Quality Management Report 2018 Q1
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1 Quality Management Report 2018 Q1
2 Care Wisconsin Participates in Many Quality Initiatives Across the State and Federal Levels These activities include: Centers for Medicare & Medicaid Services (CMS) Department of Health Services (DHS) Healthcare Effectiveness Data Integration System (HEDIS) Quality Indicator Monitoring Annual Quality Reviews Quality Indicator Monitoring Member Surveys (CAHPS & HOS) Chronic Care Improvement Projects and Quality Improvement Projects STAR Ratings Appeals and Grievances Member Satisfaction Surveys Performance Improvement Projects Pay for Performance Appeals and Grievances
3 Current Quality Initiatives Comprehensive Diabetes Management As part of the CMS-required Chronic Care Improvement Project we have various activities in place to improve HbA1C lab values, statin adherence rate, and blood pressure readings for members in the Partnership and Dual Advantage programs. Also, we are committed to ensuring members will have an annual eye exam, HbA1C labs, and visit the clinic to receive a kidney function test Dementia Care Wisconsin Quality Management is focused on improving care management of chronic health conditions. Currently there are many interventions and initiatives focused on our members with dementia. Honoring Choices We are committed to the Honoring Choices Wisconsin initiative which promotes advance care planning for our members. Incident Management System We manage member incidents through internal systems that track appropriate follow up and interventions, to avoid further incidents from occurring in the future. Internal File Reviews Care Wisconsin monitors the quality of documentation and care management of members through internal file reviews.
4 2018 Medicare Star Rating Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. 4½ Stars Above Average Overall Rating Care Wisconsin Health Plan, Inc. (Contract H5209)
5 STAR One of CMS s strategic goals is to improve the quality of care and general health status for Medicare beneficiaries CMS publishes Part C and D star Ratings each year to measure quality in Medicare Advantage plans Care Wisconsin Highest Rated STAR Measures: Medication Reconciliation Post-Discharge Diabetes Care Eye Exam Medication Adherence for Diabetes Medications Medication Therapy Management completion rate
6 Member Satisfaction Survey Results Everything is great. I couldn't be taken care of any better. Thank You Partnership Member
7 Member Satisfaction Survey Results I'm really thankful for Care Wisc. They stand behind their name. The care managers are all very adequate over everything. Faith, trust, responsibilities such as rides, help at home, with information, friendly, patient with elderly. -Family Care Member
8 Medicaid Appeals Care Wisconsin views the grievances and appeals process as important for both members and the organization. Care Wisconsin staff encourages members to utilize the Member Rights Specialists and resources that are available to them that will ensure they get a fair hearing and that their dignity and rights are a priority. A high appeal rate may not be an indication that something is wrong, but rather that members are exercising their rights.
9 Medicaid Mediation Our goal is to help maintain communication and encourage all Medicaid members to stay engaged in the process throughout their appeal by participating in mediation. In many cases, through mediation we are able to resolve differences without a formal appeal hearing. While not all members choose to participate, we offer mediation to all Medicaid members and work towards our goal of 100% member engagement.
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