Florida Asthma & Tobacco Cessation Learning & Action Network UnitedHealthcare Lessons Learned Diana P. Valderrama, MPH Quality- Senior Clinical Data Analyst
About our Plan • Quality- Primary Care Provider Model. • 82% Medicaid membership • Majority of asthmatic population in Region 4: Volusia and Duval counties. • Goal: to improve asthma control for children ages 5 – 18 by September 30, 2018 as evidenced by reducing ED visits for asthma by at least 10% from baseline Definition Number Children ages 5 – 18 with asthma 12,504 (Aug 2016-Aug 2017) Diagnosed > 90 days and with > 2 ED visits in past year 1,267 (Aug 2016-Aug 2017) Sub-population (Region 7) 140 (Aug 2016-Aug 2017) 2 Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Lessons Learned • Quality Improvement Process • PCP Access and Availability • Pharmacy Rejection for Asthma Medication • Post ER- Follow up
Quality Improvement Process • PDSA Cycle- Plan, Do, Study , Act • Adapt or • Plan the Abandon test • Simple test of change ACT PLAN • Process measures • Fishbone diagram and driver’s diagrams STUDY DO • Analyze • Run the • Interdepartmental collaboration results test • Leveraging available resources 4 Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PCP Access and Availability Survey • Top 10 PCPs for Subpopulation • What we learned: - Referrals to specialist - Same day walk in appointments - Extended hours/weekend hours - Access to PDL - Patient Education • Opportunities for improvement identified: - Symptom management plan (e.g. allergen testing) - Teaching proper use of medication - Resources availability 5 Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Pharmacy Rejection Data • Top 10 providers with rejections for asthma medication - Both control and rescue medicine Findings: - Plan benefits limitations message- Refills too early - Majority of rejections at 1 provider group - Majority of rejections were resolved - Members did not come back for the medication • Opportunity: - Improve use and communication of pharmacy rejection data for asthma medication. Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Post-ER Outreach • Implemented post-ER outreach by Community Health Workers (CHWs) • Successfully engaged leadership and clinical frontline staff Member Stories: • One member was utilizing the ER because it was close to home and they did not have transportation to medical appointments. The CHW informed the member of the transport benefit available to them, and provided the phone number to schedule transportation whenever it is needed. The member was not aware of this benefit. • Another member stated they did not have a PCP nor specialist treating the child’s asthma. The CHW connected the member with our Member Services department to correct the assigned PCP to one that is in close proximity to the member. Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Rate of ER Visits for Asthma Rate of ER Visits for Asthma (n=140) 200.0 180.0 160.0 Count of ER Visits per 1,000 140.0 120.0 100.0 80.9 71.4 70.9 80.0 65.7 63.5 57.6 51.5 50.4 60.0 43.5 44.1 40.7 28.8 40.0 8.4 20.0 0.0 0.0 0.0 0.0 0.0 0.0 8 Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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