2016 cahps child medicaid with ccc executive summary€¦ · executive summary summary of key...

2016 CAHPS® Child Medicaid with CCCExecutive Summary

July 2016

AmeriHealth Caritas Louisiana

Morpace research is completed in compliance with ISO 20252

2016 CAHPS® 5.0H Child Medicaid with CCC SurveyAmeriHealth Caritas Louisiana

M160005 July 2016 2

Table of Contents


M160005 July 2016 2

3

3

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

5

6

7

9

11

24

30Supplemental Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Scoring for NCQA Accreditation - General Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Comparison to Quality Compass® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Background and Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disposition Summary and Response Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Summary of Key Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Key Driver Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


M160005 July 2016 3

Executive SummaryBackground and Protocol

Background

• CAHPS® measures health care consumers' satisfaction with the quality of care and customer service provided by their health plan. Plans which are collecting HEDIS® (Healthcare Effectiveness Data and Information Set) data for NCQA accreditation are required to field the CAHPS® survey among their eligible populations.

Protocol

• For CAHPS® results to be considered in HEDIS® results, the CAHPS® 5.0H survey must be fielded by an NCQA (National Committee for Quality Assurance)-certified survey vendor using an NCQA-approved protocol of administration in order to ensure that results are collected in a standardized way and can be compared across plans. Standard NCQA protocols for administering CAHPS® 5.0H include a mixed-mode mail/telephone protocol and a mail-only protocol.

• The protocol includes the following:

Pre-notification postcard mailed

(optional)

1st reminder postcard mailed

2nd reminder postcard mailed

Telephone interviews

conducted with non-responders

(min of 3/max of 6 attempts)

• AmeriHealth Caritas Louisiana chose the mail/telephone protocol with pre-notification postcard.

Questionnaire with cover letter and business reply envelope (BRE)

mailed

Internet link included on cover

letter (optional)

Replacement questionnaire with

cover letter and BRE to all non-

responders

Internet link included on cover

letter (optional)


M160005 July 2016 4

Sample Size

Total Completes

General Population Completes

CCC Population Completes

English Completes

Spanish Completes


3958 528 269 217 490 38

Executive Summary

Sample

• NCQA originally designed this protocol with the goal of achieving a total response rate of at least 45%. In 2015, the average response rate for all Child Medicaid with CCC plans reporting to NCQA was 25%, which is lower than the 2014 average (29%).

• In February, 3958 AmeriHealth Caritas Louisiana members were randomly selected to participate in the 2016 CAHPS® 5.0H Child Medicaid with CCC Survey. This sample consisted of 2,025 randomly selected Child members and 1,933 CCC Supplemental Sample. The CCC Supplemental Sample was pulled after the CAHPS® 5.0H Child survey sample was drawn. The CCC Supplemental Sample consisted of members with the prescreen status code of 2 (children more likely to have a chronic condition) who were not already selected for the CAHPS® 5.0H Child survey sample. Morpace combined the CAHPS® 5.0H Child survey sample and the CCC Supplemental Sample for survey administration and submission of data to NCQA for calculation of survey results. The survey results presented in this report are compiled from the 528 AmeriHealth Caritas Louisiana members who responded to the survey (CAHPS® 5.0H Child survey sample and CCC Supplemental sample combined).

• For purposes of reporting the Child Medicaid with CCC survey results, the results are divided into two groups: General Population and CCC Population. The General Population consists of all child members who were randomly selected for the CAHPS® 5.0H Child survey during sampling. The CCC Population consists of all children (either from the CAHPS® 5.0H Child survey sample or the CCC Supplemental Sample) who are identified as having a chronic condition, as defined by the member's responses to the CCC survey-based screening tool.


M160005 July 2016 5

Executive Summary

• A response rate is calculated for those members who were eligible and able to respond.

• A completed questionnaire is defined as a respondent who completed three of the five required questions that all respondents are eligible to answer (question # 3, 30, 45, 49, 54).

• According to NCQA protocol, ineligible members include those who are deceased, do not meet eligible criteria, have a language barrier, are either mentally or physically incapacitated, or duplicate household to another member selected in the sample.

• Non-responders include those members who refuse to participate in the current year’s survey, could not be reached due to a bad address or telephone number, members that reached a maximum attempt threshold without a response, or members that did not meet the completed survey definition.

• The table below shows the total number of members in the sample that fell into each of the various disposition categories.

• Ineligible surveys are subtracted from the sample size when computing a response rate (see below):

Completed mail and telephone surveys = Response Rate Sample size - Ineligible surveys

• Using the final figures from AmeriHealth Caritas Louisiana’s Child Medicaid with CCC survey, the 2016 response rate is calculated using the equation below:

Disposition Summary and Response Rate

Non-responseTotal

SampleGeneral

PopulationBad address/phone (M23/T23) 470 240Partial complete (M31/T31) 7 3Refusal (M32/T32) 113 61Maximum attempts made (M33/T33) 2697 1402

Total Non-response 3287 1706

IneligibleTotal

SampleGeneral

PopulationDeceased (M20/T20) 1 0

Does not meet criteria (M21/T21) 5 2

Language barrier (M22/T22) 6 4Mentally/physically incapacitated (M24/T24) 0 0

Sample duplicates (IDI/ID2) 131 44

Total Ineligible 143 50

AmeriHealth Caritas Louisiana2016 Disposition Summary

Mail completes (333) + Phone completes (195)=

528= Total Sample Response Rate = 14%

Total Sample (3958) - Total Ineligible (143) 3815

Mail completes (179) + Phone completes (90)=

269= General Population Response Rate = 14%



M160005 July 2016 6

Executive SummarySummary of Key Measures

• For purposes of reporting the CAHPS® results, the National Committee for Quality Assurance (NCQA) uses 5 core composite measures plus an additional 5 CCC measures and 4 rating questions from the survey.

• Each of the composite measures is the average of 2 - 4 questions on the survey, depending on the measure, while each rating score is based on a single question. CAHPS® scores are most commonly shown using Summary Rate scores (percentage of positive responses).


General Population CCC Population

Composite Measures 2015 2016 2015 2016

Getting Care Quickly 93% 93% 95% 93%

Shared Decision Making 76% 69% 82% 86%

How Well Doctors Communicate 96% 93% 95% 93%

Getting Needed Care 93% 84% 91% 86%

Customer Service 95% 88% 91% 91%

CCC Composite Measures

Access to Prescription Medicines 89% 89% 89% 89%

Access to Specialized Services 78% 81% 75% 77%

Family-Centered Care: Personal Doctor Who Knows Child 93% 89% 93% 93%

Family-Centered Care: Getting Needed Information 94% 93% 93% 95%

Coordination of Care for Children with Chronic Conditions 76% 85% 84% 79%

Overall Rating Measures

Health Care 87% 86% 86% 84%

Personal Doctor 92% 87% 89% 86%

Specialist 92% 81% 90% 80%

Health Plan 86% 87% 80% 85%

Health Promotion & Education 77% 75% 85% 82%

Coordination of Care 77% 80% 87% 84%

General Population Total Sample

Sample Size 1980 2025 3820 3958

# of Completes 291 269 597 528

Response Rate 15% 14% 16% 14%

Legend: / 2016 results significantly higher/lower than 2015.


M160005 July 2016 7

2016 NCQA National Accreditation Comparisons*

Below 25th Nat'l 25th Nat'l 50th Nat'l 75th Nat'l 90th Nat'l

AccreditationPoints

0.37 0.74 1.26 1.63 1.86

Composite ScoresSample

SizeMean

Approximate Percentile Threshold

Approximate Score

Getting Care Quickly (n=147) 2.740 90th 2.54 2.61 2.66 2.69 1.86

How Well Doctors Communicate (n=206) 2.739 75th 2.63 2.68 2.72 2.75 1.63

Getting Needed Care (n=133) 2.473 50th 2.39 2.47 2.53 2.58 1.26

Customer Service*** (n=72) 0.000 NA 2.50 2.53 2.58 2.63 NA

Overall Ratings Scores

Q14 Health Care (n=205) 2.620 90th 2.49 2.52 2.57 2.59 1.86

Q41 Personal Doctor (n=246) 2.667 75th 2.58 2.62 2.65 2.69 1.63

Q48 Specialist*** (n=53) 0.000 NA 2.53 2.59 2.62 2.66 NA

Accreditation Points

0.74 1.49 2.53 3.27 3.71

Q54 Health Plan (n=265) 2.645 75th 2.51 2.57 2.62 2.67 3.27

Estimated Overall CAHPS® Score:

11.51

Executive SummaryScoring for NCQA Accreditation (Includes How Well Doctors Communicate) –General Population

NOTE: NCQA begins their calculation with an unadjusted raw score showing six digits after the decimal and then compares the adjusted score to their benchmarks and thresholds (also calculated to the sixth decimal place). Starting in 2015, NCQA will no longer use an adjusted score. This report displays accreditation points and scores with only two digits after the decimal. Therefore, the estimated overall CAHPS® score may differ from the sum of the individual scores due to rounding and could differ slightly from official scores provided by NCQA. The CAHPS® measures account for 13 points towards accreditation. *Data Source: NCQA Memorandum of January 21, 2016 . Subject: 2016 Accreditation Benchmarks and Thresholds.*** Not reportable due to insufficient sample size.


M160005 July 2016 8


Below 25th Nat'l 25th Nat'l 50th Nat'l 75th Nat'l 90th Nat'l

AccreditationPoints

0.43 0.87 1.47 1.91 2.17

Composite ScoresSample

SizeMean

Approximate Percentile Threshold

Approximate Score



Customer Service*** (n=72) 0.000 NA 2.50 2.53 2.58 2.63 NA

Care Coordination*** (n=76) 0.000 NA 2.36 2.41 2.46 2.51 NA


Q14 Health Care (n=205) 2.620 90th 2.49 2.52 2.57 2.59 2.17


Q48 Specialist*** (n=53) 0.000 NA 2.53 2.59 2.62 2.66 NA

Accreditation Points

0.87 1.73 2.95 3.81 4.33

Q54 Health Plan (n=265) 2.645 75th 2.51 2.57 2.62 2.67 3.81

Estimated Overall CAHPS® Score:

11.53

Executive SummaryScoring for NCQA Accreditation (Includes Care Coordination) – General Population

NOTE: NCQA begins their calculation with an unadjusted raw score showing six digits after the decimal and then compares the adjusted score to their benchmarks and thresholds (also calculated to the sixth decimal place). Starting in 2015, NCQA will no longer use an adjusted score. This report displays accreditation points and scores with only two digits after the decimal. Therefore, the estimated overall CAHPS® score may differ from the sum of the individual scores due to rounding and could differ slightly from official scores provided by NCQA. The CAHPS® measures account for 13 points towards accreditation. *Data Source: NCQA Memorandum of January 21, 2016 . Subject: 2016 Accreditation Benchmarks and Thresholds.*** Not reportable due to insufficient sample size.


