2015 Medicare CAHPS At-A-Glance Report

Transcription

1 2015 Medicare CAHPS At-A-Glance Report Advantage by Bridgeway Health Solutions CMS MA PD Contract: H5590 Project Number(s): Current data as of: 07/01/ Evergreen Boulevard Suite 100, Duluth, Georgia 30096

2 2015 At-A-Glance Report for Advantage by Bridgeway Health Solutions 1. Executive Summary SPH Analytics (SPHA), a Centers for Medicare and Medicaid Services (CMS) approved vendor and a National Committee for Quality Assurance (NCQA) Certified Healthcare Effectiveness Data and Information Set (HEDIS )¹ Survey Vendor, was selected by Advantage by Bridgeway Health Solutions to conduct its 2015 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS ) Survey. This At-A-Glance report is designed to give you a summary view of those Medicare CAHPS results. SPHA collected 217 valid surveys from a sample size of 1016 provided by CMS. Results were collected from March through June of 2015, yielding a response rate of 23.4%. Topics included in the include: Throughout this report, results are shown as scaled mean scores, the same method that CMS uses to calculate Star scores.² It is important to note that these results are not case-mix adjusted and therefore will not match the results you receive from CMS. Since results are not case-mix adjusted, they should only be used for quality improvement purposes, not for estimating Star Ratings and/or bonus payments. Additionally, the measures and methodology used are reflective of the 2015 Star calculations. Composites Getting Needed Care Getting Care Quickly Doctors Who Communicate Well Care Coordination Health Plan Customer Service Getting Needed Prescription Drugs Getting Information About Prescription Drug Coverage and Cost Provider and Plan Ratings Other Single-Item Measures The Getting Needed Care composite measures member experiences when attempting to get care from doctors and specialists in the last six months (Questions 35 and 40). The Getting Care Quickly composite measures member experiences with receiving care and getting appointments in a reasonable amount of time (Questions 4, 6 and 8). The Doctors Who Communicate Well composite includes four questions measuring how well providers listen and explain, listen carefully to members, show respect for what members have to say, and whether they spend enough time with members (Questions 15 through 18). As of the 2012 Star Ratings, CMS is no longer including this composite in the Star Ratings. ¹ HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). ² The contract score is the mean score converted to a 100-point scale. Some questions do not lend themselves to a scaled mean score calculation. For these questions, the value is the percentage of members responding Yes. Note: Results in SPH Analytics reporting do not represent CMS official results. SPH Analytics 2015 At-A-Glance Report 1-1

3 2015 At-A-Glance Report for Advantage by Bridgeway Health Solutions The Care Coordination composite asks members to report whether their doctor had medical records or other information about their care and whether the doctor talked about prescription medicines. This composite also contains questions asking members if they got help managing their care and if the doctor was informed and up-to-date about their specialty care. Additionally, this composite evaluates whether the member s personal doctor s office followed up to give them test results and if they got the test results as soon as they needed (Questions 20, 22-23, 25, 31, and 38). When calculating this composite, Personal doctor's office followed up to give you test results (Question 22) and Got test results as soon as you needed (Question 23) are combined according to CMS conventions. This combined item measure is then averaged with the remaining composite questions in order to form the overall Care Coordination composite. The Health Plan Customer Service composite asks members to rate the ease of getting information or help from customer service, how often they were treated with courtesy and respect by customer service staff, and how often health plan forms were easy to fill out (Questions 42, 43, and 45). The Getting Needed Prescription Drugs composite measures the ease of using the health plan to get prescribed medicines, to fill prescriptions at the local pharmacy and to fill prescriptions by mail (Questions 69, 71, and 73). When calculating this composite, the Ease of using health plan to fill prescriptions at local pharmacy (Question 71) and the Ease of using health plan to fill prescriptions by mail (Question 73) measures are weighted and combined according to CMS conventions. This combined measure is then averaged with the Ease of using health plan to get prescribed medicines (Question 69) in order to form the overall Getting Needed Prescription Drugs composite. The Getting Information from the Plan About Prescription Drug Coverage and Cost composite measures how often members got the information or help they needed from the prescription drug plan customer service, how often members were treated with courtesy and respect by the prescription drug plan customer service staff, the ease of getting information about which medications were covered, and the ease of getting information about the cost of medications (Questions 58, 59, 61, and 63). As of the 2013 Star Ratings, CMS is no longer including this composite in the Star Ratings. Ratings There are five questions with responses scaled 0 to 10 in the Medicare CAHPS survey: Rating of Health Care (Q12), Rating of Personal Doctor (Q19), Rating of Specialist (Q37), Rating of Health Plan (Q46), and Rating of Drug Plan (Q74) where zero represents worst possible and 10 represents best possible. Note: Results in SPH Analytics reporting do not represent CMS official results. SPH Analytics 2015 At-A-Glance Report 1-2

