BMC HealthNet Plan | BMC HealthNet Plan - Quality .../media/dd312d8064bd4e5d8b5a54b880...According to the 2017 National Diabetes Statistics Report (released July 2017), 9.4% of the

Quality Improvement Program

Annual Work Plan Evaluation for Massachusetts

2018

Approved:

Approved by the Quality Improvement Committee (QIC) August 14, 2019

Approved by the Quality and Clinical Management Committee (Q&CMC) September 5, 2019

Approved by the Boston Medical Center Health Plan, Inc. Board of Trustees

January 28, 2020

BMC HealthNet Plan Page 2 2018 Quality Improvement Work Plan Evaluation for Massachusetts

Boston Medical Center HealthNet Plan

Quality Improvement (QI) Program Work Plan for Massachusetts Table of Contents

Section 1 Executive Summary

Section 2 Quality Improvement Project Work Plan Grids • Diabetes Disease and Care Management • Asthma Disease and Care Management • Follow-Up for Children Prescribed ADHD Medication • Postpartum Care • Antidepressant Medication Management • Well Child and Adolescent Care • Women’s Preventive Health • Cultural and Linguistic Needs • Member Experience • 2018 MA QI Work Plan Evaluation • Retrospective DUR for High Risk Medications (patient Safety

Project) • Senior Care Options Quality Measurement • Dual Eligible Special Needs Plan Most Vulnerable Population

Identification • Special Needs Program • Accountable Care Organizations

Section 3 Health Effectiveness and Data Information Set (HEDIS®) Measures Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Section 5 Senior Care Options HEDIS Measures (SCO)

Section 6 Dual Eligible Special Needs Plan (DSNP) Vulnerable Population Criteria and Goals


Section I. Executive Summary Boston Medical Center HealthNet Plan’s (BMCHP, the Plan) 2018 Quality Improvement (QI) Work Plan Evaluation is based on the QI program’s 2018 Annual QI Work Plan, developed in 2017. The document provides information on ongoing quality activities including project names, goals, baseline data, actions taken during 2018, outcome data, analysis, identification of opportunities for improvement, and recommendations for improvement activities. BMCHP’s quality measure performance compared to national benchmarks indicates the Plan is maintaining quality of care and services to members. Healthcare Effectiveness Data and Information Set (HEDIS®) along with supplemental data from other QI initiatives are utilized to establish performance baselines and targets. The Plan reported HEDIS 2019 rates (data year 2018) to the National Committee for Quality Assurance (NCQA). Rates were generated for MassHealth (including CarePlus members), Qualified Health Plan (QHP) and a limited set of measures for the Senior Care Options product. The 2018 QI Work Plan Evaluation includes recommendations for the 2020 QI Work Plan as to whether or not projects or measures should continue or be retired. If the recommendation is a project should be continued, the framework of the project is re-evaluated prior to the development of the 2020 QI Work Plan. Project measures and goals are also reassessed to determine whether any changes need to be made based on lessons learned, or barriers identified. Overall Accomplishments

• The Plan’s MassHealth product was rated 4.0 out of 5 according to NCQA's Medicaid Health Insurance Plan Ratings, 2018-2019. NCQA ratings are based on three types of quality measures: measures of clinical quality; measures of member satisfaction; and results from NCQA’s triennial review of a health plan’s health quality processes. The clinical quality measures include prevention and treatment measures, which are a subset of the HEDIS measures.

• The Plan successfully implemented the ACO program to help support improved coordination of care with partner provider groups and improve the health for all BMCHP members.

• To help close gaps in care for select HEDIS measures and educate members about chronic disease and wellness topics, the Plan implemented a preventive health text messaging program, allowing members to opt into different programs or campaigns; examples of campaigns include Medication Management for Asthma, Breast Cancer Screening, & Diabetes Screenings. Campaigns were also added to highlight topics such as January Cervical Cancer Awareness Month, February Heart Health Month and October National Breast Cancer Awareness Month.

Overall Barriers

• Several HEDIS measures were not reported for the Senior Care Options (SCO) because of the small membership resulting in only 23 reportable Effectiveness of Care measures.


• There was a delay in outreach to MassHealth providers and members due to the transition to the ACO program structure which created a lot of confusion for providers and members upon implementation.

• Due to the transition of MassHealth members to the ACO program structure in March 2018, multiple measures were impacted by the continuous enrollment criteria and/or lack of historical claims to confirm services prior to enrolling with BMC HealthNet Plan.

• Due to ongoing concerns regarding interpretation of the Telephone Consumer Protection Act as it pertains to enrollment in texting programs by health plans, BMCHP legal counsel advised that members be invited to join the texting program and “opt in” to enroll. Opt-in enrollment methods result in significantly lower member participation in the texting program than opt-out methods.

• CAHPS survey was not required to be fielded by MassHealth or the National Committee for Quality Assurance (NCQA) with the launch of statewide ACOs. Therefore no results were reported for CY 2017 which limits the year over year analysis with CY 2018.

Clinical Improvements The goals in the 2018 MA QI Work Plan were set based on the 2017 NCQA Quality Compass HEDIS Medicaid HMO benchmarks since they were the most current benchmarks available at the time the Work Plan was written and approved. The projects in the Work Plan were evaluated on the goals and benchmarks. The graphs below compare the Plan’s performance to the 2018 NCQA Quality Compass HEDIS Medicaid HMO benchmarks that are the most current available data. Graph 1: MassHealth Measures Exceeded 2018 NCQA Quality Compass HEDIS Medicaid HMO 90th Percentile Benchmark

0% 20% 40% 60% 80% 100%

Appropriate Treatment for Children With URI

Appropriate Testing for Children With Pharyngitis

Use of Imaging Studies for Low Back Pain

Avoid of Antibiotic Trtmnt in Adults With AcuteBronchitis

Comphrensive Diabetes Care - Eye Exams

Chlamydia Screening in Women - All Ages

Pharmacotherapy for COPD - Bronchodilators

Pharmacotherapy for COPD - Systemic Corticosteriods

IET Initiation - All Ages

Childhood Immunization Status (Combination 10)

Statin therapy for patients with cardiovascular disease- Received statin therapy

Follow-Up After ED Visit for Mental Illness (7 day rate)

Follow-Up After ED Visit for Mental Illness (30 dayrate)

Well Visits (0-15 months) 6+

2018 NCQAQualityCompassHEDISMedicaidHMO 90thPercentileBMCHPMassHealth


Graph 2: QHP Measures Exceeded 2018 NCQA Quality Compass HEDIS Medicaid HMO 90th

Percentile Benchmark

MassHealth and Qualified Health Plan Clinical Opportunities for Improvement Graph 3: MassHealth Measures Below 2018 NCQA Quality Compass HEDIS Medicaid HMO 50th


82.65%

78.54%

93.61%

60.69%

78.54%

61.02%

73.89%

81.57%

100.00%

100.00%

82.53%

75.40%

92.82%

59.12%

73.67%

39.53%

70.29%

78.29%

88.00%

95.98%

0.00% 50.00% 100.00% 150.00%

Weight Assessment andCounseling - Nutrition Counseling

Weight Assessment andCounseling - Physical Counseling

CDC - HbA1c Testing

CDC - HbA1c <8%

Postpartum Care

Avoidance of Antibiotic Treatmentin Adults With Acute Bronchitis

Breast Cancer Screening

Use of Imaging Studies for LowBack Pain

Appropriate Testing for Childrenwith Pharyngitis

Appropriate Treatment forChildren with Upper Respiratory…

2018 NCQAQuality CompassHEDIS MedicaidHMO 90thPercentile

BMCHP QHP

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Antidepressant Medication ManagementContinuation Phase

Asthma Med Ratio

Follow-Up for Children Prescribed ADHDMedication Initiation Phase

Follow-Up for Children Prescribed ADHDMedication Continuation and Maintenance

Phase (C&M) 2018 NCQAQualityCompassHEDISMedicaidHMO 50thPercentileBMCHPMassHealth


Graph 4: QHP Measures At or Below 2018 NCQA Quality Compass HEDIS Medicaid HMO 50th


0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

Timeliness of Prenatal Care

Comprehensive Diabetes CareNephropathy

Adult BMI Assessment

Med Management for People withAsthma 75% - 19-50 yo

Med Management for People withAsthma 75% - 51-64 yo

2018 NCQAQualityCompass HEDISMedicaid HMO50th Percentile

BMCHP QHP


Section II. Quality Improvement Work Plan Grids

Diabetes Disease and Care Management

Project Title: Diabetes Disease and Care Management Post-Approval Change Log Quality Improvement Project Program Description According to the 2017 National Diabetes Statistics Report (released July 2017), 9.4% of the US population of all ages had diabetes in 2015. This includes 30.2 million adults aged 18 years or older of which (12.2% of all US adults) 7.2 million are undiagnosed. (https://www.cdc.gov/diabetes/data/statistics/statistics-report.html). According to the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html), 482,854 (8.0%) of the Massachusetts adult population had diabetes in 2015. In December 2016, BMCHP identified 12,360 members (7.00%) with diabetes 18 and over, which is lower than the national and state prevalence of diabetes. Diabetes is an important area of focus for the Plan. The HEDIS 2017 rates for recommended screenings are below the 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentiles that are used as benchmarks. Diabetes increases the risk of heart attack and stroke, blindness, kidney disease and neuropathy and research demonstrates that effective management reduces these complications. The program is aimed at improving members’ self-management skills using multi-modal initiatives such as educational materials, care management, and member outreach. Additionally the program supports providers with periodic care gap reports.

Measurement & Goal HEDIS 2019 specifications and rates. Measure Goal

MassHealth (including CarePlus)

HbA1c testing 92.82% 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

Poor HbA1c Control (> 9.0%)*

29.07% 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

Eye exams 68.33% 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

Medical Attention for Nephropathy


BP < 140/90 75.91% 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

Qualified Health Plan HbA1c testing 92.82%

2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

∆ This measure is no longer reportable for the QHP population. This measure will be removed from the analysis.

https://www.cdc.gov/diabetes/data/statistics/statistics-report.html


Project Title: Diabetes Disease and Care Management Post-Approval Change Log Quality Improvement Project Program Description HbA1c < 8.0% 59.12%

2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

Eye exams 68.33% 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

Medical Attention for Nephropathy


Senior Care Options HbA1c (poor control >9%)*

Establish baseline

Eye exams Establish baseline Medical Attention for Nephropathy

Establish baseline

Project Team Lead: Karen Szvoren, RN Medical Director: Jonathan Welch, MD

*A lower rate indicates better performance for this measure.

2018 Actions Action Expected date Description Implementation

date Continue to provide a link on the Plan’s website to the most recent American Diabetes Association clinical practice guideline.

01/2018 A link to the current American Diabetes Association clinical practice guideline is available on the Plan’s provider website.

01/2018

Continue the diabetes Care Management (CM) and Disease Management (DM) programs.

01/2018 CM is offered to members with diabetes identified through the Plan’s registry (run monthly), Health Needs Assessment, and provider or member referrals.

01/2018

Continue to use the HEDIS and CM registries to identify members for possible CM, DM, and interventions.

01/2018 Plan registries are used to identify members for the CM and DM programs.

01/2018

Collect, store and utilize lab data from high volume labs, and include results on the Diabetes Treatment Alert Report.

