Adverse occurrences are reviewed by the PIC. The QM department is also responsible for on site monitoring visits. The results of on site visits are forwarded to the credentialing committee for review. The Clinical Services and Utilization Review department is responsible for the development of the UM program description and all UM policies and procedures, which are reviewed and approved by the PIC. UM staff implements the policies and procedures. The UM department provides quarterly reports of timeliness of decision making, denial rates and type and appeal overturns to the PIC. The Member Service department is responsible for the network development of policies and Page 13 of 16

14 procedures that govern the management of the complaint, grievance and appeals system, trend reports of member complaints and grievances and report to the UM committee and the Customer Satisfaction Committee. The Provider Relations department is responsible for all contracting functions, updating provider manuals, initial site visits, orientation to the health plan, and maintaining the directory. Meeting Minutes FHCP maintains contemporaneous, dated and signed meeting minutes of the QI committee, all subcommittees, time limited task forces and work groups. Meeting minutes, which are documented using a standardized format, include as attachments documents presented to the committee for review. Minutes are maintained in a secure confidential file. QI Work Plan A comprehensive QI work plan describes measurable objectives for each planned QI activity, activity time frames and the individuals responsible for implementation. Additionally, the work plan schedules the evaluation of the QI program, activities related to oversight of delegation and committee reporting. QI Evaluation Annually, the QI department facilitates a comprehensive organizational evaluation of the progress of the QI program. The analysis focuses the progress made towards improving and/or sustaining clinical and service measures and barriers to success. The evaluation serves as a basis for changes to the subsequent year s program and work plan. Quality Improvement Staffing The table below lists the resources dedicated to the QI function. Allocation of Adequate Resources to QI Position Personnel resources (FTEs) (List positions and number of FTEs devoted to QI) Administrator, Quality Management 1 Administrator, Contract Services 1 Administrator, Utilization Management 1 Director Clinical Measurement, Analysis & Reporting 1 Manager, Member Services 1 Manager, Disease Management 1 Manager, Case Management 1 Support staff 3 Number of FTEs Page 14 of 16

15 Position Allocation of Adequate Resources to QI Personnel resources (FTEs) (List positions and number of FTEs devoted to QI) Manager, Referrals 1 Supervisor, Referrals 1 Manager, Utilization Management 1 Analytic Supervisor 1 Project Coordinators 2 Reporting Analyst 4 Clinical Pharmacist 2 Clinical Quality Reviewers 2 Special Projects Manager 1 Risk Manager 1 Supervisor, Claims 3 Assistant Administrator of Quality 1 Number of FTEs Page 15 of 16

16 QM004 Rev. 24 (Attachment 1) Page 16 of 16