4 2015 At-A-Glance Report for Advantage by Bridgeway Health Solutions Other Single-Item Measures The Annual Flu Vaccine measure is the percentage of members who received an influenza vaccination since July 1, The score for the Annual Flu Vaccine measure is the proportion of respondents who responded Yes to the question, Have you had a flu shot since July 1, 2014 (Question 85). The Willingness to Recommend Plan for Drug Coverage question asks members if they would recommend their prescription drug plan to other people like themselves (Question 75). The Delaying or Not Filling a Prescription question is the percentage of respondents that said Yes when asked if they delayed or didn t fill a prescription because they felt they couldn t afford it (Question 82). The After Hours Call question is the percentage of members that phoned a doctor s office or clinic with a medical question after regular office hours (Question 9). The Answer as Soon as Needed question evaluates how often members got an answer to their medical question as soon as they needed when they phoned a doctor s office or clinic after regular office hours (Question 10). The Pneumonia Vaccine measure is the percentage of members who reported ever having received a pneumococcal vaccine. The score for the Pneumonia Vaccine is the proportion of respondents who responded Yes to the question, Have you ever had a pneumonia shot? This shot is usually given only once or twice in a person s lifetime and is different from the flu shot. It is also called the pneumococcal vaccine (Question 86). Question 47 is comprised of three parts that measure whether or not anyone from a doctor s office or the member s health plan contacted the member to remind them about appointments for tests or treatment, to remind them to get a flu shot or other immunization or to remind them about screening tests such as breast cancer or colorectal cancer screening (Questions 47A, 47B, and 47C). The percentage of members who reported Yes to these questions is displayed. Question 68 includes two parts that ask members if anyone from a doctor s office, pharmacy or prescription drug plan contacted them to make sure they filled or refilled a prescription or to make sure they were taking medications as directed (Questions 68A and 68B). The percentage of members who reported Yes to these questions is displayed. The Complaint Resolution measure allows respondents to report how satisfied they are with how their health plan handled their complaint, regardless of whether they agreed or disagreed with the final outcome (Question 54). The Doctor Used a Computer/Handheld Device question is the percentage of members who reported that their personal doctor used a computer or handheld device during an office visit (Question 26). Note: Results in SPH Analytics reporting do not represent CMS official results. SPH Analytics 2015 At-A-Glance Report 1-3

5 2015 At-A-Glance Report for Advantage by Bridgeway Health Solutions The Doctor s Use of Computer/Handheld Device was Helpful question asks members to evaluate whether or not they thought their personal doctor s use of a computer or handheld device was helpful to them (Question 27). The Doctor s Use of Computer/Handheld Device Made it Easier to Talk to Him/Her question allows members to assess whether their doctor s use of a computer or handheld device made it harder or easier for the member to speak with the doctor (Question 28). The Received Mail Order Medicines Not Requested question is the percentage of members who reported that they received a mail order medicine that they did not request (Question 83). Note: Results in SPH Analytics reporting do not represent CMS official results. SPH Analytics 2015 At-A-Glance Report 1-4

