2018 Coronary Artery Disease. Program Evaluation. Our mission is to improve the health and quality of life of our members

Transcription

1 2018 Coronary Artery Disease Program Evaluation Our mission is to improve the health and quality of life of our members

2 2018 Coronary Artery Disease Program Evaluation Table of Contents Program Purpose Page 1 Program Goals Page 1 Program Objectives Pages 1-2 Measurements Page 2 Evaluation Annual Participation Rates Page 2 Coronary Artery Disease Member Engagement Page 3 Coronary Artery Disease Management HEDIS Results Pages 3-7 Healthy Kentuckians Results Page 8 Analysis of Findings Page 9 Number of Referrals by Source Page 10 Member Discharge Status Page 11 Emergency, Admission and Readmission Utilization Page 12 Coronary Artery Disease Cost Trends Page 13 Overall Impact for Identified Sample of Coronary Artery Disease Members Page 14 Goals Met/Not Met Page 15 Member Satisfaction Survey Results with Services Received Page 16 Member Satisfaction Survey Results for Improvement of Health or Quality of Life Page 16 Barriers/Opportunities Page 17 Activities Pages 18-20

3 2018 Coronary Artery Disease Program Evaluation Program Title: Coronary Artery Disease (CAD) Program Evaluation Period: January1, 2018 December 31, 2018 Program Purpose: The CAD Program is a system of coordinated healthcare interventions and communications for a population with a condition in which patient self-care efforts are significant. Adherence to evidence-based medicine combined with a team approach assist in: Empowering members Supporting behavior modification Reducing incidence of complications Improving physical functioning Improving emotional well-being Supporting the clinician/patient relationship Emphasizing and reinforcing use of clinical practice guidelines Program Goals: The goal of the CAD Program is to effectively identify members with potentially avoidable healthcare needs and intervene to positively impact the health outcomes and quality of life for patients with CAD. By using a multi-faceted approach to achieve the best possible outcomes the program can lower costs through preventing avoidable episodes of care and better coordination of care. Program goals include: Partner with member, their caregiver and their primary and specialty care clinicians to develop a plan of care or action plan by a CAD Health Educator Improve medication adherence Facilitate appropriate communication across the entire care team Optimize CAD management and close relevant gaps in evidence-based care Educate patients on CAD diagnosis and self-management Program Objectives: Increase adherence to American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) Guidelines medication management protocols for coronary vascular disease. Increase the percentage of members receiving angiotensin-converting enzyme (ACE) inhibitors post-myocardial infarction (MI). Increase the percentage of members receiving beta-blocker treatment in all post-mi patients unless contraindicated. Increase the percentage of all adult members receiving (Lipid) LDL-C screening. 2/19/19 FINAL Page 1 of 20

4 Increase adherence to LDL-C monitoring in patients with coronary vascular disease or hypocholesteremia. Increase member adherence to the use of LDL-C lowering and antihypertensive drug therapy. Increase member awareness of those risk factors that increase the risk of heart disease and stroke. Promote healthy lifestyle-diet and nutrition, weight management, physical activity, smoking cessation, routine physician office visits, screenings, and treatment. Measurements: Overall effectiveness of the CAD Program is measured through annual participation rates and audited HEDIS 1 results. Annual Participation Rate Eligible members are identified and passively enrolled in the CAD Program. Members may opt out of the Program and elect not to receive services, by notifying a CAD Health Educator or the Care Connector Program, either telephonically or in writing. Participation Rates are tracked and reported annually % Participation January February March April May June July August September October November December Members Engaged Members Identified Declined Participation Graph 1. 1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA) 2/19/19 FINAL Page 2 of 20

5 Member Engagement CAD Health Educators engaged 246 members in This represents a 196% increase from Members appropriate for this program have a CAD diagnosis. CAD Health Educators work with the members to decrease readmissions and ER utilization and to increase utilization of outpatient services and compliance with treatment and care plans January February March April May June July August September October November December Graph 2. CAD Management 2018 HEDIS Results The 2018 HEDIS Results are based on measurement year 2017 data. 1. Controlling High Blood Pressure (CBP) The percentage of members years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled during the measurement year based on the following criteria: Members years of age whose BP was <140/90 mm Hg. Members years of age with a diagnosis of diabetes whose BP was <140/90 mm Hg. Members years of age without a diagnosis of diabetes whose BP was <150/90 mm Hg. Findings: In measurement year 2017, a total of 22,445 members were identified with high BP. In a sample of 398 members, 133 (33.42%) had a controlled BP. 2/19/19 FINAL Page 3 of 20

