NEW YORK STATE DEPARTMENT OF HEALTH
Office of Quality and Patient Safety
PLAN – Technical REPORT
FOR
PACE CNY
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 ........................................................................................................................ 9 Section Six: Performance Improvement Projects ...................................................................................... 14 Section Seven: Summary/Overall Strengths and Opportunities ................................................................. 18 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 contains data for reporting years 2013 and 2014.
2
Section Two: Plan Profile PACE CNY is a regional MLTC plan and provides services to the Program of All‐inclusive Care for the Elderly (PACE) population. The plan is an affiliate of the Loretto Group, located in Syracuse, NY. The following report presents plan‐specific information for PACE CNY:  Plan ID: 01519162  Managed Long‐Term Care Start Date: 1999  Product Line(s): PACE  MLTC Age Requirement: 55 and older  Contact Information: Sally Coyne Center for Independence 100 Malta Lane Syracuse, NY 13212 (800) 208‐5284 (315) 452‐5800 Participating Counties and Programs
Onondaga
PACE
3
Section Three: Enrollment Figure 1 depicts membership for PACE CNY’s 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 Plan grew over this period, increasing by 3.3% from 2012 to 2013 and by 6.1% from 2013 to 2014. Figure 1a trends enrollment. Figure 1: Membership: PACE CNY 2012‐2014 Number of Members % Change From Previous Year 2012
PACE 429
7.0% 2013
2014
443
3.3% 470
6.1% Figure 1a: Enrollment Trends 2012‐2014 PACE CNY Enrollment 2012‐2014
Number of Members
600
429
450
470
443
300
PACE
150
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%. PACE CNY’s response rate was 32.3% (113 respondents out of 350 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 PACE CNY, compared with all other PACE 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 PACE CNY Compared with all PACE Plans, and all Plans Statewide Description Plan requested list of Rx/OTC meds ** Plan explained the Consumer Directed Personal Assistance option ++ Plan Rated as Good or Excellent Quality of Care: Rated as Good or Excellent Regular Doctor (PCP) Dentist Eye Care‐Optometry Foot Care Home Health Aide Care Manager Regular Visiting Nurse Medical Supplies Transportation Services Timeliness‐ Always or Usually On Time Home Health Aide, Personal Care Aide Care Manager Regular Visiting Nurse Transportation TO the Doctor Transportation FROM the Doctor Access to Routine Care (<1 Month) Regular Doctor (PCP) Dentist Eye Care/Optometry Foot Care/Podiatry Access to Urgent Care (Same Day) Regular Doctor (PCP) Dentist Eye Care/Optometry Foot Care/Podiatry PACE CNY 2012‐2013 (N=103)a nb % 84
94%
Overall PACE 2012‐2013 (N=446)a nb % 381
88%
Statewide 2012‐2013 (N=2,522)a nb % 2,197
88%
PACE CNY 2014‐2015 (N=113)a nb % 80
93%
Overall PACE 2014‐2015 (N=574)a nb % 432
92%
Statewide 2014‐2015 (N=4,592)a nb % 3,702
94% ‐
‐
‐
‐
‐
‐
30
53%
267
58%
2,495
75% 100
92%
430
86%
2,458
84%
89
93%
453
86%
3,739
87% 88
68
80
51
71
85
71
86
90
96%
88%▲
89%
80%
90%
88%
89%
97%▲
98%▲
405
291
355
278
337
366
360
355
387
90%
73%
80%
77%
85%
86%
87%
92%
86%
2,247
1,530
1,951
1,640
2,056
2,108
2,132
1,844
1,916
89%
70%
81%
80%
87%
84%
84%
86%
78%
85
66
78
45
71
84
71
81
84
89%
85%
82%
73%
86%
87%
90%
93%▲
94%▲
446
337
391
322
373
414
401
400
421
90%
77%
78%
81%
84%
85%
88%
87%
87%
3,572
2,382
3,079
2,637
3,351
3,445
3,355
2,937
2,853
91% 73% 82% 83% 87% 83% 83% 82% 77% 74
83
58
86
85
81%
74%
74%
81%
81%
319
341
340
370
366
77%
68%
71%
71%
68%
1,897
1,876
2,027
1,766
1,742
78%
69%
69%
69%
67%
72
78
62
74
74
83%
89%
87%
99%▲
97%▲
374
380
368
370
370
90%
86%
86%
90%
84%
3,385
3,144
3,177
2,515
2,505
93% 83% 81% 81% 78% 75
52
67
34
72%
48%
51%
59%
343
229
282
223
70%
42%
45%
48%
2,104
1,234
1,647
1,390
59%
46%
43%
45%
71
41
52
24c
83%
90%▲
87%
75%
383
253
300
255
86%
70%
74%
73%
3,328
1,873
2,486
2,220
88% 73% 79% 80% 70
32
44
23c
56%
22%
23%
39%
324
173
200
163
49%
15%
13%
23%
1,755
920
1,195
1,039
45%
26%
22%
26%
68
39
55
25c
44%
21%
27%
36%
368
221
278
235
50%
20%
27%
30%
2,885
1,526
2,165
1,912
50% 29% 33% 34% 6
