2016 Member Incentive. Program Descriptions. Our mission is to improve the health and quality of life of our members

Transcription

1 2016 Member Incentive Program Descriptions Our mission is to improve the health and quality of life of our members

2 Member Incentive Program Descriptions I. Purpose Passport Health Plan (Passport) has developed a Member Incentive Program to increase members and clinicians participation in education, awareness, and engagement of preventative screenings and overall health, wellness and quality of life. Care Coordination is a process that links members with special health care needs and their families and/or caregivers to services and resources in a coordinated effort to maximize the potential of the member, and provide them with optimal health care. Members with special health care needs are those who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who require health and related services of a type or amount beyond that required by individuals generally. Care Coordination is a collaborative process that promotes quality care and cost effective outcomes which enhance the physical, psychosocial and vocational health of members. II. Program Goals Increase percentage of members who receive recommended preventative screenings, including: o Influenza immunization o Blood pressure o Microalbumin o Foot inspection o Weight with body mass index (BMI) o Hemoglobin A1c (HbA1c) o Dilated eye exam (DRE) o Breast cancer o Cervical cancer o Well child o Prenatal o Postpartum o Dental o Spirometry III. Rationale Passport selects specific diseases for targeted member incentives based on HEDIS specifications. Member incentives can change from year to year based on HEDIS results. Passport also takes into consideration the National, Kentucky and Passport specific indications for targeted member incentives. Diabetes: In 2015, Passport implemented 1,747 outbound automated call technology reminders to members needing a recommended diabetic screening/test. There were 1,395 members that took advantage of this incentive; an 80% success rate. Page 1 of8

3 Breast Cancer: In 2015, Passport implemented 10,571 outbound automated call technology reminders to members needing a breast cancer screening. There were 4,048 members that took advantage of this incentive; a 38% success rate. Cervical Cancer: In 2015, Passport implemented 40,273 outbound automated call technology reminders to members needing a cervical cancer screening. There were 5,158 members that took advantage of this incentive; a 13% success rate. Adolescent Well-Child: In 2015, Passport implemented 50,930 outbound automated call technology reminders to members needing a well-child visit. There were 19,117 members who went and had their visit, a 38% success rate. There were 1,598 teen members that qualified and took advantage of the Teen Well-Child Incentive. Pregnancy: In 2015, Passport implemented 2,417 outbound automated calls to newly identified pregnant members. There were 179 members who went to their OB clinician for a 7% success rate. There were 7,109 members that qualified that took advantage of this incentive. In 2015, Passport implemented 2,277 outbound automated call technology postpartum reminders to pregnant members. There were 783 members who went to their OB clinician for their postpartum visit, a 34% success rate. There were 7,109 members that qualified that took advantage of this incentive. Dental: In 2015, Passport implemented 57,002 outbound automated call technology reminders to members needing a dental exam. There were 11,598 members that took advantage of this incentive; a 20% success rate. Spirometry: In 2015, Passport implemented 696 outbound automated call technology reminders to members needing a spirometry test. There were 177 members that took advantage of this incentive; a 25% success rate. IV. Member Participation and Opting Out The Member Incentive Program is available to all members who qualify for each incentive. Members may opt-out of the Program and elect not to receive rewards by notifying the Rapid Response Member Incentive Team or the Care Connector Program, either telephonically or in writing. Participation is voluntary and the member has the right to opt out of the Member Incentive Program or decline all or any part of it. Members who opt out may re-enter the Member Incentive Program at any time by contacting the Rapid Response Member Incentive Team, either verbally or in writing. Page 2 of8