6 Profile of Survey Respondents Advantage by Bridgeway Health Solutions 2015 Medicare CAHPS At-A-Glance Results MA PD Contract # H5590 Sample Size 1016 Total Survey Returns 217 Response Rate 23.4% KEY: Current Year Trend Year One 2014 CMS National Data Benchmark * Health Status and Mental Health Status are defined by survey respondent. Note 1: The 2014 CMS National Data benchmark consists of 451,561 respondents from plans that submitted data to CMS in Note 2: Significance Testing - " " denotes a significantly lower 2015 percentage when compared to 2014 or the benchmark. " " denotes a significantly higher 2015 percentage when compared to 2014 or the benchmark. No arrow denotes that there was no significant difference between the percentages or that there was insufficient sample size to conduct the statistical test. All significance testing is performed at the 95% significance level. Note 3: Age and Gender were determined by database information in For this reason, a CMS benchmark is not available. Low Income Subsidy and Medicaid Dual Eligible were not evaluated prior to 2015; therefore, benchmark and trend data are unavailable for comparison. Note 4: Results in SPH Analytics reporting do not represent CMS official results. Note 5: "NA" represents results that have cell sizes of 10 or less. These results have been suppressed according to CMS rules. See Glossary of Terms for more information. SPH Analytics 2015 At-A-Glance Report Chart 1

7 Advantage by Bridgeway Health Solutions Star Domains: Scaled Mean Scores Composites, Ratings, and Key Questions Valid n Contract Score* 2015 SPH Analytics Book of Business DOMAIN: Member Experience with Health Plan Benchmarks** 2014 CMS National Data Getting Needed Care Q35 Ease of getting appointment with a specialist Q40 Getting care, tests, or treatments necessary Getting Care Quickly Q4 Obtaining needed care right away Q6 Obtaining care when needed, not when needed right away Q8 Saw person came to see within 15 minutes of appointment time Health Plan Customer Service Q42 Getting information/help from customer service Q43 Treated with courtesy and respect by customer service staff Q45 Health plan forms easy to fill out Care Coordination*** X Q22 Personal doctor's office followed up to give you test results Q23 Got test results as soon as you needed Combined Item - Test Results X Q20 Doctor had medical records or other information about your care Q25 Doctor talked about prescription medicines Q31 Got help managing care Q38 Doctor informed and up-to-date about specialty care Q46 Rating of Health Plan Q12 Rating of Health Care DOMAIN: Member Experience with Drug Plan Getting Needed Prescription Drugs**** X Q69 Ease of using health plan to get prescribed medicines Combined Local Pharmacy and Mail X Q71 Ease of using health plan to fill prescriptions at local pharmacy Q73 Ease of using health plan to fill prescriptions by mail Q74 Rating of Drug Plan DOMAIN: Staying Healthy - Screenings, Tests, and Vaccines Q85 Annual Flu Vaccine % 70.1% 72.9% OTHER MEASURES 2015 Medicare CAHPS At-A-Glance Results MA PD Contract # H5590 Doctors Who Communicate Well Q15 Doctors explaining things in an understandable way Q16 Doctors listening carefully to you Q17 Doctors showing respect for what you had to say Q18 Doctors spending enough time with you Getting Info About Rx Drug Coverage and Cost Q58 Getting information/help from PDP customer service Q59 Treated with courtesy and respect by PDP customer service staff Q61 Getting information needed about which medications covered Q63 Getting information needed about cost of medications Q19 Rating of Personal Doctor Q37 Rating of Specialist * The contract score is the mean score converted to a 100-point scale, with the exception of the Annual Flu Vaccine, Delaying or Not Filling a Prescription, After Hours Call, Pneumonia Vaccine, Contact: Appointments for Tests and Treatment Reminder, Contact: Flu Shot or Other Immunization Reminder, Contact: Screening Tests Reminder, Contact: Filled or Refilled a Prescription, Contact: Taking Medications as Directed, Doctor used a Computer/Handheld Device, and Received Mail Order Medicines Not Requested questions. For these questions, the value is the percentage of members responding "Yes." See Glossary of Terms for more information. ** The 2015 SPH Analytics Book of Business consists of 102 MA-PD and MA-Only contracts that conducted the Medicare CAHPS survey with SPH Analytics in The 2014 CMS benchmark consists of 451,561 respondents from contracts that submitted data to CMS in *** The Care Coordination composite is calculated by taking the average of those questions shaded in light blue. Please note that there is no CMS benchmark available for this composite. Furthermore, the 'Combined Item - Test Results' score is calculated by taking the average of 'Personal doctor's office followed up to give you test results' and 'Got test results as soon as you needed.' **** The Getting Needed Prescription Drugs composite is calculated by taking the average of the 'Ease of using health plan to get prescribed medicines' question and the weighted 'Combined Local Pharmacy and Mail' composite (those measures shaded light blue). There is no CMS benchmark available for this measure. Note 1: Significance Testing - Cells highlighted in red denote 2015 contract score is significantly lower when compared to benchmark data; Cells highlighted in green denote 2015 contract score is significantly higher when compared to benchmark data; No shading denotes that there was no significant difference between the scores or that there was insufficient sample size to conduct the statistical test. All significance testing is performed at the 95% significance level. Significance testing of composites should be used with caution as a rough guideline, since the test procedure is approximate. Note 2: "NA" represents results that have cell sizes of 10 or less. These results have been suppressed according to CMS rules. See Glossary of Terms for more information. Note 3: Results in SPH Analytics reporting do not represent CMS official results. X These values cannot be calculated with available data. SPH Analytics 2015 At-A-Glance Report Chart 2-1