Figure 2: Satisfaction Survey Results PACE CNY Compared with all PACE Plans, and all Plans Statewide Advance Directives Plan has discussed appointing someone to make decisions Member has legal document appointing someone to make decisions Health plan has copy of this document ◊ PACE CNY 2012‐2013 (N=103)a Overall PACE 2012‐2013 (N=446)a Statewide 2012‐2013 (N=2,522)a PACE CNY 2014‐2015 (N=113)a 80%
389
82%
2,087
68%
97
81%▲
497
78%
3,757
67% 97
92%▲
395
83%
2,145
61%
98
94%▲
494
84%
3,722
58% 68
88%
269
91%
956
77%
72
97%▲
348
94%
1,506
79% ** Represents question that has been added to the 2013‐2014 technical report ++ ▲ ◊ Represents new question in 2014‐2015 survey Represents a significantly higher rate versus the PACE/statewide rate (p < .001) Item based on a skip pattern Significance testing could not be performed due to small sample size (n<30) Symbol a
b
c Statewide 2014‐2015 (N=4,592)a 94
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 Overall PACE 2014‐2015 (N=574)a 7
Satisfaction Survey Results Summary Satisfaction survey results demonstrated that PACE CNY’s members rated the majority of their services and care similarly in 2012/2013 compared to 2014/2015. For the sections related to timeliness, access to routine care (<1 month) and advance directives, there was an improvement in satisfaction among PACE CNY members from 2012/2013 to 2014/2015. In the most recent satisfaction survey administered to PACE CNY’s membership, there were a few statistically significant differences between PACE CNY’s members, and members in other PACE plans and all plans statewide. There was a significantly higher rate of PACE CNY members who rated the quality of their transportation services as good or excellent when compared to other PACE members and members statewide (94% vs. 87% and 77%, respectively). Similarly, a higher percentage of PACE CNY members indicated they had access to routine care (<1 month) for dentists, compared to members in similar plans and all plans statewide (90% vs. 70% and 73% respectively). PACE CNY members also had a significantly higher rate for advance directives when compared to other PACE members and members statewide. In contrast, although it was not statistically significant, a lower percentage of PACE CNY members rated the quality of their foot care as good or excellent compared to similar plans and statewide (73% vs. 81% and 83%, respectively). 8
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 PACE CNY’s July 2013 SAAM results for their PACE line, and Figure 3b contains PACE CNY’s January‐June and July‐December 2014 UAS results.
1
NYS Department of Health, 2014 Managed Long Term Care Report. http://health.ny.gov 9
Figure 3a: PACE CNY PACE and Statewide SAAM Data 2013 July 2013 Plan Statewide SAAM SAAM N=527 N=111,185 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 10
89%
92%
83%
89%
87%
87%
81%
79%
88%
91%
82%
87%
100%
99%
16%
27%
69%
79%
12%
40%
14%
35%
18%
38%
71%
74%
July 2013 Plan Statewide SAAM SAAM N=527 N=111,185 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 52%
44%
63%
55%
95%
72%
SAAM July 2013 A lower percentage of PACE CNY members demonstrated intact cognitive functioning, no confusion, and no feelings of anxiety when compared with members statewide. In contrast, there were a higher percentage of members experiencing no pain, no falls requiring medical intervention, and who had received an influenza vaccine in the last year compared with members statewide. 11
Figure 3b: PACE CNY PACE and Statewide UAS Data 2014 Jan‐June 2014 UAS Items Plan UAS N=455 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 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 functioning – % with intact functioning Mood and Behavior Anxiety – % with no feelings of anxiety Depressed – % with no feelings of depression Health Conditions Frequency of Pain – 12
Statewide UAS N=125,702 July‐Dec 2014 Statewide
Plan UAS UAS N=132,42
N=465 9 71%
55% 68%
53%
25%
19% 22%
16%
51%
33% 50%
30%
43%
18% 41%
16%
68%
63% 64%
57%
89%
87% 90%
86%
20%
36% 19%
36%
68%
83% 68%
83%
30%
39% 30%
34%
64%
76% 62%
75%
66%
71% 67%
68%
43%
26% 40%
22%
Jan‐June 2014 UAS Items Plan UAS N=455 % 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=465 9 86%
88% 87%
91%
71%
49% 71%
50%
79%
71% 81%
73%
37%
33% 40%
33%
89%
75% 90%
76%
