Contra Cost Health Plan Quality Program Summary November, 2013

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1 Contra Cost Health Plan Quality Program Summary November, 2013 Mission Statement: Contra Costa Health Plan, along with our community and county health care providers, is committed to ensure our diverse customers receive compassionate, comprehensive, quality health care services. In support of our mission, the Quality Management Program is designed to: Ensure members have access and availability to medically necessary Improve members satisfaction with health care services by ensuring health care services are delivered with compassion and respect Support our members in making good decisions about their health by providing disease management programs targeted toward reducing childhood obesity and managing diabetes Support members by providing health education materials and preventive health reminders Support providers through advancing technology, up to date clinical guidelines, responsive communication regarding business related issues, and serve as a resource for transitioning members through the delivery system Ensure members have access to providers who are qualified and proficient when meeting their medical need Ensure members are given the necessary information in order to access the health system in an appropriate manner Ensure that members are provided with appropriate interpretation and translation services and care that is delivered with cultural competence Program Activities Gather and quantify data relevant to our membership and to our providers in CCHPs delivery system Analyze data relevant to system processes and treatment outcomes, in order to identify opportunities for improvement Initiate and support improvement opportunities identified in the health care delivery system Collaborate with providers and practitioners to develop safe clinical practices Analyze claim and encounter data as well as complaint and satisfaction data in order to prioritize quality improvement activities

2 Achieve and maintain health plan accreditation from the National Committee for Quality Assurance Design and execute quality improvement projects to address barriers and root causes of important processes Quality Monitoring HEDIS- Healthcare Effectiveness Data and Information Set CAHPS- Consumer Assessment of Healthcare Providers and Systems Provider Geographic Access Reports and other access and availability monitoring Member Service metrics Continuity and Coordination of care reporting Patient Safety Initiatives Monitoring care provided to seniors and persons with disabilities and special needs Audits of contracted and delegated entities Indicators are monitored on an ongoing basis with periodic reports presented and reviewed. We strive to address issues that are problematic or high volume.

3 QM Org Chart The Joint Conference Committee is the governing body of Contra Costa Health Plan. It reviews all activities of the Plan and the Quality Management Program. Joint Conference Committee represents the Board of Supervisors and reviews Quality Council recommendations. The Managed Care Commission consists of community members representing important stakeholder groups in order to ensure the public s voice is heard. Quality Council reviews reports from Quality, Utilization, Case Management, and Pharmacy departments. The committees listed in the Organizational Chart present reports specific to their area of specialty. Quality Council is chaired by the Medical Director, and co-chaired by the Health Plan Director of Quality Management. Additional physician and managerial staff are appointed. Quality Council meets at least 9 times a year.

4 Progress in Meeting Our Goals Every year CCHP evaluates efforts to improve quality of care and service for our members. Below are the latest results from some of these efforts. Medi-Cal HEDIS CCHP Medi-Cal 2011 CCHP 2012 CCHP 2013 CCHP Difference (positive indicates improvement) BMI %ile calculated for children 61.07% 59.37% 56.20% -3.41% Nutrition counseling given for children 58.88% 55.72% 55.96% 0.48% Physical activity counseling for children 46.47% 46.47% 46.23% -0.24% *Yearly well child visit 3-6 yr % 77.86% 73.31% -4.55% *Combo 3 immunizations 87.16% 85.40% 84.47% -0.93% *First trimester prenatal 81.75% 83.21% 86.86% 3.65% Postpartum visit days 67.40% 64.96% 62.53% -2.43% *Cervical cancer screening 70.62% 66.67% 66.04% -0.63% Diabetes Eye Exam 2 yrs % 52.80% 51.09% -1.71% Diabetes screening LDL-C 77.74% 75.43% 82.00% 6.57% Diabetes LDL < % 36.25% 41.61% 5.36% *Diabetes HbA1c testing 86.86% 84.91% 85.40% 0.49% Diabetes HbA1c(>9%) 33.94% 36.98% 40.39% -3.41% Diabetes HbA1c (<8%) 56.57% 53.04% 49.88% -3.16% Diabetes Nephropathy screen or treatment 89.23% 87.35% 82.00% -5.35% Diabetes BP <140/ % 54.99% 59.37% 4.38% Immunizations for Adolescents 59.85% 71.61% 11.76% July 1, 2012 Contra Costa Regional Medical Center and the Health Centers implemented a new electronic health record. Challenges with the implementation had a negative impact on our HEDIS rates. We are pleased to have an increase in diabetic lipoprotein screening, immunizations for adolescents, and initiation of prenatal care despite the difficulties encountered during the implementation phase of the electronic health record. Our 2013 goal is to achieve at least pre-implementation scores and improve going forward.

5 Medicare HEDIS rates CCHP Medicare 2013 Adult BMI Assessment 75.84% Breast Cancer Screening 67.50% Colorectal Cancer Screening 57.93% Glaucoma Screening in Older Adults 69.77% Use of Spirometry Testing in the Assessment and Diagnosis of Chronic Obstructive Pulmonary Disease 35.00% Cholesterol Management for Patients with Cardiovascular Conditions (LDL-C Screening) 62.50% Cholesterol Management for Patients with Cardiovascular Conditions (LDL-C <100) 43.75% Controlling High Blood Pressure 60.12% Diabetes Eye Exam 2 yrs % Diabetes screening LDL-C 79.59% Diabetes LDL < % *Diabetes HbA1c testing 87.76% Diabetes HbA1c(>9%) 28.57% Diabetes HbA1c (<8%) 55.10% Diabetes Nephropathy screen or treatment 63.27% Diabetes BP <140/ % This is the first year the Quality Management department is collecting and reporting HEDIS measures for our Medicare population. Over time we expect rates to increase.

6 CAHPS 2010 to 2012 Difference Mean Mean 2012 Amount Below Mean ALWAYS + USUALLY Getting Needed Care 62.60% 60.10% -2.50% 68.72% 65.25% 5.15% Getting Care Quickly 71.67% 56.70% % 71.68% 70.47% 13.77% How Well Doctors Communicate 86.91% 88.00% 1.09% 84.04% 83.45% -4.55% Shared Decision Making 65.08% 45.00% % 57.49% 57.81% 12.81% Some of the achievement scores represented in these tables are below prior year and below the mean. The Quality Management department has completed a root cause analysis of member satisfaction. We have identified opportunities as well as innovative approaches to this challenging situation. Our goal this year is to increase member satisfaction in the composites for shared decision making and rating of all of health care. For a more detailed Quality Management Program, Work Plan and analysis of quality metrics, please contact the Quality Management department at Contra Costa Health Plan ( ).