Neighborhood Health Plan of Rhode Island

1
Neighborhood Health Plan of Rhode Island

• HEDIS 2004 Results
• CAHPS 2004 Results
• HEDIS is a registered trademark of the National
  Committee for Quality Assurance (NCQA).
• CAHPS is a registered trademark of the Agency
  for Healthcare Research and Quality (AHRQ).

2
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Childhood Immunization Status

• Description
• The percentage of children who turned
• two years old during 2003 and were
• up-to-date with immunizations.
• NHPRI results
• 4 DTP (diphtheria-tetanus-pertussis) 86
• 3 OPV/IPV (oral or injectable polio virus) 95.
• 1 MMR (measles-mumps-rubella) 94.
• 3 Hib (haemophilus influenza type B) 83.
• 3 Hep B (hepatitis B) 90.
• 1 VZV (chicken pox) 92.
• Combo 1 70.
• (all required DPT, OPV, HIB, MMR, HEP B)
• Combo 2 (combo 1 and VZV) 68
• NHPRIs rate ranked above the 75th
• percentile.

2003 Improvement Initiatives NHPRI provided to
high volume primary care sites their performance
rates and a list of their patients who did not
meet immunization standards. The Plan educated
members about the benefits of childhood
immunization, provided children turning one year
of age a birthday card reminding parents about
lead screening and timely immunizations. The
plan provided a performance-based incentive for
selected large primary care sites.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
3
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Adolescent Immunization Status

• Description
• The percentage of members who turned 13 during
  2003 and were
• up-to-date with immunizations.
• NHPRI results
• 1 MMR (measles-mumps-rubella) 90
• 3 Hep B (hepatitis B) 76
• 1 VZV (chicken pox) 77
• Combo 1 (MMR and Hep B) 76
• Combo 2 (all immunizations) 68
• NHPRIs rate ranked above the 90th percentile.

2003 Improvement Initiatives NHPRI provided to
high volume primary care sites their performance
rates and a list of their patients who did not
meet immunization standards. The Plan also
educated members about the benefits of childhood
immunization, and provided a performance-based
incentive for selected large primary care sites.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
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Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Cervical Cancer Screening

• Description
• The percentage of women 21-64 years old, who
  received one or more Pap tests during the three
  year period
• 2001 - 2003.
• NHPRIs rate ranked above the
• 90th percentile.
• Rotated Measure

HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
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Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Appropriate Treatment For Children
With Upper
Respiratory Infection

• Description
• The percentage of children 3 months to 18 years
  of age who were diagnosed with upper respiratory
  infection and were not dispensed an antibiotic
  prescription on or 3 days after the Episode Date.
• First Year Measure

HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
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Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Appropriate Testing For Children
With Pharyngitis

• Description
• The percentage of children 2 18 years of age
  who were diagnosed with pharyngitis, prescribed
  an antibiotic and who received a group A
  streptococcus test for the episode.
• First Year Measure

HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
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Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Chlamydia Screening in Women

• Description
• The percentage of women age 16 through 25 years
  identified as sexually active, who had at least
  one test for chlamydia during 2003.
• NHPRIs rate ranked above the 50th percentile in
  the ages 16-20 category and the 21-26 category.

The age range changed from 21-26 to 21-25
starting with HEDIS 2004. The HEDIS 2004 rate for
the 16-20 age group is significantly higher than
the HEDIS 2003 rate, p lt 0.001.
2003 Improvement Initiatives

Performed
extensive root cause analysis to understand the
drivers of performance for Chlamydia Screening.
Shared results with high volume primary care
practices and state wide health care leaders.
Developed consensus among the managed care plans
in Rhode Island for a state wide provider
intervention.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
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Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Comprehensive Diabetes Care
The 2004 Eye Exam (p lt 0.01) and 2004 Kidney
Disease Monitoring (p lt 0.10) rates are
significantly lower than the 2003 rates.

