NEW YORK STATE DEPARTMENT OF HEALTH
Office of Quality and Patient Safety
Plan – Technical Report
For
Elderplan
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 ...................................................................................................................... 12 Section Six: Performance Improvement Projects ....................................................................................... 21 Section Seven: Summary/Overall Strengths and Opportunities ................................................................. 23 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 Elderplan is a regional Managed Long‐Term Care (MLTC) plan with partially capitated (Homefirst) and MAP product lines. The following report presents plan‐specific information for both MLTC product lines. Elderplan is an affiliate of the Metropolitan Jewish Health System, based in Brooklyn, NY.  Partially Capitated Plan ID: 03253707  MAP Plan ID: 03173113  Managed Long‐Term Care Start Date: July 2000 (partially capitated), 2010 (MAP)  Product Line(s): Partially Capitated (Homefirst), MAP  MLTC Age Requirement: 18 years or older  Contact Information: 6323 Seventh Ave. Brooklyn, NY, 11220 (718) 921‐7835 Participating Counties and Programs
Erie Partial Cap Monroe Partial Cap Nassau Partial Cap MAP New York Partial Cap MAP Albany Partial Cap Niagara
Partial Cap Saratoga
Onondaga
Partial Cap Schenectady Partial Cap Orange
Partial Cap Suffolk
Rensselaer
Partial Cap Westchester Partial Cap MAP
Rockland
Partial Cap 3
Partial Cap Partial Cap Section Three: Enrollment Figure 1 depicts membership for the Elderplan’s partially capitated and MAP product lines 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 increased by 65% from 2012 to 2013, whereas it decreased by 3% from 2013 to 2014. For the MAP line, membership grew by 12% from 2012 to 2013 and decreased by 4% from 2013 to 2014. Figure 1a trends the enrollment for both the partially capitated and MAP product lines. Figure 1: Membership: Partially Capitated and MAP 2012‐2014 2013 2014
11,114 10,822
43% 65% ‐3%
Number of Members 759 851 814
% Change From Previous Year 38% 12% ‐4%
2012
Partially Capitated
6,727 Number of Members % Change From Previous Year MAP
Figure 1a: Enrollment Trends 2012‐2014 Number of Members
Elderplan Enrollment 2012‐2014
11,114
10,822
10,000
6,727
Part Cap
5,000
759
851
814
0
2012
2013
2014
Year
4
MAP
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 Elderplan’s partially capitated product line was 24.1% (136 respondents out of 564 members in the sample). The response rate for Elderplan’s MAP product line was 25.3% (144 respondents out of 569 members in the sample). IPRO had previously conducted a similar satisfaction survey that was mailed between December 2012 and May 2013. Figure 2a represents the results of these two satisfaction surveys for Elderplan’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. Figure 2b represents survey results for Elderplan’s MAP product line, compared with all other MAP plans throughout the state, as well as all MLTC plans statewide, in these same areas.
