Quality Management Report 2017 Q2
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1 Quality Management Report 2017 Q2
2 Quality Management Program CMS STAR Ratings Member Satisfaction (CAHPS & HOS) HEDIS Risk Adjustment DHS Member Incident Reporting Member Satisfaction Surveys Pay for Performance Annual Quality Reviews DHS Quality Indicator Monitoring Member Advisory Committees DHS and CMS Quality Performance Metrics Performance Improvement Projects Grievances and Appeals Utilization Management
3 2017 Medicare Star Ratings 4 Stars Above Average Overall Rating Care Wisconsin Health Plan, Inc. (Contract H5209) 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.
4 Member Satisfaction Results The team and the entire Care Wisconsin Organization has been a necessary part of good health and management in my daily life. A great advocate for me. CW Member
5 Member Satisfaction Results Very satisfied with the knowledge, care, and understanding of services available and received through Care Wisconsin. Excellent social worker and nurse. CW Member
6 Permanent Nursing Home One of the goals of the Family Care and Partnership programs is to support people to live within their communities. Most members are considered to be eligible for nursing home care, keeping permanent nursing home residency low (under 3.0%) is an indication of Care Wisconsin s commitment to this goal. The red line below represents the 2017 results of this measure. Percent of total CW Enrollment 4% 3% 2% 1% 0% Members in Permanent NH Placement (Family Care & Partnership) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Goal
7 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 that members are exercising their rights. Our goal is to help maintain communication and encourage all 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 members and work towards our goal of 100% member engagement.
8 Employee Satisfaction Voluntary Turnover is the percent of employees who leave Care Wisconsin by their own choice (excludes terminations for performance or fit). The red line represents the results for Employee Voluntary Turnover 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 Annualized 2017 Annualized 2017 Goal
9 Hospitalization Rates PTMPY Hospitalizations PTMPY Hospitalizations SSI Hospitalizations Per Thousand Members Per Year Partnership Hospitalizations Per Thousand Members Per Year PTMPY Target Linear (PTMPY) PTMPY Target Linear (PTMPY) Hospitalizations are measured by the volume of claims paid. There is a 3 month lag in billing for hospitalizations. The different color at the end of the line shows authorization data so that we can anticipate sooner how we are doing. The higher rate of hospitalizations for Partnership reflects a population with more illness.
10 Hospital Readmission Rates 40% 35% 30% 25% 20% 15% 10% 5% 0% 40% 35% 30% 25% 20% 15% 10% Hospital Re-Admit Rate - SSI Hospital Re-Admit Rate - Partnership Rate Target Linear (Rate) Rate Target Linear (Rate) A hospital readmission is defined as an admission that occurs within 30 days of a prior admission. We are always trying to reduce the number of people who are readmitted to the hospital within 30 days of a discharge. This includes: Transition Support Nurse Program that follows people at high risk for readmission Participation in regional coalitions to work together with a variety of providers to prevent readmissions (hospitals, home care agencies, hospice, supportive home care, etc)
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