2012 Diabetes. Program Evaluation. Our mission is to improve the health and quality of life of our members

Transcription

1 2012 Diabetes Program Evaluation Our mission is to improve the health and quality of life of our members

2 Diabetes Program Evaluation Program Title: Diabetes Program Evaluation Period: January 1, 2012 December 31, 2012 Introduction: The Diabetes Program is designed to improve the health status and decrease complications of adult members with diabetes through improved adherence of both members and practitioners with the American Diabetes Association (ADA) Standards of Care. The Diabetes Program is the process of coordinating health care interventions and communications for members with diabetes in which patient self-care efforts are significant; supporting practitioner/member relationships and the member s plan of care; emphasizing prevention of exacerbations and complications utilizing evidence-based practice guidelines and patient empowerment strategies; and evaluating clinical, humanistic and economic outcomes on an ongoing basis with the goal of improving overall health. 1 Program Objectives: Decrease complications of members age 18 and over with diabetes by increasing practitioner adherence to ADA Standards of Care regarding Hemoglobin A1c (HbA1c) testing, LDL-C testing, medical attention for nephropathy, Dilated Retinal Eye (DRE) Exams, and blood pressure (BP) control. Increase member adherence with ADA Standards of Care regarding HbA1c testing, LDL-C testing, medical attention for nephropathy, DRE Exams, and BP treatment. Decrease the frequency of diabetes related inpatient admissions, readmissions within 30 days, and emergency room (ER) visits. Promote healthy lifestyle-diet and nutrition, measurement of blood sugars as prescribed by the practitioner, adherence to medication regimen, weight management, physical activity, smoking cessation, and adherence to recommended screenings/tests. Program Goals: Increase percentage of members receiving at least one HbA1c test during the measurement year. Increase percentage of members with an HbA1c good control of < 7%. Increase percentage of member with an HbA1c good control of < 8%. Decrease percentage of members with an HbA1c poor control of > 9%. Increase percentage of members receiving a DRE Exam during the measurement year /27/2013 Page 2 of 7

3 Increase percentage of members receiving an LDL-C screening during the measurement year. Increase percentage of members with an LDL-C level < 100 mg/dl. Increase percentage of members with medical attention for nephropathy during the measurement year. Increase percentage of members with a BP level of < 140/80 mm Hg. Increase percentage of members with a BP level of < 140/90 mm Hg. Decrease frequency of diabetes related inpatient admissions, readmissions within 30 days, and ER visits. Promote a healthy diet and nutrition lifestyle, measurement of blood sugars as prescribed by the practitioner, adherence to medication regimen, weight management, physical activity, smoking cessation, and adherence to recommended screenings/tests. Measurements: Overall effectiveness of the program is measured through annual participation rates and audited HEDIS results. Annual Participation Rate Eligible members are identified, and passively enrolled, in the Diabetes Program. Members may opt out of the Program, and elect not to receive disease management services, by notifying the Diabetes Disease Manager either telephonically or in writing. Participation Rates are tracked and reported annually. Diabetes Membership (avg) Opt Out Participation Rate , % , % , % 11/27/2013 Page 3 of 7

4 HEDIS Results Measure HbA1c testing 84.63% 86.17% 87.30% 87.83% 86.49% 81.95% HbA1c poor control (> 9.0%) * 34.52% 31.29% 31.35% 35.93% 35.33% 34.76% HbA1c good control (< 8.0%) 59.92% 57.79% 55.79% 55.48% HbA1c good control (< 7.0%) 37.59% 46.94% 56.95% 82.25% ** 50.00% *** 42.18% LDL-C testing 79.67% 79.82% 78.17% 78.14% 76.06% 76.34% LDL-C < 100 mg/dl 38.53% 43.08% 45.24% 47.91% 40.73% 41.04% DRE Exams 52.96% 54.42% 47.62% 52.09% 43.82% 54.28% Microalbumin testing/medical 81.15% 77.07% 78.68% 78.77% 86.50% 77.41% Attention for Nephropathy BP controlled < 140/80 mm Hg **** 41.51% 41.58% BP controlled < 130/80 mm Hg 31.44% 29.02% 33.33% 34.41% Retired Retired BP controlled < 140/90 mm Hg 65.01% 60.32% 63.10% 66.16% 62.16% 63.64% Analysis Results for 2011 demonstrated an increase in seven of the 10 measures. Increases included: HbA1c poor controls (>9.0%) demonstrated an increase of.57 percentage points LDL testing demonstrated an increase of.28 percentage points LDL-C <100mg/dl demonstrated an increase of.31 percentage points DRE Exams demonstrated an increase of percentage points Medical Attention for Nephropathy demonstrated an increase of 3.74 percentage points BP controlled <140/80 demonstrated an increase of.07 percentage points BP controlled <140/90 demonstrated an increase of 1.48 percentage points Results for 2011 demonstrated seven of the 10 measures exceeded the 2012 Quality Compass Mean. These measures included: HbA1c <8, LDL-C testing, LDL-C < 100 mg/dl, DRE Exams, Medical Attention for Nephropathy, BP controlled < 140/80 mm Hg, and BP controlled < 140/90 mm Hg. * This is an inverted rate with a lower rate indicating better performance. ** HEDIS methodology changed for this measure from the previous measurement year. *** Additional exclusion criteria are required for this indicator that will result in a different eligible population from all other indicators. **** In measurement year 2010, NCQA replaced blood pressure control of < 130/80 mm Hg with blood pressure control of <140/80 mm Hg. 11/27/2013 Page 4 of 7