• Description
• The percentage of members with diabetes age 18
  through 75 years old, who had each of the
  following during 2003
• Hemoglobin A1c (HbA1c) tested
• HbA1c well controlled (lt9.0)
• LDL-C Control (LDL lt130 mg/dL)
• LDL-C Control (LDL lt100 mg/dL) (First Year)
• Dilated eye exam performed
• Lipid profile performed
• Kidney disease monitored

2003 Improvement Initiatives NHPRI sent primary
care sites a quarterly list of their members with
diabetes, noting which members had received four
important milestones of comprehensive diabetes
care in the preceding 12 months report included
a performance summary for the site with a
comparison to plan-wide performance on these
diabetes measures. Members received educational
materials to enhance self-management. NHPRI
supported a primary care collaborative effort to
improve diabetes care at primary care sites.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
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Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Use of Appropriate Medications for
People with
Asthma

• Description
• This process measure evaluates whether members,
  age 5 through 56 with persistent asthma are being
  prescribed medication acceptable as primary
  therapy for long-term control of asthma. process
  measure evaluates
• NHPRIs rate ranked above the 90th percentile in
  the 5-9 age group. The 10-17, 18-56 and combined
  rates ranked above the 75th percentile.

2003 Improvement Initiatives NHPRI sent primary
care sites a quarterly list of their members with
persistent asthma, noting recent pharmacy fills
for inhaled anti-inflammatory medication. Every
3 months NHPRI sent primary care providers a
pharmacy report on any member assigned to them
who had high beta-agonist use and no
anti-inflammatory medication fills. The asthma
case manager followed up with members recently
hospitalized for asthma and their providers to
ensure appropriate management. Members received
educational materials to encourage appropriate
asthma self-management.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
10
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Follow-Up After Hospitalization
for Mental Illness

• Description
• The percentage of members age 6 and older who
  were hospitalized for treatment of selected
  mental health disorders and were seen on an
  ambulatory basis or were in day/night treatment
  with a mental health practitioner within 7 days
  and within 30 days of discharge.

• The 2004 rates are significantly higher than the
  2003 rates, p lt 0.001.
• 2004 NHPRI unaudited (corrected) plan rate
  2004 audited plan rate is 51 and 66

2003 Improvement Initiatives



Beacon Health Strategies After Care
Coordination contacts members discharged from the
hospital to remind them of their follow up
appointments and offer assistance if they need to
reschedule. The After Care Coordinator also
assists the utilization review clinicians to
schedule follow up appointments when the hospital
is having difficulty finding an appointment.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
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Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Antidepressant Medication Management

• Description
• The percentage of members age 18 years and older
  as of April 30, 2003 who were diagnosed with a
  new episode of depression, treated with
  antidepressant medication, and
• 1) had at least 3 follow-up contacts with a PCP
  or mental health PCP during the 84-day Acute
  Treatment Phase (Contacts)
• 2) remained on an antidepressant drug during the
  entire 84-day Acute Treatment Phase (Effective
  Acute Phase Treatment)
• 3) remained on an antidepressant drug for at
  least 180 days (Effective Continuation Phase
  Treatment).
• NHPRIs rate ranked above the 50th percentile in
  practitioner contacts. The acute phase treatment
  rate and the continuation phase treatment rate
  ranked above the 25th percentile.

The 2004 optimal practitioner contacts rate is
significantly lower than the 2003 rate, p lt
0.001. The effective continuation phase
treatment rate is significantly higher than the
2003 rate, p lt 0.05.
2003 Improvement Initiatives


Beacon Health Strategies contacted members
newly diagnosed with depression an inpatient
behavioral health admission. The clinician
discusses the importance of following up with an
outpatient provider and medication compliance,
members also receive follow up letters with
similar information.
Members newly diagnosed with
depression in an outpatient setting, are sent a
letter stressing the importance of following up
with an outpatient provider.


HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
12
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Medical Assistance with Smoking
Cessation -
Advising Smokers to Quit

• Description
• This rate is calculated using combined responses
  from the HEDIS 2003 and 2004 CAHPS 2.0H Adult
  Medicaid survey. It measures the percent of
  current smokers or recent quitters, seen by a
  health plan provider, who received advice to quit
  smoking from a health plan provider.
• NHPRIs rate ranked above the 50th percentile.