8 Advantage by Bridgeway Health Solutions Star Domains: Scaled Mean Scores Single-Items Q75 Willingness to Recommend Plan for Drug Coverage Q82 Delaying or Not Filling a Prescription % 12.8% 12.2% Q9 After Hours Call % 11.7% 9.9% Q10 Answer as Soon as Needed Q86 Pneumonia Vaccine - All Respondents % 66.2% 70.3% Q47A Contact: Appointments for Tests and Treatment Reminder % 57.6% 59.5% Q47B Contact: Flu Shot or Other Immunization Reminder % 40.9% 46.1% Q47C Contact: Screening Tests Reminder % 37.9% 39.4% Q68A Contact: Filled or Refilled a Prescription % 36.4% 37.6% Q68B Contact: Taking Medications as Directed % 25.2% 22.8% Q54 Complaint Resolution Q26 Doctor used a Computer/Handheld Device % 85.2% 82.8% Q27 Doctor's use of Computer/Handheld Device was Helpful Q28 Doctor's use of Computer/Handheld Device Made it Easier to Talk to Him/Her 2015 Medicare CAHPS At-A-Glance Results MA PD Contract # H Q83 Received Mail Order Medicines Not Requested 200 NA 1.4% 1.4% * The contract score is the mean score converted to a 100-point scale, with the exception of the Annual Flu Vaccine, Delaying or Not Filling a Prescription, After Hours Call, Pneumonia Vaccine, Contact: Appointments for Tests and Treatment Reminder, Contact: Flu Shot or Other Immunization Reminder, Contact: Screening Tests Reminder, Contact: Filled or Refilled a Prescription, Contact: Taking Medications as Directed, Doctor used a Computer/Handheld Device, and Received Mail Order Medicines Not Requested questions. For these questions, the value is the percentage of members responding "Yes." See Glossary of Terms for more information. ** The 2015 SPH Analytics Book of Business consists of 102 MA-PD and MA-Only contracts that conducted the Medicare CAHPS survey with SPH Analytics in The 2014 CMS benchmark consists of 451,561 respondents from contracts that submitted data to CMS in *** The Care Coordination composite is calculated by taking the average of those questions shaded in light blue. Please note that there is no CMS benchmark available for this composite. Furthermore, the 'Combined Item - Test Results' score is calculated by taking the average of 'Personal doctor's office followed up to give you test results' and 'Got test results as soon as you needed.' **** The Getting Needed Prescription Drugs composite is calculated by taking the average of the 'Ease of using health plan to get prescribed medicines' question and the weighted 'Combined Local Pharmacy and Mail' composite (those measures shaded light blue). There is no CMS benchmark available for this measure. Note 1: Significance Testing - Cells highlighted in red denote 2015 contract score is significantly lower when compared to benchmark data; Cells highlighted in green denote 2015 contract score is significantly higher when compared to benchmark data; No shading denotes that there was no significant difference between the scores or that there was insufficient sample size to conduct the statistical test. All significance testing is performed at the 95% significance level. Significance testing of composites should be used with caution as a rough guideline, since the test procedure is approximate. Note 2: "NA" represents results that have cell sizes of 10 or less. These results have been suppressed according to CMS rules. See Glossary of Terms for more information. Note 3: Results in SPH Analytics reporting do not represent CMS official results. X These values cannot be calculated with available data. SPH Analytics 2015 At-A-Glance Report Chart 2-2

