2015 SCORE. Program Evaluation

Transcription

1 2015 SCORE (Shrinking Childhood Obesity with Real Expectations) Program Evaluation Our mission is to improve the health and quality of life of our members

2 SCORE Program Evaluation Shrinking Childhood Obesity with Real Expectations Program Title: SCORE Program Evaluation Period: January 1, 2015 December 31, 2015 Introduction: The Shrinking Childhood Obesity with Real Expectations (SCORE) Program is designed to improve the health status and decrease complications of overweight and obese members through the coordination of health care interventions; supporting clinician and member relationships; emphasizing prevention of complications utilizing the American Academy of Pediatrics (AAP) Recommendations and patient empowerment strategies with the goal of improving overall health Program Goals: Increase adherence to AAP recommendations: o Clinician: prevention, assessment, and treatment of child and adolescent overweight and obesity. o Member: healthy eating, physical activity and recommended screen time. Promote healthy lifestyle behavior changes by modifying dietary and activity behaviors involving the member and/or caregiver in process of a positive change. Improve long-term physical health outcomes through permanent healthy lifestyle habits. Decrease prevalence of obesity through reduction of Body Mass Index (BMI) for age through weight loss or maintenance during linear growth Program Objectives: To increase member awareness of healthy lifestyle changes through healthy eating habits, increased physical activity, and decreased screen time (computer, TV, video games, etc.). To decrease incidence of obesity related complications including asthma, diabetes, hypertension (HTN), depression, heart disease, sleep apnea, orthopedic issues, and poor academic performance. To increase Healthy Kentuckians (HK) results of Height/Weight Assessment/BMI Assessment and Assessment/Counseling for Nutrition and Physical Activity for Children, Adolescents, and Adults. Measurements: Overall effectiveness of the Program is measured through annual participation rates, audited HEDIS 1, and HK results. 1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 5/5/2016 Page 1 of 13

3 Annual Participation Rate Eligible members are identified, and passively enrolled, in the SCORE Program. Members may opt out of the Program at any time, and elect not to receive disease management (DM) services, by notifying the SCORE Disease Manager or the Care Connector Program, either telephonically or in writing. Participation Rates are tracked and reported annually. SCORE Membership Participation (avg) 2 Opt Out Rate , % , % , % Obesity Management 2015 HEDIS Results The 2015 HEDIS Results are based on measurement year 2014 data. 1. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) 3 The percentage of members 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetricians and Gynecologists (OB/GYN) and who had evidence of the following during the measurement year: BMI Percentile Documentation 4 Counseling for Nutrition Counseling for Physical Activity Findings: In a sample of 453 members, 391 (86.31%) had a documented BMI, 330 (72.85%) received nutrition counseling, and 288 (63.58%) received physical activity counseling. Measure MY 2010 MY 2011 MY 2012 MY 2013 MY 2014 BMI Percentile Documentation (Total) 35.76% 43.49% 60.49% 77.48% 86.31% Nutrition Counseling (Total) 52.98% 52.76% 64.02% 66.67% 72.85% Physical Activity Counseling (Total) 42.38% 44.37% 44.37% 52.98% 63.58% 2 Program membership numbers are annualized 3 WCC will be looked at for NCQA Accreditation for Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value. 5/5/2016 Page 2 of 13

4 The goal to meet or exceed the 2015 Quality Compass 5 90 th Percentile for WCC measure BMI Percentile Documentation 85.61% was met. For measurement year 2014, Nutrition Counseling and Physical Activity Counseling met the 2015 Quality Compass th Percentile. 2. Adult BMI Assessment (ABA) 6 The percentage of members years of age who had an outpatient visit and whose BMI was documented during the measurement year or the year prior to the measurement year. Findings: In a sample of 432 members, 386 (89.35%) members had a documented BMI. Measure MY 2010 MY 2011 MY 2012 MY 2013 MY 2014 Adult BMI Assessment 48.76% 60.62% 76.38% 85.43% 89.35% The goal to meet or exceed the 2015 Quality Compass 90 th Percentile for Adult BMI Assessment 92.94% was not met. For measurement year 2014, Adult BMI Assessment met the 2015 Quality Compass th Percentile. 5 The source for data contained in this publication is Quality Compass 2015 (Medicaid) and is used with the permission of the NCQA. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. 6 ABA will be looked at for NCQA Accreditation for /5/2016 Page 3 of 13

