NEW YORK STATE DEPARTMENT OF HEALTH
Office of Quality and Patient Safety
Plan – Technical Report
For
Total Aging in Place
Reporting Years 2013 and 2014
February 2017
Table of Contents Section One: About This Report ................................................................................................................... 1 Section Two: Plan Profile ............................................................................................................................. 3 Section Three: Enrollment ........................................................................................................................... 4 Section Four: Member Satisfaction .............................................................................................................. 5 Section Five: SAAM and UAS ........................................................................................................................ 8 Section Six: Performance Improvement Projects ...................................................................................... 13 Section Seven: Overall Strengths and Opportunities .................................................................................. 17 Section One: About This Report New York State (NYS) is dedicated to providing and maintaining the highest quality of care for enrollees in managed long term care (MLTC) plans. MLTC enrollees are generally chronically ill, often elderly enrollees and are among the most vulnerable New Yorkers. The New York State Department of Health’s (NYSDOH) Office of Quality and Patient Safety (OQPS) employs an ongoing strategy to improve the quality of care provided to plan enrollees, to ensure the accountability of these plans and to maintain the continuity of care to the public. The MLTC Plan‐Technical Reports are individualized reports on the MLTC plans certified to provide Medicaid coverage in NYS. The reports are organized into the following domains: Plan Profile, Enrollment, Member Satisfaction, SAAM and UAS Clinical Assessment Data, and Performance Improvement Projects (PIPs). When available and appropriate, the plans’ data in these domains are compared to statewide benchmarks. The final section of the report provides an assessment of the MLTC plan’s strengths and opportunities for improvement in the areas of service quality, accessibility, and timeliness. For areas in which the plan has opportunities for improvement, recommendations for improving the quality of the MLTC plan’s services are provided. During the review period of this report (2013‐14), there were three (3) MLTC plan types: a) Partially Capitated b) Program of All‐inclusive Care for the Elderly (PACE) c) Medicaid Advantage Plus (MAP) A description of each of the plan types follows: Partially Capitated ‐ A Medicaid capitation payment is provided to the plan to cover the costs of long term care and selected ancillary services. The member’s ambulatory care and inpatient services are paid by Medicare if they are dually eligible for both Medicare and Medicaid, or by Medicaid if they are not Medicare eligible. For the most part, those who are only eligible for Medicaid receive non‐MLTC services through Medicaid fee for service, as members in partially capitated MLTC plans are ineligible to join a traditional Medicaid managed care plan. The minimum age requirement is 18 years. PACE ‐ A PACE plan provides a comprehensive system of health care services for members 55 and older, who are otherwise eligible for nursing home admission. Both Medicaid and Medicare pay for PACE services on a capitated basis. Members are required to use PACE physicians. An interdisciplinary team develops a care plan and provides ongoing care management. The PACE plan is responsible for directly providing or arranging all primary, inpatient hospital and long term care services required by a PACE member. The PACE is approved by the Centers for Medicare and Medicaid Services (CMS). Medicaid Advantage Plus (MAP) ‐ MAP plans must be certified by the NYSDOH as MLTC plans and by CMS as a Medicare Advantage plan. As with the PACE model, the plan receives a capitation payment from both Medicaid and Medicare. The Medicaid benefit package includes the long term care services and the Medicare benefit package includes the ambulatory care and inpatient services. 1
An MLTC plan can service more than one of the above products and, where applicable, the report will present data for each product. In an effort to provide the most consistent presentation of this varied information, the report is prepared based upon data for the most current calendar year available. Where trending is desirable, data for prior calendar years may also be included. This report includes data for reporting years 2013 and 2014.
