Quest for Quality: Immunizations

Transcription

1 Quest for Quality: Immunizations DANE COUNTY IMMUNIZATION COALITION MEMBERSHIP MEETING November 13, 2012 Elaine Rosenblatt MSN, FNP-BC Director, Quality and Care Management UW Medical Foundation/ Unity Health Insurance

2 Agenda Increase awareness about Quality measures for immunizations What is HEDIS Immunization measures What is CAHPS Plan, Health System and Public Health Initiatives

3 Where Immunization Quality Measures Are Used Accreditation Decision-making by businesses about health plan purchasing Decision-making by consumers about health plan/provider choice External oversight/medicare Internal quality improvement Pay-for-reporting Public reporting

4 Immunization Quality Measures Pneumonia vaccination status: percentage of Medicare members 65 years of age and older who have ever received a pneumococcal vaccination Where monitored: NCQA: HEDIS and CAHPS Joint Commission CMS

5 Physician Quality Reporting System (PQRS) Immunization Quality Measures (CMS) Preventive Care and Screening: Pneumonia vaccination for patients 65 years and older Percentage of patients 65 years and older who have ever received a pneumococcal vaccine Preventive Care and Screening: Influenza immunization for patients 50 years and older Percentage of patients 50 years and older who received an influenza immunization flu season (September February)

6 Immunization Quality Measure: Pediatrics Immunizations: percentage of patients or parents (if patient younger than 18 years) who received education regarding the importance of immunizations and recommended immunization schedules. (Institute for Clinical Systems Improvement)

7 Immunization Quality Measure: Pediatrics Immunizations: percentage of patients who by age 13 years were up-to-date with the following recommended adolescent immunizations (Institute for Clinical Systems Improvement); one human papillomavirus vaccine (HPV) [for females], one meningococcal (MCV4), one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), and one influenza within the last year.

8 Immunization Quality Measure: Pediatrics HIV: percentage of pediatric patients for whom DTaP, IPV, HIB, Hep B, MMR, pneumococcal, (and varicella, if asymptomatic and immunologic class 1) are provided. (New York State Department of Health AIDS Institute)

9 National Nursing Home Vaccination Quality Measures (QM) (CMS) 1. A Chronic Care influenza vaccination QM 2. A Post-Acute Care influenza vaccination QM 3. A Chronic Care pneumococcal vaccination QM 4. A Post-Acute Care pneumococcal vaccination QM

10 What is NCQA The National Committee for Quality Assurance is an independent, not-for-profit organization dedicated to improving health care quality NCQA accomplishes this in three ways: 1. Through accreditation (a rigorous on-site review of clinical and administrative processes) 2. Through HEDIS data collection; and 3. Through a comprehensive member satisfaction survey Consumer Assessment of Healthcare Providers and Systems More than half the nation s MCOs participate in accreditation and certification programs, and almost 90% report HEDIS measures

11 What is NCQA? National Committee for Quality Assurance Mission: To improve the quality of health care Vision: To transform health care quality through measurement, transparency and accountability Values: NCQA s passion is improving the quality of health care They stand for accountability throughout the health care system NCQA s information empowers people to make informed decisions They are committed to providing excellent service to all customers, both internal and external They realize their mission through the invaluable commitment and contributions of diverse stakeholders

12 What is HEDIS Healthcare Effectiveness Data and Information Set is a tool used to measure performance on important dimensions of care and service HEDIS consists of 90+ measures across eight domains of care and accounts for 46 out of 100 points in the accreditation process HEDIS is designed to provide purchasers and consumers with the information they need to reliably compare the performance of health care plans Quality Compass is a comparison tool that allows users to view plan results and benchmark information

13 What is HEDIS? HEDIS was initially developed in 1991 NCQA assumed management in 1992 HEDIS incorporated into Managed Care Organization accreditation in 1999 The performance measures in HEDIS are related to many significant public health issues such as cancer, immunizations, heart disease, smoking, asthma and diabetes

14 Why do HEDIS? Requirement NCQA accreditation Employee Trust Fund (ETF) Office of the Commissioner of Insurance (OCI) Department of Human Services (DHS) Employers and agents use HEDIS data to compare health plans and make decisions NCQA Health Plan Rankings and report cards ETF information packets Consumer Reports Top Health Plans Ranking Quality will be an important issue for insurance exchanges