01/2018 Lab result data are collected on a monthly basis from high volume laboratories and stored in the Plan’s data warehouse. The data are included on the Diabetes Treatment Advisory Report.

01/2018

Continue to promote the Plan’s website as an additional resource for educational material on diabetes for members and providers.

01/2018 Member and provider mailings refer members to the Plan’s diabetes webpage for additional education and information. The diabetes webpage had approximately 750 page views in 2018, which is an increase from 2017 (416 views).

01/2018



date Utilize the monthly HEDIS Dashboard to track administrative rates for select diabetes measures.

01/2018 The HEDIS dashboard is used to track measure trends month to month for specific HEDIS measures compared to benchmarks and goals. The HEDIS dashboard is reviewed by the MA Quality Committee throughout the year to determine if additional interventions are needed.

01/2018

Continue to promote enrollment in the text messaging program to promote closing gaps in diabetes care. Include information on member mailings, the member portal and during other Plan contact with members.

01/2018 Quality Outreach Coordinators, Customer Care staff and Care Management staff encourage and assist members to enroll in the texting program. Information is included on all member mailings and the Plan website.

01/2018

Utilize Quality Outreach Coordinator(s) to call members to close gaps in diabetes care.

07/2018 Quality Outreach Coordinators (QOC) placed outbound calls educating members due for HbA1c testing, nephropathy screening, and/or eye exams about the importance of preventive care and encouraging members to schedule appointments to obtain diabetes related tests and screenings. • 23.53% (12/51) of members needing an

eye exam were reached • 42.86% (3/7) of members needing an

HbA1c screening were reached • 11.11% (1/9) of members needing

nephropathy screenings were reached

07/2018

Mail the Diabetes Treatment Alert Report (DTAR) to providers.

• 02/2018 • 08/2018

The DTAR was not distributed to providers in Massachusetts due to the implementation of the ACO program and the transition of members.

N/A

Evaluate the effectiveness of the DTAR six months after distribution of the report.

• 08/2018 The DTAR was not distributed to providers in Massachusetts due to the implementation of the ACO program and the transition of members.

N/A



date Continue to send the diabetes self-management tips to members with diabetes.

• 03/2018 • 09/2018

The Diabetes Self-Management Tip sheet promotes self-management of diabetes and to educate members on the importance of recommended diabetes screenings and targets. The tip sheet was sent to all BMCHP MassHealth and QHP members with diabetes 18-75 years old identified using HEDIS specifications suppressing continuous enrollment. The tip sheet also has information on the texting program. April 2018:

• SCO: 152 members November 2018

• MassHealth: 1,874 members • QHP: 5,136 members • SCO: 135 members

The April mailing was not sent to MassHealth or QHP mailings due to the implementation of the ACO program and the transition of members.

• 04/2018 • 11/2018

Assess the effectiveness of the texting program.

06/2018 A compliance tracking report was used to trend month to month rates for specific HEDIS measures among participants vs. non-participants. The compliance tracking report is reviewed by the Quality department throughout the year. See the Final Analysis section for results.

06/2018

Educate providers in the Accountable Care Organizations (ACO) about member mailings and provider reports available from the Plan.

06/2018 The Plan distributed to all ACOs a catalog of member and provider initiatives. Additionally initiatives were shared at BMC Health System quality meetings.

02/2018

Continue to send to providers the All In One Care Gap Report including diabetes measures.

• 01/2018 • 05/2018 • 09/2018

The All in One Care Gap Report was not distributed to providers in Massachusetts due to the implementation of the ACO program and the transition of members.

N/A

Track effectiveness of the All in One Care Gap Report.

07/2018 Due to the All in One Care Gap Report not being distributed, an effectiveness report was not performed.

N/A



date Mail 2019 diabetes calendar to members with diabetes.

12/2018 The 2019 diabetes calendar and recipe cards were mailed to all MassHealth/QHP and SCO members with diabetes in both English and Spanish. The calendar provides information about diabetes, healthy recipes, and provides reminders and a place to track pertinent lab values through the course of the year. The mailing was sent to 7,410 members:

• English: 1,730 MassHealth MCO; 3,886 QHP and 196 SCO members

• Spanish: 128 MassHealth MCO; 928 QHP and 27 SCO members

12/2018

Additional Actions Implemented Additional Action Description Implementation

date QHP Diabetes Eye Exam Incentive The Plan provided a $25 incentive to QHP members with diabetes

to have an eye exam. See Final Analysis for the effectiveness of this intervention.

01/2018

Barriers Encountered

• The transition to the ACO program structure delayed the distribution of provider reports and member mailings. • There was an impact on all measures for MCO and ACO due to the transition to the ACO program as some measures

require one year continuous enrollment, however the transition of members (around 50%) occurred in March 2018, reducing the number of members that meet the criteria.


• Due to hiring of only one QOC per semester in 2018, and only one QOC available for their full semester, a limited number of members were reached during this data year.

• Members are dealing with family issues (death, caring for others); working multiple jobs or overtime, miss appointments and never reschedule them.

• Providers don’t discuss diabetes screenings with members. • Members do not remember that they have access to transportation to a medical appointment through the Plan. • Some members with diabetes are homeless and annual screenings are not the priority. • Members with diabetes may not understand the importance of self-management for their condition. • Members do not want to talk about their health over the phone. • Difficulty contacting members with no phone numbers or wrong phone numbers.

Measurement Milestones

Measure HEDIS 2017 HEDIS 2018 HEDIS 2019 Goal

Goal met?

MassHealth (including CarePlus) HbA1c testing 88.38% 89.29% 91.97% 92.82% No Poor HbA1c Control * (> 9.0%)

32.57% 36.25% 33.09% 29.07% No


Measurement Milestones Measure HEDIS 2017 HEDIS 2018 HEDIS 2019 Goal

Goal met?

Eye exams 64.61% 68.61% 70.56% 68.33% Yes Medical Attention for Nephropathy 90.49% 90.75% 91.73% 93.27% No BP <140/90 73.59% 69.10% 65.59% 75.91% No QHP HbA1c testing 88.63% 93.61% N/A 92.82% N/A HbA1c < 8.0% 55.92% 60.69% 53.42% 59.12% No Eye exams 63.98% 64.86% 68.35% 68.33% Yes Medical Attention for Nephropathy 86.49% 89.68% 90.38% 93.27% No Senior Care Options HbA1c (poor control >9%)* N/A 27.03% 28.74% Set

Baseline Yes

Eye exams N/A 86.49% 79.31% Set Baseline

Yes

Medical Attention for Nephropathy N/A 94.59% 94.25% Set Baseline

Yes


Final Analysis MassHealth HEDIS results (including CarePlus members)

• HbA1c Testing: the HEDIS 2019 rate increased 3.00% from the HEDIS 2018 rate. The increase is not statistically significant (p = 0.1879) and is below the goal rate (92.82%).

• HbA1c control >9% (members with HbA1c greater than 9%): the HEDIS 2019 rate decreased 8.72%* from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0.3407) and did not meet the goal rate (29.07%)*.

• Eye Exam: the HEDIS 2019 eye exam rate increased 2.84% from the HEDIS 2018 rate. The increase is not statistically significant (p = 0.5442) and is below the goal rate (68.33%).

• Nephropathy Screening: the HEDIS 2019 rate increased 1.08% from the HEDIS 2018 rate. The increase is not statistically significant (p = 0.6216) and is below the goal rate (93.27%).

• BP 140/90: The HEDIS 2019 rate increased less than 1% from the HEDIS 2018 rate. The increase is not statistically significant (p= 0.9398) and is below the goal rate (75.91%).

*A lower rate indicates better performance for this measure. QHP HEDIS results

• HbA1c control <8%: the HEDIS 2019 rate decreased 11.98% from the HEDIS 2018 rate. The decrease is statistically significant (p = 0.0375) and did not meet the goal rate (59.12%).

• Eye Exam: the HEDIS 2019 eye exam rate increased 5.38% from the HEDIS 2018 rate. The increase is not statistically significant (p = 0.2949) however is above the goal rate (68.33%).

• Nephropathy Screening: the HEDIS 2019 rate increased less than 1% from the HEDIS 2018 rate. The increase is not statistically significant (p = 0.6571) and did not meet the goal rate (93.27%).

SCO HEDIS results Baseline has been established.

• HbA1c control >9% (members with HbA1c greater than 9%): the HEDIS 2019 rate increased 6.33% from the HEDIS 2018 rate. The increase is not statistically significant (p = 0.8466)*.

• Eye Exam: the HEDIS 2019 eye exam rate decreased 8.30% from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0.3469).

• Nephropathy Screening: the HEDIS 2019 rate decreased less than 1% from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0.9399).



Final Analysis HealthCrowd Text Messaging Program None of the three diabetes measures included in the text messaging program (HbA1c testing, Nephropathy Screening, and eye exams) resulted in a higher rate for members participating in the program versus not participating. However, denominators were small. Due to the ongoing ACO implementation in 2018, ACO members were excluded from the text messaging program and the number of program participants decreased significantly. The number of participants in the diabetes campaign was down to about 25 members. Member Survey data were also collected once at the end of any text messaging campaign:

• 66.66% (12/18) members who took the survey strongly agreed or agreed that the text messages from this program gave helpful information about staying healthy

• 73.33% (11/15) members who took the survey strongly agreed or agreed that the text messages reminded them about needed care

• 53.85% (7/ 13) members who took the survey strongly agreed or agreed that they took action because of the text messages

QHP Diabetes Eye Exam Incentive In 2018, 2,090 QHP members who were non-complaint with the eye exam measure received a mailing about the incentive program. Additionally, an email was sent to 1,208 QHP members with email addresses, of which 36.51% (441) of those emails were opened. Subsequent to the distribution, a total of 2,754 QHP members received the $25 incentive for completing an eye exam in 2018.

Recommendation for 2020 Continue as a quality improvement project.


Asthma Disease and Care Management

Project Title: Asthma Disease and Care Management Post-Approval Change Log Quality Improvement Project Program Description According to data from national and state surveillance systems administered by the Center for Disease Control and Prevention, as of 2015, 7.8% of the US population has asthma. In Massachusetts, the prevalence is higher at 12% of the population (https://www.cdc.gov/asthma/asthmadata.htm). In December 2016, BMCHP identified 21,599 MassHealth members (12.51%) with asthma, which is slightly higher than the prevalence in Massachusetts. The Plan’s MassHealth HEDIS measures remain below the 2017 NCQA Quality Compass HEDIS Medicaid HMO 50th percentile. Medication management is a key component of the National Heart, Lung and Blood Institute and National Asthma Education and Prevention Program Guideline endorsed by the Plan. Without proper management, asthma can result in frequent emergency department (ED) visits, hospitalization and premature deaths. This project aims to improve the health of members with asthma by promoting interventions that improve member self-management and raise provider awareness of asthma guidelines and medication compliance.

Measurement & Goal HEDIS 2019 specifications and rates. Measure Goal MassHealth (including CarePlus) Medication Management for Asthma 75% Compliance (5-64 years of age)


Asthma Medication Ratio


Qualified Health Plan Medication Management for Asthma 75% Compliance (5-64 years of age)

50.00% 2017 NCQA Quality Compass HEDIS Medicaid HMO 90h percentile.