5 HK Results The 2015 HK Results are based on measurement year 2014 data. Healthy Kentuckians assess adult and child weight management through the following measures: 1. Height/Weight Assessment/BMI Assessment and Assessment/Counseling for Nutrition and Physical Activity for Children and Adolescents Members 3-17 years of age who were continually enrolled during the measurement year, whose medical record contains the following during the measurement year: Documented Height and Weight documentation of both a height and weight documented on the same date of service. Documented BMI Percentile/Value documentation of the date and percentile/value of the BMI. Healthy Weight for Height subset of documented weight and height and a documented or calculated BMI value resulting in appropriate weight for height, 5 th percentile to <85 th percentile. Counseling for Nutrition documentation of counseling for nutrition or referral for nutrition education. Counseling for Physical Activity documentation of counseling for physical activity or referral for physical activity. Findings: In measurement year 2014, documentation of Height and Weight, BMI Percentile/Value, and Assessment/Counseling for Physical Activity have increased. Measure MY 2010 MY 2011 MY 2012 MY 2013 MY 2014 Documented Height and Weight 81.90% 83.22% 88.96% 92.05% 94.70% Documented BMI Percentile / Value 35.76% 47.46% 46.36% 75.06% 86.31% Healthy Weight for Height 52.29% 52.79% 55.83% 55.64% 56.64% Documented Assessment / Counseling for Nutrition 52.98% 58.94% 64.02% 60.71% 72.85% Documented Assessment / Counseling for Physical Activity 42.38% 43.71% 44.59% 49.45% 63.58% Results for MY 2014 demonstrated an increase all five HK categories related to children and adolescents. Documented Height and Weight increased 2.65 percentage points, Documented BMI Percentile/Value significantly increased by percentage points, Healthy Weight for Height increased 1.00 percentage point, Documented Assessment/Counseling for Nutrition significantly increased by percentage points and Documented Assessment/Counseling for Physical Activity significantly increased by percentage points. 5/5/2016 Page 4 of 13

6 2. Height/Weight Assessment/BMI Assessment and Assessment/Counseling for Nutrition and Physical Activity for Adults Members years of age who were continually enrolled during the measurement year, whose medical record contains the following during the measurement year: Documented Height and Weight documentation of both a height and weight documented on the same date of service. Documented BMI Value documentation of the date and value of the BMI. Healthy Weight for Height subset of documented weight and height and a documented or calculated BMI value resulting in appropriate weight for height as Counseling for Nutrition documentation of counseling for nutrition or referral for nutrition education. Counseling for Physical Activity documentation of counseling for physical activity or referral for physical activity. Findings: In measurement year 2014, Documented Height and Weight, Documented BMI Value, and Documented Assessment/Counseling for Physical Activity have increased. Measure MY 2010 MY 2011 MY 2012 MY 2013 MY 2014 Documented Height and Weight 68.99% 71.90% 83.89% 89.85% 90.05% Documented BMI Value 48.76% 47.79% 71.52% 83.66% 89.35% Healthy Weight for Height 20.20% 21.23% 22.63% 23.59% 22.62% Documented Assessment / Counseling for Nutrition 31.24% 32.52% 38.85% 43.05% 40.28% Documented Assessment / Counseling for Physical Activity 26.74% 30.53% 30.68% 40.40% 41.67% Results for MY 2014 demonstrated an increase in three of the five HK categories related to adults. Documented Height and Weight increased 0.20 percentage points, Documented BMI Value significantly increased by 5.69 percentage points, and Documented Assessment/Counseling for Physical Activity increased 1.27 percentage points. Results for MY 2014 demonstrated a decrease in two of the five HK categories related to adults. Healthy Weight for Height decreased 0.97 percentage points, and Documented Assessment/Counseling for Nutrition decreased 2.77 percentage points. 5/5/2016 Page 5 of 13

7 Hospital Utilization with a Secondary or Third Diagnosis of Obesity 2,933 3,000 2,500 2,296 2,427 2,639 2,000 1,500 1, ER Visits Inpatient admissions Readmission within 30 days Member Count Utilization for Members with Obesity (per 1,000) 6,000 5,000 5,045 4,868 4,000 3,577 3,330 3,000 2,000 1, ER Visits Inpatient Admissions PCP Visits Specialists Visits /5/2016 Page 6 of 13

