CAHPS in the States: Collaboration and Innovation to Maximize Public Resources

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CAHPS in the States Collaboration and
Innovation to Maximize Public Resources
Presented by the CAHPS User Network
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Todays Panelists

• Colorado Department of Public Health and
  Environment
• KaraAnn Donovan, MSPH, Epidemiologist
• New York Department of Health, Office of Managed
  Care, Bureau of Quality Management and Outcomes
  Research
• Joseph Anarella, MPH, Assistant Director
• Anne Schettine, RN, Quality Improvement

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Todays Panelists

• CAHPS Consortium
• Julie Brown, CAHPS RAND Team
• Carla Zema, PhD, CAHPS User Network

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KaraAnn Donovan, MSPH Epidemiologist and
StatisticianColorado Department of Public
Health and Environment
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Measuring Indicators for Children with Special
Health Care Needs with CAHPS

• KaraAnn M. Donovan, MSPH

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Presentation

• Measuring outcomes for children and youth with
  special health care needs
• history
• outcomes
• Why CAHPS
• Process to obtain CAHPS
• Challenges
• Strategies
• Where is Colorado now?

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History

• Children and Youth with Special Health Care Needs
  is a Title V Program
• established a Federal/State partnership to
  provide and assure mothers and children access to
  quality services (Social Security Act of 1935)

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History

• Children and Youth with Special Health Care Needs
  (continued)
• administered by the Maternal and Child Health
  Bureau (MCHB) as part of the Health Resources and
  Services Administration, U.S. Department of
  Health and Human Services revised legislative
  mandate (OBRA 89)

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History

• Goals of Maternal and Child Health Program which
  specifically pertain to Children and Youth with
  Special Health Care Needs
• reduce the incidence of preventable diseases and
  handicapping conditions among children
• provide and promote family-centered care

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History

• Goals of Maternal and Child Health Program
  (continued)
• offer community-based, coordinated care for
  children with special health care needs
• facilitate the development of community based
  systems of services for these children

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History

• In 2001 the National Maternal and Child Health
  Bureau established six outcome measures for
  Children and Youth with Special Health Care Needs
• In 2002, indicators were established through the
  Measuring and Monitoring Community Based Systems
  of Care for CSHCN

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History

• Development of 2002 Indicators
• collaborative endeavor of the Early Intervention
  Research Institute (EIRI) at Utah State
  University and more than eight states across the
  country
• the MM project is funded by the Maternal and
  Child Health Bureau's Division of Services for
  Children with Special Health Care Needs

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Outcomes

• Families of CYSHCN will partner in decision
  making at all levels and be satisfied with the
  services they receive
• All CYSHCN will receive ongoing comprehensive
  coordinated care within a medical home
• All CYSHCN will have adequate public and private
  insurance to pay for the services they need

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Outcomes

• 4. All CYSHCN will be screened early and
  continuously for special health care needs
• 5. Community based service systems will be
  organized so families can use them easily
• 6. All youth with special health care needs will
  receive the services necessary to transition to
  all aspects of adult life

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Why CAHPS?

• Includes information needed for the six outcome
  measures
• Utilizes the HRSA definition of children with
  special health care needs
• based on health or services needs which last more
  than 12 months
• prescription medication
• utility of services
• limited ability

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Why CAHPS?

• Includes information for children on public
  insurance
• Access to the full database
• Longitudinal data

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Process to Acquire CAHPS Data

• Web search of available public use data which
  included public insurance
• Research Proposal
• Colorado Department of Public Health and
  Environment IRB
• National CAHPS Benchmarking Database
• Administered by Westat and Shaller Consulting

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Process to Acquire CAHPS

• Approval from the Department of Health Care
  Policy and Financing for dissemination to the
  Colorado Department of Public Health and
  Environment

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Challenges

• High turnover within agencies
• Incongruent agency missions
• Disparate agency or program goals
• Concerns about data use

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Challenges

• Different dissemination requirements
• Cost of collecting chronic condition module
• Different definition of children with special
  health care needs

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Strategies

• For agency collaboration
• For the research proposal

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Strategies Collaboration

• Identify key players for data sharing discussion
  (privacy officer, directors, data owners,
  programmers / analysts, data technicians running
  reports)
• Illustrate how results will benefit both programs

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Strategies Collaboration

• Agree on dissemination plan within both agencies
  rules
• Respect the time and resources of other agency

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Strategies - Proposal

• Illustrate how data are unique to program or
  population
• Illustrate how results will be utilized (program
  evaluation, research, quality of care)
• Illustrate how data will be disseminated

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Where is Colorado Now?

