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1SNP Educational Session – January 13, 2014
SNP Results2013
SNP Educational Session - January 13, 2014
Brett Kay, AVP, SNP Assessment, NCQA
2SNP Educational Session, January 13, 20142
Objectives
• Present key findings from 2012-2013 SNP assessment program-major contract tasks
– 2012 S&P measures review
• 394 SNP reviews
– 2013 (CY 2014) MOC reviews
• 210 SNP reviews
• 104 MMP review
– 2013 SNP HEDIS
• 415 SNP submissions
3SNP Educational Session, January 13, 20143
• Six areas of focus:– SNP 1: Complex case management– SNP 2: Member satisfaction– SNP 3: Clinical quality improvement– SNP 4: Care Transitions– SNP 5: Institutional SNP relationship
with facilities– SNP 6: Coordination of Medicare and
Medicaid
S&P Measures Assessment
4SNP Educational Session, January 13, 20144
• Wide range of performance within and across S&P measures
• SNPs showed improvement on majority of measures that did not change between 2011 and 2012
• D-SNPs compose majority of plans and enrollment, so drive overall performance results– 262 of 394 SNPs (66.5%)– 1.12 million enrollees of 1.35 million total
SNP members (83%)
S&P Key Findings
5SNP Educational Session, January 13, 20145
• I-SNPs tend to outperform other SNP types– Smallest # of plans (58), overall
enrollment (46,000) and avg. # of members (793)
– Dominated by a few organizations• 5 organizations comprise nearly ¾ of I-SNP
plans• One organization has >40% of the I-SNP
market: their results drive overall I-SNP performance
• C-SNPs had lowest performance across all measures
S&P Key Findings Continued
6SNP Educational Session, January 13, 20146
• SNP 1: Complex Case Management– Raised the bar in 2012– Overall performance was strong– Added 3 new elements(Satisfaction with case
management; Analyzing effectiveness/Identifying opportunities; Implementing interventions and follow-up evaluation)
– Lower performance than existing elements (78%, 48% and 43 % achieved benchmark
• SNP 2: Member Satisfaction– Added new element: implementing
interventions—performance was relatively low (52.9 percent achieved benchmark)
SNP 1 & 2 Findings
7SNP Educational Session, January 13, 20147
• SNP 3: Clinical Quality Improvements– Show statistically significant
improvement on HEDIS measures year-to-year
– Duals outperformed other SNP types; percentage of plans achieving improvement on at least two measures:• D-SNPs = 93.2% • C-SNPs = 86.8%• I-SNPs = 67.6%
– Larger plans outperform smaller plans• Ranged from 75% to 94.9%
SNP 3 Findings
8SNP Educational Session, January 13, 20148
• SNP 4: Care Transitions– Improvement over time; however, still
presents difficulties for some SNPs– 4 of the 6 elements improved from
2011– Analysis of
communication/coordination activities rose dramatically (51.9% vs. 39.3%)
– Many plans have documented processes pertaining to requirements, but cannot show actual evidence of implementation • e.g., transition notifications across settings;
identifying/coordinating care for at-risk members
SNP 4 Findings
9SNP Educational Session, January 13, 20149
• SNP 5: Institutional Relationship with Facility– SNP 5 is for I-SNPs only– Excludes I-SNPs that care for all
members in community (Institutional equivalent)
– Performance high across all elements– Element C had highest scores– Larger plans had higher scores
SNP 5 Findings
10SNP Educational Session, January 13, 201410
• SNP 6: Coordination of Medicare/Medicaid– Slight improvement from 2011– D-SNPs and I-SNPs perform well– Many plans still do not conduct
network adequacy assessments for Medicaid providers
– All three SNP types showed improvement from 2011 to 2012.