2
Section Two: Plan Profile Total Aging in Place (TAIP) is a regional, partially capitated Managed Long‐Term Care (MLTC) plan, and is an affiliate of the Weinberg Campus, an organization providing healthcare and housing programs for the elderly and disabled in the Buffalo, NY area. The following report presents plan‐specific information.  Partially Capitated Plan ID: 02188296  Managed Long‐Term Care Start Date: 2003  Product Line(s): Partially Capitated  MLTC Age Requirement: 21 and older  Contact Information: 461 John James Audubon Parkway Amherst, NY 14228 (855) 665‐1112 Participating Counties and Programs Erie Part Cap
Niagara
3
Part Cap
Section Three: Enrollment Figure 1 depicts membership for TAIP’s partially capitated product line for calendar years 2012 to 2014, as well as the percent change from the previous year (the data reported are from December of each of these years). Membership in the partially capitated plan decreased by 7.0% from 2012 to 2013 and increased by 23.5% from 2013 to 2014. Figure 1a trends the enrollment for the partially capitated product line. Figure 1: Membership: Partially Capitated 2012‐2014 2012
Partially Capitated
Number of Members 128
% Change From Previous Year ‐0.8%
2013
2014
119
‐7.0%
147
23.5%
Figure 1a: Enrollment Trends 2012‐2014 Total Aging in Place Enrollment 2012‐2014
160
Number of Members
140
147
128
120
119
100
80
60
Part Cap
40
20
0
2012
2013
2014
Year
4
Section Four: Member Satisfaction IPRO, in conjunction with the NYSDOH, conducted a member satisfaction survey mailed between December 2014 and May 2015. The NYSDOH provided the member sample frame for the survey, which included the primary language for the majority of members. From this file, a sample of 600 members from each plan was selected, or the entire membership if the plan’s enrollment was less than 600. Of the 18,909 surveys that were mailed, 1,109 were returned as undeliverable due to either mailing address issues or the member being deceased. This yielded an adjusted population of 17,800. A total of 4,592 surveys were completed, yielding an overall response rate of 25.8%. The response rate for TAIP’s partially capitated product line was 28.4% (27 respondents out of 95 members in the sample). IPRO had previously conducted a similar satisfaction survey that was mailed between December 2012 and May 2013. Figure 2 represents the results of these two satisfaction surveys for TAIP’s partially capitated product line, compared with all other partially capitated plans throughout the state, as well as all MLTC plans statewide, in the areas of plan rating, quality ratings for key services, timeliness of critical services, access to critical services, and advance directives. 5
Figure 2: Satisfaction Survey Results Overall Part Cap
TAIP TAIP Compared with all Partially 2012‐2013 2012‐2013 (N=1,662)a Capitated Plans, and all Plans (N=21)a Statewide Description nb % nb % c
1,439
87%
Plan requested list of Rx/OTC meds ** 13
85%
Plan explained the Consumer Directed ‐
‐
‐
‐
Personal Assistance option ++ Plan rated as good or excellent 21c
67%
1,625
84%
Quality of Care Rated as Good or Excellent Dentist 14c
57%
1,009
71%
c
Eye Care‐Optometry 15
67%
1,279
82%
c
Foot Care 14
50%
1,087
82%
c
Home Health Aide 12
75%
1,358
88%
c
Care Manager 18
83%
1,389
84%
Regular Visiting Nurse 10c
70%
1,420
84%
c
Medical Supplies 19
74%
1,185
85%
c
Transportation Services 18
72%
1,242
77%
Timeliness‐ Always or Usually On Time Home Health Aide, Personal Care Aide 13c
69%
1,258
79%
c
Care Manager 16
69%
1,225
70%
c
Regular Visiting Nurse 11
64%
1,351
70%
c
Transportation TO the Doctor 10
70%
1,147
68%
c
Transportation FROM the Doctor 10
70%
1,124
67%
Access to Routine Care (<1 Month) Dentist 10c
40%
832
47%
c
Eye Care/Optometry 10
40%
1,093
43%
c
Foot Care/Podiatry 8
13%
932
45%
Access to Urgent Care (Same Day) Dentist 6c
0%
612
28%
c
Eye Care/Optometry 4
0%
788
25%
c
Foot Care/Podiatry 7
0%
692
27%