8 Hospital Cost with a Secondary or Third Diagnosis of Obesity $2,500, $2,000, $1,500, $1,000, $500, $0.00 ER Cost Inpatient Cost Readmit Cost Members with Obesity by Category of Aid 2,500 2,395 2,054 2,000 1,500 1, Foster Care 28 0 Medicaid Expansion Adult SSI - Adult SSI - Child TANF - Adult TANF - Child Unknown /5/2016 Page 7 of 13

9 Analysis HEDIS : All three (3) WCC measures noted an increase from the previous measurement year: BMI Percentile Documentation showed an increase of 8.83 percentage points Nutrition Counseling had an increase of 6.18 percentage points Physical Activity Counseling had a significant increase of percentage points Results for MY 2014 for ABA measure noted an increase from the previous measurement year of 3.92 percentage points. HK: Results for MY 2014 noted an increase in all five (5) HK categories related to children and adolescents from the previous measurement year: Documented Height and Weight increased 2.65 percentage points Documented BMI Percentile/Value showed a significant increase of percentage points Healthy Weight for Height increased by 1.00 percentage point Documented Assessment/Counseling for Nutrition significantly increased by percentage points Documented Assessment/Counseling for Physical Activity significantly increased percentage points Results for MY 2014 noted an increase in three (3) of the five (5) HK categories related to adults from the previous measurement year: Documented Height and Weight increased 0.20 percentage points Documented BMI Value showed a significant increase of 5.69 percentage points Documented Assessment/Counseling for Physical Activity increased 1.27 percentage points Results for MY 2014 noted a decrease in two (2) of the five (5) HK categories related to adults from the previous measurement year: Healthy Weight for Height decreased 0.97 percentage points Documented Assessment/Counseling for Nutrition decreased 2.77 percentage points Member Engagement: Multiple member interventions are conducted to educate the member on the importance of healthy lifestyle changes, modify dietary and activity behaviors and less screen time based on the AAP Recommendations. The Care Coordination Department has Case Managers in high volume/clinician office in order to educate and encourage the members face-to-face to complete screenings. Community and Provider Engagement: Clinicians received educational mailings and information on Passport Health Plan s (Passport) website. Community activity involvement included collaboration with the Health Service Advisory Committee with Jefferson County Public School (JCPS) and the Nutrition and Childhood Obesity Sub-Committee for JCPS, attendance of the Food and Nutrition Conference and Exposition and Healthy Hoops for education on healthy weight, nutrition, and physical activity. Clinician engagement continued through collaboration with members of Passport s Child and Adolescent Health Committee. This collaborative effort included visits to targeted clinician offices. 5/5/2016 Page 8 of 13

10 ER/Readmissions: The SCORE Program received daily facility-specific ER and readmission reports. Staff used this report to identify members diagnosed as being overweight or obese. Members identified received targeted mailings and telephonic outreach. Members who are newly identified as being overweight or obese received a new member packet, along with individualized and quarterly mailings. High risk members also received telephonic outreach. The SCORE Program began a collaborative effort with Passport s ER Navigators for targeted face-to-face, mailing and telephonic outreach to members with an obesity diagnosis who were identified through an ER visit. Risk Stratification: During 2015, an average of 2,735 members was enrolled in the SCORE Program. Of those members enrolled, an average of 46 was identified as medium risk members and an average of 322 was identified as high risk. There were 113 adult members who were active with one-on-one telephonic outreach, and 350 pediatric members who were active with oneon-one telephonic outreach. A total of 1,120 members received a new member packet via mail. Three separate attempts are made to contact the member by telephonic outreach or mail. All members receive quarterly mailings, and medium and high risk members receive individualized mailings based on assessment by the SCORE Disease Manager. Member Complaints: During 2015, there were no complaints received regarding the SCORE Program or the SCORE Disease Manager. Program Materials Member materials: SCORE Healthy Lifestyle Assessment Coloring Pages All Inclusive Brochure Five Brochure Two Brochure One Brochure Zero Brochure Parent Tips: Get Started! Eating Healthy and Moving More Parent Tips: Help Your Kids Reduce Screen Time and Move More Parent Tips: We Can! Screen Time Chart MyPlate for Kids 10 Tips for Making Healthy Foods More Fun for Children 10 Tips to Help You Eat More Vegetables 10 Tips for Making Healthy Foods More Fun for Children 10 Tips for Setting Good Examples 10 Tips to Help You Eat More Fruits 10 Tips for Physical Activity at Home, Work, and Play Clinician Materials: Fruits & Veggies More Matters Coloring and Workbook Pages Eat Together, Stay Together: Family Meals Matter Come Together for Family Exercise Less Screen Time = Healthier Kids Drink Less Sugar, Lose Weight Be More Active & Enjoy Your Life 5 Reasons to Eat Home Cooked Meals Let s Eat Healthy Nutrition Booklet My Plate Placemat: Healthy Eating for Kids 2 to 3 My Plate Placemat: Healthy Eating for Kids 4 to 8 My Plate Placemat: Healthy Eating for Kids/ Preteens 9 to 12 My Plate Placemat: Healthy Eating for Teen Boys 13 to 18 My Plate Placemat: Healthy Eating for Teen Girls 13 to 18 Healthy Choices During the Holidays How to Eat a Better Breakfast 5/5/2016 Page 9 of 13