2003 Improvement Initiatives NHPRI has two
tobacco treatment projects funded by the RI
Department of Health. QuitNow is a tobacco
cessation program designed to help adult patients
at the Providence Community Health Centers quit
tobacco use. Baby and Me Smoke Free provides
smoking education/cessation to pregnant NHPRI
RIte Care members. Referrals to Baby and Me are
from provider sites and from Bright Start,
NHPRI's high risk pregnancy program. Both
programs provide face-to-face and telephonic
individualized counseling and education. Free
nicotine replacement therapy patches are provided
to those who are medically approved in the
QuitNow program.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
13
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Medical Assistance with Smoking
Cessation - Discussing Smoking
Cessation Medications

• Description
• This rate is calculated using combined responses
  from the HEDIS 2003 and 2004 CAHPS 2.0H Adult
  Medicaid survey. It measures the percent of
  current smokers or recent quitters, seen by a
  health plan provider, whose practitioner
  recommended or discussed smoking cessation
  medications.
• NHPRIs rate ranked above the 50th percentile.

2003 Improvement Initiatives NHPRI has two
tobacco treatment projects funded by the RI
Department of Health. QuitNow is a tobacco
cessation program designed to help adult patients
at the Providence Community Health Centers quit
tobacco use. Baby and Me Smoke Free provides
smoking education/cessation to pregnant NHPRI
RIte Care members. Referrals to Baby and Me are
from provider sites and from Bright Start,
NHPRI's high risk pregnancy program. Both
programs provide face-to-face and telephonic
individualized counseling and education. Free
nicotine replacement therapy patches are provided
to those who are medically approved in the
QuitNow program.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
14
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Medical Assistance with Smoking
Cessation - Discussing Smoking
Cessation Strategies

• Description
• This rate is calculated using combined responses
  from the HEDIS 2003 and 2004 CAHPS 2.0H Adult
  Medicaid survey. It measures the percent of
  current smokers or recent quitters, seen by a
  health plan provider, whose practitioner
  recommended or discussed smoking cessation
  methods or strategies.
• NHPRIs rate ranked above the 50th percentile.

2003 Improvement Initiatives

NHPRI has two tobacco
treatment projects funded by the RI Department of
Health. QuitNow is a tobacco cessation program
designed to help adult patients at the Providence
Community Health Centers quit tobacco use. Baby
and Me Smoke Free provides smoking
education/cessation to pregnant NHPRI RIte Care
members. Referrals to Baby and Me are from
provider sites and from Bright Start, NHPRI's
high risk pregnancy program. Both programs
provide face-to-face and telephonic
individualized counseling and education. Free
nicotine replacement therapy patches are provided
to those who are medically approved in the
QuitNow program.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
15
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Adults Access to
Preventive/Ambulatory
Health Services

• Description
• The percentage of enrollees age 20 and older, who
  have had an ambulatory or preventive care visit
  during 2003.
• NHPRIs rate ranked above the 75th percentile in
  the ages 20-44 category, and above the 50th
  percentile in the ages 45-64 category.

The 2004 rate in the 20-44 age group is
significantly higher than the 2003 rate, p lt
0.001.
2003 Improvement Initiatives NHPRI provided to
high volume primary care sites their performance
rates and a list of their patients who did not
meet the access standard. NHPRIs members were
educated on routine preventive care guidelines.
For this measure, the Plan also provided a
performance-based incentive for selected large
primary care sites.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
16
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Childrens Access to Primary Care
Practitioners

• Description
• The percentage of enrollees between 12 months and
  19 years of age who have had a visit with a
  health plan primary care practitioner (PCP)
  during 2003.
• NHPRIs rate ranked above the 90th percentile for
  all age groups.

12-19 yrs age group added for HEDIS 2004. The
2004 12-24 month and 7-11 yrs rates are
significantly higher than the 2003 rates, p lt
0.001. The 2004 25 mo-6yrs rate is significantly
higher than the 2003 rate, p lt 0.01.
2003 Improvement Initiatives NHPRI provided to
high volume primary care sites their performance
rates and a list of their patients who did not
meet the access standard. NHPRI also focused on
increasing use of school-based health centers for
primary and preventive health care.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
17
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Timeliness of Prenatal Care

• Description
• The percentage of women who delivered a live
  birth between November 6, 2002 November 5,
  2003, who received a prenatal care visit during
  the first trimester OR within 42 days of
  enrollment in NHPRI.
• NHPRIs 2004 rate ranked above the 75th
  percentile.