4 V. Integrating Member Information Once notified that a member has completed a screening, they are entered into the Member Incentive Application for processing of the reward(s) that the member qualifies to receive. The Rapid Response Member Incentive Team reviews claims for appropriate codes for each specific screen, verifies that the member is eligible to receive the reward(s) and finalizes the process of sending the reward(s) to the member. Passport also utilizes JIVA, an integrated documentation system, in order to allow all health plan staff access to member information. In JIVA s Member Centric view, all users are able to view information that is specific to the member such as demographics, eligibility, member s clinician, spoken language, and preferences on receiving educational materials or phone contact. Users also have the ability to enter additional addresses or phone numbers, which the member may give as an alternative way to reach him/her that is not associated with the state file download that populates the basic demographic fields in JIVA. The Member Centric view may be utilized to denote a caregiver name and phone number, as needed. In addition, JIVA utilizes widgets to provide quick reference to open authorizations, care coordination activities and appeals. Users can view detail of each open item, or view a summary of each, depending on what information is needed. JIVA also has multiple quick access tabs located across the top of the Member Centric view. This quick access allows a user the ability to: Edit demographic information and preferences, as needed. Add an episode or open cases. Upload documents related to the member and/or the member s care that need to be visible to all users in order to facilitate seamless care coordination. View all the documentation that has been entered as it relates to the member. View any correspondence that the member has sent to Passport, or that Passport has sent to the member. View the member s established care coordination assessment and plan of care. View claims, both pharmacy and medical, related to the member. View results of labs/screenings, as available. Review care gaps. View a clinical summary/history of the last six months of the member including tests and services, medical conditions, medications, ER visits, IP admissions, office visits, etc. View historical data or closed cases. All of this data allows everyone interacting with the member to have to most current and available data in order to make every member contact count to its fullest potential and improve coordination of care by all users having the same information. Page 3 of8

5 VI. Population Identification Eligible members for the Member Incentive Program are identified primarily through clinician notification to Passport but can include the following: Notification from members Claims/encounter data Data collected through the Care Connector Program health and wellness outreach representatives Referrals from other Passport departments, examples include, but are not limited to, Case Management (CM), Disease Management (DM), EPSDT, or Member Services Members who meet the criteria are eligible to participate in the Member Incentive Program. This determination of eligible members occurs on a daily basis. VII. Member Contact Eligible members are identified daily and can request a diabetic incentive form (Appendix A) be sent to them. Members can contact the Rapid Response Member Incentive Team or the Care Connector Program, to let them know when a service is schedule or has been completed for all other incentives that are offered. Along with the diabetic incentive form, a letter is included that encourages the member to participate in the Member Incentive Program to help them improve their health and quality of life. Members also receive information specific to the Member Incentive Program through the Passport s Member Handbook and on the Passport Member VIII. Clinician Notification and Involvement Participating clinicians in the health plan are notified of the Member Incentive Program by the following: The Passport Provider Clinician outreach visits by the Provider Relations Department IX. Member Complaints Complaints regarding the Member Incentive Program may be received by the Member Services Department during routine member contacts. The Member Service staff document the complaint in EXP, a customer service software package that records, tracks, and reports all member inquiries and/or complaints. Each department has a mailbox specific to the department. Member Services forwards the EXP complaint to the Manager of Member Services for follow-up. The Manager of Member Services conducts a quantitative and qualitative analysis of complaints regarding the Member Incentive Program annually. This analysis is used to identify patterns of member complaints and opportunities to improve satisfaction with the Member Incentive Program. Changes to the Member Incentive Program are made as needed. Page 4 of8

6 X. Annual Evaluation The annual evaluation of the Member Incentive Program is conducted by Passport s Manager of Member Services, the Director of Member Services, the Director of Quality, the Chief Medical Officer, or designee. Objectives, activities and outcomes are evaluated at a minimum of annually in order to: Measure participation rates. Determine whether the Member Incentive Program has demonstrated improvement in member s health outcomes. Evaluate the overall effectiveness of the Member Incentive Program. Allow for exploration of barriers and limitations of the Member Incentive Program. Revise areas as needed to improve effectiveness of the Member Incentive Program. Formal measurements are performed annually through HEDIS 1 reviews using HEDIS methodology. Goals are based on HEDIS measures. Results are utilized to revise the program and set the program goals for the following year. More frequent barrier analyses are performed on an ongoing basis and adjustments to the Member Incentive Program are made accordingly. Final approval by the Quality Medical Management Committee: July 14, 2015 June 14, HEDIS is a registered trademark of the National Committee of Quality Assurance (NCQA). Page 5 of8

7 A. Diabetic Member Incentive Forms Appendices

8 Diabetic Member Incentive Form Appendix A