arizona health care cost containment system administrator meeting

“Reaching across Arizona to provide comprehensive quality health care for those in need”

Arizona Health Care Cost Containment System

Administrator Meeting

Quality Update

March 19, 2014


CAHPS CHPRA legislation required State Medicaid programs to conduct a CAHPS member

satisfaction survey by December 2013 for the CHIP (KidsCare) population The AHCCCS 2011 Demonstration Waiver requires AHCCCS to conduct the CAHPS

survey for: KidsCare in 2013 and at the end of the Waiver (2015) SMI Integrated Population - pre-integration, mid-Waiver and at the end of the

Waiver CRS Integrated Population - pre-integration, mid-Waiver and at the end of the

Waiver

Goal: The goal of the CAHPS Health Plan Survey is to provide performance feedback that is actionable and that will aid in improving overall member satisfaction


CAHPS Baseline Measurement The 2013 CAHPS results represent a baseline assessment of

member’s (or their parents’/caretakers’) satisfaction with the AHCCCS program across the following lines of business: KidsCare Acute Seriously Mentally Ill (pre-integration) Children’s Rehabilitative Services (pre-integration)

The CAHPS was completed by the CMS External Quality Review Organization, Health Services Advisory Group


CAHPS Survey Tool In 2012, the Agency for Healthcare Research and Quality (AHRQ) released the

CAHPS 5.0 Medicaid Health Plan Surveys The National Committee for Quality Assurance (NCQA) introduced new HEDIS

versions of the Child Health Plan Surveys in August 2012, which are referred to as the CAHPS 5.0 Child Medicaid Health Plan Surveys

There were no changes made to the four CAHPS global ratings: Rating of Health Plan Rating of All Health Care Rating of Personal Doctor, and Rating of Specialist Seen Most Often

This allowed comparisons to national data to be performed for all global rating categories


CAHPS Composite Measures Getting Needed Care Getting Care Quickly How Well Doctors Communicate Customer Service Shared Decision Making Coordination of Care Health Promotion and Education Children with Chronic Conditions


Scoring Methodology The results of the health plan surveys were scored using the

NCQA Star Ratings National Medicaid results. The rating scale is as follows:

***** 90th Percentile or above **** 75th – 89th Percentile *** 50th – 74th Percentile ** 25th – 49th Percentile * Below 25th Percentile For the children’s measures, the rates and proportions were

compared to NCQA Child Medicaid Quality Compass data


KidsCare CAHPS Results Results are at the Program Level only The KidsCare program scored at or above the national

average on seven measures: Rating of Health Plan Rating of All Health Care Rating of Specialist Seen Most Often Getting Needed Care Getting Care Quickly How Well Doctors Communicate Customer Service


KidsCare CAHPS Opportunities for Improvement

Based on the results of the NCQA comparisons, priority assignments were derived for each measure

The following are the high priority areas for KidsCare: Getting Care Quickly How Well Doctors Communicate Rating of Specialist Seen Most Often


KidsCare High and Low Percentile Results KidsCare scored at or above the 90th

percentile on one measure: Rating of All Health Care

KidsCare scored below the 25th percentile on none of the measures


Acute Care Program Adult and Child Medicaid CAHPS Results Acute Care Program: Results are at the Program Level and

the Health Plan Level Arizona Physicians IPA Bridgeway Health Solutions Department of Economic Security/Comprehensive Medical and Dental Program

(DES/CMPD) Care 1st Health Plan of Arizona Health Choice Arizona Maricopa Health Plan Mercy Care Plan Phoenix Health Plan University Family Care Acute Care Program Aggregate