• MOU between agencies for data which is currently
  collected
• Exploring solutions to barriers for collecting
  the chronic condition module
• additional funds

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Thank You

• Sandra Mortensen
• Dale Shaller, National CAHPS Benchmarking Database

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Contact Information

• KaraAnn M. Donovan, MSPH
• [phone]
• kara.donovan_at_state.co.us

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New York States Use of CAHPS

• Joseph Anarella, MPH, Assistant Director
• Anne Schettine, RN, Quality Improvement
• Bureau of Quality Management and Outcomes
  Research, Office of Managed Care, New York State
  Department of Health

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Background

• NYS Medicaid Program is one of the largest and
  most costly in the nation.
• 4.2 million recipients
• gt 44 billion in annual expenditures
• The state began implementing an 1115 waiver in
  1997. To date, over 2.6 million (62 of total)
  are enrolled in plans.
• Mandatory SSI enrollment begins in November 2005
  in NYC (160,000 eligible).

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Background

• The state contracts with 28 fully capitated plans
  (enrollment ranges from 2,700 to 230,000/plan).
• - pharmacy is carved-out (but pharmacy data
  is fed back to the plans)
• - exempt populations (HIV, SPMI, foster
  care kids, others)
• - 15 of all recipients are autoassigned

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Background

• Other publicly funded managed care programs
• 4 partial cap plans that serve upstate rural
  areas (20,000 members)
• Child Health Plus (SCHIP) (325,000 members)
• 3 HIV Special Needs Plans (1,400 members)

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CAHPS in NY

• State sponsors a biennial CAHPS for the 28 plans
  that participate in the states Medicaid managed
  care program.
• Survey is subcontracted to a vendor.
• A modified version of both the child and adult
  CAHPS 3.0 surveys for Medicaid are used.

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CAHPS in NY

• Methodological differences
• provide incentive (1)
• smaller sample size
• -750 adults
• -750 parent/guardian of children
• English and Spanish survey sent
• Up to 10 calls
• NYS-specific questions
• - would you recommend your plan to a family
  member of friend?
• - checklist of 11 chronic conditions (used for
  research purposes)

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Uses

• Public reporting
• Medicaid Consumer Guides, Annual Managed Care
  Performance Report, posting on the DOH website
  (www.health.state.ny.us)
• Research
• special populations smokers, autoassignees,
  persons with behavioral health problems
• Health Plan Quality Assurance
• Quality performance matrices

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Uses continued

• Quality Incentive/Quality Weight in
  Autoassignment
• Implemented in fall of 02. Plans can earn an
  extra 1 (3 in upcoming cycle) in premium if
  they perform well.
• Also allows DOH to direct autoassignees to high
  performing plans.
• CAHPS data counts as 1/3 of the total score
• (HEDIS/QARR measures 2/3 of score).

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CAHPS Measures Used in the Quality Incentive

• Problem getting care needed (composite)
• Receive services quickly (composite)
• Rating of personal doctor or nurse
• Rating of health plan
• Problem getting service (composite)

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05 Results

• Winners
• 4 plans - 3
• 6 plans - 2.25
• 2 plans - 1.5
• 6 plans - .75

• Losers
• 8 plans
• No Quality Incentive
• -and-
• No quality preference in autoassignment

26 of the 28 plans were included in the incentive
calculation due to requirements of participation
in the Medicaid program for two consecutive years.
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What that means -

• Over 13 million distributed to high performing
  plans in the first two years (02/03 and 03/04) of
  the program.
• Estimated 9.3 million to be distributed in
  04/05.
• Estimated 40 million to be distributed in 05/06!
  
• A pool of approximately 105,000 autoassignees who
  could provide high performing plans w/ an
  additional 55 million in premium payments.