6 60.00% 50.00% 51.66% Controlling High Blood Pressure 53.76% 59.95% Goal 71.04% 40.00% 30.00% 33.42% 20.00% 10.00% 0.00% MY 2014 MY 2015 MY 2016 MY 2017 Graph 3. The goal to meet or exceed the 2018 Quality Compass 90 th Percentile for CBP (86.46%) was not met. For measurement year 2017, CBP fell below the 2018 Quality Compass 5 th Percentile. 2. Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) The percentage of members 18 years of age and older during the measurement year who were hospitalized and discharged from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of AMI and who received persistent beta-blocker treatment for six months after discharge. Findings: In measurement year 2017, a total of 239 members were identified and 197 (82.43%) received treatment % 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% Persistence of Beta-Blocker Treatment After a Heart Attack Goal 88.75% 86.00% 85.31% 69.41% 82.43% 0.00% MY 2014 MY 2015 MY 2016 MY 2017 Graph 4. 2/19/19 FINAL Page 4 of 20

7 The goal to meet or exceed the 2018 Quality Compass 2 90 th Percentile for PBH (95.45%) was not met. For measurement year 2017, PBH met the 2018 Quality Compass 50 th Percentile. 3. Annual Monitoring for Patients on Persistent Medications (MPM) The percentage of members 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. Annual monitoring for members on ACE inhibitors or ARB. Annual monitoring for members on diuretics. Total rate. Findings: In measurement year 2017, a total of 26,846 members were identified and 23,988 (89.35%) received monitoring % 91.50% Annual Monitoring for Patients on Persistent Medications Goal 92.87% 92.00% 91.00% 90.50% 90.33% 90.00% 89.50% 89.22% 89.29% 89.00% 88.50% 88.00% 87.50% ACE INHIBITORS OR ARBS MY 2014 MY 2015 MY 2016 MY 2017 Graph 5. 2 The source for data contained in this publication is Quality Compass 2018 (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. 2/19/19 FINAL Page 5 of 20

8 Annual Monitoring for Patients on Persistent Medications 93.00% 92.50% 92.00% 91.50% 91.00% 90.50% 90.00% 89.50% 89.00% 88.50% 88.00% 87.50% 92.68% 90.71% DIURETICS 90.02% 89.44% Goal 92.90% MY 2014 MY 2015 MY 2016 MY 2017 Graph 6. Annual Monitoring for Patients on Persistent Medications 92.50% Goal 92.76% 92.00% 92.04% 91.50% 91.00% 90.50% 90.33% 90.00% 89.50% 89.00% 88.50% 88.00% 89.48% TOTAL RATE FOR ANNUAL MONITORING 89.35% MY 2014 MY 2015 MY 2016 MY 2017 Graph 7. The goals to meet or exceed the 2018 Quality Compass 90 th Percentile for MPM ACE/ARB (92.87%), MPM Diuretics (92.90%) and Total Rate (92.76%) were not met. For measurement year 2017, all three MPM measures met the 2018 Quality Compass 50 th Percentile. 2/19/19 FINAL Page 6 of 20

9 4. Statin Therapy for Patients with Cardiovascular Disease (SPC) The percentage of males years of age and females years of age during the measurement year, who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria: Received Statin Therapy. Members who were dispensed at least one high or moderateintensity statin medication during the measurement year. Statin Adherence 80%. Members who remained on a high or moderate-intensity statin medication for at least 80% of the treatment period. Findings: In measurement year 2017, a total of 1,891 members were identified as needing a statin medication. Of those members, 1,392 (73.61%) received a statin therapy and 987 (70.91%) of the 1,392 members had 80% adherence. Statin Therapy for Patients with Cardiovascular Disease Goal 83.75% Statin Therapy for Patients with Cardiovascular Disease 75.50% 75.00% 75.43% 75.32% 90.00% 80.00% 70.00% 82.22% 70.91% Goal 74.03% 74.50% 60.00% 74.00% 73.61% 50.00% 40.00% 47.15% 73.50% 30.00% 73.00% 20.00% 10.00% 72.50% RECEIVED STATIN THERAPY 0.00% STATIN ADHERENCE 80% MY 2015 MY 2016 MY 2017 MY 2015 MY 2016 MY 2017 Graph 8. Graph 9. The goals to meet or exceed the 2018 Quality Compass 90 th Percentile for SPC Received Statin Therapy (83.75%) and SPC Statin Adherence 80% (74.03%) were not met. SPC Statin Adherence 80% met the 2018 Quality Compass 75 th Percentile and SPC Received Statin Therapy met the 2018 Quality Compass 25 th Percentile. 2/19/19 FINAL Page 7 of 20