Advance Directives Plan has discussed appointing someone 16c
69% 1,346
64%
to make decisions 6
Statewide 2012‐2013 (N=2,522)a TAIP 2014‐2015 (N=27)a Overall Part Cap
2014‐2015 (N=3,306)a Statewide 2014‐2015 (N=4,592)a nb 2,197
% 88%
nb 12c
% 100%
nb 2,677
% 94%
nb 3,702
% 94% ‐
‐
5c
0% 1,831
77%
2,495
75% 2,458
84%
15c
73%
2,688
87%
3,739
87% 1,530
1,951
1,640
2,056
2,108
2,132
1,844
1,916
70%
81%
80%
87%
84%
84%
86%
78%
13c
14c
13c
14c
14c
14c
14c
13c
77%
71%
62%
64%
71%
57%
86%
54%
1,669
2,167
1,903
2,437
2,479
2,412
2,066
2,000
73%
81%
83%
87%
83%
83%
82%
77%
2,382
3,079
2,637
3,351
3,445
3,355
2,937
2,853
73% 82% 83% 87% 83% 83% 82% 77% 1,897
1,876
2,027
1,766
1,742
78%
69%
69%
69%
67%
13c
11c
10c
11c
11c
77%
64%
60%
91%
73%
2,471
2,270
2,297
1,763
1,753
92%
83%
81%
81%
78%
3,385
3,144
3,177
2,515
2,505
93% 83% 81% 81% 78% 1,234
1,647
1,390
46%
43%
45%
7c
10c
8c
71%
90%
88%
1,323
1,767
1,608
75%
80%
82%
1,873
2,486
2,220
73% 79% 80% 920
1,195
1,039
26%
22%
26%
6c
9c
8c
17%
11%
0%
1,062
1,497
1,368
31%
34%
35%
1,526
2,165
1,912
29% 33% 34% 2,087
68%
21c
81%
2,660
64%
3,757
67% Member has legal document appointing someone to make decisions Health plan has a copy of this document ◊ 18c
100% 1,387
55%
2,145
61%
23c
91%
2,645
53%
3,722
58% 13c
100%
533
74%
956
77%
15c
93% 913
75%
1,506
79% LEGEND Description N reflects the total number of members who completed the survey n reflects the total number of members who responded to each survey item ** Represents question that has been added to the 2013‐2014 technical report ++ ◊ Represents new question in 2014‐2015 survey Item based on a skip pattern Significance testing could not be performed due to small sample size (n<30) Symbol a
b
c Due to the fact that there was a small sample of members who responded to this survey (21 members in 2012/2013 and 27 members in 2014/2015), statistical significance testing could not be employed. It is therefore recommended that the observations made from the results in Table 2 be interpreted with caution. There was an improvement in satisfaction across the majority of categories of care from 2012/2013 to 2014/2015. This difference was especially notable in access to routine care. In contrast, there was a decline in the percent of members who indicated the quality of their transportation services were good or excellent. In the most recent satisfaction survey administered to Total Aging in Place’s membership, there was a noticeable difference between the percent of Total Aging in Place members who reported having a legal document appointing a healthcare proxy when compared to members enrolled in other partially capitated plans and all members statewide (91% vs. 53% and 58%, respectively). Additionally, a higher percentage of Total Aging in Place’s members reported that the plan had discussed appointing someone to make healthcare decisions with them, compared with other partially capitated members and members statewide (81% vs. 64% and 67%, respectively). 7
Section Five: SAAM and UAS The Semi Annual Assessment of Members (SAAM) was the assessment tool utilized by the MLTC plans to conduct clinical assessments of members, at start of enrollment and at six month intervals thereafter, through 2013. There are fifteen (15) care categories, or domains, in SAAM, as follows: Diagnosis/Prognosis/Surgeries Falls Living arrangements Neuro/Emotional Behavioral Status Supportive assistance ADL/IADLs Medications Sensory status Equipment Management Integumentary status Emergent Care Respiratory status Hospitalizations
