Medicare 2013 QI Program Evaluation

Transcription

1 #1 Priority Measures Diabetes Medication Adherence D 3 69% 71% High Risk Meds in the Elderly D 3 8% 3% Sleep medications were added to the measure after the 2013 formulary was accepted. A number of high risk medications were removed from the 2013 formulary. Statin Adherence D 3 68% 69% ACE/ARB Adherence D 3 70% 76% Controlling Blood Pressure (CMS CCIP program measure) C 3 70% 73% Financial incentive for CHP PCPs and staff. Physician reports are available; CHP's EMR provides an alert to recheck high BP readings. Network News articles in May and October, 2013 on blood pressure control. Savvy Senior presentation for Medicare members in July, 2013 on high blood pressure. Plan All-Cause Readmission (CMS QIP) C 3 10% 9% Care Coordination staff monitor and encourage post hospital visits; high risk members are referred to case management or consults with designated Internal Medicine physician. Network News article in August and October, 2013 encouraging post hospital visits. Diabetes Treatment D 3 88% 86% Savvy Senior presentation for Medicare members in July, 2013 about treatment of diabetes. Diabetes Care HbA1c Control C 3 95% Statistically significant decrease (p=0.0066). Letters to members with elevated HbA1c, followup PCP appointments are encouraged. HealthLine article in October, 2013 promoting interactive patient eduation tools on CHP's website on blood sugar control. Diabetes Care LDL Control C 3 69% 75% Financial incentive for CHP PCPs and staff, and affiliate PCPs. Letters to members with elevated HbA1c, followup PCP appointments are encouraged. Improving or Maintaining Mental Health C 3 78% 78% Savvy Senior presentations for Medicare members in March and April 2013 about how to maintain good mental health. 1

2 Improving or Maintaining Physical Health C 3 64% Quality Improvement (composite) C Quality Improvement (composite) D % Improvement score is based on significant change in measures collected over 2 years using the same specifications. Improvement score is based on significant change in measures collected over 2 years using the same specifications. Savvy Senior presentations in January and February, 2013 about physical activity. #2 Priority Measures Appeals Auto-Forward D Reviewing Appeals Decisions C 1.5 N.A. 92% Plan Makes Timely Appeals Decisions C % Appeals Upheld D 1.5 N.A. N.A. Foreign Language & TTY/TTD C Foreign Language & TTY/TTD D Care Coordination (CAHPS) C % Complaints about Plan C/D Members Choosing to Leave C/D 1.5 1% Beneficiary Access Problems C Getting Needed Prescription Drugs D 1.5 Getting Information from Drug Plan D 1.5 Rating of Drug Plan D % Customer Service C 1.5 Getting Appointments & Care Quickly C % 85 1 star 87% % 100 N.A. 91% 95% 79% 2012: data is not reported for plans with 10 or fewer cases. CHP's score was lower in 2013 because of an error; BCBS incorrectly indicated that CHP shares their call center. Issue will be resolved for Same issue as above. New question for Medicare CAHPS % is the 5 star cut point, but CHP's score was not "statistically significant" over the national average. Measure of problems found during audit. No problems or N.A. is = to 100%/. CMS has retired this measure for the 2014 Plan Ratings. Improvements in the Contact Tracking System, and procedural changes in the Claims department in 2012 resulted in zero auto-forward appeals in Member Services staff track and review all test calls, and provide training for staff on an ongoing basis. Same as above. Healthline article in 1st quarter of 2014 that addresses the individual Care Coordination questions, and an article encouraging participation in the Medicare CAHPs survey if appropriate. Member Services held weekly staff meetings to provide ongoing education and training. 2

3 Getting Needed Care C % Overall Rating of Health Care Quality C % Overall Rating of Health Plan C % 91% 95% #3 Priority Measures MTMP CMR Completion Rate D N/A 9.80% N/A Proposed 2015 Plan Rating Measure. Pharmacotherapy Management of COPD Exacerbation, Bronchodilator C N/A 65% 82% Eligible population: 72 members Health Promotions staff monitor the population to be sure they fill prescriptions. Network News article in August, 2013 about updated guidelines for COPD treatment. Pharmacotherapy Management of COPD Exacerbation, Systemic Corticosteroid C N/A 74% 74% Eligible population: 72 members Statistically significant improvement (p=0.0208). Health Promotions staff monitor the population and intervene as necessary. Network News article in August, 2013 about updated guidelines for COPD treatment. Initiation of Alcohol and Other Drug DependenceTreatment C N/A 67% 58% Eligible population: 126 members Health Promotions staff monitor the population, and work to improve accuracy of diagnosis coding. Engagement of Alcohol and Other Drug Dependence Treatment Osteoporosis Management C 1 56% Diabetes Care Eye Exam C 1 88% Diabetes Care - Nephropathy C 1 C N/A 13% 5% Eligible population: 126 members Health Promotions staff monitor the population, and work to improve accuracy of diagnosis coding. 61% CHP Radiology staff monitor and schedule appointments for patients who need DEXA scanning. CHP Eye Care staff contact appropriate members for testing and provide exams in affiliate PCP offices. Savvy Senior presentation for Medicare members in November, 2013 about Eye Care. A lab request is sent to patients needing testing; patients are asked to have the lab test completed within the calendar year. Diabetes Care LDL Screening C 1 99% A lab request is sent to patients without an LDL completed within the calendar year. Network News article in March, 2013 about lipid testing. Glaucoma Testing C 1 85% 83% Statistically significant decrease (p=0.000). Incentive for CHP Eye Care staff to perform glaucoma screenings during routine visits. Eye Care staff provides testing at high volume affiliate offices and Health Fairs. 3