Project Team Lead: Karen Szvoren, RN Medical Director: Jonathan Welch, MD

2018 Actions

Action Expected date

Description Implementation date

https://www.cdc.gov/asthma/asthmadata.htm


2018 Actions Action Expected

date Description Implementation

date Continue to provide a link on the Plan’s website to the most recent asthma clinical practice guideline from the National Heart, Lung and Blood Institute.

01/2018 A link to the current asthma clinical practice guideline is available on the Plan’s website.

01/2018

Continue the asthma CM and DM programs. 01/2018 Care Management is offered to members with asthma identified through the Plan’s registry, Health Risk Assessment, and provider or member referrals.

01/2018

Continue to use the HEDIS, CM and asthma prednisone burst registries to identify members with asthma for possible CM, DM and interventions.

01/2018 The HEDIS, CM and asthma prednisone burst registries are utilized to identify members for CM, DM and mailings.

01/2018

Continue to send to providers the All In One Care Gap Report including asthma measures.

• 01/2018 • 05/2018 • 09/2018


N/A

Track effectiveness of the All in One Care Gap Report.

• 07/2018 An effectiveness analysis was not performed as the All in One Care Gap Report was not distributed in 2018.

N/A

Utilize the monthly HEDIS Dashboard to track asthma measures.

01/2018 The HEDIS Dashboard is used to track measure trends month to month for specific HEDIS measures compared to benchmarks and goals. The HEDIS dashboard is reviewed by the MA Quality Committee throughout the year to determine if additional interventions are needed.

01/2018

Continue to promote Plan website as resource for additional educational material on asthma for members and providers.

01/2018 The Plan’s website address is included on the asthma postcards. Asthma self-management tools are promoted on the Health Topics page of the Plan’s website.

01/2018

Continue to promote enrollment in the text messaging program to promote asthma control and increase asthma medication adherence. Include information on member mailings, the member portal and during other Plan contact with members.

01/2018 The asthma post card and the Plan’s website include information on enrolling in the texting program. Members can be “opted in” using short code or Facets. Quality Outreach Coordinators, customer Care staff and Care Management staff encourage members to enroll in the texting program.

01/2018

Continue to collaborate with BMC pharmacy to increase asthma medication adherence with BMC members.

01/2018 The Plan continues to send lists of members with asthma and a PCP at BMC to BMC Pharmacy for outreach to improve medication adherence. Engaged members are provided with monthly medication refill reminders as well as the option to enroll in the mail order program.

01/2018




date Continue to utilize the Quality Outreach Coordinators to call members to close gaps in asthma medication adherence.

01/2018 QOCs placed outbound calls educating members with gaps in care and medication compliance concerns about the importance of understanding their medications, asthma triggers and asthma control.

• 20.57% (108/525) of non-adherent members with asthma controller medication were reached.

See the Final Analysis section for effectiveness of the Quality Outreach Coordinators.

01/2018

Mail Asthma Treatment Advisory Report (ATAR) to providers.

• 03/2018 • 09/2018

The ATAR report identifies members with asthma per HEDIS specifications who have not filled an asthma controller medication within the previous 60 days and have filled one or more rescue medications within the same timeframe. It also identifies any asthma-related emergency department visits or inpatient utilization in the previous 12 months. September 2018

• 128 provider/provider groups identified

• 147 members: 87 MassHealth and 60 QHP

The reports were not mailed in March of 2018 due to the implementation of the ACO program and the transition of membership. See the Final Analysis section for results

09/2018




date Mail Asthma Self-Management card to members identified on the ATAR.

• 03/2018 • 09/2018

The asthma self-management postcard was mailed to members identified on the ATAR reports. . The postcard educates members on asthma symptoms, triggers, control, medications, and the importance of developing an asthma action plan with their provider. This mailing is sent in both English and Spanish. November 2018:

• Child: 13 English • Adult: 103 English, 2 Spanish

The postcards were not mailed in March of 2018 due to the implementation of the ACO program and the transition of membership.

10/2018

Measure the effectiveness of the ATAR six months after distribution of the report.

• 09/2018

Six months after the distribution of the ATAR, the Plan identifies members on the report and still active with the Plan that filled a prescription for an asthma controller medication. See the Final Analysis section for results

02/2019

Send asthma postcards with targeted messages to members with asthma.

• 05/2018 • 11/2018

The Plan mailed the asthma postcards to members with persistent asthma per HEDIS specifications. Postcards included messages promoting self-management of asthma and providing education on seasonal triggers, medication utilization and the importance of asthma control. December 2018

• 665 English MassHealth and QHP members

• 33 Spanish MassHealth and QHP members

The Spring postcard was not mailed in May 2018 due to the implementation of the ACO program and the transition of membership.

12/2018



02/2018




date Assess the effectiveness of the texting program.


06/2018

Additional Actions Implemented

Additional Action Description Implementation date

N/A

Barriers Encountered • The transition to the ACO program structure delayed the distribution of provider reports and member mailings. • There was an impact on all measures for MCO and ACO due to the transition to the ACO program as some measures

require one year continuous enrollment, however the transition of members (around 50%) occurred in March 2018, reducing the number of members that met the criteria.

• Due to ongoing concerns regarding interpretation of the Telephone Consumer Protection Act as it pertains to enrollment in texting programs by health plans, BMCHP legal counsel advised that members be invited to join the texting program and “opt in” to enroll. Opt-in enrollment methods result in significantly lower member participation than opt-out methods.

• Members are dealing with family issues (death, caring for others); working multiple jobs or overtime, and forget about taking medications as prescribed.

• Members do not always understand benefits and what is covered. • Members do not remember that they have access to transportation to a medical appointment through MassHealth. • Some members with asthma are homeless and taking medications as prescribed is not the priority. • Members with asthma sometimes do not understand the importance of self-management for their condition. • Members do not want to talk about their health over the phone. • Difficulty contacting members with no phone numbers or wrong phone numbers.



Goal met?

MassHealth Medication Management for Asthma 75% Compliance (5-64 years of age)

29.35% 33.82% 35.47% 33.33% Yes

Asthma Medication Ratio (5-64 years of age) 52.22% 49.21% 54.20% 62.16%

No

QHP Medication Management for Asthma 75% Compliance (5-64 years of age)

41.67% 40.28% 39.57% 50.00% No


Final Analysis MassHealth HEDIS results (including CarePlus members)

• Medication Management for Asthma 75% Compliance (5-64 years of age): the HEDIS 2019 rate increased 4.88% from the HEDIS 2018 rate. The increase is statistically significant (p = 0.0001) and exceeds the goal rate (33.33%).

• Asthma Medication Ratio: the HEDIS 2019 rate increased 10.14% from the HEDIS 2018 rate. The increase is statistically significant (p = 0.0054); however it does not meet the goal rate (62.16%).

QHP HEDIS results

• Medication Management for Asthma 75% Compliance (5-64 years of age): the HEDIS 2019 rate decreased 1.76% from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0.8789) and it did not meet the goal rate (50.00%).

HealthCrowd Text Messaging Program There were less than 20 MassHealth and QHP members enrolled in the asthma text messaging program, therefore a valid analysis could not be performed. Member Survey data were also collected once at the end of any text messaging campaign:




ATAR Effectiveness

• Six months after the September 2018 ATAR report, 11.11% (2/18) MassHealth and 4.76% QHP (1/21) members still enrolled with the Plan were compliant.

BMC Pharmacy/BMCHP Medication Adherence Pilot Program: The HEDIS MMA rate increased 4.88% from CY 2017 (33.82%) to CY 2018 (35.47%). This was a statistically significant increase (p = 0.0001).



Follow-Up for Children Prescribed ADHD Medication

Project Title: Follow-Up for Children Prescribed ADHD Medication Post-Approval Change Log Quality Improvement Project Program Description Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children. The primary care clinician should alert parents and children that changing medication dose and occasionally changing a medication might be necessary for optimal medication management, that the process might require a few months to achieve optimal success, and that medication efficacy should be systematically monitored at regular intervals (http://pediatrics.aappublications.org/content/128/5/1007).

The Plan’s MassHealth HEDIS 2016 and 2017 rates have remained below the 2017 NCQA Quality Compass HEDIS Medicaid 50th percentile. This project aims to improve compliance with follow up appointments with a prescribing clinician for members with ADHD, promote member and provider focused interventions and increase HEDIS rates to the 2016 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

Measurement & Goal HEDIS 2019 specifications and rates. Measure Goal MassHealth (including CarePlus) Initiation Phase


Continuation and Maintenance Phase (C&M)


Project Team Lead: Sharon Wai Medical Director: Jonathan Welch, MD

2018 Actions



Send provider report including ADHD measures performance, provider performance comparisons, and member outreach list.

03/2018 A report was developed however the distribution of reports were halted due to the transition to the ACO program.

N/A

Educate providers on frequency and timeliness of appointments.

03/2018 Due to the transition to the ACO program and provider transition to new networks, this activity was not implemented.

N/A

Educate providers in the Accountable Care Organizations (ACO) about provider reports available from the Plan.


02/2018

http://pediatrics.aappublications.org/content/128/5/1007



date Description Implementation date

Explore developing member outreach education materials.

03/2018 The Plan analyzed data for the population and identified mailers that could be sent after the initial fill. This was delayed due to the implementation of the ACO program and transition of members and provider networks.

04/2018


Additional Action Description Implementation date N/A


• The transition to the ACO program structure delayed the distribution of provider reports and member mailings. • Due to the transition to the ACO program, there was great confusion among providers and members which impeded on

the Plan’s ability to outreach to both cohorts without the risk of further confusion.


Goal met?

MassHealth Initiation Phase 49.13% 47.75% 41.43% 57.05% No

Continuation and Maintenance Phase (C&M) 55.90% 60.93% 50.00% 69.47% No

Final Analysis MassHealth HEDIS (including CarePlus members)

• ADHD Initiation Phase: the HEDIS 2019 rate decreased 13.24% from the 2018 rate. The decrease is statistically significant (p = 0.0220) and remains below the goal rate (57.05%).

• ADHD Continuation: the HEDIS 2019 rate decreased 17.94% from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0.1195) and remains below the goal rate (69.47%).

Recommendation for 2020

Continue as a quality improvement project.


Postpartum Care Project Title: Postpartum Care Post-Approval Change Log Quality Improvement Project Program Description A postpartum visit 21-56 days after delivery is an opportunity to address important postpartum care needs of the mother. These include pregnancy complications, chronic conditions, inter conception care, postpartum depression screening, and providing guidance on breastfeeding and other issues. A postpartum assessment allows for early identification of risks and timely interventions. This project is designed to improve the rate of postpartum visits for pregnant members 21-56 days after delivery and to increase and sustain rates at or above the 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile for both MassHealth and QHP members. The MassHealth HEDIS 2017 rate increased from the HEDIS 2016 rate; however remains below the 2017 NCQA Quality Compass HEDIS Medicaid 90th percentile. The HEDIS 2017 QHP rate decreased from the HEDIS 2016 rate. Postpartum visits are also a recommendation of the 2017 Massachusetts Quality Health Partners Perinatal Care Guidelines endorsed by the Plan to assess physical and psychosocial needs after delivery.