Elimination status Nursing Home Admissions SAAM data were submitted to the NYSDOH twice annually, in January and July, through July 2013. The January submission consisted of assessments conducted between July and December of the prior year; the July submission consisted of assessments conducted between January and June of the same year. Twice annually, following submissions, the NYSDOH issued plan‐specific reports containing plan mean results and comparison to statewide averages. In 2007, the SAAM was expanded beyond its role as a clinical assessment tool, to determine MLTC plan eligibility. An eligibility scoring index was created; the scoring index consisted of 13 items/questions, as follows: Ability to dress lower body Urinary Incontinence Bathing Bowel incontinence frequency Toileting Cognitive functioning Transferring Confusion Ambulation/Locomotion Anxiety Feeding/Eating Depression Ability to dress upper body Each item had a point value; a combined total score of 5 or greater constituted MLTC eligibility. Effective October 2013, the SAAM tool was replaced by the Uniform Assessment System for NY (UAS‐
NY). The UAS‐NY is a web based clinical assessment tool based on a uniform data set, which standardizes and automates needs assessments for home and community based programs in New York1. Data are immediately available to users during and upon completion of the assessment. Figure 3a contains TAIP’s July 2013 SAAM results for their partially capitated line, and Figure 3b contains TAIP’s January‐June and July‐December 2014 UAS results. 1
NYS Department of Health, 2014 Managed Long Term Care Report. http://health.ny.gov 8
Figure 3a: TAIP Partially Capitated and Statewide SAAM Data 2013 July 2013 Plan Statewide SAAM SAAM N=143 N=111,569 SAAM Items Activities of Daily Living (ADL) Ambulation/Locomotion – % of members who could perform task independently, with setup help/device, or with supervision Bathing – % of members who could perform task independently, with setup help/device, or with supervision Upper Body Dressing – % of members able to perform task independently, with setup help, or with supervision Lower Body Dressing – % of members able to perform task independently, with setup help, or with supervision Toileting – % of members able to perform task independently, with setup help, or with supervision Transferring‐ % of members able to transfer independently, with use of an assistive device, or with supervision/minimal assistance Feeding/Eating – % of members able to eat/drink independently, with setup help, or with supervision Continence Urinary Continence – % who are continent, have control with catheter/ostomy, or were infrequently incontinent Bowel Continence – % who are continent, have control with ostomy, or were infrequently incontinent Cognition Cognitive Impairment – % members with no cognitive impairment When Confused – % with no confusion Mood and Behavior Anxiety – % with no feelings of anxiety Depressed – % with no feelings of depression 9
93%
92%
94%
89%
95%
87%
92%
79%
90%
91%
84%
87%
100%
99%
21%
27%
83%
79%
44%
40%
8%
34%
10%
38%
72%
74%
July 2013 Plan Statewide SAAM SAAM N=143 N=111,569 SAAM Items Health Conditions Frequency of Pain – % experiencing no pain, or pain less than daily Falls Resulting in Medical Intervention – % of members experiencing no falls requiring medical intervention Prevention Influenza Vaccine – % who had influenza vaccine in last year 57%
44%
52%
55%
68%
73%
Total Aging in Place Partially Capitated SAAM July 2013 A lower percentage of Total Aging in Place members had no confusion and no feelings of anxiety compared to members statewide. In contrast, a higher percentage of Total Aging in Place members experienced no pain (or pain less than daily) compared with members statewide (57% vs. 44%, respectively). Additionally, a higher percentage of Total Aging in Place members were able to perform upper and lower body dressing independently, with set up help, or with supervision as compared to members statewide. 10