M160005 July 2016 9

AmeriHealth Caritas

Louisiana

2015 Child Medicaid Quality Compass® Comparisons*5th Nat’l

%10th Nat’l

%25th Nat'l

%50th Nat'l

%75th Nat'l

%90th Nat'l

%95th Nat’l

%

Composite Scores

Getting Care Quickly (% Always/Usually) 92.97% 79.93 82.51 85.94 89.61 92.30 93.65 94.33

Shared Decision Making (% Yes) 69.35% 68.18 72.77 75.76 78.91 80.88 82.61 83.50

How Well Doctors Communicate (% Always/Usually) 92.86% 89.33 89.91 91.84 93.53 94.64 95.65 96.02

Getting Needed Care (% Always/Usually) 84.29% 76.72 78.92 81.38 85.01 87.83 89.67 90.65

Customer Service (% Always/Usually) 88.22% 82.09 83.31 85.96 87.67 89.43 91.06 91.63


Q14 Rating of Health Care (% 8, 9, 10) 85.85% 80.94 81.55 83.39 85.39 87.02 88.07 88.69

Q41 Rating of Personal Doctor (% 8, 9, 10) 86.59% 84.21 84.91 86.89 88.34 89.66 90.78 92.16

Q48 Rating of Specialist (% 8, 9, 10) 81.13% 79.29 80.95 82.91 84.81 87.27 90.00 90.76

Q54 Rating of Health Plan (% 8, 9, 10) 87.17% 76.85 79.57 81.95 84.79 87.05 89.22 90.06

Executive SummaryComparison to Quality Compass® – General Population

*Data Source: 2015 Child Medicaid Quality Compass® . Scores above based on 95 public and non-public reporting health plan products (All Lines of Business excluding PPOs).

= Plan score falls below 5th Percentile


M160005 July 2016 10

AmeriHealth Caritas

Louisiana

2015 Child Medicaid with CCC Quality Compass ® Comparisons*5th Nat’l

%10th Nat’l

%25th Nat'l

%50th Nat'l

%75th Nat'l

%90th Nat’l

%95th Nat'l

%Composite Scores






Access to Prescription Medicines (% Always/Usually) 89.30% 82.73 84.58 87.67 90.11 93.02 94.42 94.68

Access to Specialized Services (% Always/Usually) 76.65% 67.73 69.06 74.92 77.63 82.01 83.23 84.51

Family-Centered Care: Personal Doctor Who Knows Child (% Yes)

92.80% 82.63 85.64 88.44 90.47 91.40 92.61 92.69

Family-Centered Care: Getting Needed Information(% Always/Usually)

94.68% 86.87 88.39 89.54 91.16 93.10 93.92 94.44

Coordination of Care for Children with Chronic Conditions(% Yes)

79.20% 71.78 72.04 75.26 77.58 79.89 80.63 81.81



Q41 Rating of Personal Doctor (% 8, 9, 10) 86.27% 82.95 83.45 85.86 87.07 88.57 90.05 90.22

Q48 Rating of Specialist (% 8, 9, 10) 80.49% 78.10 80.77 83.07 84.43 87.11 89.43 90.27

Q54 Rating of Health Plan (% 8, 9, 10) 85.12% 74.04 75.93 79.42 82.12 82.98 84.25 86.64

Executive SummaryComparison to Quality Compass® – CCC Population

*Data Source: 2015 Child Medicaid with CCC Quality Compass® . Scores above based on 48 public and non-public reporting health plan products (All Lines of Business excluding PPOs).

= Plan score falls below 5th Percentile


M160005 July 2016 11

Executive SummaryAction Plan – Rating of Health Plan - General PopulationA Key Driver Analysis is conducted to understand the impact that different aspects of plan service and provider care have on members' overall satisfaction with their health plan, their personal doctor, their specialist, and health care in general. Two specific scores are assessed both individually and in relation to each other. These are:

1. The relative importance of the individual issues (Correlation to overall measures)

2. The current levels of performance on each issue (Percentile group in Quality Compass®)

Items that are a High Priority for Improvement are those measures that are highly correlated to the overall measure, and the plan’s scores are below the 50th percentile of Quality Compass®. Below is a list of items that are considered a High Priority for Improvement to the Overall Rating of Health Plan as well as the Primary Recommendation for improving this measure. For more ideas on how to improve your scores, please see the Action Plans for Improving CAHPS® Scores section of this report.

High Priority for Improvement(High correlation/Relatively low performance)

Overall Rating of Health Plan Primary Recommendation

Q50 - Got Information or Help Needed

On a monthly basis study Call Center reports for reasons of incoming calls and identify the primary drivers of calls. Bring together Call Center representatives and key staff from related operational departments to design interventions to decrease call volume and/or improve member satisfaction with the health plan.

Q33 - Listen Carefully to You

Provide the physicians with patient education materials. These materials could reinforce that the physician has heard the concerns of the patient and/or that they are interested in the well-being of the patient. The materials might also speak to a healthy habit that the physician wants the patient to adopt, thereby reinforcing the communication and increasing the chances for compliance. Materials should be available in appropriate/relevant languages and reading levels for the population.

Q46 - Easy to Get Appointment for Child with SpecialistReview authorization and referral patterns for internal barriers to member access to needed specialists. Include Utilization Management staff in the review process to assist in barrier identification and process improvement development.


M160005 July 2016 12

Q54. Rating of Health Plan CompositeSample

Size

Health Plan's Score

Plan’s Percentile

Q15. Easy to Get Care Believed Necessary for Child 0.49 0.49 205 93.17% 87th

Q50. Got Information or Help Needed 0.36 0.36 72 80.56% 33rd

Q51. Treated You with Courtesy and Respect 0.35 0.35 73 95.89% 87th

Q33. Listen Carefully to You 0.34 0.34 207 94.20% 37th

Q46. Easy to Get Appointment for Child with Specialist 0.34 0.34 61 75.41% 13th

Q37. Spend Enough Time with Child 0.29 0.29 207 88.89% 42nd

Q6. Getting Appointment for Child as Soon as Needed 0.28 0.28 204 93.63% 96th

Q34. Show Respect for What You Had to Say 0.23 0.23 206 95.63% 44th

Q13. Asked Preference for Medicine 0.18 0.18 62 66.13% 2nd

Q32. Explain Things in a Way You Could Understand 0.18 0.18 206 92.72% 35th

Q12. Discussed Reasons Not to Take Medicine 0.10 0.10 62 53.23% 4th

Q11. Discussed Reasons to Take Medicine 0.04 0.04 62 88.71% 17th

Q4. Getting Care for Child as Soon as Needed 0.03 0.03 91 92.31% 61st

High Priority for Improvement(High Correlation/

Lower Quality Compass®

Group)Q50 - Got Information or Help NeededQ33 - Listen Carefully to YouQ46 - Easy to Get Appointment for Child with Specialist

Continue to Target Efforts(High Correlation/

Higher Quality Compass®

Group)Q15 - Easy to Get Care Believed Necessary for ChildQ51 - Treated You with Courtesy and Respect

0.49

0.36

0.35

0.34

0.34

0.29

0.28

0.23

0.18

0.18

0.10

0.04

0.03

0.0 0.5 1.0

Q15. Easy to Get Care Believed Necessary for Child

Q50. Got Information or Help Needed

Q51. Treated You with Courtesy and Respect

Q33. Listen Carefully to You

Q46. Easy to Get Appointment for Child with Specialist

Q37. Spend Enough Time with Child

Q6. Getting Appointment for Child as Soon as Needed

Q34. Show Respect for What You Had to Say

Q13. Asked Preference for Medicine

Q32. Explain Things in a Way You Could Understand

Q12. Discussed Reasons Not to Take Medicine

Q11. Discussed Reasons to Take Medicine

Q4. Getting Care for Child as Soon as Needed

Executive SummaryKey Driver Analysis for General Population – Health Plan

"Health Plan's Score" is the percent of respondents that answered "Always", "Usually"; "Yes"

Use caution when reviewing scores with sample sizes less than 25.


M160005 July 2016 13

Q14. Rating of Health Care CompositeSample

Size

Health Plan's Score

Plan’s Percentile

Q15. Easy to Get Care Believed Necessary for Child 0.56 0.56 205 93.17% 87th

Q37. Spend Enough Time with Child 0.56 0.56 207 88.89% 42nd



Q6. Getting Appointment for Child as Soon as Needed 0.39 0.39 204 93.63% 96th


Q46. Easy to Get Appointment for Child with Specialist 0.35 0.35 61 75.41% 13th




Q13. Asked Preference for Medicine 0.10 0.10 62 66.13% 2nd


Q12. Discussed Reasons Not to Take Medicine 0.03 0.03 62 53.23% 4th

Executive SummaryKey Driver Analysis for General Population – Health Care




Group)Q37 - Spend Enough Time with ChildQ33 - Listen Carefully to YouQ34 - Show Respect for What You Had to Say



Group)Q15 - Easy to Get Care Believed Necessary for Child


0.56

0.56

0.54

0.54

0.39

0.36

0.35

0.32

0.13

0.13

0.10

0.09

0.03

0.0 0.5 1.0















M160005 July 2016 14

Q41. Rating of Personal Doctor

Health Plan's Score

Plan’s Percentile

Q34. Show Respect for What You Had to Say 0.56 0.56 95.63%Q34. Sho

w Respect

for Wha

t You Had

to Say

44th

Q33. Listen Carefully to You 0.55 0.55 94.20%Q33. Liste

n Carefully to You

37th

Q37. Spend Enough Time with Child 0.53 0.53 88.89%Q37. Spe

nd Enough Tim

e with Chil

d

42nd

Q15. Easy to Get Care Believed Necessary for Child 0.46 0.46 93.17%Q15. Easy to Get Car

e Believed Necessa

ry for

Child

87th

Q32. Explain Things in a Way You Could Understand 0.45 0.45 92.72%Q32. Explain

Things in

a Way You

Could

Understand

35th

Q4. Getting Care for Child as Soon as Needed 0.33 0.33 92.31%Q4.

Getting

Care for Child as Soon as Needed

61st

Q6. Getting Appointment for Child as Soon as Needed 0.33 0.33 93.63%Q6.