5
Figure 2a: Satisfaction Survey Results Elderplan Elderplan Compared with all Partially 2012‐2013 Capitated Plans, and all Plans (N=146)a Statewide Description nb % Plan requested list of Rx/OTC meds ** 129
88%
Plan explained the Consumer Directed ‐
‐
Personal Assistance option ++ Plan rated as good or excellent 144 72%
Quality of Care Rated as Good or Excellent Dentist 74
66%
Eye Care‐Optometry 110
76%
Foot Care 91
80%
Home Health Aide 121
85%
Care Manager 110
73%
Regular Visiting Nurse 129
78%
Medical Supplies 97
81%
Transportation Services 94
63%
Timeliness‐ Always or Usually On Time Home Health Aide, Personal Care Aide 103
76%
Care Manager 92
58%
Regular Visiting Nurse 111
62%
Transportation TO the Doctor 93
61%
Transportation FROM the Doctor 87
62%
Access to Routine Care (<1 Month) Dentist 63
44%
Eye Care/Optometry 95
44%
Foot Care/Podiatry 76
46%
Access to Urgent Care (Same Day) Dentist 49
27%
Eye Care/Optometry 77
25%
Foot Care/Podiatry 60
15%
Overall Part Cap
2012‐2013 (N=1,662)a Statewide 2012‐2013 (N=2,522)a Elderplan 2014‐2015 (N=136)a Overall Part Cap
2014‐2015 (N=3,306)a Statewide 2014‐2015 (N=4,592)a nb 1,439
% 87%
nb 2,197
% 88%
nb 107
% 90%
nb 2,677
% 94%
nb 3,702
% 94% ‐
‐
‐
‐
76
74%
1,831
77%
2,495
75% 1,625
84%
2,458
84%
112
80%
2,688
87%
3,739
87% 1,009
1,279
1,087
1,358
1,389
1,420
1,185
1,242
71%
82%
82%
88%
84%
84%
85%
77%
1,530
1,951
1,640
2,056
2,108
2,132
1,844
1,916
70%
81%
80%
87%
84%
84%
86%
78%
78
89
78
94
97
100
84
78
71%
82%
81%
83%
78%
80%
75%
71%
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% 1,258
1,225
1,351
1,147
1,124
79%
70%
70%
68%
67%
1,897
1,876
2,027
1,766
1,742
78%
69%
69%
69%
67%
96
91
93
69
69
91%
73%
75%
71%
71%
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% 832
1,093
932
47%
43%
45%
1,234
1,647
1,390
46%
43%
45%
52
73
65
85%
80%
80%
1,323
1,767
1,608
75%
80%
82%
1,873
2,486
2,220
73% 79% 80% 612
788
692
28%
25%
27%
920
1,195
1,039
26%
22%
26%
45
60
55
33%
38%
38%
1,062
1,497
1,368
31%
34%
35%
1,526
2,165
1,912
29% 33% 34% 6
Advance Directives Plan has discussed appointing someone to make decisions Member has legal document appointing someone to make decisions Health plan has a copy of this document ◊ 113
62%
1,346
64%
2,087
68%
113
65%
2,660
64%
3,757
67% 123
56%
1,387
55%
2,145
61%
108
52%
2,645
53%
3,722
58% 50
68%
533
74%
956
77%
35
77%
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 Represents a significantly higher rate versus the Partially Capitated/statewide rate (p < .001)
Represents a significantly lower rate versus the Partially Capitated/statewide rate (p < .001)
Item based on a skip pattern Symbol a
b
▲  ◊ 7
Elderplan Partially Capitated Satisfaction Survey Results 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 and timeliness of care. In contrast, there was a slight decline in the percent of members who had appointed a healthcare proxy. In the most recent satisfaction survey administered to Elderplan’s membership, there were several notable differences between the Plan’s average and the partially capitated/statewide averages. A lower percentage of Elderplan members indicated that their care manager, regular visiting nurse and transportation services were always or usually on time when compared to other partially capitated members and members statewide. In contrast, a higher percentage of Elderplan members reported they had access to routine care to their dentist compared to similar plans and all plans statewide (85% vs. 75% and 73%, respectively). 8
Figure 2b: Satisfaction Survey Results Elderplan Elderplan Compared with all MAP 2012‐2013 (N=157)a Plans, and all Plans Statewide Description nb % Plan requested list of Rx/OTC meds ** 142
90%
Plan explained the Consumer Directed ‐
‐
Personal Assistance option ++ Plan Rated as Good or Excellent 152
87%
Quality of Care Rated as Good or Excellent Regular Doctor (PCP) 139
87%
Dentist 69
70%
Eye Care‐Optometry 114
79%
Foot Care 98
80%
Home Health Aide 134
90%
Care Manager 126
83%
Regular Visiting Nurse 130
73%
Medical Supplies 115
84%
Transportation Services 99
68%
Timeliness‐ Always or Usually On Time Home Health Aide, Personal Care Aide 109
78%
Care Manager 106
60%
