20-983m Stay Informed on Quality Goals and Activities to Improve the Health of Members

Date: 11/30/20

Check out the progress made and improvements still needed from 2020 HEDIS^® quality performance results

The California Health & Wellness Plan (CHWP) Quality Improvement (QI) program monitors clinical care performance and service measures using many internal and external health care data collection systems. The national benchmarks from year to year allow us to compare our results and identify areas for improvement.

CHWP results are compared to the Department of Health Care Services (DHCS) 50th percentile Minimum Performance Level (MPL) for Managed Care Accountability Set (MCAS) measures, as well as the National Committee for Quality Assurance (NCQA) Quality Compass^® national HMO 75th percentile, if applicable.

Quality Improvement support for members and providers to improve health outcomes

Quality Improvement supports you and our members to help make access to care easier with the following programs:

• Outreach campaigns to address many gaps in care. The goal is to improve compliance in:
  • Breast and cervical cancer screenings
  • Child and adolescent well-care visits
  • Comprehensive diabetes control
  • Controlling high blood pressure
  • Antidepressant medication adherence
  • Immunizations
• Member incentives to close care gaps. Incentive program includes breast cancer screening, cervical cancer screening, chlamydia screening, diabetes testing and well-care visits.
• Mails in-home test kits to members to help close care gaps for the comprehensive diabetes control sub-measures. Partners with a vendor to mail kits, and help address common barriers to health care for transportation, limited appointment availability and minimal access to lab centers.
• Weekend and extended-hour clinics. Engages with providers/clinic sites to implement with added support of clinical staff and on-site services for members who need care outside of provider’s normal business hours.
• Cozeva™ deployment. Enhances the data exchange with providers to support and improve quality measures, reporting, and customer service.
• Outreach calls for high-risk members. Interview members to address social concerns, link members to needed resources, and remove barriers to care.
• Launches a robust flu campaign called Fluvention^®. Educates members and promotes the importance of getting a flu shot during the current flu season and address concerns members may have due to the 2019 Novel Coronavirus (COVID-19) pandemic.

Quality Improvement supports CAHPS^® improvements

• Develops a member-facing Consumer Assessment of Healthcare Providers and Systems (CAHPS) mailer to urge participation in the 2020 CAHPS Survey.
• Partners with a survey vendor to launch the yearly regulatory survey to a random sample of membership. Shares final results with stakeholders to identify member pain points and to identify improvement opportunities.
• Deploys an off-cycle mock survey for Medi-Cal members to assess performance with high-volume providers and at provider offices.
• Conducts yearly CAHPS participating physician group (PPG) training webinars.
• Manages CAHPS action plan and met routinely with many CHWP departments to discuss how to incorporate the needs of our members to improve and track progress of programs.

Our response to the pandemic

COVID-19 has had a large impact on utilization, especially at the beginning of the pandemic (March-July). CHWP responded quickly to provide alternative service-delivery modes, such as telehealth, to mitigate the drop of in-person visits. CHWP’s Provider Network Management team conducted a provider readiness survey to evaluate providers’ ability to accommodate members’ needs during the pandemic. There were major technical changes for most of the Healthcare Effectiveness Data and Information Set (HEDIS^®) measures due to COVID-19. The data based on the updates will not be added to the HEDIS system until later this year.

Tables to compare performance goals

The table below indicates if clinical care and service measures improved or declined from Reporting Year 2019 (RY 2019) to Reporting Year 2020 (RY 2020). It also shows how our performance compares to national benchmarks.

Due to the COVID-19 pandemic, DHCS waived the RY 2020 MPL requirement for hybrid measures with alternative reporting options. See provider update 20-698, Help Your Patients Achieve Better Health Outcomes, for more information on COVID-19 impacts to plans’ performance reporting.

Measures of clinical care	RY2019 Score	RY2020 Score	Rates compared to previous year	2020 DHCS MPL 50th percentile or 2020 Quality Compass®National HMO 75th percentile	2020 score compared to DHCS MPL
Adult body mass index (BMI) assessment	86.62%	91.79%	↑	90.27%	↑
Antidepressant medication management – acute phase	52.42%	54.65%	↑	52.33%	↑
Antidepressant medication management – continuation phase	35.86%	39.04%	↑	36.51%	↑
Asthma medication ratio	64.53%	63.99%	↓	63.58%	↑
Breast cancer screening	53.41%	56.52%	↑	58.67%	↓
Cervical cancer screening	59.37%	59.37%R	↔	60.65%	↓
Childhood immunization – combo 10	22.87%	27.98%	↑	34.79%	↓
Chlamydia screening in women	52.34%	52.93%	↑	58.34%	↑
Comprehensive diabetes care: hemoglobin A1c (HbA1c) testing	85.89%	85.89% R	↔	88.55%	↓
Comprehensive diabetes care  – HbA1c poor control > 9%	35.28%	35.28%R	↔	38.52% (inverted rate)	↑
Controlling high blood pressure	66.67%	66.67%R	↔	61.04%	↑
Immunizations for adolescents – combination 2	27.49%	31.39%	↑	34.43%	↓
Timeliness of prenatal care	86.13%	91.48%NT	-	83.76%	↑
Postpartum care	65.45%	80.78%NT	-	65.69%	↑
Weight assessment and counseling for nutrition and physical activity for children/adolescents: BMI assessment	79.32%	79.32%R	↔	79.09%	↑
Well-child visits in the first 15 months of life: six or more well-child visits	24.37%	Not reported at product level	-	65.83%	-
Well-child visits in 3rd, 4th, 5th, and 6th years of life	63.92%	Not reported at product level	-	72.87%	-

 

Measures of service1	RY2019 score	RY2020 score	Compared to previous year	2020 Quality Compass® National HMO 75th percentile	2020 score compared to 75th percentile
Customer service	85.4%	90.5%	↑	91.1%	↓
Getting care quickly	81.3%	75.4%	↓	85.1%	↓
How well doctors communicate	90.9%	87.5%	↓	93.4%	↓

¹ SPH Analytics CAHPS survey results.

^NTNot trend-able year over year due to significant differences in NCQA technical specifications.

^RRY 2019 rates were reported due to COVID-19 impacts.

Additional information

If you have questions regarding the information above, contact CHWP at 1-877-658-0305.