Getting

Appointment for Child as Soon as Needed

96th

Q46. Easy to Get Appointment for Child with Specialist 0.18 0.18 75.41%Q46. Easy to Get Appointment for Chil

d with Speciali

st

13th

Q11. Discussed Reasons to Take Medicine 0.17 0.17 88.71%Q11. Discusse

d Reasons

to Tak

e Medicine

17th

Q13. Asked Preference for Medicine 0.14 0.14 66.13%Q13. Asked

Preferen

ce for

Medicine

2nd

Q50. Got Information or Help Needed 0.12 0.12 80.56%Q50. Got

Informati

on or

Help Needed

33rd

Q51. Treated You with Courtesy and Respect 0.07 0.07 95.89%Q51. Trea

ted You with Courtes

y and Respect

87th

Q12. Discussed Reasons Not to Take Medicine 0.01 0.01 53.23%Q12. Discusse

d Reasons Not

to Tak

e Medicine

4th

Q48. Rating of Specialist

Health Plan's Score

Plan’s Percentile

Q46. Easy to Get Appointment for Child with Specialist 0.50 0.50 75.41% 13th

Q15. Easy to Get Care Believed Necessary for Child 0.41 0.41 93.17% 87th

Q6. Getting Appointment for Child as Soon as Needed 0.37 0.37 93.63% 96th

Q34. Show Respect for What You Had to Say 0.34 0.34 95.63% 44th

Q37. Spend Enough Time with Child 0.31 0.31 88.89% 42nd

Q12. Discussed Reasons Not to Take Medicine 0.30 0.30 53.23% 4th

Q33. Listen Carefully to You 0.28 0.28 94.20% 37th

Q51. Treated You with Courtesy and Respect 0.14 0.14 95.89% 87th

Q11. Discussed Reasons to Take Medicine 0.12 0.12 88.71% 17th

Q32. Explain Things in a Way You Could Understand 0.04 0.04 92.72% 35th

Q4. Getting Care for Child as Soon as Needed 0.03 0.03 92.31% 61st

Q13. Asked Preference for Medicine 0.02 0.02 66.13% 2nd

Q50. Got Information or Help Needed 0.01 0.01 80.56% 33rd

Executive SummaryKey Driver Analysis for General Population – Doctor and Specialist


0.50

0.41

0.37

0.34

0.31

0.30

0.28

0.14

0.12

0.04

0.03

0.02

0.01

0.0 0.5 1.0














0.56

0.55

0.53

0.46

0.45

0.33

0.33

0.18

0.17

0.14

0.12

0.07

0.01

0.0 0.5 1.0















M160005 July 2016 15

Q54. Rating of Health Plan CompositeSample

Size

Health Plan's Score

Plan’s Percentile

Q18. Getting Help You Needed from Doctor in Contacting School/Daycare 0.86 0.86 29 82.76% NA

Q20. Easy to Get Special Medical Equipment for Child 0.75 0.75 19 78.95% NA

Q15. Easy to Get Care Believed Necessary for Child 0.60 0.60 188 93.09% 82nd

Q50. Got Information or Help Needed 0.59 0.59 81 90.12% 100th


Q34. Show Respect for What You Had to Say 0.51 0.51 184 95.65% 52nd

Q46. Easy to Get Appointment for Child with Specialist 0.47 0.47 91 79.12% 22nd

Q56. Easy to Get Prescription Medicine for Child 0.47 0.47 187 89.30% 40th

Q23. Easy to Get Therapy for Child 0.45 0.45 47 76.60% 46th

Q26. Easy to Get Treatment or Counseling for Child 0.42 0.42 86 74.42% 25th


Q6. Getting Appointment for Child as Soon as Needed 0.38 0.38 190 92.63% 63rd


Q29. Health Plan or Doctor's Office Helps Coordinate Care 0.35 0.35 78 75.64% 100th

Q37. Spend Enough Time with Child 0.35 0.35 184 88.59% 28th

Q9. Getting Questions Answered by Child's Doctor 0.28 0.28 188 94.68% 95th

Q11. Discussed Reasons to Take Medicine 0.22 0.22 96 96.88% 71st

Q38. Discussion About Child Feeling/ Growing/Behaving 0.21 0.21 184 90.76% 84th

Executive SummaryKey Driver Analysis for CCC Population – Health Plan

"Health Plan's Score" is the percent of respondents that answered "Always", "Usually"; "Yes"Use caution when reviewing scores with sample sizes less than 25.Above are 18 of the 23 key measures. The 5 measures with lowest correlation to Rating of Health Plan are not displayed.



Group)

Q51 - Treated You with Courtesy and Respect



Group)Q15 - Easy to Get Care Believed Necessary for ChildQ50 - Got Information or Help NeededQ34 - Show Respect for What You Had to Say

0.86

0.75

0.60

0.59

0.52

0.51

0.47

0.47

0.45

0.42

0.39

0.38

0.36

0.35

0.35

0.28

0.22

0.21

0.0 0.5 1.0

Q18. Getting Help You Needed from Doctor in ContactingSchool/Daycare

Q20. Easy to Get Special Medical Equipment for Child






Q56. Easy to Get Prescription Medicine for Child

Q23. Easy to Get Therapy for Child

Q26. Easy to Get Treatment or Counseling for Child




Q29. Health Plan or Doctor's Office Helps Coordinate Care


Q9. Getting Questions Answered by Child's Doctor


Q38. Discussion About Child Feeling/ Growing/Behaving


M160005 July 2016 16

Q14. Rating of Health Care CompositeSample

Size

Health Plan's Score

Plan’s Percentile

Q18. Getting Help You Needed from Doctor in Contacting School/Daycare 0.77 0.77 29 82.76% NA

Q20. Easy to Get Special Medical Equipment for Child 0.67 0.67 19 78.95% NA

Q34. Show Respect for What You Had to Say 0.61 0.61 184 95.65% 52nd

Q15. Easy to Get Care Believed Necessary for Child 0.58 0.58 188 93.09% 82nd

Q37. Spend Enough Time with Child 0.52 0.52 184 88.59% 28th



Q23. Easy to Get Therapy for Child 0.45 0.45 47 76.60% 46th

Q6. Getting Appointment for Child as Soon as Needed 0.44 0.44 190 92.63% 63rd

Q11. Discussed Reasons to Take Medicine 0.41 0.41 96 96.88% 71st

Q46. Easy to Get Appointment for Child with Specialist 0.39 0.39 91 79.12% 22nd


Q9. Getting Questions Answered by Child's Doctor 0.33 0.33 188 94.68% 95th


Q56. Easy to Get Prescription Medicine for Child 0.28 0.28 187 89.30% 40th

Q29. Health Plan or Doctor's Office Helps Coordinate Care 0.27 0.27 78 75.64% 100th

Q43. Doctor Understands How Medical Conditions Affect Child's Day-to-Day Life 0.27 0.27 155 94.84% 84th

Q26. Easy to Get Treatment or Counseling for Child 0.26 0.26 86 74.42% 25th

Executive SummaryKey Driver Analysis for CCC Population – Health Care

Use caution when reviewing scores with sample sizes less than 25.Above are 18 of the 23 key measures. The 5 measures with lowest correlation to Rating of Health Care are not displayed.




Group)Q37 - Spend Enough Time with ChildQ33 - Listen Carefully to You



Group)

Q34 - Show Respect for What You Had to SayQ15 - Easy to Get Care Believed Necessary for Child

0.77

0.67

0.61

0.58

0.52

0.51

0.47

0.45

0.44

0.41

0.39

0.33

0.33

0.30

0.28

0.27

0.27

0.26

0.0 0.5 1.0

Q18. Getting Help You Needed from Doctor inContacting School/Daycare

Q20. Easy to Get Special Medical Equipment for Child






Q23. Easy to Get Therapy for Child





Q9. Getting Questions Answered by Child's Doctor


Q56. Easy to Get Prescription Medicine for Child

Q29. Health Plan or Doctor's Office Helps CoordinateCare

Q43. Doctor Understands How Medical ConditionsAffect Child's Day-to-Day Life

Q26. Easy to Get Treatment or Counseling for Child


M160005 July 2016 17

Executive SummaryAction Plans for Improving CAHPS® ScoresMorpace has consulted with numerous clients on ways to improve CAHPS® scores. Even though each health plan is unique and faces different challenges, many of the improvement strategies discussed on the next few pages can be applied by most plans withappropriate modifications.

In addition to the strategies suggested below, we suggest reviewing AHRQ’s CAHPS® Improvement Guide, an online resource located on the Agency for Healthcare Research and Quality website at:

http://www.ahrq.gov/cahps/quality-improvement/improvement-guide/improvement-guide.html

GETTING NEEDED CARE (1 of 2)GETTING NEEDED CARE (1 of 2)

Easy to get appointment with specialist

• Develop referral guidelines to identify which clinical conditions the PCPs should manage themselves and which should be referred to the specialists.

• Review authorization and referral patterns for internal barriers to member access to needed specialists. Include Utilization Management staff in the review process to assist in barrier identification and process improvement development.

• Review Complaint and Grievance information to assess if issues are with the process of getting a referral/authorization to a specialist, or if the issue is the wait time to get an appointment.

• Include supplemental questions on the CAHPS® survey to determine whether the difficulty is in obtaining the initial consult or subsequent appointments.

• Include a supplemental question on the CAHPS® survey to determine with which type of specialist members have difficulty making an appointment.

• Perform a GeoAccess study of your panel of specialists to assure that there are an adequate number of specialists and that they are dispersed geographically to meet the needs of your members.

• Instruct Provider Relations staff to question PCP office staff regarding which types of specialists they have the most problems scheduling appointments for their patients.

• Conduct an Access to Care survey to validate appointment availability of specialist appointments.• Include specialists in a CG-CAHPS Study to determine ease of access as well as other issues with specialist care. • Develop a worksheet which could be completed and given to the patient by the PCP explaining the need and urgency of the referral as well as

any preparation on the patient’s part prior to the appointment with the specialist. Including the patient in the decision making process improves the probability that the patient will visit the specialist.

• Develop materials to introduce and promote your specialist network to the PCPs and encourage the PCPs to develop new referral patternsthat align with the network.


M160005 July 2016 18

Executive SummaryAction Plans for Improving CAHPS® Scores (cont’d)

GETTING NEEDED CARE (2 of 2)GETTING NEEDED CARE (2 of 2)

Easy to get care believed necessary

• Evaluate pre-certification, authorization, and appeals processes. Of even more importance is to evaluate the manner in which the decisions are communicated to the member. Members may be told that the health plan has not approved specific care, tests, or treatment, but are not being told why. The health plan should go the extra step to ensure that the member understands the decision and hears directly from them.

Additional recommendations

• Include a supplemental question on the CAHPS® survey to identify the type of care, test or treatment which the member has a problem obtaining.

• Review complaints received by Customer Service regarding inability to receive care, tests or treatments. Identify the issues generating the highest number of complaints and prioritize improvement activities to address these first.

• When care or treatment is denied, care should be taken to ensure that the message is understood by both the provider and the member. Evaluate language utilized in denial letters and scripts for telephonic notifications of denials to make sure messaging is clear and appropriate for a lay person. If state regulations mandate denial format and language in written communications, examine ways to also communicate denial decisions verbally to reinforce reasons for denial.


M160005 July 2016 19


GETTING CARE QUICKLYGETTING CARE QUICKLY

Getting care as soon as you needed

• Distribute to members listings of Urgent Care/After Hours Care options available in network. Promote Nurse on Call lines as part of the distribution. Refrigerator magnets with Nurse On-Call phone numbers and names of participating Urgent Care centers are very effective in this population.

Getting appointment as soon as needed

• Encourage PCP offices to implement open access scheduling – allowing a portion of each day to be left open for urgent care and follow-up care.


• Include in member newsletters articles regarding scheduling routine care and check ups and informing members of the average wait time for a routine appointment for your network.