15 Measurement Results What drives changes to the HEDIS rates? Internal Ongoing quality improvement interventions by the HMO and its providers External -- public interest, media-driven education, unforeseeable external events such as flu vaccine shortage Interventions initiated within the measurement year Data-gathering process Measure specification changes

16 8 HEDIS Domains Effectiveness of Care Access/Availability of Care Satisfaction with the Experience of Care Health Plan Stability Use of Services Cost of Care Informed Health Care Choices Health Plan Descriptive Information

17 Quality Compass: A National Benchmark 90 th percentile: In top 10% of all health plans 75 th percentile: In top 25% of all health plans 25 th percentile: In bottom 25% of all health plans 10 th percentile: In bottom 10% of all health plans

18 HEDIS High Level Tasks Purchase software or develop internal software Administrative data comes from claims (medical, pharmacy), lab sources, P4P data, and Wisconsin Immunization Registry (WIR). Hybrid data comes from chart review Year long process of clinical improvement

19 How HEDIS Data is Used Disease Management Programs Wellness Initiatives Pay-for-Performance Provider Incentives Help focus on improving HEDIS scores CAHPS data used to identify service improvements Marketing HMO s use HEDIS rates to measure the efficacy of ongoing and current quality improvement efforts and to identify improvement opportunities

20 HEDIS Immunizations Measures: Childhood (age 2) Individual Immunizations Measured: DTaP/DT OPV/IPV MMR HiB Hep B VZV PNE Hep A Rotavirus Influenza

21 HEDIS Immunizations Measures: Childhood (age 2). Combinations of Immunizations Combination #2 Tetanus through Varicella Combination #3 Tetanus through PCV Combination #4 Tetanus through hepatitis A Combination #5 Tetanus through PCV + RV Combination #6 Tetanus through PCV + flu Combination #7 Tetanus through RV Combination #8 Tetanus through hepatitis A + flu Combination #9 Tetanus through PCV + RV + flu Combination #10 Tetanus through flu

22 HEDIS Immunization Quality Measure: Pediatrics Childhood immunization status: percentage of children 2 years of age who had, by their second birthday. (Combination #2 HEDIS, National Committee for Quality Assurance): four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps, and rubella (MMR); three H influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV) vaccine

23 HEDIS Immunization Measures: Adolescent Meningococcal Tdap/Td Combination of above New Measure for 2012 Human Papillomavirus Vaccine for Female Adolescents (HPV)

24 CAHPS Consumer Assessment of Healthcare Providers and Systems: annual member satisfaction survey that NCQA Accredited Health Plans are required to conduct The survey evaluates plan performance, e.g. customer service, access to care, satisfaction with practitioners and claims processing Like HEDIS, CAHPS results are publicly reported so consumers can make informed choices regarding their health plan options Quality Compass benchmarking tool Flu shots for adults years old is monitored

25 Questions?

26 Unity s Focus on Immunizations Focus on Quality Staffed by Quality Care Coordinators with backgrounds in the health field, health education, therapy Dedicated to improving care for members Always Room for Improvement Same struggles as Dane County for adherence Continuous focus on areas for improvement Always Room for Collaboration UW Health affiliation Partnership with other provider groups County-wide quality improvement projects

27 Unity s Sources for Immunization Rates Annual HEDIS Rates Chart Review UW Health Link EMR s and paper charts for other clinics Claim s Data WIR All Unity clinics submit to WIR Periodic reviews of specific immunizations through Unity and WIR reports

28 Analyze Clinic-specific rates Local, state-wide and national comparison Brainstorm Areas for Improvement and Collaboration Member Practitioner, Clinic Data Analysis

29 Unity Immunization Interventions Monthly Mail Reminders General immunization reminders Disease-specific immunizations Ad hoc Mail Reminders As Needed Incentives Pay for Performance Member drawings

30 Unity Immunization Interventions, cont Quarterly Newsletters Member, Practitioner and Employer Clinic best practices Information on unityhealth.com Including HealthWise health encyclopedia Quality Collaboration with partners

31 Working with Participating Clinics Collaboration with Practitioners on Quality Regional Meetings Various presentation topics, including immunizations Open to regional clinic staff Resource management

32 Questions?