Measurement & Goal Performance Improvement Project HEDIS 2019 specifications and rates. Measure Goal MassHealth Postpartum Visits


QHP Postpartum Visits

73.67% Maintain performance at or above the 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

Project Team Lead: Jeanne Murphy, RN Medical Director: Jonathan Welch, MD

2018 Actions



Continue to provide a link on the Plan’s website to the most recent Massachusetts Health Quality Partners (MHQP) Perinatal Care Guidelines.

01/2018 A link to the current MHQP Perinatal clinical practice guideline is available on the Plan’s website.

01/2018

Continue the Maternal Child Health Care Management (CM) Program providing care management for low and high risk pregnant members during prenatal and postpartum as well as for complex newborns through one year of life.

01/2018 The Plan continues the Maternal Child Health Care Management Program providing care management for high risk pregnant members.

01/2018

Continue the diaper incentive to promote postpartum visits 21-56 days after delivery.

01/2018 253 members with a confirmed postpartum visit 21-56 days after delivery returned a form completed by their provider and were mailed a box of diapers.

01/2018




date Continue to promote text4baby. 01/2018 Text4baby is promoted to pregnant members

on the Plan’s website, during care management interactions and in member materials mailed to pregnant members. Text4baby is included on the MHQP Perinatal clinical practice guideline.

01/2018

Continue to include the postpartum checklist with the prenatal and postpartum packets.

01/2018 The postpartum postcard highlights the importance of the postpartum visit. The postpartum postcard is included in the prenatal and postpartum packets.

01/2018

Educate providers in the Accountable Care Organizations (ACO) about member mailings.

06/2018 The Plan distributed all ACOs a catalog of member and provider initiatives. Additionally initiatives were shared at BMC Health System quality meetings.

02/2018



N/A

Barriers Encountered • Pregnant members may not be aware of the importance and benefit of going to the postpartum visit. • Some members do not attend the postpartum visit within the recommended HEDIS timeframes, but ultimately receive

appropriate clinical care outside of the timeframe (either before 21 days or after 56 days). • Members being treated for more chronic conditions such as substance use may not consider the need for the postpartum visit

if they are seeing a doctor already regarding the other condition. • It is difficult to track the progress of this measure accurately throughout the year due to global billing which includes

pregnancy-related antepartum care, admission to Labor and Delivery, management of labor including fetal monitoring, delivery, and uncomplicated postpartum care until six weeks postpartum.

• Although providers are aware of the recommended timeframes for postpartum visits, they also have difficulty contacting the members or the members do not go to scheduled postpartum visit.



Goal met?

MassHealth Postpartum Visit 72.59% 72.54% 67.46% 73.67% No QHP Postpartum Visit 78.70% 78.54% 74.04% 73.67% Yes

Final Analysis

MassHealth HEDIS (including CarePlus members) • Postpartum Care: the HEDIS 2019 rate decreased 7.00% from the HEDIS 2018 rate. The decrease is not statistically

significant (p = 0. 1518) and is below the goal rate (73.67%). QHP HEDIS results

• Postpartum Care: the HEDIS 2019 rate decreased 5.73% from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0. 2699) and remains above the goal rate (73.67 %).


Continue as a quality improvement project (prenatal and postpartum care).


Antidepressant Medication Management

Project Title: Antidepressant Medication Management (AMM) Post-Approval Change Log Quality Improvement Project Program Description “Major depression can lead to serious impairment in daily functioning, including change in sleep patterns, appetite, concentration, energy and self-esteem, and can lead to suicide, the 10th leading cause of death in the United States each year. Clinical guidelines for depression emphasize the importance of effective clinical management in increasing patients’ medication compliance, monitoring treatment effectiveness and identifying and managing side effects.” http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2016-table-of-contents/antidepressant Current recommendations suggest that antidepressant medications should continue between four to nine months after depressive symptoms go away. Studies have shown that achieving remission and continuing antidepressant therapy long after the initial symptoms subside can protect against relapse (an early return or worsening of symptoms) or recurrence (later episodes occurring after remission) of the depressive episode. Discontinuing antidepressant treatment too soon may increase the risk of relapse or recurrence. http://www.pdrhealth.com/antidepressants/antidepressant-treatment-timeline The Plan’s MassHealth AMM rates are below the 2017 NCQA Quality Compass Medicaid HMO 25th percentile. This project aims to improve antidepressant medication adherence of members with depression by promoting interventions that educate member on the importance of medication adherence and raise provider awareness of depression guidelines.

Measurement & Goal Performance Improvement Project HEDIS 2019 specifications and rates. Measure Goal MassHealth (including CarePlus) AMM Acute Phase 51.89%

2017 NCQA Quality Compass Medicaid HMO 50th percentile.

AMM Continuation Phase

36.19% 2017 NCQA Quality Compass Medicaid HMO 50th percentile.

Qualified Health Plan AMM Acute Phase 63.55%

2017 NCQA Quality Compass Medicaid HMO 90th percentile.

AMM Continuation Phase

49.15% 2017 NCQA Quality Compass Medicaid HMO 90th percentile.


http://www.pdrhealth.com/antidepressants/antidepressant-treatment-timeline




date Continue to provide a link on the Plan’s website to the most recent Institute for Clinical Systems Improvement (ICSI) Adult Depression in Primary Care clinical practice guideline.

01/2018 A link to the current ICSI Adult Depression in Primary Care clinical practice guideline is available on the Plan’s provider website.

01/2018

Continue to work collaboratively with Beacon to identify AMM interventions.

01/2018 BMCHP included Beacon in the Wellness and Disease Management workgroups to review the root cause analysis data for the AMM measures and identify additional interventions.

01/2018

Utilize the monthly HEDIS Dashboard to track AMM rates.

01/2018 The HEDIS dashboard is used to track measure trends month to month for specific HEDIS measures compared to administrative rate trends from previous years, benchmarks and goals. The HEDIS dashboard is reviewed by the MA Quality Committee each month to determine if additional interventions are needed.

01/2018

Continue to send the Medication Adherence mailing to members starting antidepressant medications (Selective Serotonin Reuptake Inhibitor (SSRI) category) using pharmacy data.

01/2018 A bi-weekly medication adherence mailer is sent to members 18 years and older who were newly prescribed an SSRI. Due to other off-label uses for other categories of antidepressants, the mailing is only sent to members with a new prescription for an SSRI. The mailer encourages compliance with medication (not specifically mentioning depression) and the importance of continuing medication and communicating with the prescribing physician. The mailer is available in both English and Spanish and was sent to MassHealth and QHP members in 2018.

• English – 4,568 Mass Health members, 1,457 QHP members

• Spanish – 136 MassHealth members, 91 QHP members

01/2018




date Continue monthly educational mailing including pill box to members 18 and over with a new start of antidepressant medication and a confirmed medical claim for depression.

01/2018 The Plan continues to send monthly educational mailings to members 18 years of age and older identified with a new prescription for antidepressant medication. The mailings promote the importance of staying on the prescribed antidepressants, taking medication as ordered and discussing any issues with the provider. The mailings also address concerns about taking antidepressants while pregnant, and promote physical activity. A pill box is included with the mailings to help members keep track of their medication. The mailer is available in both English and Spanish and was sent to MassHealth and QHP members in 2018.

• English – 5234 MassHealth members, 1047 QHP members

• Spanish – 161 MassHealth members, 86 QHP members

The Plan did not send the mailings from February through May 2018 to allow for the transition of MassHealth members to ACOs.

01/2018 06/2018 to 12/2018

Continue to promote enrollment in the text messaging program to promote medication adherence. Include information on member mailings, the member portal and during other Plan contact with members.

01/2018 The mailings and the Plan’s website include information on enrolling in the texting program. Members can be “opted in” using short code or Facets. Quality Outreach Coordinators, customer Care staff and Care Management staff encourage members to enroll in the texting program.

01/2018

Continue to provide PCP toolkit and member educational material on Beacon’s provider website (Beacon intervention).

01/2018 The Beacon Health Options website includes educational materials for behavioral health and medical providers, along with member facing materials. These materials include depression management/guidelines, the PHQ-9 screening tools, as well as member a depression brochure in English and Spanish, and the Member Depression Treatment Tool. A postcard is mailed annually to providers to inform them of depression management tools and information available on the Beacon website.

01/2018

Send letter to members identified for Beacon’s AMM program (Beacon intervention).

01/2018 The Psychotropic Drug Interaction Program (PDIP) AMM program was put on hold because of a change in member ID’s due to the implementation of the ACO. This program has been discontinued.

01/2018




date Partner with BMC Pharmacy to implement a pilot program to enroll BMC members in mail order of antidepressant medications, and provide education on medication adherence.

01/2018 The Plan successfully implemented a pilot program to engage members that fall within the AMM measure with a PCP at BMC into the BMC pharmacy program. The number of members engaged in the program is too small to analyze the effectiveness of the program for this cohort.

01/2018

Review and update member and provider materials promoting adherence to anti-depressant medications and depression screening tools (Beacon intervention).

03/2018 Beacon revised and sent the Depression & Medication Adherence Newsletter to all in-network BH providers. The newsletter provided information on the HEDIS AMM measure, depression screening, family therapy and adolescent depression, post-partum depression screening and provided resources and links to Beacon’s website, PCP Toolkit and Achieve Solutions. (10,171 emails/MA providers – Q2 2018). Member facing materials regarding the importance of medication adherence, side effects, and discontinuing medication were translated from English into four additional languages (Q1 2018). A postcard containing a link to the depression guideline, screening tools, and the Achieve Solutions website (Q3 2018), was mailed to all Beacon Practices.

03/2018



06/2018

Educate providers in the Accountable Care Organizations (ACO) about provider reports available from the Plan.

06/2018 The Plan distributed a catalog of member and provider initiatives to all ACOs. Additionally initiatives were shared at BMC Health System quality meetings.

02/2018

Assess the effectiveness of the Medication Adherence and educational mailing.

06/2018 An analysis was run to assess the effectiveness of the Medication Adherence and educational mailing. See the Final Analysis section for results.

06/2018



N/A


Barriers Encountered • Due to ongoing concerns regarding interpretation of the Telephone Consumer Protection Act as it pertains to enrollment in

texting programs by health plans, BMCHP legal counsel advised that members be invited to join the texting program and “opt in” to enroll. Opt-in enrollment methods result in significantly lower member participation in the texting program than opt-out methods.

• The two to three month medical claims lag to confirm the diagnosis of depression delays identifying members for the AMM mailing and the AMM Member Outreach Program.

• Members may not understand the importance of taking antidepressants as ordered and that changes in dosage or medication may be required to achieve therapeutic results.

• Members may experience side effects to medications and stop taking them. • Hispanic members may be resistant to treating depression with medication due to social stigma or cultural barriers. • Women who are pregnant or thinking of becoming pregnant may have concerns about the potential health risks

antidepressants may have for their baby. • Members with chronic or comorbid conditions may need additional help with managing depression. • Laws preventing the dissemination of behavioral health information to the PCP without permission from the member limit the

Plan’s ability to involve PCPs in the outreach effort to help members understand and stay on their antidepressant medication. • PCPs may not be aware of available support tools, best practice recommendations and guidelines for the effective treatment

of depression. • Members may not fill their antidepressant medication due to the copay and are not aware that the medication can be filled

without paying the copay.