11 Care Coordination: Your Connection to Disease and Case Management Programs Brochure Admitted 1on1 Letter Unable to Contact (UTC) Letter DM Discharge Letter Thank You Referral Letter Program Discharge Letter Member Opted-Out Letter Barriers and Opportunities Barrier: Lack of clinician awareness regarding AAP Recommendations, resources, and management of child and adolescent obesity. Opportunity: Educate clinicians of available AAP resources on the Passport website for use, on what constitutes an assessment or education/counseling for nutrition and physical activity, and collaborating with Provider Relations to educate clinicians during all site visits to improve compliance with AAP recommendations and availability of the SCORE Program. Barrier: Member lack of knowledge about healthy nutrition and appropriate amount of physical activity for age. Opportunity: Increase member awareness regarding specific AAP recommendations for nutrition, physical activity, and behavioral changes through: o Distribution of educational materials at health fairs o Face-to-face outreach o Telephonic outreach o Member newsletters o On-hold SoundCare messages o Passport s website o Member educational materials Educate members on the specific AAP Recommendations for nutrition, physical activity and behavioral changes. Utilize the Care Connector Program to assist members with urgent issues related to obesity. Barrier: Collaborate with ER Navigators for identification of members for targeted mailing and telephonic educational outreach. Opportunity: Utilize the ER Navigators to help increase member s knowledge of available resources, education, and willingness to participate in the SCORE program. 5/5/2016 Page 10 of 13

12 Interventions completed for 2015: Provider Education: Increased clinician awareness of AAP Recommendations on Passport s website, through Embedded Case Managers, the SCORE Disease Manager, and through Provider Relations and Quality site visits related to EPSDT education with focus on the availability of the SCORE Program. Updated Care Coordination: Your Connection to DM and Case Management Programs pamphlet for clinician education on support programs Passport offers to members with obesity. Member Education: Educated members/caregivers regarding nutrition and physical activity through face-to-face outreach, telephonic outreach, member newsletters, on-hold SoundCare messages, Passport s website, and member educational material. Distributed the new member packet and assessment form to 1,120 newly diagnosed members to assess the member s understanding and current management of their weight and nutritional status, and provide follow-up recommendations based on the member s needs. Updated Special Health Programs, Just for You! brochure for member education on support programs available for them. Screening Activities: Administered the Patient Health Questionnaire (PHQ) 2 with seven (7) members with 43% of the members with a positive screening. Further depression screenings (PHQ-9 for adults) were conducted with those members. There were three members referred for Behavioral Health (BH) services. The Pediatric Symptom Checklist-17 (PSC-17) is a depression screening for children ages 4-17; 33 members were screened with 18% of the members with a positive screening. There were six members referred for BH services. Identification Activities: Identified and outreached to members with inpatient admissions or ER visits. Continued to improve integration and collaboration with BH to improve overall coordination of care for members with co-existing medical and BH diagnoses/conditions. Reviewed surveys as received and conducted outreach to those members who indicate fair or poor responses on their survey (if the member completes contact information section of the survey tool) and monitored surveys for trends, none identified. Provided feedback to individual staff when appropriate and addressed any identified areas that needed improvement, none identified. 5/5/2016 Page 11 of 13