• Identify for members, PCP, Pediatric and OB/GYN practices that offer evening and weekend hours.

• Encourage PCP offices to make annual appointments 12 months in advance

• Conduct an Access to Care Study

• Calls to physician office - unblinded

• Calls to members with recent claims

• Desk audit by provider relations staff

• Conduct a CG-CAHPS survey to identify offices with scheduling issues


M160005 July 2016 20


HOW WELL DOCTORS COMMUNICATEHOW WELL DOCTORS COMMUNICATE

Explain things in a way you could understand

• Include supplemental questions from the Item Set for Addressing Health Literacy to identify communication issues.

Listen carefully to you

• Provide the physicians with patient education materials. These materials could reinforce that the physician has heard the concerns of the patient and/or that they are interested in the well-being of the patient. The materials might also speak to a healthy habit that the physician wants the patient to adopt, thereby reinforcing the communication and increasing the chances for compliance. Materials should be available in appropriate/relevant languages and reading levels for the population.

Show respect for what you had to say

• Conduct focus group of members to identify examples of behaviors identified in the questions. Video the groups to show physicians how patients characterize excellent and poor physician performance.

Spend enough time with you

• Develop “Questions Checklists” on specific diseases to be used by members when speaking to doctors. Have these available in office waiting rooms or provided by office staff prior to the patient meeting with the doctor. The doctor can review and discuss the checklist during the office visit.


• Conduct a CG-CAHPS survey to identify physicians for whom improvement plans should be developed.

• Provide communication tips in the provider newsletters. Often, these are better accepted if presented as a testimonial from a patient.


M160005 July 2016 21


SHARED DECISION MAKINGSHARED DECISION MAKING

Discussed reasons to take medicine

• Develop patient education materials about common medicines described for your members explaining pros of each medicine.Examples: asthma medications, high blood pressure medications, statins.

Discussed reasons not to take medicine

• Develop patient education materials about common medicines described for your members explaining cons of each medicine. Examples: asthma medications, high blood pressure medications, statins.

Asked preference for medicine

• Conduct a CG-CAHPS survey and include the Shared Decision Making Composite as supplemental questions.


• Develop or purchase audio recordings and/or videos of patient/doctor dialogues/vignettes with information about common mediations. Distribute to provider panel via podcast or other method.


M160005 July 2016 22


HEALTH PLAN CUSTOMER SERVICEHEALTH PLAN CUSTOMER SERVICE

Got information or help needed

• On a monthly basis, study Call Center reports for reasons of incoming calls and identify the primary drivers of calls. Bring together Call Centerrepresentatives and key staff from related operational departments to design interventions to decrease call volume and/or improve member satisfaction with the health plan.

Treated you with courtesy and respect

• Operationally define customer service behaviors for Call Center representatives as well as all staff throughout the organization. Train staff on these behaviors.


• Conduct Call Center Satisfaction Survey. Implement a short IVR survey to members within days of their calling customer service to explore/assess their recent experience.

• Implement a service recovery program so that Call Center representatives have guidelines to follow for problem resolution and atonement.

• Acknowledge that all members who respond that they have called customer service have actually talked to plan staff in other areas than the Call Center. Promote the idea of customer service is the responsibility for all staff throughout the organization.


M160005 July 2016 23


COORDINATION OF CARECOORDINATION OF CARE

Personal doctor informed and up-to-date about the care you got from other doctors or other health providers

• Institute process where the plan notifies the PCP when a member is admitted/discharged from a hospital or SNF. Upon discharge, send a copy of the discharge summary to the PCP.

Coordination of Care is an area in which the health plan can be seen as the partner to the physician in the management of a member’s care. A plan’s words and actions can emphasize the plan’s willingness to work with the physician to improve the health of their members and to assist the physician in doing so.

• Offer to work with larger/high volume PCP groups to facilitate EMR connectivity with high volume specialty groups.

• Conduct a referring physician survey with PCPs via the Internet to ascertain the level of communication between PCPs and specific specialists.

• Investigate how the plan can assist the PCP in coordinating care with specialists and ancillary providers.

• Institute a policy and procedure whereby copies of MTM information is faxed/mailed to the member’s assigned PCP.

• Have Provider Relations staff interview PCP office staff as to whether they communicate with Specialist offices to request updates on care delivered to patients that the PCP referred to the Specialist.

• Encourage PCP offices to assist members with appointment scheduling with specialists and other ancillary providers and for procedures and tests.


M160005 July 2016 24

Excellent/Very good77%

Good19%

Fair/Poor4%

Race / Ethnicity

15%

43%

48%

1%

0%

3%

8%

0% 20% 40% 60% 80% 100%

Hispanic or Latino

White

African American

Asian

Native Hawaiian or other Pacific Islander

American Indian or Alaska Native

Other

Executive SummaryDemographics – General Population

CHILD’S HEALTH STATUS

1 yr and under6%

2-5 yrs25%

6-9 yrs26%

10-14 yrs27%

15-18 yrs16%

Male56%

Female44%

CHILD’S GENDERCHILD’S AGE

CHILD’S MENTAL/EMOTIONAL HEALTH STATUS

Excellent/Very good

72%

Good22%

Fair/Poor6%

CHILD’S RACE / ETHNICITY


M160005 July 2016 25

Excellent/Very good59%

Good27%

Fair/Poor15%

Executive SummaryDemographics – CCC Population

Race / Ethnicity

8%

46%

53%

1%

0%

5%

4%

0% 20% 40% 60% 80% 100%

Hispanic or Latino

White

African American

Asian



Other

CHILD’S HEALTH STATUS

1 yr and under3%

2-5 yrs15%

6-9 yrs23%

10-14 yrs38%

15-18 yrs21%

Male63%

Female37%

CHILD’S GENDERCHILD’S AGE

CHILD’S MENTAL/EMOTIONAL HEALTH STATUS

Excellent/Very good

43%

Good31%

Fair/Poor27%

CHILD’S RACE / ETHNICITY


M160005 July 2016 26

Executive SummaryChild Demographics

General Population 2015 Quality Compass®- General

Population

CCC Population 2015 Quality Compass®-CCC

Population 2015 2016 2015 2016

Q58. Child's Health StatusExcellent/Very good 71% 77% 75% 51% 59% 55%

Good 23% 19% 20% 33% 27% 32%Fair/Poor 5% 4% 5% 15% 15% 13%

Q59. Child's Mental/Emotional Health StatusExcellent/Very good 75% 72% 73% 49% 43% 44%

Good 17% 22% 18% 27% 31% 31%Fair/Poor 8% 6% 9% 24% 27% 25%

Q74. Child's Age1yr and under 9% 6% NA 4% 3% NA

2-5 yrs 20% 25% NA 14% 15% NA6-9 yrs 23% 26% NA 20% 23% NA

10-14 yrs 25% 27% NA 35% 38% NA15-18 yrs 22% 16% NA 26% 21% NA

Q75. Child's GenderMale 50% 56% 52% 57% 63% 59%

Female 50% 44% 48% 43% 37% 41%Q76/77. Child's Race/Ethnicity

Hispanic or Latino 6% 15% 29% 6% 8% 23%White 51% 43% 44% 48% 46% 72%

African American 45% 48% 19% 53% 53% 32%Asian 3% 1% 5% 2% 1% 6%

Native Hawaiian or other Pacific Islander 0% 0% 2% 0% 0% 1%American Indian or Alaska Native 3% 3% 3% 3% 5% 4%

Other 3% 8% 11% 4% 4% 20%

Data shown are self reported.NA = Data not available.


M160005 July 2016 27

Executive SummaryRespondent Demographics General Population 2015 Quality

Compass®-General Population

CCC Population 2015 Quality Compass®-CCC

Population 2015 2016 2015 2016

Q7. Number of Times Going to Doctor's Office/Clini c for Care

None 16% 21% 24% 8% 11% 13%1 time 26% 25% 26% 15% 15% 20%

2 times 26% 25% 23% 23% 22% 24%3 times 12% 14% 12% 20% 18% 16%4 times 9% 6% 6% 15% 8% 10%

5-9 times 9% 7% 6% 12% 18% 13%10 or more times 3% 3% 2% 8% 8% 5%

Q31. Number of Times Visited Personal Doctor to Ge t CareNone 12% 16% 20% 4% 9% 13%

1 time 30% 31% 32% 15% 22% 27%2 times 27% 28% 23% 28% 26% 24%3 times 13% 11% 12% 20% 15% 15%4 times 7% 6% 6% 13% 5% 8%

5-9 times 9% 7% 6% 15% 17% 10%10 or more times 2% 2% 1% 5% 6% 3%

Q78. Respondent's AgeUnder 18 8% 9% 8% 10% 12% 8%18 to 24 9% 7% 7% 3% 4% 4%25 to 34 32% 36% 32% 29% 31% 26%35 to 44 27% 32% 31% 32% 25% 31%45 to 54 14% 8% 15% 12% 15% 18%55 to 64 7% 4% 5% 9% 8% 9%

65 or older 3% 4% 2% 5% 6% 4%Q79. Respondent's Gender

Male 11% 9% 12% 10% 9% 10%Female 89% 91% 88% 90% 91% 90%

Q80. Respondent's EducationDid not graduate high school 19% 21% 20% 20% 25% 18%

High school graduate or GED 34% 34% 33% 35% 32% 32%Some college or 2-year degree 38% 36% 33% 37% 34% 38%

4-year college graduate 7% 7% 9% 5% 5% 8%More than 4-year college degree 2% 2% 5% 3% 3% 5%

Data shown are self reported.


M160005 July 2016 28

Executive SummaryGeneral Knowledge about Demographic Differences

Age Little difference is noted between responses for the children in the different age groups.

Health Status

Responses for children whose health status is rated as ‘Excellent’ or ‘Very good’ tend to be more satisfied than people who rate the child’s health status lower. The ‘Excellent/Very good’ group scores higher in the following areas: Getting Care Quickly, How Well Doctors Communicate, Getting Needed Care, three rating questions (Health Care, Personal Doctor and Health Plan) and Coordination of Care.

EducationIn the Morpace Book of Business, the more educated respondents (some college or more) have significantly higher scores for Getting Care Quickly, How Well Doctors Communicate and Getting Needed Care. The less educated respondents have significantly higher scores for all rating questions.

Race and ethnicity effects are independent of education and income. Lower income generally predicts lower satisfaction with coverageand care.

Race

Whites tend to give higher scores to both the rating and composite questions than the African Americans or the ‘All other’ group. Significantly higher scores are noted for Whites in the following composites: Getting Care Quickly and Getting Needed Care. Scores for ‘All other’ tend to be lower across the board.Morpace Book of Business: White - 52%, African American - 25%, All other - 27%

Growing evidence denotes that lower satisfaction ratings from Asian Americans are partially attributable to cultural differences in their response tendencies. Therefore, the lower scores for ‘All other’ might not reflect an accurate comparison of their experience with health care.