9 Advantage by Bridgeway Health Solutions Trend Comparisons 2015 Medicare CAHPS At-A-Glance Results MA PD Contract # H Composites, Ratings, and Key Questions Valid n Contract Score* Valid n Contract Score* DOMAIN: Member Experience with Health Plan Getting Needed Care Q35 Ease of getting appointment with a specialist Q40 Getting care, tests, or treatments necessary Getting Care Quickly Q4 Obtaining needed care right away Q6 Obtaining care when needed, not when needed right away Q8 Saw person came to see within 15 minutes of appointment time Health Plan Customer Service Q42 Getting information/help from customer service Q43 Treated with courtesy and respect by customer service staff Q45 Health plan forms easy to fill out Care Coordination** Q22 Personal doctor's office followed up to give you test results Q23 Got test results as soon as you needed Combined Item - Test Results Q20 Doctor had medical records or other information about your care Q25 Doctor talked about prescription medicines Q31 Got help managing care Q38 Doctor informed and up-to-date about specialty care Q46 Rating of Health Plan Q12 Rating of Health Care DOMAIN: Member Experience with Drug Plan Getting Needed Prescription Drugs*** 86.7 NA Q69 Ease of using health plan to get prescribed medicines Combined Local Pharmacy and Mail NA NA Q71 Ease of using health plan to fill prescriptions at local pharmacy Q73 Ease of using health plan to fill prescriptions by mail NA NA Q74 Rating of Drug Plan DOMAIN: Staying Healthy - Screenings, Tests, and Vaccines Q85 Annual Flu Vaccine % % OTHER MEASURES Doctors Who Communicate Well Q15 Doctors explaining things in an understandable way Q16 Doctors listening carefully to you Q17 Doctors showing respect for what you had to say Q18 Doctors spending enough time with you Getting Info About Rx Drug Coverage and Cost Q58 Getting information/help from PDP customer service Q59 Treated with courtesy and respect by PDP customer service staff Q61 Getting information needed about which medications covered Q63 Getting information needed about cost of medications Q19 Rating of Personal Doctor Q37 Rating of Specialist * The contract score is the mean score converted to a 100-point scale, with the exception of the Annual Flu Vaccine, Delaying or Not Filling a Prescription, After Hours Call, Pneumonia Vaccine, Contact: Appointments for Tests and Treatment Reminder, Contact: Flu Shot or Other Immunization Reminder, Contact: Screening Tests Reminder, Contact: Filled or Refilled a Prescription, Contact: Taking Medications as Directed, Doctor used a Computer/Handheld Device, and Received Mail Order Medicines Not Requested questions. For these questions, the value is the percentage of members responding "Yes." See Glossary of Terms for more information. ** The Care Coordination composite is calculated by taking the average of those questions shaded in light blue. Furthermore, the 'Combined Item - Test Results' score is calculated by taking the average of 'Personal doctor's office followed up to give you test results' and 'Got test results as soon as you needed.' *** The Getting Needed Prescription Drugs composite is calculated by taking the average of the 'Ease of using health plan to get prescribed medicines' question and the weighted 'Combined Local Pharmacy and Mail' composite (those measures shaded light blue). Note 1: Significance Testing - Cells highlighted in red denote 2015 contract score is significantly lower when compared to trend data; Cells highlighted in green denote 2015 contract score is significantly higher when compared to trend data; No shading denotes that there was no significant difference between the scores or that there was insufficient sample size to conduct the statistical test. All significance testing is performed at the 95% significance level. Significance testing of composites should be used with caution as a rough guideline, since the test procedure is approximate. Note 2: "NA" represents results that have cell sizes of 10 or less. These results have been suppressed according to CMS rules. See Glossary of Terms for more information. Note 3: Results in SPH Analytics reporting do not represent CMS official results. SPH Analytics 2015 At-A-Glance Report Chart 3-1

