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

Transcription

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

2 2012 Chronic Respiratory Program Evaluation Program Title: Chronic Respiratory Program Evaluation Period: January 1, 2012 December 31, 2012 Introduction: The Chronic Respiratory Program combined our two separate programs: Asthma and Chronic Obstructive Pulmonary Disease (COPD). Asthma: Designed to improve the health status and quality of life for members with asthma through improved compliance of both members and practitioners with the National Institutes of Health (NIH) Guidelines for the Diagnosis and Management of Asthma. Asthma Disease Management is the process of coordinating healthcare interventions and communications for members with asthma in which patient self-care efforts are significant, supporting practitioner/member relationships and the established treatment care plan; 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 COPD: Designed to improve the health status, and decrease complications, of adult members with COPD through improved compliance of both members and practitioners with the NIH Global Initiative for Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Program Objectives: Asthma: To improve the health status and quality of life of members, with asthma, while decreasing inpatient admissions and emergency room (ER) visits through increased compliance of both members and practitioners with the NIH Guidelines for the Diagnosis and Management of Asthma. To increase practitioner adherence to the NIH Guidelines for the Diagnosis and Management of Asthma regarding members on appropriate medication for treatment of persistent asthma, specifically prescription of long-term controller medications. To increase member compliance with recommended treatment, including the use of inhaled anti-inflammatory medication for treatment of persistent asthma. COPD: Increase practitioner adherence to GOLD guidelines for the use of medications, such as: o Bronchodilator o Systemic corticosteroid Increase the percentage of members who receive appropriate pharmacotherapy management of COPD exacerbation. Increase the use of Spirometry testing to confirm COPD for newly diagnosed members. Increase the percentage of members who receive flu and pneumonia vaccinations. 1 Medicare Direct Contracting for Disease Management. Disease Management Association of America, March /27/2013 Page 1 of 9

3 Promote healthy lifestyle including exercise, smoking cessation, other air pollutants, and improved nutrition. Increase member s self-management skills. Program Goals: Asthma: Increase the number of members with persistent asthma, ages 2-4, on controller medication. Increase the number of members with persistent asthma, ages 5-64, on controller medication. Increase the overall rate of members with persistent asthma, ages 5-64, on controller medication that continue to refill the medication at least 50% of the expected number of refills. COPD: Improve compliance with the NIH Global Initiative for GOLD guidelines for medication and oxygen therapy. Reduce the need for inpatient/er admission. Increase the percentage of members in the COPD population knowledgeable in self-management skills. Increase the percentage of members who receive appropriate pharmacotherapy management of COPD exacerbation (HEDIS ). Increase the use of Spirometry testing to confirm COPD for newly diagnosed members (HEDIS ). 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 Chronic Respiratory Program. Members may opt out of the program, and elect not to receive disease management services, by notifying the Chronic Respiratory Disease Manager or the Care Connection Program, either telephonically or in writing. Participation Rates are tracked and reported annually. Asthma Membership (avg) Opt Out Participation Rate 2012??? ,905 * 0 100% COPD Membership (avg) Opt Out Participation Rate 2012??? ,113* % 11/27/2013 Page 2 of 9

4 Asthma Medication Management Medication Management is a new measure for 2012, looking at the members with persistent asthma, who were dispensed appropriate medication and remained on them during the treatment period, as defined by two rates; 50% of the treatment period and 75% of the treatment period. HEDIS Results The 2012 HEDIS Results are based on calendar year 2011 data. CY2011 Measure 50% 75% Ages 5-11 on Controller Med 65.73% 41.27% Ages on Controller Med 60.80% 35.60% Ages on Controller Med 62.40% 41.74% Ages on Controller Med 79.03% 54.84% Overall Rate (ages 5-64 on Controller Med) 64.12% 39.74% HEDIS Results** The 2012 HEDIS Results are based on calendar year 2011 data. Measure CY 2009 CY 2010 CY2011 Ages 5-11 on Controller Med 96.32% 97.33% 95.41% Ages on Controller Med NA NA 91.78% Ages on Controller Med NA NA 69.43% Ages on Controller Med NA NA 65.96% Overall Rate (age 5-64 on Controller Med) NA NA 90.63% ** HEDIS methodology changed for this measure from the previous measurement year HEDIS Results The 2011 HEDIS Results are based on calendar year 2010 data. Measure CY2009 CY2010 CY2011 Ages 2-4 on Controller Med ** 95.00% 99.00%? Ages on Controller Med 90.04% 92.42% NA Overall Rate (age 5-50 on Controller Med) 92.92% 94.84% NA Note: For HEDIS 2010, the upper age limit for this measure lowered from 56 to 50. The age stratifications were modified to 5-11 years, years, and a Total rate. * 2011 Asthma Program membership numbers are annualized ** While there are no HEDIS measures for the asthma population age 2-4, PHP has chosen to provide interventions for these members. The results for this age group and the overall rates are those received from internal claims data review. 11/27/2013 Page 3 of 9