EthnicityNon-Hispanic respondents have significantly higher scores for Getting Care Quickly, How Well Doctors Communicate and Getting Needed Care. Hispanics have significantly higher scores for all rating questions. Hispanics make up 41% of the Morpace Book of Business.

The commentary below is based on the 2016 Morpace Child Medicaid Book of Business:


M160005 July 2016 29

Executive SummaryComposite & Rating Scores by Demographics - General Population

Child’sAge

Child’sRace

Child’sEthnicity

Respondent’s Educational

Level

Child’sHealth Status

Demographic1 yr and

under

2-5 yrs

6-9yrs

10-14yrs

15-18yrs

WhiteAfrican

AmericanAll

otherHispanic

Non-Hispanic

HS Grad or

Less

Some College+

Excellent/Very Good

GoodFair/Poor

Sample size (n=16) (n=67) (n=68) (n=71) (n=41) (n=117) (n=130) (n=34) ( n=38) (n=224) (n=146) (n=121) (n=207) (n=51) (n=11)

Composites (% Always/Usually)

Getting Care Quickly 94 90 93 96 92 94 93 90 85 94 90 96 95 95 65

Shared Decision Making (% Yes)

50 60 70 86 58 80 62 69 67 69 71 68 71 59 78

How Well Doctors Communicate

92 90 95 95 92 93 91 91 90 93 92 94 95 88 73

Getting Needed Care 80 76 87 87 86 82 87 70 73 85 85 83 86 83 71

Customer Service 83 87 88 91 91 84 92 82 85 89 88 88 90 84 90

Overall Ratings (% 8,9,10)

Health Care 94 86 80 89 87 85 87 83 74 87 85 86 90 74 78

Personal Doctor 81 89 87 88 86 83 85 90 83 87 89 84 88 80 82

Specialist 100 71 60 87 100 79 79 71 50 82 79 83 81 81 83

Health Plan 94 86 83 93 83 84 87 91 92 86 90 83 86 88 100


M160005 July 2016 30

Supplemental Questions


M160005 July 2016 31

Supplemental Questions – Doctor

2016

Always 66%

Usually 11%

Sometimes 7%

Never 16%

Sample Size: (n=349)

Q85. In the last 6 months, how often did your chil d's personal doctorgive you easy to understand information about any h ealth questions

or concerns about your child?

2015 2016

Never 66% 74%

Sometimes 24% 20%

Usually 3% 1%

Always 6% 5%

Sample Size: (n=575) (n=457)

Q84. How often did your child’s personal doctor use medical words you did not understand?


M160005 July 2016 32

Supplemental Questions – Website

2016

Yes 16%

No 83%

I don't know 2%


Q86. Have you visited AmeriHealth Caritas Louisian a's website to get information?


M160005 July 2016 33


2016

Benefits and covered services 74%

Claims information 13%

Prescription drug information 13%

Membership 11%

Provider information 10%

Co-payment, co-insurance and deductible information 5%

Referrals 4%

Health management programs 3%

Other 4%


Q87. What type of information were you seeking whe n you visited theAmeriHealth Caritas Lousiana website?

(Multiple Mentions)


M160005 July 2016 34

Supplemental Questions – Information

2016

By postal mail 71%

A phone call from someone at the plan 19%

By text message 15%

By email 15%

On the plan's website 10%

Mobile phone app 6%


Q88. When your child's plan needs to share informa tion with you, how do you prefer to receive this information?

(Multiple Mentions)


M160005 July 2016 35

Supplemental Questions – Recommend

2015 2016

Definitely would 62% 67%

Probably would 30% 24%

Might or might not 7% 7%

Probably would not 1% 2%

Definitely would not 0% 0%


Q89. Which of the following best describes your wi llingness torecommend AmeriHealth Caritas Louisiana to a friend or family member?

2016 CAHPS® Adult Medicaid Survey

Executive Summary

July 2016


Morpace research is completed in compliance with ISO 20252

Table of Contents

2016 CAHPS® 5.0H Adult Medicaid Survey


M160003 July 2016 2

3

3

4

5

6

7

9

10

21

25

26

27

30

31

Aspirin Use and Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Supplemental Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HEDIS® Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical Assistance with Smoking and Tobacco Use Cessation. . . . . . . . . . . . . . . . . . . . . .

Key Driver Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Flu Vaccinations for Adults Ages 18-64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Background and Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disposition Summary and Response Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Summary of Key Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Scoring for NCQA Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Comparison to Quality Compass® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sample. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Executive Summary Background and Protocol

Background

• CAHPS® measures health care consumers' satisfaction with the quality of care and customer service provided by their

health plan. Plans which are collecting HEDIS® (Healthcare Effectiveness Data and Information Set) data for NCQA

accreditation are required to field the CAHPS® survey among their eligible populations.

Protocol

• For CAHPS® results to be considered in HEDIS® results, the CAHPS® 5.0H survey must be fielded by an NCQA

(National Committee for Quality Assurance)-certified survey vendor using an NCQA-approved protocol of administration

in order to ensure that results are collected in a standardized way and can be compared across plans. Standard NCQA

protocols for administering CAHPS® 5.0H include a mixed-mode mail/telephone protocol and a mail-only protocol.

• The protocol includes the following:

Pre-notification

postcard mailed

(optional)

1st reminder

postcard

mailed

2nd reminder

postcard

mailed

Telephone

interviews

conducted with

non-responders

(min of 3/max of 6

attempts)

Questionnaire with

cover letter and

business reply

envelope (BRE)

mailed

Internet link

included on cover

letter (optional)

Replacement

questionnaire with

cover letter and

BRE to all non-

responders

Internet link

included on cover

letter (optional)



M160003 July 2016 3

• AmeriHealth Caritas Louisiana chose the mail/telephone protocol with pre-notification postcard.

Sample Size Total

Completes

English

Completes

Spanish

Completes

AmeriHealth Caritas Louisiana 1625 293 288 5

Executive Summary

Sample

• NCQA originally designed this protocol with the goal of achieving a total response rate of at least 45%. In 2015, the average

response rate for all Adult Medicaid plans reporting to NCQA was 27%, which is lower than the 2014 average (29%).

• In February, 1625 AmeriHealth Caritas Louisiana members were randomly selected to participate in the 2016 CAHPS® 5.0H

Adult Medicaid Survey. The survey results presented in this report are compiled from the 293 AmeriHealth Caritas Louisiana

members who responded to the survey.



M160003 July 2016 4

Executive Summary

Ineligible Number

Deceased (M20/T20) 0

Does not meet criteria (M21/T21) 4

Language barrier (M22/T22) 2

Mentally/physically incapacitated (M24/T24) 7

Sample Duplicates (ID1/ID2) 4

Total Ineligible 17


2016 Disposition Summary

Non-response Number

Bad address/phone (M23/T23) 177

Partial complete (M31/T31) 11

Refusal (M32/T32) 35

Maximum attempts made (M33/T33) 1092

Total Non-response 1315



M160003 July 2016 5

Disposition Summary and Response Rate

• According to NCQA protocol, ineligible members include those who are deceased, do not meet eligible criteria, have a language barrier,

are either mentally or physically incapacitated, or duplicate household to another member selected in the sample.

• Non-responders include those members who refuse to participate in the current year’s survey, could not be reached due to a bad

address or telephone number, members that reached a maximum attempt threshold without a response, or members that did not meet

the completed survey definition.

• The table below shows the total number of members in the sample that fell into each of the various disposition categories.

• Ineligible surveys are subtracted from the sample size when computing a response rate (see below):

Completed mail and telephone surveys = Response Rate

Sample size - Ineligible surveys

• Using the final figures from AmeriHealth Caritas Louisiana’s Adult Medicaid survey, the 2016 response rate is calculated using the

equation below:

• A response rate is calculated for those members who were eligible and able to respond.

• A completed questionnaire is defined as a respondent who completed three of the five required questions that all respondents are

eligible to answer (question #3, 15, 24, 28, 35).

Mail Completes (227) + Phone completes (66) =

293 = Response Rate = 18%


Executive Summary Summary of Key Measures

• For purposes of reporting the CAHPS® results

in HEDIS® (Healthcare Effectiveness Data

and Information Set) and for scoring for health

plan accreditation, the National Committee for

Quality Assurance (NCQA) uses 5 composite

measures and 4 rating questions from the

survey.

• Each of the composite measures is the

average of 2 - 4 questions on the survey,

depending on the measure, while each rating

score is based on a single question.

CAHPS® scores are most commonly shown

using Summary Rate scores (percentage of

positive responses).


Trended Data

Composite Measures 2013 2014 2015 2016

Getting Care Quickly 77% 77% 82% 84%

Shared Decision Making NT NT 81% 74%

How Well Doctors Communicate 87% 86% 87% 89%

Getting Needed Care 75% 77% 80% 78%

Customer Service 87% 80% 89% 89%

Overall Rating Measures

Health Care 68% 62% 67% 72%

Personal Doctor 75% 75% 78% 78%

Specialist 82% 81% 79% 84%

Health Plan 66% 63% 73% 77%

HEDIS® Measures

Flu Vaccinations*** NA 39% 39% 35%

Advising Smokers and Tobacco Users to Quit* 76% 81% 83% 78%

Discussing Cessation Medications* 42% 44% 43% 44%

Discussing Cessation Strategies* 32% 36% 45% 45%

Aspirin Use** NR NR NR NR

Discussing Aspirin Risks and Benefits** NR NR NR NR

Health Promotion & Education 72% 71% 71% 76%

Coordination of Care 74% 78% 72% 81%

Sample Size 1620 1620 1620 1625

# of Completes 443 327 344 293

Response Rate 28% 21% 21% 18%

*Measure is reported using a Rolling Average Methodology. The score shown is the reportable score for the corresponding year.

**Measure is reported using a Rolling Average Methodology and is not reportable in 2016.

***Question text and age range changed in 2014. This is a single year measure.

Legend: / Statistically higher/lower compared to prior year results.

NA=Data not available NT=Data not trendable NR=Data not reportable



M160003 July 2016 6

Executive Summary Scoring for NCQA Accreditation (Includes How Well Doctors Communicate)


Below

25th

Nat'l 25th Nat'l 50th Nat'l 75th Nat'l 90th Nat'l

Accreditation

Points 0.29 0.58 0.98 1.27 1.44

Composite Scores Sample

Size Mean

Approximate

Percentile

Threshold

Approximate

Score


How Well Doctors Communicate (n=202) 2.622 75th 2.48 2.54 2.58 2.64 1.27


Customer Service (n=114) 2.658 90th 2.48 2.54 2.58 2.61 1.44


Q13 Health Care (n=240) 2.333 25th 2.31 2.36 2.42 2.45 0.58


Q27 Specialist (n=125) 2.632 90th 2.48 2.51 2.56 2.59 1.44

Accreditation

Points 0.58 1.16 1.96 2.54 2.89

Q35 Health Plan (n=286) 2.441 50th 2.37 2.43 2.49 2.55 1.96

Estimated Overall

CAHPS® Score: 9.30

NOTE: NCQA begins their calculation with an unadjusted raw score showing six digits after the decimal and then compares the adjusted score to their benchmarks and thresholds (also calculated to

the sixth decimal place). Starting in 2015, NCQA will no longer use an adjusted score. This report displays accreditation points and scores with only two digits after the decimal. Therefore, the

estimated overall CAHPS® score may differ from the sum of the individual scores due to rounding and could differ slightly from official scores provided by NCQA. The CAHPS® measures account

for 13 points towards accreditation.