10 Healthy Kentuckians (HK) Results The 2018 HK Results are based on measurement year 2017 data. 1. Cholesterol Screening The percentage of male member >35 years of age and female members >45 years of age who had an outpatient office visit and had LDL-C screening in the measurement year or during the four years prior. Findings: In measurement year 2017, a total of 57,323 members were identified in the appropriate age range, of those members 45,887 received a LDL-C Screening. LDL-C Screening 90.00% 80.00% 87.79% 77.95% 80.05% 70.00% 60.00% 59.62% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% MY 2014 MY 2015 MY 2016 MY 2017 Graph 10. Specific results include: o LDL-C Screening had an increase by 2.10 percentage points 2/19/19 FINAL Page 8 of 20

11 Analysis HEDIS : Passport aspires to be in the Quality Compass 90 th Percentile for each measure. Results for HEDIS 2018 (MY 2017) for CBP indicator indicated a significant decrease of percentage points which fell below the 2018 Quality Compass 5 th Percentile. Results for PBH indicator indicated an increase of percentage points from MY 2017 and achieved the 2018 Quality Compass 50 th Percentile. Results for MPM ACE Inhibitors or ARBs remains relatively the same with a slight increase 0.07 percentage points, MPM Diuretics had a slight decrease of 0.58 percentage points, and MPM Total Rate for Annual Monitoring had a slight decrease of 0.13 percentage points. All three MPM measures achieved the 2018 Quality Compass 50 th Percentile. Results for SPC indicator for Received Statin Therapy had a decrease of 1.71 percentage points and Statin Adherence 80% had a significant increase of percentage points. SPC Statin Adherence 80% achieved the 2018 Quality Compass 75 th Percentile and SPC Received Statin Therapy achieved the 2018 Quality Compass 25 th Percentile. Member Engagement: Multiple member interventions were conducted to educate the member on the importance of screenings/tests needed based on the ACCF/AHA Guidelines. Providers are notified of members in need of screenings and provided with resources to track members with cardiovascular conditions. Members receive a new member packet upon identification along with monthly mailings in addition to telephonic outreach to high risk members. Community and Clinician Engagement: Providers received status updates on members enrolled in the CAD Program and provided reference information on the ACCF/AHA Guidelines on Passport s website. Risk Stratification: During 2018, an average of 624 members were identified via the stratification tool as having CAD. Of those members, an average of 522 received one-on-one telephonic outreach by a CAD Health Educator. Three separate attempts are made to contact the member. All members receive an initial mailing, and high-risk members receive individualized mailings based on assessment by a CAD Health Educator. Because members with a cardiovascular diagnosis typically have multiple comorbid conditions, some members will continue to be stratified in the Complex Care Management Program versus the CAD Program. Member Complaints: During 2018, there were no complaints received regarding the CAD Program or a CAD Health Educator. 2/19/19 FINAL Page 9 of 20

12 Referral Sources n = 479 Patient/Family 3 Stratification 436 Member Services 5 Utilization Management 13 Physician/Provider 15 Graph 11. Passport proactively identifies CAD members through multiple resource avenues. Findings: Graph 11 represents referrals by source. The top three sources were: 1) Stratification 2) Physician/Provider 3) Utilization Management Multiple avenues are used to proactively identify members for the CAD Program. Education and information are distributed via the Member and Provider Handbooks, Member Newsletter, New Member Packets, and Member and Provider Program brochures. Provider Request for Care Management Forms are available as well on the Passport website. Education is provided through internal department meetings and internal referrals between Care Management and Behavioral Health (BH) is encouraged. A daily report is obtained from the 24-7 Nurse Advice Line of identified members. Health Risk Assessments (HRA) are utilized as a means of risk screening for the member. An attempt is made to obtain an HRA for all members. 2/19/19 FINAL Page 10 of 20