CAHPS Adult Composite Results – NCQA Comparison

Contractor Name

Rating of Health Plan

Rating of all Health Care

Rating of Personal Doctor

Rating of Specialist Seen

Most Often

Acute Care Program

***2.402

***2.347

**2.454

***2.504

Arizona Physicians IPA

*****2.562

*****2.472

****2.548

*****2.574

Bridgeway Health

Solutions

*2.311

**2.295

****2.511

***2.477

Care 1st Health Plan of Arizona

**2.389

***2.320

**2.423

*2.391

Health Choice Arizona

*2.309

***2.331

*2.405

*2.408

Maricopa Health Plan

**2.392

***2.347

**2.453

***2.510

Mercy Care Plan

***2.437

***2.330

**2.422

***2.494

Phoenix Health Plan

**2.344

*2.248

*2.385

****2.553

University Family Care

****2.468

*****2.423

***2.473

*****2.622


CAHPS Adult Composite Results – NCQA Comparison

Contractor Name

Getting Needed Care

Getting Care Quickly

How Well Doctors

Communicate

Customer Service

Acute Care Program

***2.325

**2.370

***2.553

****2.510


****2.401

****2.403

****2.599

****2.486

Bridgeway Health

Solutions

***2.320

***2.437

****2.611

***2.459


**2.268

**2.376

***2.574

****2.480


***2.296

**2.392

**2.516

***2.450


****2.389

**2.355

**2.524

*****2.569

Mercy Care Plan

***2.306

*2.312

**2.509

****2.484

Phoenix Health Plan

**2.264

**2.342

**2.491

*****2.573


****2.360

**2.333

****2.589

*****2.564


Health Plan Satisfaction Ranking Based on Number of Adult Measures at or Above the NCQA National Average

Health Plan Number of Measures At or Above the National Average

Arizona Physicians IPA 9Acute Care Program Overall 7Bridgeway Health Solutions 7

University Family Care 7Health Choice Arizona 4

Care 1st Health Plan 3Maricopa Health Plan 3

Mercy Care Plan 3Phoenix Health Plan 3


Adult Acute Care Health Plan NCQA Comparison Highlights


Bridgeway Health Solutions




↑ Rating of Health Plan

↓ Rating of Health Plan

↓ Health Promotion and Education

↓ Rating of Health Plan

↑ Rating of Health Plan

↑ Rating of All Health Care

↑ Coordination of Care

↑ Rating of Specialist Seen Most Often

↑ Rating of Personal Doctor

↑ Health Promotion and Education

↑ Statistically better than the Acute Care Program average ↓ Statistically worse than the Acute Care Program average


CAHPS Child Composite Results – NCQA ComparisonContractor

NameRating of

Health PlanRating of all Health Care


Rating of Specialist Seen

Most Often

Acute Care Program

****2.627

*****2.624

****2.680

****2.642


*****2.694

*****2.699

*****2.706

*****2.736

Bridgeway Health

Solutions

**2.565

*****2.591

****2.680

*2.516


***2.620

*****2.636

****2.673

*****2.776

DES/CMDP *2.499

*****2.625

****2.650

**2.542


***2.602

***2.541

****2.667

****2.622


****2.665

*****2.597

****2.655

****2.653

Mercy Care Plan

*****2.683

*****2.646

*****2.705

****2.642

Phoenix Health Plan

****2.628

*****2.635

****2.672

*****2.673


****2.653

*****2.646

*****2.698

***2.593


CAHPS Child Composite Results – NCQA Comparison

Contractor Name Getting Needed Care

Getting Care Quickly

How Well Doctors

Communicate

Customer Service

Acute Care Program ***2.44

**2.599

**2.671

****2.546

Arizona Physicians IPA *****2.525

**2.592

***2.710

****2.529


***2.393

***2.642

***2.717

****2.554


***2.360

*2.523

*2.601

****2.527

DES/CMDPCustomer service had

fewer than 100 respondents

*****2.562

*****2.810

****2.747

*****2.641

Health Choice Arizona ***2.373

**2.573

*2.623

***2.493

Maricopa Health Plan ****2.469

*2.442

*2.551

****2.514

Mercy Care Plan ***2.416

**2.585

***2.697

****2.516

Phoenix Health Plan ***2.443

***2.623

**2.671

*****2.649

University Family Care ****2.484

***2.633

***2.719

****2.544


Health Plan Satisfaction Ranking Based on Number of Child Measures at or Above the NCQA National Average

Health Plan Number of Measures At or Above the National Average

Phoenix Health Plan 9Acute Care Program Overall 8

Arizona Physicians IPA 8Bridgeway Health Solutions 8

Mercy Care Plan 8University Family Care 8

Care 1st Health Plan 6DES/CMDP 6

Health Choice Arizona 6Maricopa Health Plan 6


Health Plan Satisfaction Ranking Based on Number of Child Measures at or Above the NCQA National Average