*Data Source: NCQA Memorandum of January 21, 2016. Subject: 2016 Accreditation Benchmarks and Thresholds.

*** Not reportable due to insufficient sample size.



M160003 July 2016 7


Below 25th

Nat'l 25th Nat'l 50th Nat'l 75th Nat'l 90th Nat'l

Accreditation

Points 0.29 0.58 0.98 1.27 1.44

Composite Scores Sample

Size Mean

Approximate

Percentile

Threshold

Approximate

Score



Customer Service (n=114) 2.658 90th 2.48 2.54 2.58 2.61 1.44

Care Coordination (n=128) 2.430 75th 2.33 2.39 2.43 2.49 1.27


Q13 Health Care (n=240) 2.333 25th 2.31 2.36 2.42 2.45 0.58


Q27 Specialist (n=125) 2.632 90th 2.48 2.51 2.56 2.59 1.44

Accreditation

Points 0.58 1.16 1.96 2.54 2.89

Q35 Health Plan (n=286) 2.441 50th 2.37 2.43 2.49 2.55 1.96

Estimated Overall

CAHPS® Score: 9.30

Executive Summary Scoring for NCQA Accreditation (Includes Care Coordination)

NOTE: NCQA begins their calculation with an unadjusted raw score showing six digits after the decimal and then compares the adjusted score to their benchmarks and thresholds (also calculated to

the sixth decimal place). Starting in 2015, NCQA will no longer use an adjusted score. This report displays accreditation points and scores with only two digits after the decimal. Therefore, the

estimated overall CAHPS® score may differ from the sum of the individual scores due to rounding and could differ slightly from official scores provided by NCQA. The CAHPS® measures account

for 13 points towards accreditation.

*Data Source: NCQA Memorandum of January 21, 2016. Subject: 2016 Accreditation Benchmarks and Thresholds.

*** Not reportable due to insufficient sample size.



M160003 July 2016 8

Executive Summary Comparison to Quality Compass®

AmeriHealth

Caritas Louisiana

2015 Quality Compass® Adult Medicaid Comparisons*

5th Nat’l 10th Nat’l 25th Nat'l 50th Nat'l 75th Nat'l 90th Nat'l 95th Nat'l

Composite Scores % % % % % % %








Q23 Rating of Personal Doctor (% 8, 9,10) 77.59% 73.07 75.00 77.69 80.00 82.06 84.17 86.28

Q27 Rating of Specialist (% 8, 9,10) 84.00% 73.95 75.14 78.05 80.67 82.82 85.34 86.19

Q35 Rating of Health Plan (% 8, 9,10) 77.27% 65.23 67.85 72.44 76.15 78.65 81.16 83.25

*Data Source: 2015 Adult Medicaid Quality Compass®. Scores above based

on 155 public and non-public reporting health plan products (All Lines of Business excluding PPOs). = Plan score falls below 5th Percentile



M160003 July 2016 9

Executive Summary Action Plan – Rating of Health Plan

A Key Driver Analysis is conducted to understand the impact that different aspects of plan service and provider care have on members'

overall satisfaction with their health plan, their personal doctor, their specialist, and health care in general. Two specific scores are

assessed both individually and in relation to each other. These are:

1. The relative importance of the individual issues (Correlation to overall measures)

2. The current levels of performance on each issue (Percentile group in Quality Compass®)

Items that are a High Priority for Improvement are those measures that are highly correlated to the overall measure, and the plan’s

scores are below the 50th percentile of Quality Compass®. Below is a list of items that are considered a High Priority for Improvement to

the Overall Rating of Health Plan as well as the Primary Recommendation for improving this measure. For more ideas on how to

improve your scores, please see the Action Plans for Improving CAHPS® Scores section of this report.

High Priority for Improvement

(High correlation/Relatively low performance) Overall Rating of Health Plan Primary Recommendation

Q14 - Easy to Get Care Believed Necessary

Evaluate pre-certification, authorization, and appeals processes. Of even more importance is to

evaluate the manner in which the decisions are communicated to the member. Members may be

told that the health plan has not approved specific care, tests, or treatment, but are not being told

why. The health plan should go the extra step to ensure that the member understands the

decision and hears directly from them.



M160003 July 2016 10


Executive Summary Key Driver Analysis – Health Plan


(High Correlation/

Lower Quality Compass® Group)


Continue to Target Efforts

(High Correlation/

Higher Quality Compass® Group)

Q32 - Treated You with Courtesy and Respect

Q31 - Got Information or Help Needed

Q35. Rating of Health Plan Composite

Sample

Size

Health

Plan's

Score

Plan's

Percentile

Q32. Treated You with Courtesy and Respect 0.45 0.45 114 95.61% 82nd


Q14. Easy to Get Care Believed Necessary 0.39 0.39 239 82.85% 48th

Q25. Easy to Get Appointment with Specialist 0.33 0.33 135 73.33% 17th

Q4. Getting Care as Soon as Needed 0.28 0.28 163 85.89% 70th

Q17. Explain Things in a Way You Could Understand 0.26 0.26 203 89.16% 22nd



Q20. Spend Enough Time with You 0.21 0.21 202 86.14% 16th

Q6. Getting Appointment as Soon as Needed 0.16 0.16 223 82.51% 85th

Q11. Discussed Reasons Not to Take Medicine NA NA 119 57.98% 1st

Q12. Asked Preference for Medicine NA NA 118 71.19% 7th

Q10. Discussed Reasons to Take Medicine NA NA 118 92.37% 54th

0.45

0.42

0.39

0.33

0.28

0.26

0.23

0.23

0.21

0.16

0.02

0.02

0.01

0.0 0.5 1.0



Q14. Easy to Get Care Believed Necessary

Q25. Easy to Get Appointment with Specialist

Q4. Getting Care as Soon as Needed




Q20. Spend Enough Time with You

Q6. Getting Appointment as Soon as Needed






M160003 July 2016 11

"Health Plan's Score" is the percent of respondents that answered “Always”, “Usually”; “Yes”

Getting Care

Quickly

How W ell

Doctors Communicate

Shared

DecisionMaking

Getting

NeededCare

Customer

Service


Executive Summary Key Driver Analysis – Health Care


(High Correlation/

Lower Quality Compass® Group)


Continue to Target Efforts

(High Correlation/

Higher Quality Compass® Group)

Q4 - Getting Care as Soon as Needed

Q13. Rating of Health Care Composite

Sample

Size

Health

Plan's

Score

Plan's

Percentile

Q14. Easy to Get Care Believed Necessary 0.59 0.59 239 82.85% 48th

Q4. Getting Care as Soon as Needed 0.45 0.45 163 85.89% 70th


Q32. Treated You with Courtesy and Respect 0.36 0.36 114 95.61% 82nd

Q17. Explain Things in a Way You Could Understand 0.35 0.35 203 89.16% 22nd



Q20. Spend Enough Time with You 0.29 0.29 202 86.14% 16th

Q25. Easy to Get Appointment with Specialist 0.27 0.27 135 73.33% 17th

Q6. Getting Appointment as Soon as Needed 0.27 0.27 223 82.51% 85th

Q12. Asked Preference for Medicine 0.18 0.18 118 71.19% 7th

Q11. Discussed Reasons Not to Take Medicine 0.12 0.12 119 57.98% 1st


0.59

0.45

0.36

0.36

0.35

0.35

0.33

0.29

0.27

0.27

0.18

0.12

0.06

0.0 0.5 1.0
















M160003 July 2016 12


Getting Care

Quickly

How W ell

Doctors Communicate

Shared

DecisionMaking

Getting

NeededCare

Customer

Service

Q27. Rating of Specialist

Health

Plan's

Score

Plan's

Percentile


Q25. Easy to Get Appointment with Specialist 0.33 0.33 73.33% 17th

Q17. Explain Things in a Way You Could Understand 0.30 0.30 89.16% 22nd

Q20. Spend Enough Time with You 0.30 0.30 86.14% 16th


Q12. Asked Preference for Medicine 0.27 0.27 71.19% 7th

Q14. Easy to Get Care Believed Necessary 0.26 0.26 82.85% 48th

Q11. Discussed Reasons Not to Take Medicine 0.25 0.25 57.98% 1st


Q4. Getting Care as Soon as Needed 0.14 0.14 85.89% 70th

Q6. Getting Appointment as Soon as Needed 0.11 0.11 82.51% 85th

Q32. Treated You with Courtesy and Respect 0.07 0.07 95.61% 82nd

Q10. Discussed Reasons to Take Medicine NA NA 92.37% 54th

0.37

0.33

0.30

0.30

0.28

0.27

0.26

0.25

0.21

0.14

0.11

0.07

0.00

0.0 0.5 1.0














Q23. Rating of Personal Doctor

Health

Plan's

Score

Plan's

Percentile

Q20. Spend Enough Time with You 0.63 0.63 86.14% 16th



Q17. Explain Things in a Way You Could Understand 0.49 0.49 89.16% 22nd

Q32. Treated You with Courtesy and Respect 0.40 0.40 95.61% 82nd

Q14. Easy to Get Care Believed Necessary 0.38 0.38 82.85% 48th

Q6. Getting Appointment as Soon as Needed 0.28 0.28 82.51% 85th


Q4. Getting Care as Soon as Needed 0.21 0.21 85.89% 70th

Q25. Easy to Get Appointment with Specialist 0.15 0.15 73.33% 17th

Q11. Discussed Reasons Not to Take Medicine 0.12 0.12 57.98% 1st

Q12. Asked Preference for Medicine 0.05 0.05 71.19% 7th

Q10. Discussed Reasons to Take Medicine NA NA 92.37% 54th

0.63

0.62

0.60

0.49

0.40

0.38

0.28

0.25

0.21

0.15

0.12

0.05

0.02

0.0 0.5 1.0














Executive Summary Key Driver Analysis – Doctor and Specialist



M160003 July 2016 13


Executive Summary Action Plans for Improving CAHPS® Scores Morpace has consulted with numerous clients on ways to improve CAHPS® scores. Even though each health plan is unique and

faces different challenges, many of the improvement strategies discussed on the next few pages can be applied by most plans with

appropriate modifications.

In addition to the strategies suggested below, we suggest reviewing AHRQ’s CAHPS® Improvement Guide, an online resource

located on the Agency for Healthcare Research and Quality website at:




M160003 July 2016 14

GETTING NEEDED CARE (1 of 2)

Easy to get appointment with specialist

• Develop referral guidelines to identify which clinical conditions the PCPs should manage themselves and which should be referred to the

specialists.

• Review authorization and referral patterns for internal barriers to member access to needed specialists. Include Utilization Management staff in

the review process to assist in barrier identification and process improvement development.