Regular Visiting Nurse 121
56%
Transportation TO the Doctor 82
63%
Transportation FROM the Doctor 81
61%
Access to Routine Care (<1 Month) Regular Doctor (PCP) 129
58%
Dentist 50
46%
Eye Care/Optometry 87
43%
Foot Care/Podiatry 82
42%
Access to Urgent Care (Same Day) Regular Doctor (PCP) 111
38%
Dentist 42
24%
Eye Care/Optometry 62
16%
Foot Care/Podiatry 65
26%
Overall MAP 2012‐2013 (N=414)a nb % 377
93%
Statewide 2012‐2013 (N=2,522)a nb % 2,197
88%
Elderplan 2014‐2015 (N=144)a nb % 129
97%
Overall MAP 2014‐2015 (N=712)a nb % 593
95%
Statewide 2014‐2015 (N=4,592)a nb % 3,702
94% ‐
‐
‐
‐
82
73%
397
74%
2,495
75% 403
85%
2,458
84%
127
88%
598
90%
3,739
87% 375
230
317
275
361
353
352
304
287
88%
62%
78%
77%
85%
84%
79%
82%
69%
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%
121
70
106
79
115
113
114
108
86
93%
73%
84%
80%
87%
81%
81%
83%
69%
583
376
521
412
541
552
542
471
432
90%
72%
86%
80%
86%
81%
81%
81%
72%
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% 320
310
336
249
252
78%
67%
64%
66%
63%
1,897
1,876
2,027
1,766
1,742
78%
69%
69%
69%
67%
107
95
108
77
74
97%
80%
79%
75%
72%
540
494
512
382
382
95%
81%
78%
75%
73%
3,385
3,144
3,177
2,515
2,505
93% 83% 81% 81% 78% 358
173
272
235
58%
46%
40%
40%
2,104
1,234
1,647
1,390
59%
46%
43%
45%
104
59
80
70
89%
66%
80%
81%
533
297
419
357
86%
67%
79%
76%
3,328
1,873
2,486
2,220
88% 73% 79% 80% 307
135
207
184
38%
29%
21%
25%
1,755
920
1,195
1,039
45%
26%
22%
26%
92
47
73
67
50%
38%
36%
42%
460
243
390
309
49%
32%
33%
32%
2,885
1,526
2,165
1,912
50% 29% 33% 34% 9
Figure 2b: Satisfaction Survey Results Elderplan Compared with all MAP 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 ◊ Symbol a
b
Elderplan 2012‐2013 (N=157)a Overall MAP 2012‐2013 (N=414)a Statewide 2012‐2013 (N=2,522)a Elderplan 2014‐2015 (N=144)a Overall MAP 2014‐2015 (N=712)a Statewide 2014‐2015 (N=4,592)a 139
65%
352
70%
2,087
68%
121
74%
600
75%
3,757
67% 144
65%
363
62%
2,145
61%
120
55%
583
61%
3,722
58% 70
64%
154
65%
956
77%
45
73%
245
71%
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 10
Elderplan MAP Satisfaction Survey Results There was an improvement in satisfaction across the majority of categories of care from 2012/2013 to 2014/2015 for Elderplan’s MAP membership. This difference was especially notable in access to routine care, as well as access to urgent care. In contrast, there was a decline in the percent of members who had appointed a healthcare proxy. In the most recent satisfaction survey administered to Elderplan’s membership, there were some notable differences. A lower percentage of Elderplan members rated the quality of their transportation services as good or excellent when compared to other MAP plans and plans statewide (69% vs. 72% and 77%, respectively). In contrast, a higher percentage of Elderplan members had access to urgent dental and podiatry care when compared with other MAP members and members statewide (dentist, 38% vs. 32% and 29% respectively; podiatrist, 42% vs. 32% and 34%, respectively). 11
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 Elderplan’s July 2013 SAAM results for their partially capitated line, and Figure 3b contains Elderplan’s January‐June and July‐December 2014 UAS results. Figure 4a contains Elderplan’s July 2013 SAAM results for their MAP product line, and Figure 4b contains Elderplan’s January‐June and July‐December 2014 UAS results. 1
NYS Department of Health, 2014 Managed Long Term Care Report. http://health.ny.gov 12
Figure 3a: Elderplan Partially Capitated and Statewide SAAM Data 2013 July 2013 Plan Statewide SAAM SAAM N=10,353 N=101,359 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 13
94%
92%
91%
89%
89%
87%
75%
79%
94%
90%
89%
87%
99%
99%
21%
27%
83%
78%
31%
41%
40%
34%
64%
35%
87%
73%
July 2013 Plan Statewide SAAM SAAM N=10,353 N=101,359 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 32%
46%
35%
57%
70%
73%