Figure 3b: TAIP Partially Capitated and Statewide UAS Data 2014 Jan‐June 2014 UAS Items Plan UAS N=125 Activities of Daily Living (ADL) Ambulation/Locomotion – % of members who could perform task independently, with setup help/device, or with supervision Bathing – % of members who could perform task independently, with setup help/device, or with supervision Upper Body Dressing – % of members able to perform task independently, with setup help, or with supervision Lower Body Dressing – % of members able to perform task independently, with setup help, or with supervision Toileting – % of members able to perform task independently, with setup help, or with supervision Feeding/Eating – % of members able to eat/drink independently, with setup help, or supervision Continence Urinary Continence – % who are continent, have control with catheter/ostomy, or were infrequently incontinent Bowel Continence – % who are continent, have control with ostomy, or were infrequently incontinent Cognition Cognitive functioning – % with intact functioning Mood and Behavior Anxiety – % with no feelings of anxiety Depressed – % with no feelings of depression Health Conditions Frequency of Pain – 11
Statewide UAS N=125,702 July‐Dec 2014 Statewide
Plan UAS UAS N=132,42
N=142 9 78%
56% 79%
53%
25%
19% 22%
16%
54%
33% 57%
30%
37%
18% 40%
16%
69%
63% 70%
57%
95%
87% 96%
86%
26%
36% 27%
36%
78%
83% 75%
83%
47%
39% 48%
34%
70%
76% 61%
75%
73%
71% 68%
68%
64%
26% 51%
22%
Jan‐June 2014 UAS Items Plan UAS N=125 % experiencing no severe daily pain Falls Resulting in Medical Intervention – % of members experiencing no falls requiring medical intervention Prevention Dental Exam – % who had dental exam in last year Eye Exam – % who had eye exam in last year Hearing Exam – % who had hearing exam in last 2 years Influenza Vaccine – % who had influenza vaccine in last year Statewide UAS N=125,702 July‐Dec 2014 Statewide
Plan UAS UAS N=132,42
N=142 9 88%
88% 89%
91%
42%
49% 42%
50%
50%
71% 58%
73%
33%
33% 32%
33%
76%
75% 76%
76%
TAIP Partially Capitated UAS January‐June 2014 Compared with members statewide, a higher percentage of Total Aging in Place members could perform the six ADLs represented in Figure 3b above. Additionally, a higher percentage of Total Aging in Place members demonstrated intact cognitive functioning and experienced no severe daily pain compared with members statewide. In contrast, a lower percentage of Total Aging in Place members had a dental or eye exam in the last year, compared with members statewide. TAIP Partially Capitated UAS July‐December 2014 Similar to the UAS outcomes for the ADLs in the first half of the year, Total Aging in Place demonstrated higher percentages of members who could perform these activities with a higher level of ability, when compared with members statewide. Also consistent with UAS results in the first reporting period, a higher percentage of Total Aging in Place members exhibited intact cognitive functioning and no severe daily pain. 12
Section Six: Performance Improvement Projects MLTC plans conduct performance improvement projects (PIPs) on an annual basis. Proposed project topics are presented to IPRO and to the NYSDOH prior to the PIP period, for approval. Periodic conference calls are conducted during the PIP period to monitor progress. The following represents a summary of TAIP’s PIP for 2013: Diabetes is a comprehensive chronic disorder with short and long‐term complications. Diabetes management can be difficult to achieve in the elder population given willingness to change eating behaviors, limited care giver support, and physical limitations limiting independence with meals. Therefore, Total Aging in Place developed a project which organizes required services/visits of members with diagnosis of diabetes. This includes obtaining HgbA1c levels no less than twice a year, acceptable blood glucose levels per primary care provider, improve the coordination of visits to a specialist, and assess the need for current diabetic medication regiment with primary care physicians. Members of the TAIP program with diabetes (type 1, type 2, and pre‐diabetes) will have improved knowledge of macronutrients by attending no less than two health and wellness programs. HgbA1c levels will improve and podiatry and optometry visits will be made no less than yearly. Family education will also be put in place for those members whose family participates in a member’s care and nutrition. Project indicators include the following: 1) Members of the program with diagnosis of diabetes (type 1, type 2, pre‐diabetes). 