5 Overall analysis of program goals notes a continued trend of ups and downs in overall HEDIS results. Increases in individual HEDIS elements seem to be noted short term with no sustained increase. Passport aspires to be in the 90 th percentile for each measure and in 2011 we noted the majority of the diabetic HEDIS measures fell into the 50 th percentile ( 7 out of 10- BP controlled < 140/80 and <140/90, DRE Exam, HbA1c <8 and >9, LDL Screening and Medical Attention for Nephropathy). In addition two measures HbA1c <7.0 and LDL-C <100 were in the 75 th percentile and one measure HbA1c testing in the 25 th percentile. Multiple member interventions are conducted to educate the member on the importance of testing and remind the member to they need ADA recommended screenings/testing. Providers are notified of members in need of screenings and resources to track diabetic members and their screenings are available on Passport s provider website. In 2012, the Care Coordination department initiated a new program placing case managers in high volume/care gap provider office in order to educate and encourage the members face-to-face to complete screenings. In 2013, Passport is utilizing member engagement rewards to entice members to complete screenings. Barriers and Opportunities Barrier: Practitioner identification of needed testing, as recommended by the ADA Standards of Care. Opportunity: Collaborate with Provider Relations to educate clinicians during all site visits to improve compliance with ADA recommendations. Collaborate with the Kentucky Diabetes Network (KDN) to increase community awareness of diabetes and distribute the Diabetes Care Tool. Collaborate with Provider Relations to educate clinicians regarding available monthly Care Gap Reports available on-line. Until Care Gap Reports are readily available on-line they will be distributed via mail. Collaborate with the embedded case managers to make clinicians aware of the monthly care gaps reports and to assist the office staff with member outreach efforts. Educate provider of available Diabetes Tracking Tools available on the Passport website for use. Barrier: Member lack of knowledge about diabetes. Opportunity: Increase members and caregivers knowledge regarding the appropriate treatment, and appropriate self-management skills, for persons with diabetes through targeted education. Collaborate with pharmacies to distribute member education when dispensing the preferred testing meter. Increase community awareness regarding the appropriate treatment and appropriate self-management skills for persons with diabetes by distributing educational materials at health fairs and events. Investigate additional opportunities to engage diabetic members in education regarding needed diabetic screening. 11/27/2013 Page 5 of 7

6 Increase member awareness regarding the appropriate treatment and appropriate self-management skills for persons with diabetes through: o Performing outreach to those members identified as needing a recommended diabetic screen. o Distributing reminder postcards bi-annually to those members identified as needing diabetic screenings. o Distributing the comprehensive Diabetes Care Booklet to newly diagnosed diabetic members and to members needing additional education. o Conducting face-to-face outreach, telephonic outreach, member newsletters, on-hold SoundCare messages, the Plan s website, and member educational material. o Collaboration with the embedded case managers in the high volume PCP office to engage members in face-to-face education regarding diabetic care gaps. o Collaboration with Block Vision to assist with member outreach and education regarding DRE and glaucoma screenings. o Leverage the access of auto-dialing technology to engage more members in diabetic care gap reminders o Leverage the Rapid Response Outreach team to engage members in need of assistance making appointment during auto dialer campaigns to reduce diabetic care gaps. Barrier: Member lack of knowledge of ADA recommendations for testing and results. Opportunity: Educate members on the specific ADA recommendations to include reminder postcards. Collaborate with Block Vision to provide quarterly outreach for members delinquent in DRE testing. Perform targeted telephonic outreach to diabetic members delinquent in ADA testing. Utilize the Rapid Response Outreach Team (RROT) to assist members with urgent issues related to diabetes. Initiate a member engagement reward strategy to encourage member compliance with screening. Activities for 2013: Increase practitioner awareness of the diabetic screening recommended by the ADA Standards of Care on the Plan s website, embedded Case Managers, Diabetes Disease Manager, and through Provider Relations site visits. Collaborate with Provider Relations to develop and implement on-line monthly Care Gap reporting. To assist clinicians to identify members on the clinician s panel who are delinquent in specific screenings. Leverage the access of auto-dialing technology to engage more members in 11/27/2013 Page 6 of 7

7 diabetic care gap reminders Leverage the Rapid Response Outreach team to engage members in need of assistance making appointment during auto dialer campaigns to reduce diabetic care gaps. Educate members/caregivers regarding diabetic screenings through face-toface outreach, telephonic outreach, member newsletters, on-hold SoundCare messages, the Plan s website, and member educational material. Increase community initiatives related to the treatment of diabetes through: o Block Vision, the Plan s vision care benefits manager, to increase outreach to members delinquent in obtaining their DRE Exam. o Collaboration with community resources to assist members in getting corrective lenses, if needed. o Collaboration with statewide and Greater Louisville Medical Society (GLMS), and other community partners, to promote healthy vision in diabetics. o Collaboration with community partners to continue to raise awareness of diabetes within the community such as KDN, ADA, National Kidney Foundation (NKF), Heart and Stroke State Task Force (Know Your Numbers Project), and local Departments of Health. o Collaboration with community agencies and statewide initiatives to increase awareness of diabetes and diabetes management. Administer the Patient Health Questionnaire (PHQ) 2 and PHQ-9 for prescreening and screening for depression in newly identified diabetic members. Initiate a member engagement reward strategy to encourage member compliance with screening. 11/27/2013 Page 7 of 7