Health Plan Number of Measures Above the 90th Percentile

Number of Measures Below the 25th Percentile

Acute Care Program Overall 1 0Arizona Physicians IPA 5 0

Bridgeway Health Solutions 1 1Care 1st Health Plan of

Arizona2 2

DES/CMDP 4 1Health Choice Arizona 0 2Maricopa Health Plan 1 2

Mercy Care Plan 3 0Phoenix Health Plan 3 0

University Family Care 2 0


Child Acute Care Health Plan NCQA Comparison Highlights

Health Plan Rating of Health Plan

Rating of All Health

Care


Rating of Specialist

Seen Most Often

Getting Needed

Care

Getting Care

Quickly

How Well Doctors

Communicate

Customer Service

Shared Decision Making


74.4% ↑ 75.6% ↑ 76.4% 79.1% 87.85 87.2% 93.7% 85.9% 58.6%


65.4% ↓ 65.6% 73.2% 67.1% 82.3% 91.5% ↑ 95.4% ↑ 89.6% 60.4%

Care 1st Health plan of Arizona

69.2% 69.6% 74.0% 83.5% 80.6% 84.5% ↓ 90.6% 88.9% 52.0%

DES/CMDP* had fewer than 100 respondents

63.0% ↓ 71.0% 73.9% 66.3%* 87.5% 96.2% ↑ 94.3% 93.6%* ↑ 52.8%


68.2% 63.4% ↓ 73.8% 73.2% 80.4% 89.1% 90.7% 86.3% 49.2% ↓


73.9% 67.9% 73.2% 76.0% 85.7% 80.4% ↓ 87.9% ↓ 87.1% 53.8%

Mercy Care Plan

73.8% ↑ 71.0% 76.2% 73.7% 81.7% 87.9% 93.6% 85.9% 57.3%

Phoenix Health Plan

70.8% 69.1% 74.2% 73.8% 85.8% 90.1% 91.9% 91.9% ↑ 54.6%


72.2% 71.8% 76.2% 70.4% 84.2% 89.6% 92.3% 86.6% 60.2%


CAHPS Results for the Seriously Mentally Ill (SMI) Program

Pre-integration – reflects care in both the physical and the behavioral health plans

Star Rating Measure* Getting Care Quickly

* How Well Doctors Communicate

* Rating of All Health Care

* Rating of Health Plan

* Rating of Personal Doctor

* Rating of Specialist Seen Most Often

** Customer Service

** Getting Needed Care

** 25th – 49th Percentile *Below 25th Percentile


Health Care Satisfaction Ranking Based on Number of SMI Measures at or Above the NCQA National Average

The SMI members cored their health care at or above the national average on two measures: Getting Needed Care Customer Service

The SMI members scored their health care below the national average on seven measures: Rating of Health Plan Rating of All Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Getting Care Quickly How Well Doctors Communicate Coordination of Care


High and Low Percentile Scores of SMI Member CAHPS Survey Results

The SMI Program scored at or above the 90th percentile on none of the measures

The SMI Program scored below the 25th percentile on six measures: Rating of Health Plan Rating of All Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Getting Care Quickly How Well Doctors Communicate


SMI Program’s Priority Assignments to Improve Member Satisfaction

Measure NCQA Comparisons (Star Ratings)

Priority Assignments

Getting Care Quickly * TopHow Well Doctors Communicate

* Top

Rating of All Health Care

* Top

Rating of Health Plan * TopRating of Personal Doctor

* Top

Rating of Specialist Seen Most Often

* Top

Customer Service ** HighGetting Needed Care ** High


CAHPS Results for the Children’s Rehabilitative Services Program – NCQA Comparison

Star Rating Measure

** Getting Care Quickly** How Well Doctors Communicate** Customer Service* Rating of Health Plan

** 25th – 49th Percentile *Below 25th Percentile


CRS Program CAHPS Comparison to NCQA Averages

Results reflect pre-integration member satisfaction with an acute, CRS and behavioral health Contractor

The CRS Program scored at or above the national average on eight measures: Rating of All Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Getting Needed Care Getting Care Quickly How Well Doctors Communicate Customer Service Coordination of Care

The CRS Program scored below the national average on one measures: Rating of Health Plan


High and Low Percentile Scores of CRS Members’ CAHPS Survey Results

The CRS Program scored at or above the 90th percentile on two measures” Rating of Personal Doctor Rating of Specialist Seen Most Often

The CRS Program scored below the 25th percentile on one measure: Rating of Health Plan


CRS Program’s Priority Assignments to Improve Member Satisfaction

Measure NCQA Comparisons (Star Ratings)

Priority Assignments

Rating of Health Plan * TopCustomer Service ** HighHow Well Doctors Communicate

** High

Getting Care Quickly ** HighGetting Needed Care *** ModerateRating of All Health Care

***** Low


***** Low

Rating of Specialist Seen Most Often

***** Low


CAHPS Survey Results Next Steps Contractors should review results and identify top

priorities/opportunities to improve member satisfaction results Contractors should review positive results and determine what

the drivers were for the results AHCCCS will notify Contractors of need to submit action

plans to improve member satisfaction with its health plan AHCCCS will identify priorities to improve systemic member

satisfaction AHCCCS will work with Contractors in the development of

action plans to improve systemic member satisfaction

arizona health care cost containment system administrator meeting

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