Improving Quality and Satisfaction for Commercial Health Plan Members: Measuring Key Areas of Quality

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Ernest Warner
5 years ago
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1 Improving Quality and Satisfaction for Commercial Health Plan Members: 2016 Measuring Key Areas of Quality Health Plan of Nevada (HPN) measured many key areas of quality in To review the health plan s success, HPN collects and reports on a national set of performance measures. The performance measures are called the Healthcare Effectiveness Data and Information Set (HEDIS ). Health plans across the country use these different measures to look at how well a health plan is doing at improving quality for health plan members. Key Areas of Focus Adult health: o Colorectal Cancer screening Child and Adolescent health: o Weight Assessment and Counseling for Nutrition and Physical Activity for children and adolescents. o Appropriate treatment for children with upper respiratory infection Chronic conditions, like asthma, chronic obstructive pulmonary disease, diabetes, heart disease and high blood pressure: o Use of imaging studies for low back pain o Persistence of beta-blocker use after a heart attack o Comprehensive diabetes care Women s health: o Chlamydia screening for women o Prenatal and postpartum care Behavioral health and Substance Abuse: o Follow-up appointments after hospitalization for mental illness o Initiation and engagement of alcohol or drug dependency treatment o Antidepressant medication management

2 Progress Made in 2016: HMO/POS Improving Quality for Health Plan of Nevada Members Health Plan of Nevada showed improvements in many key HEDIS measures in The largest increases were seen in the: Number of adults with diabetes who received a retinal or dilated eye exam in the past year or negative retinal or dilated exam in the year prior to the current year by an eye care professional o Increased by 5.84 percentage points from the previous years reported rate. Number of adults years with a primary diagnosis of low back pain who did not have an imaging study within 28 days of diagnosis o Increased by 9.87 percentage points from the previous years reported rate. Number of adults age 50 to 75 years who had appropriate screening for colorectal cancer o Increased by 3.54 percentage points from the previous years reported rate. Number of adults years with a primary diagnosis of low back pain who did not have an imaging study within 28 days of diagnosis o Decreased by 9.87 percentage points from the previous years reported rate. Number of adults 18 years of age and older who remained on an antidepressant medication for at least 12 weeks. o Increased by 4.73 percentage points from the previous years reported rate. Number of women who received Prenatal Care in the first trimester or within 42 days of enrollment in the organization. o Increased by 2.26 percentage points from the previous years reported rate. Number of women who received Postpartum Care between 21 and 56 days after delivery within the last year o Increased by 5.13 percentage points from the previous years reported rate. Number of women 16 to 24 years of age who had at least one test for chlamydia during the measurement year. o Increased by 3.34 percentage points from the previous years reported rate. Number of children age 3 months to 18 years of age were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. o Increased by 2.41 percentage points from the previous years reported rate. Number of children and adolescents 3 to 17 years who had an outpatient visit that included a BMI assessment o Increased by percentage points from the previous year. Number of children and adolescents 3 to 17 years who had an outpatient visit that included nutrition counseling o Increased by 5.91 percentage points from the previous year. Number of children and adolescents 3 to 17 years who had an outpatient visit that included physical activity counseling o Increased by 6.43 percentage points from the previous year. Number of members age 6 or older who kept a follow-up appointment after hospitalization for Mental Illness within 7 days o Increased by 8.29 percentage points from the previous years reported rate. Number of members age 6 or older who kept a follow-up appointment after hospitalization for Mental Illness within 30 days o Increased by 6.19 percentage points from the previous years reported rate.

3 Number of members age 5 to 85 years of age who were identified as having persistent asthma and were dispensed appropriate asthma controller medications and remained on them for at least 75 percent of their treatment period. o Increased by 4.71 percentage points from the previous years report rate. Health Plan of Nevada is working to increase our rates in other areas that did not improve or change. Focused actions are being taken to improve: Initiation and engagement of alcohol or drug dependency treatment Childhood Immunizations Follow-up care for children prescribed ADHD medication Follow-up care after hospitalization for mental illness Anti-depressant medication management Prenatal and postpartum care Cervical cancer screening Breast cancer screening

4 Looking at Key Areas of Satisfaction for Health Plan Members Health Plan of Nevada also measures how satisfied commercial health plan members are with the health plan and the health care they have received. HPN contracts with an outside survey firm to conduct the survey. Four Key Areas of Satisfaction Rating of health plan o This rating looks at the percentage of members who rated the health plan as an 8, 9 or 10 on a 10 point scale. Rating of all health care o This rating looks at the percentage of members who rated the health care they received as an 8, 9 or 10 on a 10 point scale. Getting needed care o This rating looks at the percentage of members who stated that it was always or usually easy to get appointments with specialists and to get needed care, tests or treatment. Getting care quickly o This rating looks at three key areas. The three areas focused on how many members responding to the survey stated that: 1) it was always or usually easy to get care as soon as they thought it was needed; 2) it was always or usually easy to get an appointment at a doctor s office or clinic as soon as they thought it was needed; and 3) it was always or usually easy to get into see the person they came to see within 15 minutes of the appointment time.

5 2017 Survey Results: Four Key Areas of Satisfaction In 2017, goals for improvement were set by the health plan s Quality Improvement Committee for the four key areas of satisfaction. The 2017 survey results below were then compared against these goals. Rating of health plan: o The goal for Health Plan of Nevada was to have percent of health plan members rate the health plan as an 8, 9 or 10 on a 10 point scale. o 2017 Survey Results: percent of commercial health plan members rated the health plan as an 8, 9, or 10 on a 10 point scale. This is an increase of 2.78 percentage points from last year. o The goal of percent was met. Rating of all health care: o The goal for HPN is to have percent of health plan members rate the health care they o 2017 Survey Results: percent of commercial health plan members rated the health care they received as an 8, 9, or 10 on a 10 point scale. This is an increase of 3.05 percentage points from last year. o The goal of percent was met. Rating of getting needed care: o The goal for HPN is to have percent of health plan members rate the health care they o 2017 Survey Results: percent of commercial health plan members stated that it was always or usually easy to get appointments with specialists and to get care, tests, or treatment they thought were needed. This is an increase of 7.60 percentage points from last year. o The goal of percent was met. Rating of getting care quickly: o The goal for HPN is to have percent of health plan members rate the health care they o 2017 Survey Results: percent of commercial health plan members stated that it was always or usually easy to get needed care, get an appointment at a doctor s office or clinic, and get into see the person they came to see within 15 minutes of the appointment time. This is a decrease of 3.35 percentage points from last year. o The goal of percent was not met. Going Forward into 2018 Health Plan of Nevada realizes that there is always room for improvement and we will continue to put into place projects that will improve the quality of health care and services for health plan members.

and HEDIS Measures

1 SC Medicaid Managed Care Initiative and HEDIS Measures - 2009 Ana Lòpez De Fede, PhD Institute for Families in Society University of South Carolina Regina Young, RNC SC Department of Health and Human