State of New Hampshire Department of Health and Human Services - - PowerPoint PPT Presentation

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State of New Hampshire Department of Health and Human Services - - PowerPoint PPT Presentation

Feb 25, 2024 22 likes •290 views

State of New Hampshire Department of Health and Human Services Quality Assurance and Improvement: Medicaid Care Management LTSS Waiver Quality Data July, 2020 Medicaid Care Management Program: Presentation Agenda 2 Overview Access to

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State of New Hampshire Department of Health and Human Services Quality Assurance and Improvement: Medicaid Care Management LTSS Waiver Quality Data

July, 2020

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Medicaid Care Management Program: Presentation Agenda

  • Overview
  • Access to Care Data
  • Quality of Care Data
  • Member Experience of Care
  • Service Authorization Data
  • MCO LTSS Performance Improvement Project
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OVERVIEW:

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Data Domains

Domain Description Access to Care Service utilization data trended over time to evaluate “common” patterns of patient access to care. Quality of Care Data indicating if care is being delivered following evidence based practices. Member Experience of Care Data describing member’s experience accessing care. Service Authorization Process data showing member’s experience with the Managed Care Organization’s service authorization process.

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Data Availability and Limitations Most Data at LTSS System Level

  • All waivers combined;
  • Includes Nursing Home Services;
  • Separate Adult and Child; and
  • Excludes Adults over age 65

(should exclude most Nursing Home and CFI clients)

LTSS System Level Label

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Overview: Confidence Intervals

The lines shown on the chart are called confidence intervals (CI). CIs show an upper and lower range of rates. DHHS is 95% confident that the rates in this report are between the upper and lower range of the CIs. If the CIs of two rates intersect at any point, the difference between the two rates is not statistically significant at the 95% CI.

CI Upper Range CI Lower Range CI Intersection

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ACCESS TO CARE:

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Physician/APRN/Clinic Visits - Adult

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: Physician/APRN/Clinic visits per 1,000 member months by subpopulation.

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Physician/APRN/Clinic Visits - Children

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: Physician/APRN/Clinic visits per 1,000 member months by subpopulation.

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Emergency Department Visits-Potentially Treatable in Primary Care- Adult

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: Ambulatory emergency department visits for conditions potentially treatable in primary care per 1,000 member months by subpopulation.

15.6 18.6 12.4 11.2 11.2 17.2 17.0 13.3 12.4 13.4

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Emergency Department Visits-Potentially Treatable in Primary Care- Child

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: Ambulatory emergency department visits for conditions potentially treatable in primary care per 1,000 member months by subpopulation.

9.5 7.6 13.3 9.2 14.7 12.8 9.4 4.9 7.1

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Frequent Emergency Department Use - Adult

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: Percent of members with frequent (4 or more) emergency department use in the previous 12 months, by subpopulation.

2.5 2.2 2.9 6.9 6.1 6.5

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Frequent Emergency Department Use - Child

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: Percent of members with frequent (4 or more) emergency department use in the previous 12 months, by subpopulation.

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QUALITY OF CARE:

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Antidepressant Medication Management (AMM) by Subpopulation- Effective Continuation Phase Treatment - Adult

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: The percentage of members 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression and who remained on an antidepressant medication treatment..

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Breast Cancer Screening (BCS) by Subpopulation

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: The percentage of women members 50-74 years of age, who had a mammogram to screen for breast cancer, by subpopulation groups.

61.6 60.1 57.4 54.4 49.5 46.6

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Pharmacotherapy Management of COPD Exacerbation (PCE) by Subpopulation- Systemic Corticosteroid- Adult

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: The percentage of COPD exacerbations for members 40 years of age and older who had an acute inpatient discharge or ED visit on or between January 1-November 30 of the measurement year and who were dispensed appropriate medications.

87.7 88.3 88.8 84.4 79.4 87.2

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Future Quality of Care Measures

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

  • Use of Imaging Studies for Low Back Pain
  • Adherence to Antipsychotics for Individuals with Schizophrenia
  • Diabetes Screening for People with Schizophrenia or Bipolar Disorder

Who are Using Antipsychotic Medications

  • Metabolic Monitoring for Children Prescribed Antipsychotic

Medications

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MEMBER EXPERIENCE OF CARE:

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Member Experience of Care Survey

  • Consumer Assessment of Healthcare Plans and Systems (CAHPS)
  • Produced by Agency for Healthcare Research and Quality (ARHQ)

with administrative standards created by National Committee for Quality Assurance of health plans (NCQA)

  • Adult and Child Surveys
  • Child Survey has subset of Children with Chronic Conditions
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MCM Rate: 2018 Member Experience of Care Survey (CAHPS) Children with Chronic Conditions

CAHPS Question(s) 2016 Rate 2017 Rate 2018 Rate 2018 National Overall Rating of Health Plan (8,9,10) 73.8 73.3 82.2 84.0 How often did your child’s personal doctor seem informed and up-to-date about the care you got from these doctors or other health providers? (Usually + Always) 89.8 89.4 84.0 83.7 Ease in Getting Care, Tests, and Treatment (Usually + Always) 94.5 94.2 90.2 90.9 Getting Needed Care Right Away (Usually + Always) 95.9 97.1 95.6 94.1

Source Data: 2018 Consumer Assessment of Health Care Providers and Systems. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality

Member Experience of Care

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SERVICE AUTHORIZATION:

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Service Authorizations: Physical, Occupational & Speech Therapy Service Authorization Denials by Waiver & Non-HCBC Waiver Populations

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: Percent of physical, occupational and speech therapy service authorizations denied during the measurement period, by each of the following waiver and non- HCBC waiver groups

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Service Authorizations Denials for Waiver & Non- HCBC Waiver Populations

Data Source: Medicaidquality.nh.gov retrieved 6/26/2020

Measure Description: Percent of service authorization requests denied during the measurement period, by each of the following waiver and non-HCBC waiver groups:

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State of New Hampshire Department of Health and Human Services

Questions & Answers

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Contact Information

Patrick McGowan, MS, CPHQ:

  • Patrick.mcgowan@dhhs.nh.gov
  • https://medicaidquality.nh.gov/
  • 603-271-9534