2) Members with type 1, 2 and pre‐diabetes who have had at least a yearly podiatry visit. 3) Members with type 1, 2 and pre‐diabetes who have had at least a yearly eye exam. 4) Members with type 1, 2 and pre‐diabetes who have attended two health and wellness programs. 5) Members with type 1, 2 and pre‐diabetes who have HgA1c <8%. 6) Members with type 1, 2 and pre‐diabetes who have HgbA1c <8%. 7) Members who had HgbA1c level drawn and was <8%. Interventions are as follows:  The program will develop a new data collection tool to identify needs of the coordination of services as detailed in the project’s goals.  Data will be entered by a designee in order to generate appropriate needs to establish and achieve the goal of diabetic management.  Interdisciplinary Team members will be educated on the spreadsheet which is developed for the intervention.  Development of a diabetic nutritional education program. o Interdisciplinary Team members will be educated prior to member teaching. o Follow‐through of family education.  Develop a communication tool for primary care provider to coordinate nutritional concerns and HgbA1c levels. Results are summarized on the following page: 13
Indicators (Baseline) 1) Members of the program with diagnosis of diabetes (type 1, type 2, pre‐diabetes) – 34.9% 2) Members with type 1, 2 and pre‐diabetes who have had at least a yearly podiatry visit – 54.5% 3) Members with type 1, 2 and pre‐diabetes who have had at least a yearly eye exam – 38.6% 4) Members with type 1, 2 and pre‐diabetes who have attended two health and wellness programs – 11.4% 5) Members with type 1, 2 and pre‐diabetes who have HgA1c <8% – 56.8% 6) Members with type 1, 2 and pre‐diabetes who have HgbA1c <8% – 15.9% 7) Members who had an HgbA1c level drawn and was <8% Indicators (Final Results) 1) Members of the program with diagnosis of diabetes (type 1, type 2, pre‐diabetes) – 34.6% 2) Members with type 1, 2 and pre‐diabetes who have had at least a yearly podiatry visit – 88.6% 3) Members with type 1, 2 and pre‐diabetes who have had at least a yearly eye exam – 93.2% 4) Members with type 1, 2 and pre‐diabetes who have attended two health and wellness programs – 50.0% 5) Members with type 1, 2 and pre‐diabetes who have HgA1c <8% – 34.1% 6) Members with type 1, 2 and pre‐diabetes who have HgbA1c <8% – 56.8% 7) Members who had an HgbA1c level drawn and was <8% – 88.6% Numerator Denominator 44 24 17 5 Eligible Population = 126 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members with diabetes type 1, 7 2, and pre‐diabetes = 44 Members who have had a N/A HgA1c drawn = 44 Numerator Denominator 25 44 39 41 22 15 25 39 Eligible Population = 127 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members with diabetes type 1, 2, and pre‐diabetes = 44 Members who have had a HgA1c drawn = 44 Conclusions: Overall, the project proved beneficial to the diabetic population of the program. The Plan was able to engage members in the study to acknowledge and discuss the management of their disease along with the barriers to maintain their health and wellness related to diabetes. During the project, one of the barriers identified was the member’s desires to change their eating behaviors and food choices. In addition, members sometimes found it easier to have the physicians change their medication orders rather than changing their nutritional lifestyle. A key intervention to the success of the goal of an HgbA1c less than 8% was the ongoing involvement with the members’ physicians. In addition, the coordination of care and services was the most important aspect in preventing further co‐morbidities with a diagnosis of diabetes.