Goal met?

MassHealth (including CarePlus) AMM Acute Phase 44.74% 46.93% 45.96% 51.89%

No

AMM Continuation Phase 31.59% 31.97% 32.48% 36.19%

No

QHP AMM Acute Phase 59.76% 60.00% 56.45% 63.55%

No

AMM Continuation Phase 47.71% 46.73% 43.55% 49.15%

No

Final Analysis

MassHealth HEDIS results (including CarePlus members) • AMM Acute Phase: the HEDIS 2019 rate decreased 2.07% from the HEDIS 2018 rate. The decrease is not statistically

significant (p = 0.4058) and remains below the goal rate (51.89 %). • AMM Continuation Phase: the HEDIS 2019 rate increased 1.60% from the HEDIS 2018 rate. The increase is not statistically

significant (p = 0.6422) and remains below the goal rate (36.19 %). QHP HEDIS results

AMM Acute Phase: the HEDIS 2019 rate decreased 5.92% from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0.1798) and remains below the goal rate (63.55%)

• AMM Continuation Phase: the HEDIS 2019 rate decreased 6.81% from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0.2334) and remains below the goal rate (49.15%).

Member Survey data were also collected once at the end of any text messaging campaign: • 66.66% (12/18) members who took the survey strongly agreed or agreed that the text messages from this program gave

helpful information about staying healthy • 73.33% (11/15) members who took the survey strongly agreed or agreed that the text messages reminded them about


Final Analysis needed care


Medication Adherence Mailing: 56.54% of the 948 members who received the Medication Adherence Mailer and also in the AMM denominator were compliant with the AMM Acute Phase measure, and 41.35% were compliant with the AMM Continuation Phase measure. Both rates were higher than the overall MassHealth rates and similar to the QHP rates.



Well Child and Adolescent Care

Project Title: Well Child and Adolescent Care Post-Approval Change Log Quality Improvement Project Program Description Well-child and well adolescent visits are routine visits to the child’s/adolescent’s physician for:

• physical examinations • immunization updates • tracking growth and development • finding any problems before they become serious • information on health and safety issues • information on nutrition and physical fitness • information on how to manage emergencies and illnesses

Counseling and treatment can help adolescents avoid or recover from a number of problems including addictive behaviors like alcohol, smoking and drug use; sexually transmitted diseases and pregnancy; eating disorders and mental disorders. All of the leading causes of adolescent death – accidents, homicide and suicide – are avoidable and well care services are one way for teens to get the help they need. This project is designed to improve the health of children and adolescents by promoting appropriate well child visits for all ages for early identification and treatment of any behavioral or developmental issues. Although the well visit rate for children 3-6 years of age remains above the 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile the rate decreased 6.5% from CY 2015 to CY 2016 and the adolescent well visit rate is below the 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile

Measurement & Goal HEDIS 2019 specifications and rates. Measure Goal Well Visits in the first 15 Months of Life (6 or more)


Well-Child Visits in the 3rd, 4th, 5th and 6th years of life


Adolescent Well Care Visits



2018 Actions



Provide a link on the Plan’s website to the most recent MHQP Pediatric Preventive Care Guideline and Immunization recommendations.

01/2018 A link to the current Massachusetts Health Quality Partners (MHQP) Pediatric Preventive Care clinical practice guideline is available on the Plan’s website.

01/2018

Provide educational material and resources on the Plan’s website.

01/2018 A link is available on the Plan’s website to educational material and resources including: Body Mass Index calculator, tips on healthy eating, Krames OnLine HealthSheets™, Nurse Advice Line, Wellness Guide etc.

01/2018




date Utilize the monthly HEDIS Dashboard to track administrative well visit rates.

01/2018 A HEDIS dashboard is used to track measure trends month to month for specific HEDIS measures compared to administrative rate trends from previous years, benchmarks and goals. The HEDIS dashboard is reviewed by the MA Quality Committee each month to determine if additional interventions are needed.

01/2018

Promote enrollment in text messaging on member mailings, member portal and other Plan contact with members.

01/2018 The Plan’s website includes information on enrolling in the texting program. Quality Outreach Coordinators, Customer Care staff and Care Management staff encourage and assist members to enroll in the texting program.

01/2018

Enroll parents and/or guardians in text messaging program to encourage well visits for all age categories.

01/2018 In 2018, 103 members or parents/guardians of members opted in to the texting program for health reminders related to adolescent well care visits.

01/2018

Continue to utilize the Quality Outreach Coordinators to call parents/guardians of members to close gaps in well visits.

07/2018 Quality Outreach Coordinators (QOC) discussed the importance of well visits for children 3-6 and 12-21 during calls with parents that were reached for other outreach conditions.

07/2018

Continue to send to providers the All In One Gap Report including well visits for members 3-6 years old and 12-21 years old.

• 01/2018 • 05/2018 • 09/2018


N/A

Continue to track effectiveness of the All in One Gap Report.

07/2018 An effectiveness analysis was no performed due to the report not being distributed in 2018.

N/A

Identify children birth up to 15 months in need of at least six well visits and encourage behavioral health screen and mail report to providers

• 05/2018 • 10/2018

The EPSDT report was discontinued and replaced with the All in One Care Gap report which was not distributed in 2018 due to the ACO program implementation and transition of members.

N/A



06/2018



02/2018





date Birthday Cards The Plan distributes birthday cards to the parents/guardians of

members turning 9 months to encourage timely well visits and immunizations.

01/2018


• School schedules and work impact the scheduling appointments. • Members may be receiving treatment for complex conditions and do not schedule a well visit due to the many appointments

for the condition. • Psychosocial barriers such as homelessness, health literacy and food insecurity impede on the likelihood of getting routine

preventive well visits.

Measurement Milestones Measure* HEDIS 2017 HEDIS 2018 HEDIS 2019 Goal

Goal met?

Well-Child Visits in the First 15 Months of Life (6 or more) 80.27% 83.33% 80.00% 72.46% Yes

Well-Child Visits in the 3rd, 4th, 5th and 6th years of life 83.91% 88.33% 78.82% 82.77% No

Adolescent Well Care Visits 62.50% 68.30% 65.00% 68.06% No

Final Analysis

MassHealth HEDIS (including CarePlus members) • Well Visits in the first 15 Months of Life (6 or more): the HEDIS 2019 rate decreased 4.00% from the HEDIS 2018 rate. The

decrease is not statistically significant (p = 0. 3305) and remains above the goal rate (72.46%). • Well-Child Visits in the 3rd, 4th, 5th and 6th years of life: the HEDIS 2019 rate decreased 10.77% from the HEDIS 2018

rate. The decrease is statistically significant (p = 0.0004) and is below the goal rate (82.77%). • Adolescent Well Care Visits: the HEDIS 2019 rate decreased 4.83% from the HEDIS 2018 rate. The decrease is not

statistically significant (p = 0.3388) however is below the goal rate (68.06%). Text Messaging There were less than 20 MassHealth and QHP members enrolled in the text messaging program, therefore a valid analysis could not be performed. Member Survey data were also collected once at the end of any text messaging campaign:





Retire as a quality improvement project.


Women’s Preventive Health

Project Title: Women’s Preventive Health Post-Approval Change Log Quality Improvement Project Program Description This project is designed to improve the health of women by promoting appropriate cervical, breast cancer and chlamydia screenings for early identification and treatment of any cancer or other conditions. Both the HEDIS 2017 MassHealth breast and cervical cancer rates had statistically significant decreases from the HEDIS 2016 rates. The MassHealth cervical cancer screening and QHP chlamydia screening rates are the only measures below the 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentiles.

Measurement & Goal HEDIS 2019 specifications and rates. Measure Goal MassHealth (including CarePlus) Cervical Cancer Screening




Chlamydia Screening (16-24 years of age)


Qualified Health Plan Cervical Cancer Screening




Chlamydia Screening (16-24 years of age)


Senior Care Options Breast Cancer Screening

Set Baseline


2018 Actions

Action Expected date Description Implementation date

Provide a link on the Plan’s website to the most recent MHQP Adult Routine Preventive Care Guideline.

01/2018 A link to the current Massachusetts Health Quality Partners (MHQP) Adult Preventive Care clinical practice guideline is available on the Plan’s website.

01/2018

Provide educational material and resources on the Plan’s website.

01/2018 A link is available on the Plan’s website to educational material and resources including: Body Mass Index calculator, tips on healthy eating, Krames OnLine HealthSheets™, Nurse Advice Line, Wellness Guide etc.

01/2018



date Utilize the monthly HEDIS Dashboard to track preventive screenings measures.

01/2018 The HEDIS dashboard is used to track measure trends month to month for specific HEDIS measures compared to administrative rate trends from previous years, benchmarks and goals. The HEDIS dashboard is reviewed by the MA Quality Committee each month to determine if additional interventions are needed.

01/2018

Promote enrollment in text messaging on member mailings, member portal and other Plan contact with members.

01/2018 The Plan’s website includes information on enrolling in the texting program. Quality Outreach Coordinators, Customer Care staff and Care Management staff encourage and assist members to enroll in the texting program.

01/2018

Enroll members in text messaging program to encourage breast and cervical cancer screening.

01/2018 In 2018, 68 members opted in to the texting program for health reminders related to breast cancer screening, and 247 members opted in for cervical cancer screening.

01/2018

Continue to utilize the pop up messages in Facets by member services staff to promote breast and cervical cancer screening.

01/2018 Member Services staff continue to utilize the pop up messages in Facets to promote breast and cervical screening. Breast and cervical cancer screenings are included in the on hold messages that members hear during Member Services calls.

01/2018

Continue to utilize Quality Outreach Coordinator(s) to call members to close gaps in women’s preventive health screenings.

01/2018 Quality Outreach Coordinators placed outbound calls educating members about managing chronic conditions. During these calls members overdue for breast and/or cervical cancer screening were encouraged to discuss with their PCP.

01/2018



06/2018

Continue to send to providers the All In One Gap Report including breast and cervical cancer screening.

• 01/2018 • 05/2018 • 09/2018


N/A

Track effectiveness of the All in One Gap Report.

07/2018 An effectiveness analysis was no performed due to the report not being distributed in 2018.

N/A



date N/A



• Members are unaware that they need breast and/or cervical cancer screenings. • Providers do not address gaps in preventive care. • Treatment for other medical conditions take priority over preventive health screenings • History of physical abuse/trauma influence member’s decisions.



Goal met?

MassHealth (including CarePlus) Cervical Cancer Screening 67.60% 72.40% 67.46% 70.80% No Breast Cancer Screening 70.44% 70.49% 68.27% 70.29% No Chlamydia Screening (16-24 years of age) 72.86% 74.39% 74.39% 71.45% Yes Qualified Health Plan Cervical Cancer Screening 83.10% 59.37% 68.34% 70.80% No Breast Cancer Screening 76.45% 73.89% 77.97% 70.29% Yes Chlamydia Screening (all ages) 67.65% 68.68% 69.76% 71.45% No Senior Care Options Breast Cancer Screening N/A N/A 85.71% Set

baseline Yes

Final Analysis MassHealth HEDIS (including CarePlus members)

• Cervical Cancer Screening: the HEDIS 2019 rate decreased 6.82% from the HEDIS 2018 rate. The decrease is not statistically significant (p = 0.1537) and is below the goal rate (70.80%).