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Do the Math

• For MetroPlus (a NYC providersponsored plan that
  earned the full 3)
• 179,378 members x 160 pmpm x 12 34,440,576
  in annual premium payments
• 34,440,576 x 3
• 10,332,172 in Quality Incentive funding

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New Interest in CAHPS

• DOH sponsored a CAHPS QI day.
• Plan-specific priority analyses for Medicaid and
  commercial products distributed.
• Promoted CMSs CAHPS Improvement Guide.
• Two plans presented their efforts to understand
  and act on their CAHPS data that indicated
  problems.
• CAHPS information integrated into research
  activities.
• Information from the survey explored for
  populations such as chronic diseases and SSI
  enrollees.

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Demystifying Satisfaction or Options for
Improvement and the Issues We Encounter

• Pooling providers across plans
• Data limitations (low numbers, trouble linking
  enrollee with provider, grouping providers by
  practice)
• Sharing data with plans to support quality
  improvement activities.
• Using 3 CAHPS composites that were in the
  incentive, we developed analyses of the
  individual question results for each plan

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Example of Plan Analysis
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Next Steps

• Inclusion in quality performance matrices
  facilitates understanding of factors effecting
  results and interventions that show impact.
• Plan feedback of data developing formats and
  analyses that will be useful to plan QI efforts.

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Contact Information

• Joe Anarella jpa02_at_health.state.ny.us
• Anne Schettine ams13_at_health.state.ny.us
• 518-486-9012 (for both)

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Julie Brown Project Leader for Ambulatory Care
CAHPS Member of RAND Team
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CAHPS Not Just a Health Plan Survey Anymore

• Family of surveys comprehensive and evolving
• Consumers and patients evaluate their
  experiences with health care

CAHPS surveys ask about experiences with

• Health plans
• Medical groups and clinicians
• Hospitals
• Behavioral health services
• Nursing homes
• Dialysis facilities

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Why Surveys for Ambulatory Care?

• Responding to users needs
• Products for multiple levels of ambulatory care
• Results that can drive QI

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4.0 Versions Draw Heavily on Current Surveys
ExistingCAHPS Surveys
New Items for
CAHPS Ambulatory Care Surveys
Health Plan
Health Plan
Sorted by level


Clinician/Group
Clinician/Group
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How Will This Affect State Users?

• Greater ability to meet diverse needs of States
  due to different program structures
• Continued access to NCQA's HEDIS version

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What Will the Medicaid Version Look Like?
Clinician/Group items
CAHPS Health Plan Survey
Your States Survey
Supplemental items


Your own items
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Why Start With the CAHPS Health Plan Survey?

• CAHPS Health Plan Survey will have fewer core
  items.
• Most States already using the Health Plan Survey.
• Preserve ability to benchmark across programs

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Consortium Seeks User Feedback and Input

• How are you currently using CAHPS surveys?
• What do you need from the Consortium?
• What can we do to make products meet your needs?

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How to Contact the CAHPS User Network

• Email cahps1_at_westat.com
• Phone [phone]
• Website www.cahps-sun.org

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What We Will Do With This Feedback

• Inform the CAHPS product development process
• Develop technical assistance to help States
  select the appropriate survey and items based on
  your program structure

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Development Process To Date

• Health Plan Survey
• Instrument drafted
• Cognitive testing completed
• Field testing completed
• Input received from various stakeholders
• NCQA HEDIS version to be presented to CPM in
  January

• Clinician Group Survey
• Instrument drafted
• Additional rounds of cognitive testing being
  completed
• Field test in progress
• Ongoing input from Advisory Group

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Timeline for Medicaid Version
2005
2006
Summer
Fall
Winter
Summer
Spring
Input from State users
Possible field testing by State users
Release Health Plan Survey and technical
assistance document for States
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CAHPS User Network

• Email cahps1_at_westat.com
• Phone [phone]
• Website www.cahps-sun.org

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Todays Panelists

• CO Department of Public Health and Environment
• KaraAnn Donovan, MSPH, Epidemiologist
• NY Department of Health, Office of Managed Care,
  Bureau of Quality Management and Outcomes
  Research
• Joseph Anarella, MPH, Assistant Director
• Anne Schettine, RN, Quality Improvement