SAAM July 2013 A higher percentage of Elderplan members had no feelings of anxiety or depression when compared with members statewide. Similarly, a higher percentage of Elderplan members experienced no confusion. It should be noted that these SAAM questions are prone to a high level of subjectivity on the part of the assessor and may also be scored based upon behavior/attitude exhibited solely at the time of the assessment visit. A lower percentage of members experienced no pain, and no falls requiring medical intervention. Similarly, a lower percentage of members had no cognitive impairment when compared with all members statewide. 14
Figure 3b: Elderplan Partially Capitated and Statewide UAS Data 2014 Jan‐June 2014 UAS Items Plan UAS N=11,089 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 – 15
Statewide UAS N=114,613 July‐Dec 2014 Statewide
Plan UAS UAS N=121,31
N=11,113 6 69%
54% 66%
52%
9%
21% 7%
17%
34%
33% 30%
30%
12%
19% 9%
16%
64%
63% 58%
57%
87%
87% 75%
87%
36%
36% 35%
36%
87%
82% 85%
83%
20%
41% 10%
36%
85%
75% 82%
74%
80%
70% 75%
68%
17%
27% 14%
22%
Jan‐June 2014 UAS Items Plan UAS N=11,089 Statewide UAS N=114,613 July‐Dec 2014 Statewide
Plan UAS UAS N=121,31
N=11,113 6 % 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 94%
87% 93%
91%
37%
49% 37%
51%
62%
72% 65%
73%
21%
34% 21%
35%
75%
75% 76%
76%
UAS January‐June 2014 Compared with members statewide, a lower percentage of Elderplan members could perform bathing and lower body dressing when compared with members statewide. Additionally, a lower percentage of Elderplan members demonstrated intact cognitive functioning (20% vs. 41%) and no pain (17% vs. 27%). In terms of preventive screening, a lower percentage of members reported having a dental, eye, and/or hearing exam, when compared with members statewide. In contrast, a higher percentage of members indicated having no anxiety or depression, as well as no falls resulting in medical intervention. UAS July‐December 2014 There were a lower percentage of Elderplan members with intact cognitive functioning (10% vs. 36%), members experiencing no pain (14% vs. 22%), and members who had a dental exam, eye exam and/or hearing exam compared with members statewide. Elderplan members also demonstrated a lower level of ability in being able to bathe, dress their lower bodies and eat. In contrast, a higher percentage of members indicated having no anxiety or depression, as well as no falls resulting in medical intervention. 16
Figure 4a: Elderplan MAP and Statewide SAAM Data 2013 July 2013 Plan Statewide SAAM SAAM N=927 N=110,785 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 17
89%
92%
87%
89%
86%
87%
72%
79%
89%
91%
85%
88%
99%
99%
12%
27%
77%
79%
26%
40%
43%
34%
70%
37%
90%
74%
July 2013 Plan Statewide SAAM SAAM N=927 N=110,785 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 39%
44%
31%
55%
67%
73%
SAAM July 2013 A higher percent of Elderplan members had no confusion, anxiety or feelings of depression compared with members statewide. In contrast, a lower percentage of members had no cognitive impairment. In terms of physical health, a lower percentage of members were urinary/bowel continent (although the difference in bowel continence between Elderplan members and all other members statewide was marginal), and a lower percentage experienced no falls requiring medical intervention. 18
Figure 4b: Elderplan MAP and Statewide UAS Data 2014 Jan‐June 2014 UAS Items Plan UAS N=817 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 – 19
Statewide UAS N=125,702 July‐Dec 2014 Statewide
Plan UAS UAS N=132,42
N=830 9 66%
55% 65%
53%
6%
20% 4%
16%
27%
33% 23%
30%
10%
19% 6%
16%
57%
63% 52%
57%
86%
79% 71%
86%
28%
36% 28%
36%
83%
87% 81%
83%
17%
39% 5%
34%
84%
76% 79%
75%
78%
71% 71%
68%
20%
26% 17%
22%
Jan‐June 2014 UAS Items Plan UAS N=817 % 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=830 9 96%
88% 95%
91%
25%
49% 27%
50%
59%
71% 63%
73%
17%
33% 18%
33%
74%
75% 73%
76%
UAS January‐June 2014 Compared with members statewide, there were a lower percentage of Elderplan members who could perform bathing, upper and lower body dressing, and toileting. Additionally, a lower percentage of Elderplan members had intact cognitive functioning, and experienced no severe daily pain. In terms of prevention, a lower percentage of members had a dental, eye or hearing exam. Conversely, a higher percentage of Elderplan members were able to ambulate and feed themselves, and had no depression or anxiety. UAS July‐December 2014 Lower percentages of Elderplan members with intact cognitive functioning, members experiencing no pain, and members who took part in prevention measures (dental, eye and hearing exam, and influenza vaccine) were reported as compared with members statewide. Rates for locomotion, mood and behavior measures and the percentage of members experiencing falls resulting in medical interventions were higher among Elderplan compared to members statewide. 20