13 Interventions completed for 2015 (Continued): Community Activities: Increased community initiatives related to the treatment of obesity through: o Collaborated with community resources to assist members in getting information on healthy weight and proper nutrition for age during the Healthy Hoops event and by supplying brochures to the Embedded Case Managers, ER Navigators, and Health Educators related to healthy eating, increasing physical activity and decreasing screen time. o Collaborated with Passport s Child and Adolescent Health Committee and provided updates about the SCORE Program, educational resources that the SCORE Program has available to Passport members, successes with specific members, and pilot project that is waiting for approval. o Collaborated with Text for Kids messaging to provide healthy, helpful information to members through Passport sponsored cell phones. Participated in community forums to determine additional community resources and best practices related to a healthy lifestyle for our members including: o Food and Nutrition Conference and Exposition. o Healthy Hoops. o Health Service Advisory Committee for JCPS. o Nutrition and Childhood Obesity Sub-Committee for JCPS. Planned Interventions for 2016: New Enhancements: Implement a new pilot project with several local pediatrician offices geared toward encouraging SCORE participants to reach health goals with an incentive related reward for progress towards and meeting goals. Passport will be able to offer a program for adult members diagnosed with obesity. Passport was able to hire a new adult Obesity Disease Manager to manage an adult obesity program, HOPE (Healthier Options for People Everyday) which started in late third quarter Continued Interventions: Increase clinician awareness of AAP Recommendations on Passport s website, collaboration with Embedded Case Managers, and the SCORE Disease Manager, and through Provider Relations site visits. Embedded Case Managers while in clinicians offices will assist the clinicians to increase the number of members identified who may benefit from enrollment into the SCORE Program. Identify and outreach to members with inpatient admissions or ER visits. Expand upon current processes to develop additional relationships with participating ERs to promote discharge planning and education regarding appropriate ER use. 5/5/2016 Page 12 of 13

14 Planned Interventions for 2016 (Continued): Educate members/caregivers regarding specific AAP Recommendations for nutrition, physical activity and behavioral changes through: o Face-to-face outreach o Telephonic outreach o Member newsletters o On-hold SoundCare messages o Passport s website o Member educational materials Evaluate all new member materials to ensure each piece is clear and concise. Materials continued to be utilized for member mailings; in addition to face-toface education with the members at the clinician s office. Administer the PHQ-2, PHQ-9 (for adults) and PSC-17 (for children ages 4-17) to prescreen and screen for depression in overweight and obese members and refer members to the BH team as needed. Review surveys as received and conduct outreach to those members who indicate fair or poor responses on their survey (if the member completes contact information section of the survey tool). Monitor for trends, provided feedback to individual staff and address any identified areas that needed improvement. Continue to improve integration and collaboration with BH to improve overall coordination of care for members with co-existing medical and BH diagnoses/conditions. Leverage the Care Connector Program to engage members in need of assistance making appointments. Increase community initiatives related to the treatment of obesity through: o Continue collaboration with community resources to assist members in getting nutritional information. o Continue collaboration with community agencies and statewide initiatives to increase awareness of childhood obesity and obesity management. o Continue collaboration with JCPS Childhood Obesity Program. o Continue collaboration with Passport s Child and Adolescent Committee. o Continue collaboration with Text for Kids messaging to provide healthy, helpful information to members through Passport sponsored cell phones. Participate in community forums to determine additional community resources and best practices related to a healthy lifestyle for our members, including Healthy Hoops event. Overall the SCORE Program noted improvements in 2015 by noting an increase in the number of members involved in the SCORE Program. Passport was able to launch an individual adult obesity program, providing additional opportunities allowing adult members to better meet their goals of eating healthier, staying active and losing weight to decrease prevalence of obesity through reduction of BMI. Based upon the 2014 evaluation, Passport developed new and innovative initiatives to strive towards the overall goal of improving the health and quality of life for our members with obesity. 5/5/2016 Page 13 of 13