SNP 6 Findings
11SNP Educational Session, January 13, 201411
SNP 6 ResultsElement E: Network Adequacy, by Type (2011 vs. 2012)
D-SNPS I-SNPs C-SNPs0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
2011 2012
Element E: Network Adequacy, by enrollment size, 2012
Element E0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
0-99% 100-499 500-9991,000-2,499 >2,500
12SNP Educational Session, January 13, 201412
Model of Care ResultsCY 2014 Submissions
13SNP Educational Session, January 13, 201413
• SNP Results– CMS raised the bar in 2013—One cure; only
for SNPs scoring <70% after initial review (receive 1-year approval)
– Many SNPs submitted same/similar MOC as in previous years
– 3-year approval (85+%): 149 plans– 2-year approval (75%-84%): 20 plans– 1-year approval (70%-74%): includes cure 1
plan scores): 6 plans– Not approved (<70%): 2 plans– Withdrew application: 33
Model of Care Results-SNPs
14SNP Educational Session, January 13, 201414
Results for SNPs
MOC 1 MOC 2 MOC 3 MOC 4 MOC 5 MOC 6 MOC 7 MOC 8 MOC 9 MOC10 MOC110.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
Final Score by SNP Type and MOC Element
Final Score for ChronicsFinal Score for DualsFinal Score for Institutionals
15SNP Educational Session, January 13, 201415
• MMP Results– 10 states (AZ, ID, MI, NY, RI, SC, TX, VT, VA,
WA)– Many MMPs submitted similar MOCS to SNPs
from same organization– Additional state requirements not reviewed
by NCQA (NY, RI, SC, VA, WA)– 3-year approval (85+%): 75 plans– 2-year approval (75%-84%): 17 plans– 1-year approval (70%-74%): includes cure
1&2 plan scores): 8 plans– Withdrew application: 4
MOC Results--MMP
16SNP Educational Session, January 13, 201416
AZ ID MI NY RI SC TX VT VA WA70%
75%
80%
85%
90%
95%
100%
Average Total Score
Ave. Score
MMP Results by State
17SNP Educational Session, January 13, 201417
MOC 1 MOC 2 MOC 3 MOC 4 MOC 5 MOC 6 MOC 7 MOC 8 MOC 9 MOC 10 MOC 1182.00%
84.00%
86.00%
88.00%
90.00%
92.00%
94.00%
96.00%
Average Element Score
Average Element Score
Overall MMP Results
18SNP Educational Session, January 13, 201418
SNP HEDIS Results2013
19SNP Educational Session, January 13, 201419
Required SNP Measures• (COL) Colorectal Cancer Screening• (GSO) Glaucoma Screening in Older Adults• (COA) Care for Older Adults • (SPR) Use of Spirometry Testing in the Assessment and Diagnosis of COPD• (PCE) Pharmacotherapy of COPD Exacerbation • (CBP) Controlling High Blood Pressure • (PBH) Persistence of Beta-Blocker Treatment After a Heart Attack• (OMW) Osteoporosis Management in Older Women• (AMM) Antidepressant Medication Management• (FUH) Follow-Up After Hospitalization for Mental Illness• (MPM) Annual Monitoring for Patients on Persistent Medications• (DDE) Potentially Harmful Drug-Disease Interactions• (DAE) Use of High-Risk Medications in the Elderly• (MRP) Medication Reconciliation Post-Discharge • (PCR) Plan All-Cause Readmissions • (BCR) Board Certification
HEDIS Measures for SNP Submission
20SNP Educational Session, January 13, 201420
• 415 SNPs Eligible to Report (>30 members)
• 40 HEDIS measures reported– 28 clinical performance measures– 4 board certification measures– 8 utilization measures
• Audited by NCQA-Certified HEDIS Compliance Auditors
• Reflects care provided in 2012• Compares performance among SNPs and
to non-SNP MA plans
SNP HEDIS 2013 Overview
21SNP Educational Session, January 13, 201421
• Steady improvement from 2011-2013• Performance gap between SNP and MA
plans continues to narrow– 6 measures-SNP performance is higher– 8 measures-no statistically significant
difference in performance– 13 measures – SNP performance is lower
• Performance differences among SNP types– D-SNPs-most measures with statistically
significant improvement from 2012-2013
Key Findings
22SNP Educational Session, January 13, 201422
SNP Higher than MA No Statistically Significant Difference
SNPs Lower than MA
PCE-Dispensed Bronchodilator within 30 Days of Event
GSO COL
MPM-ACE/ARB Monitoring PBH SPR
MPM-Digoxin Monitoring OMW PCE-Dispensed Systemic Corticosteroid Within 14 Days
of Event
MPM-Diuretic Monitoring FUH-Within 30 Days of Discharge
CBP
MPM-Anticonvulsant Monitoring
FUH-Within 7 Days of Discharge AMM-Acute Phase
MPM-Total Rate BCR-Internal Medicine AMM-Continuation Phase
BCR-Geriatrics BCR-Family Medicine
BCR-Other Physician Specialists
DDE-History of Falls
DDE-Dementia
DDE-Chronic Renal Failure
DDE-Total Rate
DAE-At Least One High-Risk Medication
DAE-At Least Two High-Risk Medications
SNP Versus MA Performance
23SNP Educational Session, January 13, 201423
• Three-year trend: improvement– 31 of 40 measures showed statistically
significant improvement between 2011-2013• More than 2X the measures that showed statistically
significant improvement from 2009-2011• 2012-2013—27 measures with statistically significant
improvement• Care for Older Adults—average increase of 18.4% for
the four indicators (2011-2013)– Three-Year Reporters (2011-2013)
outperformed SNP program overall• Higher results across all measures in each year, on
average
Improvement Trend
24SNP Educational Session, January 13, 201424
• 1.8 percentage point average difference between all types in 2013
• D-SNPs had the largest number of measures (9) with statistically significant improvement from 2012-2013
• C-SNPs & I-SNPs had statistically significant improvement in 2 measures
• Care for Older Adults indicators showed largest performance improvements from all SNP types– C-SNPs—39 percentage point increase
Performance by SNP Type
25SNP Educational Session, January 13, 201425
• Wide variation in performance ranges– 9 measures had >40 point differences between 10th
and 90th percentiles– Large difference (>20 points) between mean score
and 90th percentile—represents opportunity for improvement
• 50+% of SNPs improved on 25 HEDIS measures– 70% increased performance on 5 of these measures– COL had the most SNPs show improvement (~80%)
• Greatest variation: Care for Older Adults, Board Certification and Medication Reconciliation Post-Discharge
Plan Benefit Package Level Performance
26SNP Educational Session, January 13, 201426
DISCUSSION