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 Elderplan’s (Part Cap and MAP) PIPs for 2013‐2014: Elderplan sought to improve the flu immunization rate of its members to be at or above the NYS mean of 70%. This objective is based on 2012 baseline data which showed that 70% of eligible partially capitated members and 67% of eligible MAP members reported having a flu shot. The numerator for the eligible population is based on responses to the flu question from the SAAM and UAS; this question asks whether or not the member had a flu immunization in the last year. Interventions included the following:  Language‐specific mass mailings to members containing information about influenza and the need for vaccination.  Postcard reminders, or reminder letters, to members as the flu immunization season approaches.  An automated voice message in 4 different languages.  Thank you cards for receiving the flu vaccination to serve as a reminder for receiving the vaccination. Results are summarized as follows: Part Cap Baseline 2012‐January 2013 SAAM Report Homefirst NYS Average 70% 70% Project Year 1‐January 2014 SAAM/UAS Report Homefirst NYS Average 75% 73% Project Year 2‐January 2015 UAS Report Homefirst NYS Average 79% 75% For Project Year 1, the percentage of members who responded “Yes” to having a flu vaccination was 75%; this rate reflects 2 percentage points above the NYS average of 73% and an increase of 5 percentage points from the 2012 baseline of 70%. For Project Year 2, the percentage of members who responded “Yes” to having a flu vaccination was 79%; this rate reflects 4 percentage points above the NYS average of 75% and an increase of 9 percentage points from the 2012 baseline of 70%. 21
MAP Baseline 2012‐January 2013 SAAM Report MAP NYS Average 67% 70% Project Year 1‐January 2014 SAAM/UAS Report MAP NYS Average 73% 73% Project Year 2‐January 2015 UAS Report MAP NYS Average 77% 75% For Project Year 1, the percentage of members who responded “Yes” to having a flu vaccination was 73%; this rate was the same as the NYS average of 73% and reflected an increase of 6 percentage points from the 2012 baseline of 67%. For Project Year 2, the percentage of members who responded “Yes” to having a flu vaccination was 77%; this rate reflects 2 percentage points above the NYS average and an increase of 10 percentage points from the 2012 baseline of 67%. Conclusions: For this project, the Plan succeeded at improving flu vaccination rates. Both product lines (Part Cap and MAP) saw an increase in flu vaccination rates among members. In addition to improved rates, the 2013 MLTC Consumer Guide Ratings indicated that the Plan’s Part Cap line increased its rating for the flu vaccine from one star to two stars. 22
Section Seven: Summary/Overall Strengths and Opportunities Strengths Access to Routine Care‐ Dental (Partially Capitated) A higher percentage of Elderplan members indicated having access to a dentist for a routine care; 85% of Elderplan members reported having access to a dentist within a month, compared with members in the other partially capitated plans, and members statewide (75% and 73%, respectively). Activities of Daily Living (Partially Capitated and MAP) Elderplan members demonstrated a higher level of ability in ambulation, compared to plans statewide in the 2014 UAS assessment. Sixty‐six percent (66%) of Elderplan’s assessed partially capitated members were ambulatory, compared with 52% of members statewide. Similarly, 65% of Elderplan’s assessed MAP members were ambulatory, compared with 53% statewide. Mood and Behavior (Partially Capitated) A higher percentage of Elderplan members reported no feelings of anxiety, as well as no