10 Advantage by Bridgeway Health Solutions 2015 Medicare CAHPS At-A-Glance Results Trend Comparisons MA PD Contract # H5590 Single-Items Q75 Willingness to Recommend Plan for Drug Coverage Q82 Delaying or Not Filling a Prescription % % Q9 After Hours Call % % Q10 Answer as Soon as Needed Q86 Pneumonia Vaccine - All Respondents % % Q47A Contact: Appointments for Tests and Treatment Reminder % % Q47B Contact: Flu Shot or Other Immunization Reminder % % Q47C Contact: Screening Tests Reminder % % Q68A Contact: Filled or Refilled a Prescription % % Q68B Contact: Taking Medications as Directed % % Q54 Complaint Resolution Q26 Doctor used a Computer/Handheld Device % % Q27 Doctor's use of Computer/Handheld Device was Helpful Q28 Doctor's use of Computer/Handheld Device Made it Easier to Talk to Him/Her Q83 Received Mail Order Medicines Not Requested 200 NA 116 NA * The contract score is the mean score converted to a 100-point scale, with the exception of the Annual Flu Vaccine, Delaying or Not Filling a Prescription, After Hours Call, Pneumonia Vaccine, Contact: Appointments for Tests and Treatment Reminder, Contact: Flu Shot or Other Immunization Reminder, Contact: Screening Tests Reminder, Contact: Filled or Refilled a Prescription, Contact: Taking Medications as Directed, Doctor used a Computer/Handheld Device, and Received Mail Order Medicines Not Requested questions. For these questions, the value is the percentage of members responding "Yes." See Glossary of Terms for more information. ** The Care Coordination composite is calculated by taking the average of those questions shaded in light blue. Furthermore, the 'Combined Item - Test Results' score is calculated by taking the average of 'Personal doctor's office followed up to give you test results' and 'Got test results as soon as you needed.' *** The Getting Needed Prescription Drugs composite is calculated by taking the average of the 'Ease of using health plan to get prescribed medicines' question and the weighted 'Combined Local Pharmacy and Mail' composite (those measures shaded light blue). Note 1: Significance Testing - Cells highlighted in red denote 2015 contract score is significantly lower when compared to trend data; Cells highlighted in green denote 2015 contract score is significantly higher when compared to trend data; No shading denotes that there was no significant difference between the scores or that there was insufficient sample size to conduct the statistical test. All significance testing is performed at the 95% significance level. Significance testing of composites should be used with caution as a rough guideline, since the test procedure is approximate. Note 2: "NA" represents results that have cell sizes of 10 or less. These results have been suppressed according to CMS rules. See Glossary of Terms for more information. Note 3: Results in SPH Analytics reporting do not represent CMS official results. SPH Analytics 2015 At-A-Glance Report Chart 3-2

11 2015 At-A-Glance Report for Advantage by Bridgeway Health Solutions 2-1. Glossary of Terms Attributes are the questions that relate to a specific service area or composite as defined by CMS. Cell Size Suppression is required by CMS in order to protect the privacy of the members responding to the survey. When 10 or fewer people respond in any response option, those results are suppressed by SPHA and are reflected by an NA. Composites are the average of the scaled means of attributes within a given service area as specified by CMS or SPHA. CMS National Data (calculated at the respondent-level) is a collection of respondent-level data from contracts conducting Medicare CAHPS with CMS in The CMS National Data consists of 451,561 respondents that completed an MA-PD or MA Only survey in The scores shown in this report reflect the scores for all respondents. Domains refer to the main topic areas analyzed by CMS in 2014 to produce the 2015 Star Ratings. These are subject to change for this year s Star Ratings. Rating questions use a scale of 0 to 10 for assessing overall experience (doctor, specialist, health care, health plan and prescription drug plan) with zero being the worst and 10 being the best. Scaled Mean Scores are a conversion of standard mean scores to a 100-point scale in order to replicate the CMS scoring methodology. It is important to note that the results provided by SPHA are NOT CASE-MIX ADJUSTED and will not match the results you receive from CMS. Significance test is a test to determine if an observed difference is too large to have occurred by chance alone. Star Ratings are a five-star rating system calculated each year by CMS for Medicare Advantage contracts. Ratings are based on data obtained from four sources: the Medicare CAHPS survey, the Health Outcomes Survey (HOS), CMS Administrative data, and the Health Effectiveness Data and Information Set (HEDIS ). The SPHA Book of Business (calculated on a contract-level) consists of all Medicare Advantage contracts that conducted an MA-PD or MA Only survey with SPHA. In 2015, there were 102 contracts included in the Book of Business. Note: Results in SPH Analytics reporting do not represent CMS official results. SPH Analytics 2015 At-A-Glance Report 2-0