UAS January‐June 2014 Compared with members statewide, a higher percentage of PACE CNY members could perform the six ADLs, as represented in Figure 3b above. Additionally, a higher percentage of members (43%) reported no frequency of pain when compared with members statewide (26%). PACE CNY members demonstrated higher rates of participation in the prevention measures as well. However, a lower percentage of PACE CNY members (64%) reported having no feelings of anxiety when compared to members statewide (76%). UAS July‐December 2014 Similar to the UAS outcomes for the ADLs in the first half of the year, higher percentages of PACE CNY members 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 PACE CNY members exhibited no severe daily pain, and had received a dental/eye/hearing exam as well as the influenza vaccine. 13
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 PACE CNY’s PIP for 2013: PACE CNY wanted to reduce the length of stay and readmission for urinary tract infections (UTIs) and pneumonia among their membership. Many acute hospitalizations in the elderly can be treated effectively in an outpatient setting after minimal intervention at an acute or observational care setting. PACE statistics for 2012 show the average length of stay (LOS) for pneumonia exceeding 6 days, and the average LOS for UTIs exceeding 3 days. PACE’s data show significant numbers of participants admitted for pneumonia and UTIs. Any PACE participants diagnosed with pneumonia and/or a UTI who were treated in an emergency room and/or admitted to an acute care setting from January 1 to September 30, 2013 were included in this study. QA staff, along with billing and utilization review staff, collected data on a daily basis regarding patient admissions, discharges and emergency room visits for patients with pneumonia and/or UTI diagnoses. Data collection for these diagnoses was performed between January 1 and September 30, 2013. All clinical staff was educated on the project goals and rationale. PACE medical providers were instructed and encouraged to communicate via phone with hospital or emergency room medical staff as soon as possible upon notification of patient admission. To facilitate this process, several meetings were held that included the PACE medical director, PACE providers, PACE Hospital Care Coordinator, emergency room staff and hospitalists from St. Joseph’s Hospital Health Center. Outpatient support services that were available to PACE participants were outlined in a newsletter distributed to all participants. Also, one on one counseling of participants and families was conducted during clinic visits. The PACE medical director was part of a transition team with primary inpatient partner St. Joseph’s Hospital and in conjunction with this committee, developed flow pathways for decisions regarding observation, admission and discharge for pneumonia and UTI. The PACE Hospital Care Coordinator was in contact with the discharge planners for every hospitalization, and reported back to the IDT with hospital recommendations for discharge. Results are summarized as follows: Table 1: Baseline Results Numerator
Denominator
Average Indicator (# of days)
(# of patients) LOS LOS Admit UTI LOS Admit Pneumonia Indicator 50 15 3.3 129 Numerator
(# Admitted)
21 Denominator
(# Diagnosed)
6.1 217 414 52% % of ED Visits not admitted – ALL Diagnoses 14
% Table 2: Post Intervention (Final) Results Indicator LOS Admit UTI LOS Admit Pneumonia Indicator % of ED Visits not admitted – UTI only Numerator
(# of days)
Denominator
(# of patients)
Average LOS 44 11 4.0 128 Numerator
(# Admitted)
27 Denominator
(# Diagnosed)
4.7 11 22 50% % Conclusions: PACE CNY’s PIP demonstrated that increased communication with hospital providers could result in a shortened length of stay for pneumonia by over one day on average. It also was notable that a number of individuals were able to be treated for UTI in the emergency room without being admitted. The average length of stay for those with UTIs had actually increased post intervention. This is believed to be a result of the increased number of healthier individuals that were not admitted at all for a UTI compared to baseline. Therefore, the more seriously ill patients were admitted resulting in a longer length of stay. This was noticeably due to an increased number of antibiotic resistant organisms.