feelings of depression, compared with members statewide throughout 2014. The percentage of assessed members with no feelings of anxiety and no feelings of depression were 82% and 75%, respectively, compared with 74% and 68% of statewide members, respectively. Timeliness – Always or Usually On Time (MAP) The satisfaction survey results for 2014‐2015 indicate that Elderplan members perceived their home health or personal care aid to be timelier, compared to the other MAP plan members and members statewide. Access to Urgent Care (MAP) A higher percentage of Elderplan members indicated they had access to a dentist, optometrist, and podiatrist for urgent care in the 2014‐2015 satisfaction survey, compared with MAP members, and all members statewide. Opportunities Overall rating (Partially Capitated) A lower proportion of Elderplan members (80%) rated the overall quality of the plan as good or excellent compared to similar plans (87%) and other plans in the state (87%) in the 2014‐2015 satisfaction survey. It is recommended that Elderplan consider conducting additional focused surveys to a subset of members, to determine if quality issues do in fact exist, identifying and addressing specific deficiencies. Quality of Care‐Care Management (Partially Capitated) Elderplan members did not rate the quality of care they received from their care manager as favorably as members enrolled in other plans in 2014‐2015. Seventy‐eight percent (78%) of Elderplan members rated their care manager as good or excellent, compared to 83% for other partially capitated members and 83% of members statewide. It is recommended that Elderplan consider conducting additional focused surveys to a subset of members, to determine if quality issues do in fact exist with these services. 23
Activities of Daily Living (Partially Capitated and MAP) A lower percentage of Elderplan members were able to perform several of the ADLs independently, when compared with members statewide. For partially capitated members, with regard to the most recent UAS reporting period in 2014 (July‐December), 7% were able to bathe independently, compared with 17% statewide; 9% were able to dress their lower bodies, compared with 16% of members statewide; and 75% were able to eat independently, compared with 87% of members statewide. Prevention (Partially Capitated and MAP) Elderplan partially capitated members had lower rates for most of the prevention measures, with the exception of the influenza vaccine (where the rate was the same, 76%, for both Plan members and members statewide). A lower percentage of Elderplan members had a dental exam, eye exam and hearing exam when compared with members statewide. Elderplan MAP members had lower rates for all of the prevention measures. Rates for dental exam, eye exam, hearing exam and the influenza vaccine were all below the statewide rates. It is recommended that Elderplan attempt to validate these data through comparison to medical records and care management correspondence. In this manner, the plan may be able to identify if under‐reporting issues exist or if there are barriers to obtaining and reporting these data. It should be noted that Elderplan conducted a preventive screening eye exam PIP in 2015, the results of which demonstrate that this initiative had a positive impact upon their membership (there was a 12 percentage point increase in the number of MAP members receiving eye exams, and a 15 percentage point increase in the number of partially capitated members receiving eye exams). Cognition (MAP) A lower percentage of Elderplan members (5%) demonstrated intact cognitive functioning, when compared with members statewide (34%). It should be noted that UAS questions pertaining to cognition are possibly prone to a high level of subjectivity on the part of the assessor and may also be scored based upon behavior/attitude exhibited solely at the time of the assessment visit. It is therefore recommended that Elderplan conduct an inter‐rater reliability project for clinical assessments, to aid in determining whether these members do in fact have higher levels of impairment 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. 24