5 2009 HEDIS Results The 2009 HEDIS Results are based on calendar year 2008 data/methodology. Measure Ages 2-4 on Controller Med ** 83.23% 84.98% 86.05% 88.47% 97.00% Ages 5-9 on Controller Med 83.55% 82.34% 95.52% 99.87% 95.45% Ages on Controller Med 76.63% 78.94% 92.09% 94.11% 91.88% Ages on Controller Med 75.75% 76.25% 87.13% 95.33% 89.85% Overall Rate (age 5-56 on Controller Med) 77.89% 78.85% 91.15% 96.30% 92.13% Analysis Results for HEDIS 2012 (CY2011) noted a change in the NCQA age methodology as well as an increase in the under 21 population. The overall total rate noted a decrease from the previous year. Trending is somewhat difficult due to the frequent age parameter changes however the Plan continues to perform at the Quality Compass 90 th percentile in relation to controller use. HEDIS Results The 2012 HEDIS Results are based on calendar year 2011 data/methodology. Measure CY2008 CY2009 CY2010 CY2011 Use of Spirometry Testing in the Assessment & Diagnosis of COPD 21.87% 22.43% 29.74% 31.67% Pharmacotherapy Management of COPD Exacerbation with Systemic Corticosteroid 40.83% 42.41% 40.09% 39.81% Pharmacotherapy Management of COPD Exacerbation with Bronchodilator 51.65% 61.39% 59.91% 56.72% Analysis Results for HEDIS 2012 (CY2011) notes that two of the three measures demonstrated decreases from the previous measurement year. Pharmacotherapy Management of COPD Exacerbation with Systemic Corticosteroid decreased.28 percentage points and Pharmacotherapy Management of COPD Exacerbation with Bronchodilator decreased 3.19 percentage points from the previous measurement year. Use of Spirometry Testing in the Assessment & Diagnosis of COPD noted a 1.93 percentage point increase from the previous measurement year. Passport aspires to be in the 90th percentile for each measure and in CY 2011 we noted none of the COPD measures meet the 2012 Quality Compass Mean. The Use of Spirometry Testing in the Assessment & Diagnosis of COPD meets the 25 th percentile while both the Bronchodilator and Corticosteroid Pharmacotherapy Management of COPD Exacerbation both meet the 10 th percentile. 11/27/2013 Page 4 of 9

6 Barriers and Opportunities Barrier: Lack of practitioner awareness regarding NIH Guidelines for the Diagnosis and Management of Asthma and the diagnosis and treatment of persistent asthma. Opportunity: Collaborate with Provider Relations to educate practitioners during all site visits regarding NIH Guidelines for the Diagnosis and Management of Asthma and the diagnosis and treatment of persistent asthma. Increase practitioner awareness of the appropriate treatment for persons with persistent asthma by posting current NIH Guidelines for the Diagnosis and Management of Asthma on the Plan s website. Barrier: Member lack of knowledge regarding asthma control. Opportunity: Increase members and caregivers knowledge regarding the appropriate treatment and appropriate self-management skills for persons with persistent asthma. Collaborate with community agencies and statewide initiatives to increase awareness of asthma and asthma management. Increase member and caregiver awareness regarding the appropriate treatment and appropriate self-management skills for persons with persistent asthma through: o Distributing the Asthma Control Test (ACT) to newly diagnosed asthmatic members to assess the control of their asthma. o Face-to-face outreach, telephonic outreach, member newsletters, on-hold SoundCare messages, the Plan s website, and member educational material. Barrier: Lack of early recognition and treatment of asthma exacerbation leading to high ER visits/inpatient admissions. Opportunity: Identify members with ER visits/inpatient admissions with a diagnosis of asthma for targeted member educational outreach. Distribute a follow-up educational letter to practitioners notifying them of members on their panel with an ER visit related to asthma. Utilize the Rapid Response Outreach Team (RROT) to assist members with urgent issues related to asthma. Barrier: Lack of recognition of home environmental factors that lead to asthma exacerbations. Opportunity: Collaborate with home health agencies to provide home environmental assessments for high-risk asthma members based upon Environmental Protection Agency (EPA) recommendations. Collaborate with Provider Relations to educate practitioners during all site visits regarding availability of home health agency services for home environmental assessments. Provide member education regarding asthma triggers and how environmental factors can impact asthma through face-to-face outreach, telephonic outreach, member newsletters, on-hold SoundCare messages, the Plan s website, and member educational material. Collaborate with community agencies and state-wide initiatives to improve education regarding environmental factors that can impact asthmatics. 11/27/2013 Page 5 of 9