13 Member Discharge Status n = 504 Closed-Unable to Reach 244 Closed-Insurance Terminated 17 Closed-Lost Contact 40 Closed-Declines Participation 51 Closed-Problem Resolved/Goals Met 140 Graph 12. Passport aims to reduce the inability to sustain engagement for CAD members by identifying barriers and trends. Findings: Graph 12 represents reasons for member s discharge from the CAD Program during The top three reasons were: 1) Closed Unable to Reach 2) Problem Resolved/Goals Met 3) Declines Participation There were 244 (48%) members discharged due to the CAD Health Educator being unable to reach the member; 140 (28%) members were discharged/closed due to problem resolved/goals met and 51 (10%) members declined participation. Discharge reasons remains consistent with /19/19 FINAL Page 11 of 20

14 Emergency Department and Inpatient Utilization ED ED Utilization Utilization n = 244 n = % Inpatient Utilization n = % 22% 9% 9% 22% Prior Post Prior Post ED Visits ER Prior # to Members CM Percentage ER Post of CM Total Members IP Visits # Members Percentage of Total Members Graph 13. Graph 14. Readmissions within 30 Days n = % 1% Prior Graph 15. Passport aims to reduce the rate of Emergency Department (ED) utilization, Inpatient Admission, and 30- day Readmissions. Findings: Graphs 13, 14, and 15 represents a sample of CAD members and is a comparison of ED/Inpatient utilization six months prior to and after engagement. After program involvement during 2018, the data demonstrates: A decrease in the numbers of members accessing the ED (-0.07%), utilizing Inpatient (0.0%) and being readmitted (0.0%). A decrease in the number of visits to the ED (-0.06%), a decrease in readmissions (-50.0%), and inpatient utilization (+0.11%). Post Readmission Visits # Members Percentage of Total Members 2/19/19 FINAL Page 12 of 20

15 CAD Cost Trends Graph 16. Passport aims to reduce cost related to ED utilization, Inpatient Admission, and 30-day Readmissions. Findings: Graphs 16 represents a sample of CAD members analyzing utilization six months prior comparative to after engagement. After program involvement during 2018, the data demonstrates: A decrease of $3, in ED cost. A decrease of $58, in inpatient cost. A decrease of $57, in readmission cost. 2/19/19 FINAL Page 13 of 20

16 Overall Impact for Identified Sample of CAD Members n = 244 Total Cost Prior to CM $490, Total Cost Post CM $371, $- $100, $200, $300, $400, $500, $600, Graph 17. Summary: Graphs 17 represents overall impact for the identified sample of members in CC analyzing utilization six months prior comparative to after engagement. After program involvement during 2018, the data demonstrates a potential cost savings of $119, This is not representative of the entire program, but instead of only the sample for analysis. This represents what is a potentially significant higher amount for the entire program year. 2/19/19 FINAL Page 14 of 20

17 Goals Met/Not Met % 148 9% 1% 14 2 Not Met Partially Met Completely Met 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% -10% 2018 Total Goals 2018 Percentage Graph 18. Passport aims to meet or exceed a rate of 90% of care plan goals partially or completely met for members enrolled in the CAD Program. Findings: Graph 18 represents the status of care plan goals for members enrolled in the CAD Program. In 2018, 162 goals were completed/partially completed. There was a total of two (2) goals that were not met due to the members could not complete. There was a goal completion rate of 98.78% for The goal to meet or exceed the target of 90% of care plan goals partially or completely met for members enrolled in the CAD Program was exceeded. 2/19/19 FINAL Page 15 of 20

18 CAD Member Satisfaction Results for Services Received Passport aims to achieve or exceed a score of 90% or above in all areas of member satisfaction for the CAD Program. Findings: The areas surveyed represents the members satisfaction regarding services received: 1) Understand Health Condition 2) Professional and Courteous Manner 3) Value of Written Materials 4) Help with Making Decisions The goal was to achieve 90% satisfaction for each area. For 2018, three telephonic member surveys were distributed, of which none were returned (0% response rate). The target was not met in all areas due to no response from survey. Interventions: Upon closure of the CAD Program, members are encouraged to participate/provide feedback to the survey. Outreach is done to members who indicate via the satisfaction survey that they would like to be contacted. CAD Member Satisfaction Results for Improvement of Health and Quality of Life Passport aims to maintain or exceed the goal of 75% or above in member's perception of improved overall health status and quality of life. Findings: The areas surveyed represents the members satisfaction regarding improvement in health or quality of life: 1) Deal with Health Condition 2) Quality of Life 3) Overall Health The goal was to achieve 75% satisfaction/agreement for each topic. The target was not met in all areas due to no response from survey. Interventions: Upon closure of the CAD Program, members are encouraged to participate/provide feedback to the survey. Outreach is done to members who indicate via the satisfaction survey that they would like to be contacted. 2/19/19 FINAL Page 16 of 20