• Breast Cancer Screening: the HEDIS 2019 rate decreased 3.15% from the HEDIS 2018 rate. The decrease is statistically significant (p = 0.0161) and is below the goal rate (70.29%).

• Chlamydia Screening: the HEDIS 2019 remained the same as the HEDIS 2018 rate. It remains above 2017 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile (71.45%).

QHP HEDIS Results

• Cervical Cancer Screening: the HEDIS 2019 rate increased 15.11% from the HEDIS 2018 rate. The increase is statistically significant (p = 0.0079) but is below the goal rate (70.80%).

• Breast Cancer Screening: the HEDIS 2019 rate increased 5.52% from the HEDIS 2018 rate. The increase is statistically significant (p = 0.0002) and remains above the goal rate (70.29%).

• Chlamydia Screening: the HEDIS 2019 rate increased 1.57% from the HEDIS 2018 rate. The increase is not statistically significant (p = 0.5721) and is below the goal rate (71.45%).

SCO: Baseline for breast cancer screening was not established in CY 2017 due to a small denominator for the measure; therefore a comparison of data from CY 2017 is not available. HealthCrowd Text Messaging Program The cervical cancer screening rate for MassHealth members participating in the cervical cancer screening text messaging campaign


Final Analysis (61%) was 30% higher than the rate for members not participating in the campaign (47%). There were less than 20 QHP members enrolled in the cervical cancer screening text messaging campaign, therefore a valid analysis could not be performed. Additionally, there were not enough MassHealth or QHP members participating in the breast cancer screening campaign for a comprehensive analysis. Further analysis will be performed to identify opportunities to improve the rate for members participating in the texting program. Member Survey data were also collected once at the end of any text messaging campaign:






Cultural and Linguistic Needs

Project Title: Cultural and Linguistic Needs Post –Approval Change Log Quality Improvement Project Program Description Racial and ethnic disparities in health care have been well documented. Data analysis has demonstrated that racial and ethnic disparities contribute to lower HEDIS effectiveness of care scores. This project seeks to improve the collection of race, ethnicity, and language (R/E/L) data to improve the overall care of members by identifying the racial and ethnic composition of BMCHP membership so that potential health care disparities can be identified.

Measurement & Goal

Measure Goal Direct data collection of MassHealth member level R/E/L

Maintain direct collection of R/E/L data for 50% of the Plan’s MassHealth membership.

Direct data collection of CarePlus member level R/E/L

Maintain direct collection of R/E/L data for 50% of the Plan’s CarePlus membership.

Direct data collection of QHP member level R/E/L

Maintain direct collection of R/E/L data for 50% of the Plan’s QHP membership.

Direct data collection of SCO member level R/E/L

Maintain direct collection of R/E/L data for 50% of the Plan’s SCO membership.

Project Team Lead: Ana Berridge Medical Director: Jonathan Welch, MD

2018 Actions



Continue to provide Cultural Competency training to all new employees through the new hire orientation/training.

01/2018 BMCHP provides cultural competency training to all employees through the new hire orientation/training. BMCHP includes cultural competency information within the Senior Care Options model of care training. This training is required for all BMCHP staff to complete annually.

01/2018

Continue to collect R/E/L data in a sensitive manner.

01/2018 The Plan collected R/E/L data in a sensitive manner through member services, care management, and the health needs assessment.

01/2018

Continue to collect preferred written language data in a sensitive manner.

01/2018 The Plan collected both preferred spoken and preferred written language from members.

01/2018

Use available R/E/L data and HEDIS rates to identify possible disparities and barriers to care when adequate data are available.

11/2018 The Plan performed drilldown analysis by race and language for HEDIS 2018 rates to identify potential disparities. No new disparities were identified in 2018.

11/2018




date Use R/E/L data to implement culturally and linguistically appropriate interventions if identified.

12/2018 The Plan used R/E/L data to implement culturally and linguistically appropriate interventions. Interventions included sending materials in the most prevalent languages and outreaching to members by telephone in their preferred spoken language to close gaps in care and targeting barriers based on cultures as they were encountered.

12/2018



N/A

Barriers Encountered Approximately 50% of the MassHealth membership transitioned in March 2018 due to the ACO program implementation. This transition of members greatly reduced the number of members that the Plan had race, ethnicity, and language data directly collected for.


Measure CY 2016 CY 2017 CY 2018 Goal

Goal met?

Direct data collection of MassHealth member level R/E/L 55. 51% 50.93% 33.38% 50% No Direct data collection of CarePlus member level R/E/L 54. 55% 45.40% 43.60% 50% No Direct data collection of QHP member level R/E/L 32. 56% 32.50% 34.90% 50% No

Direct data collection of SCO member level R/E/L 23. 57% 80.61% 76.30% 50% Yes

Final Analysis

In 2018 the percentage of R/E/L data collected for all eligible members decreased from CY 2016 and did not meet the goal for all products except for SCO, which increased and exceeded the goal. As noted in the barriers section, there was a large transition of MassHealth members in March 2018 due to the ACO program implementation. This transition of members decreased the final rate of eligible members that had R/E/L data collected. The Plan continues to collect R/E/L data among the eligible population through multiple sources including health needs assessments, member services, and care management.




Member Experience Project Title: Member Satisfaction Post-Approval Change Log Quality Improvement Project Program Description

The most recent CAHPS results highlighted further opportunity to improve customer service, coordination of care and the components to improve the rating of health plan. This project is designed to improve member experience in these areas through interventions focused on member and provider communication, as well as internal operational improvements.

Measurement & Goal CAHPS 2019 (survey year 2018) specifications and rates. Measure Goal MassHealth Adult (including Care Plus)

Customer Service 85.5% 2016 NCQA Quality Compass HEDIS Medicaid HMO 25th percentile.

Coordination of Care 84.6% 2016 NCQA Quality Compass HEDIS Medicaid HMO 75th percentile.

Rating of Health Plan 81.4% 2016 NCQA Quality Compass HEDIS Medicaid HMO 90th percentile.

MassHealth Child

Customer Service 88.2% 2016 NCQA Quality Compass HEDIS Medicaid HMO 50th percentile

Coordination of Care 85.4%2016 NCQA Quality Compass HEDIS Medicaid HMO 75th percentile

Rating of Health Plan 85.2% 2016 NCQA Quality Compass HEDIS Medicaid HMO 50th percentile

Project Team Lead: Charles Isaac Executive Sponsor: Petrina Cherry Was: Laurie Doran

2018 Actions



Continue CAHPS Improvement Workgroup meetings every other month.

01/2018 The CAHPS Workgroup met and identified and implemented actions.

01/2018

CAHPS Improvement Workgroup will identify interventions designed to improve Customer Service Composite Score and the Rating of Health Plan score.

01/2018 See Additional Actions Implemented. 01/2018

CAHPS Improvement Workgroup will develop a project plan for each intervention

01/2018 CAHPS Improvement Workgroup developed project plans for interventions. See Additional Actions Implemented.

01/2018


CAHPS Improvement Workgroup will implement and monitor the progress of each intervention, and report results to the Quality Improvement Committee.

01/2018 Interventions were monitored and progress reported to the Quality Improvement Committee.

01/2018


date Explore options with MassHealth for arranging a dedicated contact at their vendor managed call center, so that BMCHP call center management could contact them directly in order to quickly resolve member issues

Discussed with MassHealth options for having a dedicated contact at the vendor managed MassHealth call center, and MassHealth indicated that they will not authorize a dedicated contact at this time. MassHealth will be going to bid with the call center and does not want to allow anything of this nature during that process.

03/2018

For member issues that MassHealth refers to BMCHP, work with MassHealth to determine if they would allow BMCHP to communicate the issue resolution directly to the member, with notification to MassHealth

Worked with MassHealth and they are going to allow BMCHP to respond to directly to the member with the issue resolution, and that process has begun. BMCHP also responds to MassHealth so they are aware of the resolution and that we have closed the loop with the member

03/2018

Work with MassHealth to explore receiving member redetermination lists prior to MassHealth mailing redetermination notices, in order to allow BMCHP the opportunity to proactively minimize member confusion

BMCHP discussed options for this with MassHealth multiple times, but MassHealth is not currently able to provide redetermination lists.

03/2018

Develop communication strategies that will educate members on what specific types of questions/issues can be addressed directly by BMCHP or by MassHealth, in order to help members appropriately direct their calls.

• Developed a postcard for provider offices directing members to call MassHealth if they need to change their plans during the ACO/MCO transition period. • Developed Provider Office poster directing members when to ask us about their plan and how to contact the state if they need to change plans. • Enhanced the contact us page on the website.

03/2018

Identify the top reasons members call Member Services and explore developing member communication strategies to help reduce calls for these reasons

New subject/categories have been created in Facets to best determine call reasons. Report was run and the top call reasons were common administrative reasons that didn’t require any additional communication materials.

02/2018

Explore adding vendors (Beacon, Envision, CTS) to current Call Satisfaction Tracking Survey.

Budget was not available. 01/2018

Review ACO marketing materials that are currently being developed and identify opportunities to help educate members around Care Coordination

• Developed new ACO Quick Start Guide to be included in the member packet that emphasizes importance of the PCP relationship as the main point of contact. • Developed a Transition Checklist which encourages new members to proactively share their health information and records with their new PCP to improve Care Coordination. • Developed new brochure highlighting how better coordinated care benefits the member.

03/2018



date Identify potential opportunities to develop educational content, materials or tools that could help members better understand the concept of Coordination of Care

Developed a Transition Checklist for ACO and MCO which encourages new members to proactively share their health information and records with their new PCP to improve Care Coordination. Developed a New Member FAQ for the website with this information

03/2018


• MassHealth performed a Group CAHPS separate member satisfaction survey prior to the CAHPS 2019 surveys being distributed which may have impacted the results.

• Some members are not aware of the difference between the health plan and MassHealth. • Due to the transition to the ACO program, some members and providers encountered issues with understanding the new

program structure which may have impacted member satisfaction.

Measurement Milestones Measure CAHPS 2017 CAHPS

2018 CAHPS 2019

Goal

Goal met?

MassHealth Adult (including Care Plus)

Customer Service 82.6% N/A 88.0% 85.5% Yes Coordination of Care 81.7% N/A 77.1% 84.6% No Rating of Health Plan 80.0% N/A 72.6% 81.4% No MassHealth Child

Customer Service 86.1% N/A 88.6% 88.2% Yes

Coordination of Care 84.5% N/A 88.1% 85.4% Yes Rating of Health Plan 83.0% N/A 85.2% 85.2% Yes




2018 MA QI Work Plan Evaluation

Project Title: 2018 MA QI Work Plan Evaluation Post-Approval Change Log Quality Improvement Project Program Description The QI Work Plan is evaluated annually and results are used to develop the QI Work Plan for the following year.

Measurement & Goal Evaluate the effectiveness of the 2018 MA QI Work Plan for all MA Products using HEDIS, CAHPS, and other data.

Project Team Lead: Was: Karen Szvoren, RN



date Evaluate the effectiveness of the 2018 QI Work Plan when HEDIS 2019 and CAHPS 2019 data are available.