4 Cardiovascular Care LDL Screening (CMS CCIP program measure) C 1 98% A lab request is sent to patients without an LDL completed within the calendar year. Network News article in March, 2013 about lipid testing. Breast Cancer Screening C 1 87% 88% Network News article in October, 2013 about revised breast cancer screening guidelines. Colorectal Cancer Screening C 1 91% 92% CHP's Colon Screening Program tracks members and provides screening procedures. Savvy Senior presentation in October, 2013 about colon screening. Rheumatoid Arthritis Mgmt C 1 87% 86% Letters are sent to diagnosing physicians asking them to evaluate the patients for correct diagnosis and to start patients on appropriate medications. Adult BMI Assessment C 1 86% Medicare Plan Finder Composite D 1 99 Annual Flu Vaccine C 1 74% 98 79% Statistically significant improvement (p=0.000). Financial incentive for affliate PCPs. Public health departments & local pharmacies provide services & send documentation to CHP. On Hold message for 4th quarter, Improving Bladder Control C 1 40% Reducing the Risk of Falling C 1 56% 41% 59% Savvy Senior presentation for Medicare members in December, 2013 about preventing falls. Monitoring Physical Activity C 1 56% 57% Savvy Senior presentation in January, 2013 about the benefits of exercise. High Priority Display Measures Atypical Antipsychotic Use by the D N/A 37.04% N/A Elderly in Nursing Homes Appeals - Timely Receipt D N/A 1/1 2/2 Appeals - Timely Effectuation D N/A 1/1 N/A Drug-Drug Interactions D N/A 7.09% 7% Approximately 50% of the fills counted against us are for patients taking warfarin and fibrates. These drugs are not contraindicated, just require caution and monitoring. Would not be medically appropriate to deny fills. Diabetes Medication Dosing D N/A 1.80% 1% New CAHPS survey measures C N/A N/A N/A New display measure proposed for Disenrollment Reasons C/D N/A N/A N/A CMS administered a survey of voluntary disenrollments in 2013; measure will potentially be added to future star ratings 4

5 Use of Highly Rated Hospitals C N/A N/A N/A New display measure proposed for Measure based on value-based purchasing scores. HEDIS and CAHPS Measures: Not in the Star Ratings Diabetes A1c Testing (HEDIS) N/A N/A 98% 95% Statistically significant decrease (p=0.0192). A lab request is sent to patients without an A1c completed within the calendar year. Financial incentive for affiliate PCPs. Diabetes BP Control <140/90 (HEDIS) N/A N/A 73% 69% Physician reports are available through CHP's EMR and CHP Connect. Diabetes BP Control <140/80 (HEDIS) N/A N/A 61% 58% Physician reports are available through CHP's EMR and CHP Connect. Use of Aspirin (CAHPS - CMS CCIP program measure) N/A N/A N/A 54% Million Hearts Target: 70% On Hold message for 4th quarter, Healthline article in December. New Medicare CAHPS supplemental survey question. Members Who Smoke Cigarettes or Use Tobacco (CAHPS - CMS CCIP program measure) N/A N/A 10% 8% Million Hearts Target: 17% CHP staff practices provided educational materials and community resources for Medicare members who smoke. Healthline article in May, 2013 on the Million Hearts initiative, with educational information about smoking cessation. Advising Smokers to Quit (CAHPS - CMS CCIP program measure) (% sometimes/usually/always) Pneumonia Vaccine for Older Adults (CAHPS) Spirometry Testing in Assessment & Diagnosis of COPD (HEDIS) Persistence of Beta Blocker Treatment (HEDIS) Antidepressant Medication Management, Acute Phase Treatment (HEDIS) Antidepressant Medication Management, Continuation Phase Treatment (HEDIS) Annual Monitoring of Patients on Long Term Medications (HEDIS) 7 Day Follow-up after Hospitalization for Mental Illness (HEDIS) N/A N/A 74.0% 83.0% Million Hearts Target: 100% Same interventions as above. N/A N/A 80% 73% N/A N/A 57% 62% Health Promotions staff contact appropriate members and provide the testing. N/A N/A 79% Statistically significant improvement (p=0.0168). Health Promotions staff monitors the population and intervenes as necessary. N/A N/A 68% 64% CHP staff contact PCPs when members are identified, and when antidepressant medications haven't been filled. N/A N/A 61% 53% CHP staff contacts PCPs when members are identified, and when antidepressant medications haven't been filled. Network News article distributed in August 2013 related to correct coding for depression. N/A N/A Lab requests sent to diabetic members include testing for potassium and BUN. N/A N/A 75% 74% Local hospital's Behavioral Health Center coordinates follow-up visits. Network News article in October, 2013 announced a new Access Center at TMH Behavioral Health Care. Approved by Board of Directors: 11/19/13 Report Date: 10/16/2013 5