2003 Improvement Initiatives NHPRI redesigned
the Bright Start prenatal care program and it was
rolled out in June 2003. Pregnant members
received information about the program during new
member welcome calls, when calling the general
Member Services telephone number, and from
brochures distributed to community health centers
and other community agencies. Members wishing to
enroll in Bright Start were given assistance in
making a first prenatal care visit appointment if
they had not already done so.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
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Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Frequency of Ongoing Prenatal Care

• Description
• The percentage of women who delivered a live
  birth between November 6, 2002 November 5, 2003
  and received lt21, 21-40, 41-60, 61-80, or
  gt81 of the expected number of prenatal care
  visits, adjusted for gestational age and month of
  enrollment in NHPRI.
• NHPRIs 2003 rate ranked above the 90th
  percentile.

2003 Improvement Initiatives NHPRI redesigned
the Bright Start prenatal care program and it was
rolled out in June 2003. All pregnant members
who were enrolled in the program received
educational material about the importance of
regular prenatal care visits. Moderate and high
risk members enrolled in the program also
received care management assistance in accessing
needed care.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
19
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Check-Ups After Delivery

• Description
• The percentage of women who delivered a live
  birth between November 6, 2002 November 5, 2003
  who had a postpartum visit on or between 21 days
  and 56 days after delivery.
• NHPRIs rate ranked above the 75th percentile in
  2004.

2003 Improvement Initiatives All members
enrolled in care management for the Bright Start
prenatal care program received a call from the
prenatal care manager one week after delivery to
remind them of the importance of a postpartum
check-up.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
20
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Claims Timeliness

• Description
• The percentage of all claims received by the MCO
  or its claims processing centers, from January 1,
  2003 December 1, 2003, that were paid or denied
  within 30 calendar days of receipt.
• First Year Measure

HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
21
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Call Abandonment

• Description
• The percentage of calls received by the MCO
  member services call centers during 2003 that
  were abandoned by the caller before being
  answered by a live voice.
• First Year Measure

HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
22
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Well-Child Visits in the First 15
Months of Life

• Description
• The percentage of enrollees who turned 15 months
  old during 2003, and who received either zero,
  one, two, three, four, five, or six or more
  well-child visits with a PCP during their first
  15 months of life. A child should be included in
  only one numerator.
• NHPRIs rate for six or more visits ranked
  substantially above the 90th percentile.

HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
23
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Well-Child Visits Third to Sixth
Year of Life

• Description
• The percentage of enrollees who turned three,
  four, five, or six years old during 2003 and who
  received one or more well-child visit(s) with a
  PCP during 2003.
• NHPRIs rate ranked above the 90th percentile.

HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
24
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Adolescent Well-Care Visits

• Description
• The percentage of enrollees who were age 12
  through 21 years during 2003 and who had at least
  one comprehensive well-care visit with a PCP or
  an OB/GYN practitioner during 2003.
• NHPRIs 2004 rate ranked above the 90th
  percentile.

2003 Improvement Initiatives NHPRI, in
collaboration with Thundermist Health Center of
Woonsocket, expanded its project to improve the
rate of adolescent well-care visits to include
students ages 11-19. The project offers students
who are NHPRI/Thundermist members a choice of
incentives to enroll in the school-based health
center and have a complete physical exam.
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
25
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results Consumer Assessment of Health Plans
Survey

• Mail survey that measures the health care
  experience of randomly selected Medicaid adults
  (age 18 years or older), continuously enrolled
  for at least six months.
• Available in English and Spanish.
• Survey conducted by an NCQA-certified vendor, The
  Myers Group
• 1,755 members randomly selected for the survey,
  and 619 members responded (36).

HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA).
26
Neighborhood Health Plan of Rhode IslandHEDIS
2004 Results CAHPS Summary
HEDIS is a registered trademark of the National
Committee for Quality Assurance (NCQA). CAHPS is
a registered trademark of the Agency for
Healthcare Research and Quality (AHRQ). Medicaid
Accreditation 2004 percentile ranking based on
benchmark.