7 Barrier: Practitioner identification of needed testing as recommended by the NIH Global Initiative for GOLD guidelines. Opportunity: Distribute the care gap report to assist practitioners in identifying members on the practitioner s panel who are delinquent in specific screenings, including Spirometry testing. Collaborate with Provider Relations to educate practitioners during all site visits to improve compliance with GOLD recommendations. Barrier: Member lack of knowledge about COPD. Opportunity: Increase members and caregivers knowledge regarding the diagnosis, appropriate treatment, and appropriate self-management skills for persons with COPD. Increase community awareness regarding the diagnosis, appropriate treatment, and appropriate self-management skills for persons with COPD by distributing educational materials at health fairs and events. Increase member awareness regarding the appropriate treatment and appropriate self-management skills for persons with COPD through: o Performing outreach to those members identified as needing a Spirometry test. o Distributing the comprehensive COPD Educational Booklet to COPD 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. Barrier: Member lack of knowledge of GOLD recommendations for testing and results. Opportunity: Educate members on the specific GOLD recommendations. Perform targeted telephonic outreach to COPD members delinquent in GOLD recommended testing. Utilize the Rapid Response Outreach Team (RROT) to assist members with urgent issues related to COPD. Activities for 2013: Asthma: Identify and outreach to members with an ER visits or inpatient admissions. Identify members who have had a lapse in their asthma medication refill pattern and provide targeted outreach. Collaborate with the Plan s pharmacy department to mail reminders to members regarding timely filling of prescribed controller medication(s). Outreach to members not on a controller medication, as demonstrated through pharmacy claims data, with additional written material regarding asthma and the importance of controller medication and encouraging practitioner follow-up. Distribute the ACT to newly diagnosed asthmatic members to assess the control of their asthma and provide follow-up with recommendations based on the member s level of control. 11/27/2013 Page 6 of 9

8 Activities for 2013 (Continued): Organize member educational materials to include a definition of asthma, asthma triggers, information regarding smoking cessation, asthma medications including controller medication, how to take medication, and practitioner follow-up. Collaborate with Provider Relations to educate clinicians regarding available monthly Care Gap Reports available on-line. Collaborate with the embedded case managers to make clinicians aware of the monthly care gaps reports available on-line. Collaborate with the embedded case managers, in the high volume PCP offices, to engage members in face-to-face education regarding asthma care gaps. Leverage the access of auto-dialing technology to engage more members in asthma care gap reminders. Leverage the Rapid Response Outreach team to engage members in need of assistance making appointments during auto dialer campaigns to reduce asthma care gaps. Expand upon current processes to develop additional relationships with participating EDs to promote discharge planning and education regarding appropriate ED use. Discussions have begun to utilize our clinical hospitalembedded staff to pilot this at Hardin Memorial Hospital. Utilize the auto-dialer program to assist in reaching more members to provide education regarding provider follow up, medication compliance, provider appointment reminders, verification of kept appointments, assistance with transportation, common triggers, action plans, smoking cessation, and how to prevent exacerbations. The auto dialer will enhance current outreach efforts and allow for more interaction with members. Review a daily, or weekly, report from three high volume participating EDs within our area (University of Louisville, Kosair Children s, and Hardin Memorial). The ER coordinator reviews these reports and outreaches to the members and/or guardian, telephonically, to encourage provider follow up, determine any barriers to compliance, and offer plan assistance with scheduling appointments and/or transportation. In addition, ER coordinator completes a health risk assessment and makes referrals to clinical staff for additional outreach and education. Develop provider education tools, in conjunction with committees, to educate providers regarding management of members with persisting asthma. Work with provider committees to develop tools for the providers to utilize, in order to ensure thorough documentation regarding all aspects of the guidelines. The Plan will conduct provider outreach regarding the guidelines and audit compliance with documentation. Investigate the feasibility of adding software that looks at medical and pharmacy claims to determine the asthma population, and then determine a ratio of all asthma rescue medications to determine members most at risk for exacerbation in the near future. Take the Asthma Focus Study to the Child and Adolescent Committee and the Quality Medical Management Committee to request provider feedback, as well as, final recommendations regarding a provider education tool to improve PCP performance against the guideline standards. 11/27/2013 Page 7 of 9