• Review Complaint and Grievance information to assess if issues are with the process of getting a referral/authorization to a specialist, or if the

issue is the wait time to get an appointment.

• Include supplemental questions on the CAHPS® survey to determine whether the difficulty is in obtaining the initial consult or subsequent

appointments.

• Include a supplemental question on the CAHPS® survey to determine with which type of specialist members have difficulty making an

appointment.

• Perform a GeoAccess study of your panel of specialists to assure that there are an adequate number of specialists and that they are dispersed

geographically to meet the needs of your members.

• Instruct Provider Relations staff to question PCP office staff regarding which types of specialists they have the most problems scheduling

appointments for their patients.

• Conduct an Access to Care survey to validate appointment availability of specialist appointments.

• Include specialists in a CG-CAHPS Study to determine ease of access as well as other issues with specialist care.

• Develop a worksheet which could be completed and given to the patient by the PCP explaining the need and urgency of the referral as well as

any preparation on the patient’s part prior to the appointment with the specialist. Including the patient in the decision making process improves

the probability that the patient will visit the specialist.

• Develop materials to introduce and promote your specialist network to the PCPs and encourage the PCPs to develop new referral patterns

that align with the network.









Executive Summary Action Plans for Improving CAHPS® Scores (cont’d)



M160003 July 2016 15

GETTING NEEDED CARE (2 of 2)

Easy to get care believed necessary

• Evaluate pre-certification, authorization, and appeals processes. Of even more importance is to evaluate the manner in which the decisions are

communicated to the member. Members may be told that the health plan has not approved specific care, tests, or treatment, but are not being

told why. The health plan should go the extra step to ensure that the member understands the decision and hears directly from them.


• Include a supplemental question on the CAHPS® survey to identify the type of care, test or treatment which the member has a problem

obtaining.

• Review complaints received by Customer Service regarding inability to receive care, tests or treatments. Identify the issues generating the

highest number of complaints and prioritize improvement activities to address these first.

• When care or treatment is denied, care should be taken to ensure that the message is understood by both the provider and the member.

Evaluate language utilized in denial letters and scripts for telephonic notifications of denials to make sure messaging is clear and appropriate for

a lay person. If state regulations mandate denial format and language in written communications, examine ways to also communicate denial

decisions verbally to reinforce reasons for denial.




M160003 July 2016 16

GETTING CARE QUICKLY

Getting care as soon as you needed

• Distribute to members listings of Urgent Care/After Hours Care options available in network. Promote Nurse on Call lines as part of the

distribution. Refrigerator magnets with Nurse On-Call phone numbers and names of participating Urgent Care centers are very effective in this

population.

Getting appointment as soon as needed

• Encourage PCP offices to implement open access scheduling – allowing a portion of each day to be left open for urgent care and follow-up

care.


• Include in member newsletters articles regarding scheduling routine care and check ups and informing members of the average wait time for a

routine appointment for your network.

• Identify for members, PCP, Pediatric and OB/GYN practices that offer evening and weekend hours.

• Encourage PCP offices to make annual appointments 12 months in advance

• Conduct an Access to Care Study

• Calls to physician office - unblinded

• Calls to members with recent claims

• Desk audit by provider relations staff

• Conduct a CG-CAHPS survey to identify offices with scheduling issues




M160003 July 2016 17

HOW WELL DOCTORS COMMUNICATE

Explain things in a way you could understand

• Include supplemental questions from the Item Set for Addressing Health Literacy to identify communication issues.

Listen carefully to you

• Provide the physicians with patient education materials. These materials could reinforce that the physician has heard the concerns of the patient

and/or that they are interested in the well-being of the patient. The materials might also speak to a healthy habit that the physician wants the

patient to adopt, thereby reinforcing the communication and increasing the chances for compliance. Materials should be available in

appropriate/relevant languages and reading levels for the population.

Show respect for what you had to say

• Conduct focus group of members to identify examples of behaviors identified in the questions. Video the groups to show physicians how

patients characterize excellent and poor physician performance.

Spend enough time with you

• Develop “Questions Checklists” on specific diseases to be used by members when speaking to doctors. Have these available in office waiting

rooms or provided by office staff prior to the patient meeting with the doctor. The doctor can review and discuss the checklist during the office

visit.


• Conduct a CG-CAHPS survey to identify physicians for whom improvement plans should be developed.

• Provide communication tips in the provider newsletters. Often, these are better accepted if presented as a testimonial from a patient.




M160003 July 2016 18

SHARED DECISION MAKING

Discussed reasons to take medicine

• Develop patient education materials about common medicines described for your members explaining pros of each medicine.

Examples: asthma medications, high blood pressure medications, statins.

Discussed reasons not to take medicine

• Develop patient education materials about common medicines described for your members explaining cons of each medicine.

Examples: asthma medications, high blood pressure medications, statins.

Asked preference for medicine

• Conduct a CG-CAHPS survey and include the Shared Decision Making Composite as supplemental questions.


• Develop or purchase audio recordings and/or videos of patient/doctor dialogues/vignettes with information about common mediations.

Distribute to provider panel via podcast or other method.




M160003 July 2016 19

HEALTH PLAN CUSTOMER SERVICE

Got information or help needed

• On a monthly basis, study Call Center reports for reasons of incoming calls and identify the primary drivers of calls. Bring together Call Center

representatives and key staff from related operational departments to design interventions to decrease call volume and/or improve member

satisfaction with the health plan.

Treated you with courtesy and respect

• Operationally define customer service behaviors for Call Center representatives as well as all staff throughout the organization. Train staff on

these behaviors.


• Conduct Call Center Satisfaction Survey. Implement a short IVR survey to members within days of their calling customer service to

explore/assess their recent experience.

• Implement a service recovery program so that Call Center representatives have guidelines to follow for problem resolution and atonement.

• Acknowledge that all members who respond that they have called customer service have actually talked to plan staff in other areas than the Call

Center. Promote the idea of customer service is the responsibility for all staff throughout the organization.




M160003 July 2016 20

COORDINATION OF CARE

Personal doctor informed and up-to-date about the care you got from other doctors or other health providers

• Institute process where the plan notifies the PCP when a member is admitted/discharged from a hospital or SNF. Upon discharge, send a copy

of the discharge summary to the PCP.

Coordination of Care is an area in which the health plan can be seen as the partner to the physician in the management of a member’s care. A

plan’s words and actions can emphasize the plan’s willingness to work with the physician to improve the health of their members and to assist the

physician in doing so.

• Offer to work with larger/high volume PCP groups to facilitate EMR connectivity with high volume specialty groups.

• Conduct a referring physician survey with PCPs via the Internet to ascertain the level of communication between PCPs and specific specialists.

• Investigate how the plan can assist the PCP in coordinating care with specialists and ancillary providers.

• Institute a policy and procedure whereby copies of MTM information is faxed/mailed to the member’s assigned PCP.

• Have Provider Relations staff interview PCP office staff as to whether they communicate with Specialist offices to request updates on care

delivered to patients that the PCP referred to the Specialist.

• Encourage PCP offices to assist members with appointment scheduling with specialists and other ancillary providers and for procedures and

tests.

18-24 11%

25-34 18%

35-44 15%

45-54 18%

55-64 34%

65 or older 4%

Male 33%

Female 67%

Excellent/ Very good

27%

Good 35%

Fair/Poor 38%

Executive Summary Demographics

MENTAL/EMOTIONAL HEALTH STATUS


GENDER

HEALTH STATUS

RACE / ETHNICITY

3%

43%

52%

1%

0%

4%

2%

0% 20% 40% 60% 80% 100%

Hispanic or Latino

White

African American

Asian



Other

Excellent/ Very good

27%

Good 27%

Fair/Poor 46%

MEMBER’S AGE EDUCATION

Did not graduate

high school 40%

High School

graduate or GED 39%

Some college or

2-yr degree 18%

4-yr college

graduate 2%

More than 4-year college degree

1%



M160003 July 2016 21

Executive Summary Demographics

2013 2014 2015 2016 2015 Quality

Compass®

Q36. Health Status

Excellent/Very good 24% 28% 29% 27% 34%

Good 31% 28% 27% 27% 33%

Fair/Poor 45% 44% 44% 46% 33%

Q37. Mental/Emotional Health Status

Excellent/Very good 28% 32% 36% 27% 44%

Good 32% 28% 26% 35% 28%

Fair/Poor 39% 40% 38% 38% 28%

Q52. Member's Age

18 to 24 15% 14% 16% 11% 15%

25 to 34 16% 18% 17% 18% 20%

35 to 44 16% 15% 19% 15% 17%

45 to 54 21% 19% 20% 18% 20%

55 to 64 30% 32% 28% 34% 22%

65 or older 2% 2% 1% 4% 6%

Q53. Gender

Male 32% 28% 25% 33% 35%

Female 68% 72% 75% 67% 65%

Q54. Education

Did not graduate high school 40% 40% 39% 40% 25%

High school graduate or GED 36% 37% 38% 39% 38%

Some college or 2-year degree 20% 20% 19% 18% 28%

4-year college graduate 2% 2% 3% 2% 6%

More than 4-year college degree 1% 1% 1% 1% 3%

Q55/56. Race/Ethnicity

Hispanic or Latino 3% 5% 5% 3% 17%

White 45% 43% 44% 43% 53%

African American 51% 52% 49% 52% 23%

Asian 1% 2% 2% 1% 5%

Native Hawaiian or other Pacific Islander 0% 0% 0% 0% 2%

American Indian or Alaska Native 6% 7% 6% 4% 4%

Other 3% 2% 3% 2% 9%




M160003 July 2016 22

Executive Summary General Knowledge about Demographic Differences

Age

Older respondents tend to be more satisfied with their health care experience and health plan than younger

respondents. The older population scores significantly higher in the following areas: Getting Care Quickly, Getting

Needed Care, Customer Service, Coordination of Care (Q22), all rating questions, and obtaining the flu shot or

spray.

Health Status

People who rate their health status as ‘Excellent’ or ‘Very good’ tend to be more satisfied than people who rate

their health status lower. The ‘Excellent/Very good’ group scores higher in the following areas: Shared Decision

Making, How Well Doctors Communicate, Getting Needed Care, all rating questions, and Coordination of Care

(Q22). The exceptions are Getting appointment as soon as needed (Q6) and obtaining the flu shot or spray,

where members rating their health status ‘Fair/Poor’ had significantly higher responses.

Education

Scores do not vary much when comparing education level. Shared Decision Making is the only composite where

the more educated members have a significantly higher score. Less educated members have a significantly

higher score for Coordination of Care (Q22), Rating of Personal Doctor, and Rating of Health Plan.

Race and ethnicity effects are independent of education and income. Lower income generally predicts lower satisfaction with coverage

and care.

Race

Whites tend to give higher ratings to both rating and composite questions than African Americans or the ‘All other’

group. Significantly higher scores are noted for Whites in the following composites: Getting Care Quickly and

Getting Needed Care. Scores for ‘All other’ tend to be lower across the board.