14
The following represents a summary of TAIP’s PIP for 2014: Honoring members’ choices is an important element for health care to provide quality end of life care/treatment. The MOLST (Medical Orders for Life Sustaining Treatment) is a tool designed by New York State put into effect in 2012. The purpose of the tool is to communicate the health care wishes/preferences for all persons receiving long‐term care services. Total Aging in Place developed a project to ensure that every member has thorough documentation of their health care wishes/preferences/goals regarding end of life care/treatment on one legal form. The MOLST was the form used for this purpose. Secondly, the program formatted guidelines for the MOLST to follow the member from one health care location to another and returning with the member to their home. Lastly, the program provided legal education to staff and members in regard to Advance Directives. Project indicators included the following:  Eligible Population – All members in the program, excluding long term Skilled Nursing Facilities. o Indicator 1: All members in the program who have completed an accurate MOLST that represents all of their health care wishes and is present in their home with a copy on record. o Indicator 2: Of those members who completed a MOLST, how many had another form of Advance Directive in place prior. o Indicator 3: Members who have some form of Advance Directive in place. Interventions included the following:  Discussed and reviewed project with staff.  Developed a committee for the project.  Developed corresponding documents.  Identified a sample. o Implemented reviews.  Completed a cover letter for primary care providers.  Developed program guidelines for the MOLST.  Elderlaw attorney, Bruce D. Reinoso, educated staff and members regarding Advance Directives.  Updated members’ plans of care.  Completed education. Results are summarized as follows: Indicators (Baseline) 1) All members in the program who have completed accurate MOLST that represents all of their health care wishes and is present in their home with a copy on record – 31.3% 2) Of those members who completed a MOLST, how many had another form of Advance Directive in place prior – 81.3% 3) Members who have some form of Advance Directive in place –
44.8% Indicators (Final Results) 1) All members in the program who have completed accurate MOLST that represents all of their health care wishes and is present in their home with a copy on record – 100% 2) Of those members who completed a MOLST, how many had another form of Advance Directive in place prior – 81.5% 15
Numerator
10 26 43 Numerator
Denominator
32 32 96 (Members who did not complete a MOLST)
Denominator
108 108 88 108 3) Members who have some form of Advance Directive in place –
61.1% 22 36
(Members who did not complete a MOLST) Conclusions: During the implementation of the project, the denominator for Indicator 1 increased from 32 to 108, as a result of an increase in the number of members with a MOLST. All members’ charts were reviewed who were eligible for the project and the Plan identified only 32 members who currently had a MOLST, 10 of which were accurate and in the member’s home. This process was completed and as a result, 43 identified members had an Advance Directive in place. Some barriers identified during the project include: MOLST were completed without prior consideration to previous forms of Advance Directives completed; members did not perceive end of life applicable to them; and difficulty communicating/contacting new members who were mandatorily enrolled. Protocol guidelines have been established and education to the care team members has been completed through the program’s quality meetings. Overall, the project showed successful outcomes and objectives and goals were met. 16
Section Seven: Overall Strengths and Opportunities Strengths Advance Directives Total Aging in Place is addressing advance directive needs, as evidenced by a significant percentage of question respondents with an advance directive in place (100% of respondents in 2012/2013 and 93% of respondents in 2014/2015). Additionally, when compared with members enrolled in other partially capitated plans, and in all other plans statewide, a higher percentage of Total Aging in Place members reported that the Plan is discussing appointing someone to make health care decisions with them and that they have a copy of the member’s executed advance directive. Activities of Daily Living (ADL) A higher percentage of Total Aging in Place members demonstrated the ability to perform the various activities of daily living in comparison to members statewide throughout both reporting periods in 2014. Pain 2014 UAS data indicate that a substantially higher percentage of Total Aging in Place members experience no severe daily pain, compared with members statewide (64% vs. 26%, respectively, in the first half of the year, and 51% vs. 22% in the second half of the year). Opportunities Anxiety A lower percentage of Total Aging in Place members indicated they had no feelings of anxiety, when compared with members statewide throughout both UAS reporting periods in 2014. UAS questions related to anxiety are prone to a high level of subjectivity at the time of the assessment, and it is recommended that Total Aging In Place consider conducting an inter‐rater reliability study, to aid in determining whether these members do in fact have higher rates of anxiety, or if there are scoring issues. It may prove advantageous to have two assessors independently conduct the same assessments on a sample of members, to test the validity of UAS responses. Prevention For both UAS reporting periods in 2014, a lower percentage of Total Aging in Place members had dental and eye exams in the last year compared with members statewide. It is recommended that Total Aging in Place attempt to validate these data through comparison to medical records and care management correspondence. Once data are validated, TAIP could implement a performance improvement project to address preventive screening exams among their membership. 17