9 Activities for 2013 (Continued): Provide one-on-one provider education with the Care Coordination clinical staff regarding the guidelines and provide tools for the office to utilize to educate their staff, as well as members. Provide education to internal, non-clinical, phone staff regarding action plans and how to ask scripted questions during member contact to determine compliance with action plans and when to make a clinical referral. Maintain additional outreach via the Member newsletter, SoundCare (member on hold messages), and automated medication refill calls. Continue efforts to educate members and/or caregivers in regards to asthma, asthma treatment, triggers, smoking cessation, how to prevent an exacerbation, and what to do when the member has an exacerbation. Evaluate all member materials to ensure each piece is clear and concise. Materials will continue to be utilized for member mailings; but, also face-to-face education with the members at the provider s office. The Plan currently utilizes a written asthma action plan, which is color coded red, yellow, and green, with interventions at each level. Educate members/caregivers regarding asthma control and signs and symptoms of asthma exacerbation through face-to-face 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 asthma through: o Healthy Hoops event in Healthy Hoops is an innovative community-based program designed to teach children with asthma and their families how to properly take their medication and manage their asthma, the most common chronic illness among children in the United States. o Collaborate with community partners to continue to raise awareness of asthma within the community, such as Kentucky Asthma Partnership, Care Research Advisory Board, Area Health Education Center (AHEC), and the American Lung Association (ALA). Participate in school based educational programs to educate school age children on asthma. Increase practitioner awareness of the appropriate treatment for persons with persistent asthma by posting current NIH Guidelines for the Diagnosis and Management of Asthma on the Plan s website and through Provider Relations site visits. Collaborate with home health agencies to provide home environmental assessments for high-risk asthma members based upon EPA recommendations. Coordinate with Mommy Steps Program on members with controlled asthma during their pregnancy. The Asthma Disease Care Manager will act as a resource and provide additional interventions as needed. Coordinate with Mommy Steps Perinatal Health Care Managers on members with asthma that have an inpatient admission with the primary diagnosis of asthma during their pregnancy. The Asthma Disease Care Manager will assume primary responsibility and the Mommy Steps Perinatal Health Care Managers will act as a resource and provide additional interventions as needed. 11/27/2013 Page 8 of 9

10 Activities for 2013 (Continued): Utilize the program s advisory group which is comprised of internal and external staff including nurses and physicians to assist in program review and intervention implementation as needed. COPD: Increase practitioner awareness of the COPD testing, recommended by the NIH Global Initiative for GOLD guidelines on the Plan s website, and through Provider Relations site visits. Develop a multi-measure report to assist practitioners in identifying members on the practitioner s panel who are delinquent in specific screenings, including Spirometry testing. Distribute the COPD Assessment Form to newly diagnosed COPD members to assess the control of their COPD and provide follow-up with recommendations based on the member s level of control. Educate members/caregivers regarding COPD through face-to-face outreach, telephonic outreach, member newsletters, on-hold SoundCare messages, the Plan s website, and member educational material. Increase community initiatives related to the diagnosis and treatment of COPD through: o Collaboration with community agencies such as, the American Lung Association (ALA) and the Kentucky Respiratory Disease Program to develop a statewide initiative to improve the appropriate testing in the assessment and diagnosis of COPD. o Collaboration efforts with community partners, practitioners, and specialists to promote treatment of COPD. o Collaboration with community agencies and statewide initiatives such as, the Kentucky Respiratory Disease Program to increase awareness of COPD and COPD management. o Collaboration with community partners to continue to raise awareness of COPD within the community such as the ALA and local Departments of Health. Collaboration with home health agencies to provide in home spirometry testing to members diagnosed with COPD identified as needing a spirometry test. Utilize the program s advisory group which is comprised of internal and external staff including nurses and physicians to assist in program review and intervention implementation as needed. Identify members who were diagnosed with COPD who did not receive a spirometry test and provide individual education to the member s practitioner. Leverage the access of auto-dialing technology to engage more members in COPD care gap reminders. 11/27/2013 Page 9 of 9