15
The following represents a summary of PACE CNY’s PIP for 2014: Polypharmacy is defined as when more medications are prescribed than are clinically warranted. This is a growing health concern for those patients that are at greatest risk: the elderly, those with multiple medical disorders, more than one physician, or a recent hospitalization. The current per member per month (PMPM) number of medications at PACE CNY is 10.8 for the year 2013 and has been rising over the past year. The Plan will identify participants with polypharmacy and work collaboratively with the participant, physician, interdisciplinary team, family/caregiver and consultant pharmacists to reduce the number of PMPM participant medications to less than or equal to eight. The project indicators are as follows:  Baseline #1 ‐ Average medications per member per month (PMPM) o Numerator: The total number of participant’s medications that meet criteria for the project o Denominator: The total member months of participants in study project  Re‐measurement #1a – Average medications per member per month (PMPM) o Numerator: The total number of participant’s medications that meet criteria for the project o Denominator: The total member months of participants in study project  Re‐measurement #1b ‐ Percentage of Participants able to have number of medications reduced. o Numerator: The number of participants able to discontinue one or more medications. o Denominator: Total number of participants with potential for discontinuation of medications.  Re‐measurement #2a – Average medications per member per month (PMPM) o Numerator: The total number of participant’s medications that meet criteria for the project o Denominator: The total member months of participants in study project  Re‐measurement #2b ‐ Percentage of Participants able to have number of medications reduced. o Numerator: The number of participants able to discontinue one or more medications. o Denominator: Total number of participants with potential for discontinuation of medications. Interventions for the project are described as follows:  Those participants initially identified with 20 or more medications will be brought into the clinic.  QA staff will gather information regarding participants with polypharmacy. Each week the Medical Director will take to morning meetings, and as a team, work to discontinue unnecessary and potentially harmful drug therapy in our elderly participants.  Utilizing the monthly pharmacists’ audits, we will track whether the recommended medication adjustments were adopted by the provider. This will evaluate if the dose can be decreased to minimize the likelihood of adverse events without compromising efficacy.  Review of specific drug classes with high utilization reviewed by Medical Director.  Participant education. Results are as follows: Baseline PMPM medication was at 10.8 and mid‐study it decreased to 9.5. Final results in October showed an increase, to 11.5. 16
Conclusions: This project demonstrated that increased interventions surrounding different classes of drugs, and individually focusing on certain drugs, may result in a decrease in medications. This must be an on‐going effort on the part of the IDT and providers to continually see progress. Drugs that were successfully reduced included blood pressure, antipsychotic, iron, calcium, inhalers and PRNs (“As needed”) that the participant had not used in the last six months. Unfortunately, due to some flaws in the study design, the results were not as remarkable as desired. The objective of reducing the overall per member per month medication number was not achieved. The Plan discovered that during the first re‐measurement period, the Pharmacy Billing Report was not an accurate way to identify the number of medications per member per month. Going forward, the Plan will utilize the MAR versus the pharmacy billing report as a more accurate representation of participants’ medications.
17
Section Seven: Summary/Overall Strengths and Opportunities Strengths Quality of Care Satisfaction Survey results for 2014‐2015 indicate that a significantly higher percent of PACE CNY members rated the quality of their medical supplies and transportation services as good or excellent compared to other PACE plans and all plans statewide. Timeliness PACE CNY members’ responses to the 2014‐2015 satisfaction survey indicate that members had significantly higher satisfaction with the timeliness of their transportation to and from the doctor compared to other PACE plans and all plans statewide. Ninety‐nice percent (99%) of PACE CNY members indicated that their transportation service to the doctor was usually or always on time when compared to members enrolled in other PACE plans and in all plans statewide (90% and 81%, respectively). In addition, 97% indicated that their transportation service from the doctor was always or usually on time compared to other PACE members and members statewide (84% and 78%, respectively). Access to Routine Care (<1 Month) A significantly higher percentage of PACE CNY members reported access to routine care (<1 month) for a dentist in 2014‐2015, compared with members in the other PACE plans and members statewide. Advance Directives PACE CNY appears to be addressing advance directive needs, as evidenced by a significantly higher percentage of 2014‐2015 satisfaction survey respondents with an advance directive in place as compared to other PACE members and members statewide. Additionally, a higher percentage of PACE CNY members reported that the plan is discussing appointing someone to make health care decisions with them, and that the plan has a copy of their advance directive on file. Activities of Daily Living (ADL) In both UAS assessments for 2014 (January‐June and July‐December), a higher percentage of PACE CNY members were able to performing each ADL (locomotion, bathing, upper and lower body dressing, toileting and eating) compared with members in other plans statewide. Prevention In both reporting periods throughout 2014, a higher percentage of PACE CNY members had a dental/eye/hearing exam, as well as received the influenza vaccine. Pain UAS data for both 2014 reporting periods indicate that a higher percentage of PACE CNY members experienced no severe daily pain compared to members statewide. Forty three percent (43%) of PACE CNY members had no severe daily pain, compared with 26% of members statewide in the first half of the year, and 40% of PACE CNY members had no severe daily pain, compared to 22% statewide in the second half of the year.
18
Opportunities Anxiety The most recent UAS data indicated that a lower percentage of PACE CNY members reported no feelings of anxiety compared with other members statewide. It should be noted that anxiety related assessment questions may be prone to some level of subjectivity on the part of the assessor and may be scored based upon behavior/attitude exhibited solely at the time of the assessment visit. It is therefore recommended that PACE CNY consider conducting an inter‐rater reliability project for clinical assessments, to aid in determining whether members do in fact have higher levels of anxiety than on a statewide basis, or if there are scoring issues. Two assessors could independently conduct the same assessments on a sample of members, to test the validity of responses. Continence A lower percentage of PACE CNY members demonstrated urinary and bowel continence for both reporting periods throughout 2014, when compared with other members statewide. It is recommended that, on an individual basis, causes of incontinence be reviewed to determine if interventions need to be introduced, or, if existing interventions may need to be modified. 19