08/2019 The projects included on the 2018 QI Work Plan were evaluated. HEDIS scores were used to measure progress toward goals and targets. The work plan evaluation included documentation of successes and opportunities for improvement. The evaluation was presented to the Quality Improvement Committee for approval.

08/2019


date N/A

Barriers Encountered N/A

Measurement Milestones Goal Goal met? Evaluate the effectiveness of the 2018 MA QI Work Plan for all MA Products using HEDIS, CAHPS, and other data.

Yes

Final Analysis

The Plan reported both hybrid and administrative rates for HEDIS 2019 (data year 2018) measures for MassHealth, QHP and a limited set of SCO measures (due to the small denominator). Aggressive goals were set for the 2018 QI Work Plan projects, most often set for the Quality Compass 90th percentile. Some of the HEDIS and CAHPS measures improved and met the goal set in the 2018 QI work Plan; however some goals were not met.

• MassHealth: 31% (8/26) goals were met and 69% (18/26) goals were not met • QHP: 27% (3/11) goals were met and 73% (8/11) goals were not met • SCO: 100% (5/5) goals were met.

The Plan will evaluate the opportunity for more effective interventions for the measures that did not meet the goal.



Retrospective DUR for High-Risk Medications (Patient Safety Project)

Project Title: Retrospective DUR for High-Risk Medications Post-Approval Change Log Patient Safety Project Process Improvement Project Program Description Retrospective Drug Utilization Review (DUR) program involves a review of high-risk medications like Opioids, Buprenorphines, Benzodiazepines, Muscle relaxers and gabapentin by a clinical pharmacist based on retrospective utilization of these medications. The program monitors appropriate use of these high risk drugs and intervenes as necessary to assist providers with monitoring of members on multiple medications and also achieve improved coordination of care. The program utilizes interventions such as direct provider communication and potential member communication to encourage more appropriate use of medications. In certain situations referrals to fraud and abuse may be made for further evaluation. The plans clinical pharmacist will review pharmacy claims data for the identified high risk medications and determine if an outreach to providers would be necessary. In rare instances members may be outreached for education.

Measurement & Goal Goal Implement criteria to identify members for the program. Implement appropriate interventions for the identified members. Project Team Lead: Tina Bandekar, RPh Medical Director: Rick Pollak, MD

2018 Actions



Implement criteria to identify members monthly into the DUR program using pharmacy claims data.

03/2018 Members who based on the claims file are using opioid medications and have a concurrent benzodiazepine medication fill, such members will be identified in the DUR program report and this report is received quarterly from the PBM. In 2018 system complexities and caused issues with developing and implementing criteria to identify members for provider outreach. Criteria refinements have not been able to yield a volume that would be manageable for outreach given current resources. Refinements for this intervention are in process for 2019.

03/2018




date Conduct retrospective drug utilization review (DUR) and make outreach as necessary to providers and potentially members if required.

06/2018 The Plan’s clinical pharmacists conducts medication review on the members identified in the report and determine interventions which would either be an outreach to the provider or documentation to indicate continued observation. This intervention was not implemented due to barriers with developing criterion to identify members for provider outreach.

Not implemented in 2018

Develop a process to utilize reporting tool to monitor and evaluate program.

12/2018 The program will be ongoing and will be evaluated for number of members who have been able to successfully eliminate or reduce the number of high risk medications they are on. This intervention was not implemented due to barriers with developing criterion to identify members for provider outreach.

Not implemented in 2018



Developed provider letter A letter was developed to notify providers of members who were taking Benzodiazepines and Opioid medications. The letter also encouraged provider to prescribe Naloxone to reverse any adverse effects of opioids. The letter has not yet been approved for distribution.

November 2018


• The criteria programming to identify the right population for the program were complex and there were some system complexities that have caused implementation issues resulting in a higher volume of members being identified.

• The number of members that fall into this program still remains high making the program resource intensive. • Competing priorities and competing demand for resources slowed work on this project.


Goal Goal met? Implement criteria to identify members for the program. No Implement appropriate interventions for the identified members. No

Final Analysis

The barriers identified halted progression of this project in 2018. Refinements for this intervention are in process for 2019.


Continue as a process improvement project.


Senior Care Options (SCO) Quality Measurement

Project Title: STARS Workgroup Post-Approval Change Log Process Improvement Project Program Description The purpose of the STARS Workgroup is to provide a framework/strategic direction for the identification, prioritization, and implementation of activities aimed at achieving and maintaining BMCHP’s SCO Program STAR ratings. The initial one year period will establish baseline performance and allow analysis for improvement opportunity identification and planning. The STARS Workgroup collaborates with departments across the organization to develop strategies in accordance with regulatory requirements and quality improvement processes. Activities are designed to improve member experience, access to quality care, and health outcomes.

Measurement & Goal Goal To achieve a 4 STAR rating from Centers for Medicare and Medicaid Services (CMS) by 2020 (based on 2018 activity).

Due to low denominator, CAHPS data were not available for CY 2018. Goal adjusted to: Achieve and maintain 4 STAR rating by 2021

Project Team Lead: Maureen Kelly Executive Sponsor: Jonathan Welch, MD

2018 Actions



Monitor Part C and D reporting related to STAR Ratings monthly.

01/2018 The STARS Workgroup reviewed STAR Measures at regular monthly workgroup meetings. Reviews included medication safety data (ACUMEN Reports), call center reporting, care management updates and appeals and grievance data. The SCO HEDIS Dashboard was also monitored to track monthly HEDIS performance compared to CMS STAR Rating Cut Points.

01/2018




date Continue to implement activities outlined in the Quality Improvement Project and transition to Chronic Care Improvement Program (see 8.18.17 HPMS memo).

01/2018 The Plan continued to implement activities outlined in the Quality Improvement Project, and transitioned to the Chronic Care Improvement Program as outlined in the 8.18.17 HPMS memo. As of October 2018, CMS no longer requires QIP submission. The QIP was closed out and an attestation was submitted to CMS. In October 2018, a list of all care gaps including diabetes care gaps was sent to Evans Medical Foundation, which is home to the overwhelming majority of BMCHP SCO members. BMCHP Quality staff met with the Evans Medical Director of Quality and Patient Safety to review the list and discuss the best method for addressing care gaps. Practice Managers at Evans Medical were asked to outreach to members with diabetes care gaps to attempt to close the gaps. 15.38% (6/39) of diabetes-related care gaps were closed within 6 months. Of the 6 care gaps closed, 2 were for eye exams, 2 were for medical attention for nephropathy, and 1 was for an HbA1c test. Due to low denominators, effectiveness of care gap closure by CDC measure was not assessed. In February 2019, BMCHP Quality staff met with the practice managers to review the effectiveness of the outreach and identify potential areas for process improvement. In May 2019, a new list of diabetes care gaps was sent to Evans Medical Foundation. BMCHP Quality staff met with Evans practice managers to review the list and discuss outreach scripting and care management involvement. Effectiveness of the May 2019 care gap lists will be assessed in November 2019. In December 2018, a diabetes outreach calendar was sent to SCO members with diabetes. 284 SCO members received the mailing, (34 were delivered in Spanish). A member survey was included with the mailing. Member feedback on the materials was positive, with high scores for readability, usability and utility as a reminder for future doctor appointments.

01/2018

Develop process to access data from member health risk assessment and MDS-HC results.

04/2018 Due to the delayed transition from CCMS to Jiva, a process to access data from member health risk assessments and MDS-HC results has not yet been developed.

N/A




date Identify members with gaps in care and develop and or enhance processes with care management team to close gaps to implement with members. Additionally develop a process to include potential gaps in care in the member’s ICT and ICP.

04/2018 Members with diabetes care gaps received outreach calls from Care Management in August 2018 to attempt to close the gaps. Of 27 members receiving outreach calls, 18 closed at least one care gap (66.67%). 19 closed gaps were HbA1c tests (23.17%) and 7 were eye exams (8.54%). A process to include potential gaps in care in the member’s ICT and ICP was explored, but has not yet been implemented due to staffing challenges in Care Management and the delayed transition from CCMS to Jiva.

08/2018

Develop STAR Measure training materials for all staff.

4/2018 STAR Measure training was delivered to all staff as part of the 2018 SCO Model of Care training module in the BMCHP Learning Center.

04/2018



N/A

Barriers Encountered • Staffing limitations in Care Management and Pharmacy continue to be a barrier to consistent member outreach and effective

interventions. • Due to the delay in transitioning from CCMS to Jiva, data extraction from member assessments continues to be a time-

consuming manual process. • IT challenges prevent delivery of care gap information to providers in a way that can be utilized efficiently by EMRs.


Goal Goal met? To achieve a 4 STAR rating from Centers for Medicare and Medicaid Services (CMS) by 2020 (based on 2018 activity).

N/A*

* Please note that the STAR rating will not be ready until 2021 or 2022. The minimum CAHPS sample size was not met for 2018.

Final Analysis

The goal was not met due to low membership and unavailability of STAR ratings until 2021 or 2022.




Dual Eligible Special Needs Plan (DSNP) Most Vulnerable Population Identification

Project Title: DSNP Most Vulnerable Population Identification Post-Approval Change Log Process Improvement Project Program Description This project is designed to establish identification and monitoring processes for the Most Vulnerable (see Section 5) segment of the DSNP population. Completion rates of assessments and stratification of DSNP members will be tracked and monitoring systems developed to measure the impact of care management on the experience and outcomes for the Most Vulnerable segment of membership. Continuous improvement techniques will be applied to iteratively improve identification and monitoring methods based on early learning from this population.

Measurement & Goal Measure Goal Completion of Initial Health Risk Assessment (HRA)

100% completion of initial HRA or unable to reach process within 90 days of member effective date.

Completion of annual reassessment HRA

100% completion of annual reassessment HRA or unable to reach process. If a new member does not receive an initial HRA within 90 days of enrollment that member’s HRA is due to be completed within 365 days of enrollment. A new member who receives an initial HRA within 90 days of enrollment is due to complete a reassessment HRA no more than 365 days after the initial HRA was completed.

Project Team Lead: Jeanne Murphy, RN Executive Sponsor: Jonathan Welch, MD

2018 Actions



Make best efforts to collect initial HRA within 30 days of member effective date.

01/2018 Center for Medicare and Medicaid Services (CMS) requires the initial HRA to be completed within 90 days of member’s enrollment date however; BMCHP aims for HRA’s to be completed within 30 days of enrollment in the SCO program. The HRA is a key tool to assess members’ medical, social, cognitive, and functional needs, as well as to understand their health history and environmental influences. The tool is intended to identify the personalized care needs of the member upon enrollment.

01/2018

The Unable to Complete HRA Assessment will be conducted within 30 days of member effective date when the HRA has not yet been completed. The assessment will track barriers to completing the HRA and actions are taken to remove these barriers to ensure the HRA is completed within 30 days.

01/2018 BMCHP Care Management track all HRA’s that have not been completed within 30 days of member enrollment, including barriers to why the assessment has not been completed. This allows BMCHP Care Management to track and trend assessment completion within 30 days and overcome barriers for HRA completion within 90 days of new member enrollment.

01/2018




date Complete the Initial HRA within 90 days of member enrollment date.