Morpace Book of Business: White - 53%; African American - 31%; All other - 18%

Growing evidence denotes that lower satisfaction ratings from Asian Americans are partially attributable to cultural

differences in their response tendencies. Therefore, the lower scores for ‘All other’ might not reflect an accurate

comparison of their experience with health care.

Ethnicity

Little difference is seen between the scores for Hispanics and Non-Hispanics for the majority of measures. Non-

Hispanics have significantly higher scores for Getting Care Quickly, whereas Hispanics have significantly higher

scores for all rating questions, as well as a higher number of members obtaining the flu shot or spray.

Hispanics make up 20% of the Morpace Book of Business.

The commentary below is based on the 2016 Morpace Adult Medicaid Book of Business:



M160003 July 2016 23

Executive Summary Composite & Rating Scores by Demographics

Age Race Ethnicity Educational Level Health Status

Demographic 18-34 35-54 55+ White African

American

All

other Hispanic

Non-

Hispanic

HS Grad

or Less

Some

College+

Excellent/

Very Good Good

Fair/

Poor

Sample size (n=83) (n=98) (n=110) (n=126) (n=151) (n=19) (n=9) (n=266) (n=225) (n=60) (n=77) (n=75) (n=131)

Composites (% Always/Usually)

Getting Care Quickly 81 91 80 83 83 92 63 85 83 90 93 79 83

Shared Decision Making (% Yes)

75 76 71 78 69 75 83 74 71 80 81 70 74

How Well Doctors

Communicate 95 88 87 85 92 100 75 89 89 91 93 88 87

Getting Needed Care 75 81 77 75 79 82 90 78 79 78 86 80 73

Customer Service 88 88 90 89 88 95 100 89 90 87 91 85 89

Overall Ratings (% 8,9,10)

Health Care 77 70 70 73 69 100 100 71 73 65 83 66 70

Personal Doctor 77 73 82 79 75 92 75 77 76 81 93 70 72

Specialist 77 86 86 91 77 83 100 83 81 91 93 72 86

Health Plan 73 74 83 73 79 83 100 76 78 72 90 71 73



M160003 July 2016 24

HEDIS® Measures

Flu Vaccinations for

Adults Ages 18 – 64

Medical Assistance with

Smoking and

Tobacco Use Cessation

Aspirin Use and

Discussion



M160003 July 2016 25

• In 2014, the Flu Vaccinations for Adults Ages 18-64 Measure (FVA) was added to the Medicaid product line.

• The Flu Vaccinations for Adults Ages 18-64 Measure is designed to report the percent of members:

– who are between the ages of 18-64 as of July 1st of the measurement year

– who were continuously enrolled during the measurement year, and

– who received an influenza vaccination or flu spray between July of the measurement year and the date on which the survey was completed

• Results for this measure are calculated using data collected during the measurement year.

• All members in the sample are asked to answer this question but only the members that meet the age criteria will be included in the results for this

measure. Below are the 2016 Reported Results. See Technical Notes for Accreditation Scoring.

Flu Vaccinations for Adults Ages 18 – 64

2016

Reported Results*

Q38. Have you had either a flu shot or flu spray in the nose since July 1, 2015?

Members that meet age criteria

(results are not reportable if less than 100) 271

Members that meet age criteria and received a flu vaccination 95

Flu Vaccinations for Adults Rate 35%

* The 2016 Reported Result is calculated using results collected during the measurement year. There must be a total of 100 or more respondents eligible for calculation in the

measurement year for the rate to be reportable. This measure became eligible for public reporting in 2015.

2015 Quality Compass®

Mean 5th 10th 25th 50th 75th 90th 95th

39.49 27.42 30.04 35.14 39.04 44.83 48.96 50.52



M160003 July 2016 26

Plan Score:

24th Percentile

Medical Assistance with Smoking & Tobacco Use Cessation Advising Smokers and Tobacco Users to Quit

• In 2010, the Medical Assistance with Smoking Cessation measure was revised and is now called the Medical Assistance with Smoking and Tobacco Use

Cessation (MSC) measure. The scope of the measure was expanded to include smokeless tobacco use and revised the question response choices. This

measure consists of the following components that assess different facets of providing medical assistance with smoking and tobacco use cessation:

– Advising Smokers and Tobacco Users to Quit

– Discussing Cessation Medications

– Discussing Cessation Strategies

• Criteria for inclusion in this measure are members who are at least 18 years old, who were either current smokers, tobacco users, or recent quitters, who were

seen by an MCO practitioner during the measurement year, and who received advice on quitting smoking/tobacco use.

2015 2016 2016 Reported Results*

Q40. Advising Smokers and Tobacco Users to Quit

Members that meet criteria (results are not reportable if less than 100) 140 115 255

Members that meet criteria and were advised to quit smoking or using tobacco 110 90 200

Advising Smokers and Tobacco Users to Quit Rate 79% 78% 78%

*The Reported Results are calculated using a rolling average methodology, using results collected during two consecutive years of data collection. The Reported Results

were calculated for the first time in 2011.



75.79 65.20 67.57 73.60 76.74 79.41 81.91 84.18



M160003 July 2016 27

Plan Score:

63rd Percentile

Medical Assistance with Smoking & Tobacco Use Cessation Discussing Cessation Medications


seen by an MCO practitioner during the measurement year, and who discussed smoking/tobacco use cessation medications.


Q41. Discussing Cessation Medications


Members that meet criteria and discussed medications to quit smoking or using tobacco 56 55 111

Discussing Cessation Medications Rate 40% 48% 44%





46.75 34.29 36.31 41.76 46.70 51.91 57.45 58.61



M160003 July 2016 28

Plan Score:

33rd Percentile

Medical Assistance with Smoking & Tobacco Use Cessation Discussing Cessation Strategies


seen by an MCO practitioner during the measurement year, and who discussed smoking/tobacco use cessation medications or strategies with their doctor.


Q42. Discussing Cessation Strategies


Members that meet criteria and discussed methods & strategies to quit smoking or using tobacco 66 47 113

Discussing Cessation Strategies Rate 48% 41% 45%





42.46 29.79 33.59 38.18 42.50 47.60 51.21 53.27



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Plan Score:

62nd Percentile

Aspirin Use and Discussion (ASP) • In 2010, Aspirin Use and Discussion (ASP) was added to assess different facets of managing aspirin use for the primary prevention of

cardiovascular disease.

• This measure is not yet approved to be publicly reported for Adult Medicaid plans. The Aspirin results are calculated

using a rolling average methodology, using results collected during two consecutive years of data collection.

• Criteria for inclusion in the Aspirin Use measure are:

– Women 56-79 years of age with at least two risk factors for cardiovascular disease

– Men 46-65 years of age with at least one risk factor for cardiovascular disease

– Men 66-79 years of age, regardless of risk factors

• Criteria for the Discussing Aspirin Risks/Benefits measure are:

– Women 56-79 years of age

– Men 46-79 years of age

*The Reported Results are calculated using a rolling average methodology, using results collected during two consecutive years of data collection. The Rolling Average was

calculated for the first time in 2011 and is not yet approved for public reporting.

2015 2016

2016 Rolling Average

Results*

Q43. Aspirin Use

Members that meet criteria (results are not reportable in 2016) 30 22 52

Members that meet criteria and use aspirin for preventative measures 14 8 22

Aspirin Use Rate 47% 36% 42%

Q45. Discussing Aspirin Risks and Benefits

Members that meet criteria (results are not reportable in 2016) 52 46 98

Members that meet criteria and provider discussed risks/benefits of aspirin use for preventative

measures 25 22 47

Discussing Aspirin Risks and Benefits Rate 48% 48% 48%



M160003 July 2016 30

Supplemental Questions



M160003 July 2016 31

Supplemental Questions – Emergency Room

2015 2016

Injury/illiness required emergency care not available in doctor's office NA 27%

Doctor's office instructed you to the emergency room NA 24%

Unable to reach doctor's office NA 18%

Unable to get same-day appointment in doctor's office for illness/injury NA 16%

Unable to locate an Urgent Care Center NA 5%

I felt it was an emergency 66% NA

I did not know where the nearest urgent care center was 4% NA

Other 7% 25%


Q59. What was the reason you used the emergency room?*

(Multiple Mentions)

*Question text was different in 2015.



M160003 July 2016 32

Supplemental Questions – Language, Culture, and Ethnicity

2016

Always 11%

Usually 3%

Sometimes 9%

Never 77%


Q60. In the last 6 months, how often was it hard to find

a personal doctor who speaks your language?

2016

Always 12%

Usually 5%

Sometimes 10%

Never 73%


Q61. In the last 6 months, how often was it hard to find

a personal doctor who knows your culture?

2016

Always 2%

Usually 1%

Sometimes 6%

Never 92%


Q62. In the last 6 months, how often have you been treated

unfairly at your personal provider's office

because of your race or ethnicity?



M160003 July 2016 33

Supplemental Questions – Specialist

2016

Appointment times were not available soon enough 29%

The specialist's office is located too far away 28%

The specialist I needed to see was out of network 19%

Unreasonable amount of time spent in exam room while waiting to see the doctor 16%

Not enough specialists to choose from 15%

I did not know what type of specialist to see 10%

Office hours were inconvenient 7%

I thought I needed a referral, but did not 6%

I had difficulty reaching the specialist's office by telephone 4%

Other 26%

Sample Size: (n=69)

Q63. In the last 6 months, which of the following contributed to the problem

you experienced with seeing a specialist?

(Multiple Mentions)



M160003 July 2016 34


2016

Yes 16%

No 82%

Don't Know 2%


Q64. Have you visited AmeriHealth Caritas Louisiana's website to

get information?



M160003 July 2016 35


2016

Benefits and covered services 51%

Provider information 48%

Prescription drug information 23%

Membership 11%

Referrals 11%

Co-payment, co-insurance and deductible information 6%

Health management programs 6%

Claims information 6%

Other 14%

Sample Size: (n=65)

Q65. What type of information were you seeking when you visited the

AmeriHealth Caritas Louisiana website?

(Multiple Mentions)



M160003 July 2016 36

Supplemental Questions – Communication

2015 2016

By postal mail 44% 82%

A phone call from someone at the plan NA 36%

By email 12% 11%

By text message 11% 11%

Mobile phone app NA 5%

On the plan's website NA 2%

Mobile phone number 49% NA

Home phone number 26% NA


Q66. When your plan needs to share information with you, how do

you prefer to receive this information?*

(Multiple Mentions)

*Question text was different in 2015.



M160003 July 2016 37

Supplemental Questions – Recommendation

2015 2016

Definitely would 60% 66%

Probably would 28% 24%

Might or might not 7% 7%

Probably would not 3% 2%

Definitely would not 2% 1%


Q67. Which of the following best describes your willingness to

recommend AmeriHealth Caritas Lousiana

to a friend or family member?



M160003 July 2016 38

2016 cahps child medicaid with ccc executive summary€¦ · executive summary summary of key...

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