19 Barriers and Opportunities Barrier: Lack of clinician awareness regarding ACCF/AHA Guidelines the diagnosis and treatment of cardiovascular disease. Opportunity: Increase clinician awareness of the appropriate treatment for persons with cardiovascular disease by posting current ACCF/AHA Guidelines on Passport s website. Barrier: Member lack of knowledge regarding cardiovascular disease. Opportunity: Increase members and caregivers knowledge regarding the appropriate treatment and appropriate self-management skills for persons with cardiovascular disease. Increase member and caregiver awareness regarding the appropriate treatment and appropriate self-management skills for persons with cardiovascular disease 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 Barrier: Member lack of knowledge related to risk factors for cardiovascular disease. Opportunity: Identify members with risk factors for cardiovascular disease to provide targeted member educational outreach. Collaborate with community agencies and statewide initiatives to increase awareness and management of risk factors for cardiovascular disease. Utilize the CAD Program to educate members regarding risk factors for cardiovascular disease. 2/19/19 FINAL Page 17 of 20

20 Interventions completed in 2018: Provider Education: Increase provider awareness of the appropriate treatment for persons with cardiovascular conditions by posting current ACCF/AHA Guidelines on Passport s website and through Provider Relations site visits. Member Education: Educated members/caregivers regarding cardiovascular conditions through face-to-face outreach, telephonic outreach, member newsletters, on-hold SoundCare messages, Passport s website, and member educational material. Continued efforts to educate members and/or caregivers regarding cardiovascular disease, and smoking cessation. Collaborated with community partners to provide supportive services to members/families who need advance illness management services without the requirement of discontinuing active treatments. Screening Activities: Administered the Patient Health Questionnaire (PHQ) 2 with 243 members with 19% of the members with a positive screening. Further depression screenings (PHQ-9 for adults) were conducted with those members. There were 16 members referred for Behavioral Health (BH) services. Administered the Member Satisfaction Survey telephonically to members enrolled in the CAD Program, 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. Identification Activities: Leveraged the Care Connector Program to engage members in need of assistance making appointments. Leveraged the use of Dietician and Social Worker for additional member support. Continued to improve integration and collaboration with BH to improve overall coordination of care for members with co-existing medical and BH diagnoses/conditions. Community Activities: Increased community initiatives related to the diagnosis and treatment of cardiovascular disease through: o Collaborated with community partners, providers, and specialists to promote treatment of cardiovascular conditions. 2/19/19 FINAL Page 18 of 20

21 o Collaborated with community partners to continue to raise awareness of cardiovascular conditions within the community through local departments of health. o Collaborated with community agencies and statewide initiatives to increase awareness of cardiovascular conditions and cardiovascular management. o Continued distribution of educational materials at health fairs and special events. Participated in community forums to determine additional community resources and best practices related to a healthy lifestyle for our members including: o Health and Wellness Fairs o Prevention Workshops Planned Interventions for 2019: Continued Interventions: Increase clinician awareness of the appropriate treatment for persons with cardiovascular conditions by posting current ACCF/AHA Guidelines on Passport s website and through Provider Relations site visits. Educate members/caregivers regarding cardiovascular disease 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 Continue efforts to educate members and/or caregivers regarding cardiovascular disease, and smoking cessation. 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-to-face education with the members at the clinician s office. Administer the Patient Health Questionnaire PHQ-2 and PHQ-9 for prescreening and screening for depression in identified members with cardiovascular conditions and refer 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 surveys for trends, provide feedback to individual staff and address any identified areas that needed improvement. 2/19/19 FINAL Page 19 of 20

22 Continue to improve integration and collaboration with BH to improve overall coordination of care for members with co-existing medical and BH diagnoses/conditions. Continue collaboration with CareMessage vendor to provide helpful information to members with Passport sponsored cell phones. Increase community initiatives related to the diagnosis and treatment of cardiovascular disease through: o Continue collaboration efforts with community partners, providers, and specialists to promote treatment of cardiovascular conditions. o Continue collaboration with community partners to continue to raise awareness of cardiovascular conditions within the community through local departments of health. Overall the CAD Program noted improvements in 2018, particularly in the number of members engaged in the program during the year. Based upon the 2018 evaluation, Passport developed new initiatives to strive towards the overall goal of improving the health and quality of life for our members with cardiovascular conditions. 2/19/19 FINAL Page 20 of 20