01/2018 CMS requires the HRA be completed within 90 days of new member enrollment. BMCHP tracks HRA’s completed within 90 days of new member enrollment.

01/2018

The Unable to Complete HRA Assessment will be conducted within 90 days of member effective date when the HRA has not yet been completed. The assessment will track barriers to completing the HRA and actions are taken to remove these barriers. Should the HRA not be completed in the 90 day period, the member will no longer be eligible for an initial HRA instead; the member will be eligible for an HRA reassessment.

01/2018 The Unable to Reach assessment is conducted at 30 days and again at 90 days, documenting all barriers to completing the HRA within 90 days.

01/2018

Utilize the Care Management Audit Tool to monitor compliance to assessment completion.

01/2018 The Care Management Audit tool is used to monitor compliance to assessment completion. EOHHS and CMS audits monitor the completion rate of HRAs.

01/2018

Develop individual care plans based on HRA data.

01/2018 Individual care plans are developed based on the needs identified in the HRA.

01/2018

Utilize registry to stratify and outreach to members.

01/2018 The registry is used to stratify and outreach to members.

01/2018

Analyze data (e.g., utilization, medication adherence).

05/2018 CM Steering and Pharmacy reviews medication adherence with the CM team on an ongoing basis during case rounds

01/2018



N/A



Goal CY 2016 CY 2017 CY 2018 Goal Goal met? Completion of Initial Health Risk Assessment (HRA)

87.0% 87% 89% 100% No

Completion of annual reassessment HRA

33.3% 48% 65% 100% No

Final Analysis

Both measures, Completion of Initial HRA and Completion of annual reassessment HRA, improved from CY 2017, but did not meet goal.

Recommendation for 2020 Continue as a process improvement project.


Special Needs Program Project Title: Special Needs Program Post-Approval Change Log Process Improvement Project Program Description The Plan will identify, outreach and provide CM for members with special needs. The objectives of this program are:

• To provide education about chronic disease and promote self-management of them. • To facilitate coordination of care through the continuum. • To address psychosocial needs. • Ensure utilization of care at the right time, right place and right level of care.

Measurement & Goal Goal Evaluation of all work plan measures for the members that are in the Special Needs program.

Project Team Lead: Jeanne Murphy, RN Medical Director: Jonathan Welch, MD

2018 Actions



As needed, and at least annually, continue to review and update the criteria used by the Plan to identify members eligible for the Special Needs program.

01/2018 Criteria to identify members eligible for the Special Needs program have been implemented utilizing specific state contract language. Special needs conditions are identified through the monthly registry as well as other sources such as utilization data, Health Risk Assessment (HRA) etc.

1/2018

Continue to identify sources of data that will be used to identify members with special needs such as the Health Risk Assessment, welcome calls, claims, referrals and eligibility files.

01/2018 Members with special needs continue to be identified from multiple sources including HRA, claims, authorizations, internal departments, providers, external agencies and members/caregivers.

1/2018

Continue to monitor the quality and effectiveness of care for members with special needs who are eligible for the CM program throughout the measurement year.

01/2018 Care Management helps coordinate available services including social services and resources, medical services, and assistive equipment. Individual Care Plans are developed and progress towards goals is periodically monitored by the Care Manager in collaboration with the member, family members/caregivers, and the care team members. Based on outcomes and progress, changes are made to the plan as needed.

1/2018

Continue to dedicate staff to manage members with special needs.

01/2018 The Plan’s CM model is designed to meet the members where they are in assessing, identifying and managing specific needs. Members are managed by SW and Medical care managers in collaboration with Community Health Workers, BH clinicians as Community Partners.

1/2018


Continue to collaborate with providers of members in care management.

01/2018 PCPs are notified of members in medical care management. Care Managers work with PCPs as well as Medical Specialists to assist with ensuring member’s needs are met, education regarding the Prior Authorization process as well as finding appropriate service providers.

01/2018


Action Description Implementation date

N/A



Goal Goal met? Evaluation of all work plan measures for the members that are in the Special Needs program. Yes


Final Analysis The Plan analyzed the HEDIS rates for measures identified in the 2018 QI Work Plan and compared them between the rates of the special needs population and the overall BMCHP population. In 2018 there were 235 MCO members that were identified with the criteria for the Special Needs Population (SNP). Of the 18 measures/sub-measures identified in 2018, 3 measures attained a higher rate in the SNP than the overall population, and 15 measures had a denominator too small for comprehensive analysis. Of the 3 measures that attained a higher rate, only one measure, Antidepressant Medication Management Continuation Phase, was statistically significantly higher than the overall population.

Measure HEDIS 2019 (CY 2018) Special Needs Population Rate

HEDIS 2019 (CY 2018) BMCHP MCO Overall Population Rate

Statistically Significant Difference between SNP and overall HEDIS rate? (include p-value)

**CDC Diabetes - BP Control 140/90 ^100.00% (8/8)

56.41% (44/78)

Sample size too small for comprehensive analysis

**CDC Diabetes - Eye Exams ^62.50% (5/8)

57.69% (45/78)


**CDC Diabetes - HbA1c Testing ^100.00% (8/8)

84.62% (66/78)


**CDC Diabetes - Nephropathy Screening ^100.00% (8/8)

91.03% (71/78)


**CDC Diabetes - HbA1c >9 ^25.00% (2/8)

52.56% (41/78)


*Medication Management for Asthma 75% Age 5-64 ^66.67% (6/9)

35.71% (65/182)


*Asthma Med Ratio Age 5-64 ^57.14% (8/14)

50.83% (122/240)


*ADHD Initiation Phase ^100% (1/1)

41.46% (233/562)


*ADHD Continuation and Maintenance Phase ^100% (1/1)

53.06% (26/49)


**Postpartum Visit ^50.00% (1/2)

66.17% (88/133)


*Antidepressant Medication Management Acute Phase 50.79% (64/126)

45.56% (862/1892)

No (p=0.2537)

*Antidepressant Medication Management Continuation Phase

42.86% (54/126)

32.24% (610/1892)

Yes (p=0.014)

**Well Child Visits 0-15 months old ^(0/0) 76.34% (100/131)


**Well Child Visits 3-6 yrs. old ^(0/0)

64.06% (41/64)


**Adolescent Well Visit ^50.00% (1/2)

52.80% (66/125)


**Cervical Cancer Screening ^50.00% (2/5)

52.80% (66/125)


*Breast Cancer Screening 65.71% (46/70)

59.29% (549/926)

No (p = 0.2904)

*Chlamydia Screening Total ^70.00% (7/10)

68.84% (497/722)


* Administrative Rate ** Hybrid Rate

^ Sample size too small for comprehensive analysis


Final Analysis In 2018 there were 740 ACO members that were identified with the criteria for the Special Needs Population (SNP). Of the 18 measures/sub-measures identified in 2018, 10 measures attained a higher rate in the SNP than the overall population, and 8 measures had a denominator too small for comprehensive analysis. Of the 10 measures that attained a higher rate, one measure, Medication Management for Asthma, was statistically significantly higher than the overall population.

Measure HEDIS 2019 (CY 2018) Special Needs Population Rate

HEDIS 2019 (CY 2018) BMCHP ACO Overall Population Rate

Statistically Significant Difference between SNP and overall HEDIS rate? (include p-value)

**CDC Diabetes - BP Control 140/90 85.71% (30/35)

72.67% (242/333)

No (p=0.0946)

**CDC Diabetes - Eye Exams 77.14% (27/35)

73.57% (245/333)

No (p=0.6473)

**CDC Diabetes - HbA1c Testing 94.29% (33/35)

93.69% (312/333)

No (p=0.8905)

**CDC Diabetes - Nephropathy Screening 100.00% (35/35)

91.89% (306/333)

No (p=0.0801)

**CDC Diabetes - HbA1c >9 28.57% (10/35)

28.53% (98/333)

No (p=0.9156)

*Medication Management for Asthma 75% Age 5-64 51.92% (27/52)

35.41% (262/740)

Yes (p=0.0168)

*Asthma Med Ratio Age 5-64 62.32% (43/69)

55.06% (511/928)

No (p=0.2420)

*ADHD Initiation Phase ^(0/0)

41.03% (16/39)


*ADHD Continuation and Maintenance Phase ^(0/0)

44.00% (11/25)


Postpartum Visit ^50.00% (1/2)

68.32% (138/202)


*Antidepressant Medication Management Acute Phase 51.54% (67/130)

46.63% (532/1141)

No (p=0.2877)

*Antidepressant Medication Management Continuation Phase

35.38% (46/130)

32.87% (375/1141)

No (p=0.5632)

**Well Child Visits 0-15 months old ^80.00% (4/5)

84.40% (92/109)


**Well Child Visits 3-6 yrs. old ^(0/0)

80.83% (97/120)


**Adolescent Well Visit ^66.67% (2/3)

71.49% (168/235)


**Cervical Cancer Screening ^70.00% (7/10)

72.00% (162/225)


*Breast Cancer Screening 76.19% (192/252)

71.29% (1964/2755)

No (p=0.0982)

*Chlamydia Screening Total ^77.27% (17/22)

77.15% (1239/1606)


* Administrative Rate ** Hybrid Rate

^ Sample size too small for comprehensive analysis


Recommendation for 2020 Continue as a process improvement project.


Accountable Care Organizations

Project Title: Accountable Care Organizations(ACO) Post-Approval Change Log Process Improvement Project Program Description This project is designed to establish quality improvement identification and monitoring processes for Accountable Care Organization (ACO) partners. ACOs are provider-based organizations that take accountability for the cost and quality of care delivered to a patient across the spectrum of care delivery. The aims of the ACO structure are to reduce the rising costs of care and improve quality. The Plan is partnering with four ACOs: BMCHP Community Alliance, BMCHP Mercy Alliance, BMCHP Signature Alliance and BMCHP Southcoast Alliance.

Measurement & Goal Goal Identify ACO quality infrastructures and reporting. Project Team Lead: Kim Polk and Maureen Kelly Executive Sponsor: Jonathan Welch, MD

2018 Actions



Work with strategy liaisons and account managers to identify quality contacts within each ACO.

03/2018 The Plan worked closely with the BMC Health System operations staff to identify quality contacts within each ACO.

03/2018

Work with strategy liaisons, account managers and ACOs to identify existing quality programs within each ACO.

06/2018 The Plan implemented regular meetings to identify existing quality programs within each ACO as well as initiatives in development. This

06/2018

Establish ongoing central quality infrastructure with local ACO input.

06/2018 The BMC Health System operations team built the infrastructure with the ACOs, however the Plan is still in the process of pulling all ACOs, BMCHS operations, and Plan staff on a more regular basis.

06/2018



N/A

Barriers Encountered With the new ACO implementation, priorities delayed identification of the infrastructure as well as the establishing regular meetings with the Plan, ACOs, and the system for ACO input.


Goal Goal met? Identify ACO quality infrastructures. Yes


Final Analysis The Plan successfully met the goal and identified key ACO quality infrastructures. Although the infrastructures are identified, there are still opportunities to further integrate the ACOs, the Plan, and the system.



Documents

BMC HealthNet Plan | BMC HealthNet Plan - Quality .../media/dd312d8064bd4e5d8b5a54b880...According to the 2017 National Diabetes Statistics Report (released July 2017), 9.4% of the