NEW YORK STATE DEPARTMENT OF HEALTH
Office of Quality and Patient Safety
Plan – Technical Report
For
CenterLight
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 ..................................................................................................................... 100 Section Six: Performance Improvement Projects ...................................................................................... 19 Section Seven: Summary/Overall Strengths and Opportunities ................................................................. 24 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, Semi Annual Assessment of Members (SAAM) and Uniform Assessment System (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 CenterLight , formerly Comprehensive Care Management (CCM), offers two (2) Managed Long Term Care (MLTC) product lines, a Program of All Inclusive Care for the Elderly (PACE) and a newer partially capitated product line, CenterLight Healthcare Select. CenterLight is affiliated with the Beth Abraham family of health services, including skilled nursing facilities, senior housing, and a home care agency. The following report presents plan‐specific information for both of the product lines offered.  Partially Capitated Plan ID: 02710185  PACE Plan ID: 01234037, Select Plan ID: 02710185  Managed Long‐term Care Start Date: 1992 (PACE) and 2007 (Partially Capitated)  Product Line(s): PACE and Partially Capitated  Partially Capitated MLTC Age Requirement: 18 and older  PACE MLTC Age Requirement: 55 and older  Contact Information: 1250 Waters Place Tower 1, Suite 602 Bronx, NY 10461 (877)226‐8500 Participating Counties and Programs Nassau Partial Cap PACE Rockland Partial Cap New York Partial Cap PACE Suffolk Partial Cap PACE 3 Westchester Partial Cap PACE Section Three: Enrollment Figure 1 depicts membership for the CenterLight’s partially capitated and PACE 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 grew from 2012 to 2013, increasing by 56.5%, whereas it declined by 24.9% from 2013 to 2014. For the PACE line, membership grew by 15.9% from 2012 to 2013 and decreased by 3.5% from 2013 to 2014. Figure 1a trends the enrollment for both the partially capitated and PACE product lines. Figure 1: Membership: Partially Capitated and PACE 2012‐2014 2012 Partially Capitated Number of Members 6,404 % Change From Previous Year 89.7% PACE Number of Members 3,165 2013 2014 10,024 56.5% 7,531 ‐24.9% 3,669 3,539 % Change From Previous Year 15.9% ‐3.5% 10.0% Figure 1a: Enrollment Trends 2012‐2014 Number of Members
CenterLight Enrollment 2012‐2014
12,000
10,000
8,000
6,000
4,000
2,000
0
10,024
7,531
6,404
3,165
3,669
3,539
Part Cap
PACE
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 CenterLight’s partially capitated product line was 22.5% (126 respondents out of 561 members in the sample). The response rate for CenterLight’s PACE product line was 28.5% (163 respondents out of 572 members in the sample). IPRO had previously conducted a similar satisfaction survey that was mailed between December 2012 and May 2013. Figure 2a represents these two satisfaction survey results from CenterLight’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 from CenterLight’s PACE product line, compared with all other PACE plans throughout the state, as well as all MLTC plans statewide, in these same areas.
5 Figure 2a: Satisfaction Survey Results CenterLight Compared with all Partially Capitated Plans, and all Plans Statewide CenterLight 2012‐2013 (N=155)a Description nb 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 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) Dentist Eye Care/Optometry Foot Care/Podiatry Access to Urgent Care (Same Day) Dentist Eye Care/Optometry Foot Care/Podiatry 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 ◊ Overall Part Cap 2012‐2013 (N=1,662)a CenterLight 2014‐2015 (N=126)a % nb % nb % nb 139
88%
1,439
87%
2,197
88%
‐
‐
‐
‐
‐
151
83%
1,625
84%
91
115
98
128
130
142
110
121
67%
82%
85%
88%
75%
84%
76%
72%
1,009
1,279
1,087
1,358
1,389
1,420
1,185
1,242
111
113
139
117
112
73%
58%
69%
64%
64%
69
95
77
Overall Part Cap 2014‐2015 (N=3,306)a Statewide 2014‐2015 (N=4,592)a % nb % nb % 93
91%
2,677
94%
3,702
94% ‐
63
83%
1,831
77%
2,495
75% 2,458
84%
102
78%
2,688
87%
3,739
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%
69
87
80
93
89
99
89
78
58%
69%
86%
94%
60%
80%
74%
78%
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
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%
90
84
97
66
68
87%
62%
74%
77%
77%
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
33%
45%
42%
832
1,093
932
47%
43%
45%
1,234
1,647
1,390
46%
43%
45%
48
62
60
63%
76%
83%
1,323
1,767
1,608
75%
80%
82%
1,873
2,486
2,220
47
69
51
19%
20%
20%
612
788
692
28%
25%
27%
920
1,195
1,039
26%
22%
26%
38
57
55
29%
23%
31%
1,062
1,497
1,368
31%
34%
35%
1,526
2,165
1,912
87% 73% 82% 83% 87% 83% 83% 82% 77% 93% 83% 81% 81% 78% 73% 79% 80% 29% 33% 34% 120
50%
1,346
64%
2,087
68%
90
54%
2,660
64%
3,757
67% 124
40%
1,387
55%
2,145
61%
92
39%
2,645
53%
3,722
58% 35
63%
533
74%
956
77%
25c
60%
913
75%
1,506
79% 6 Statewide 2012‐2013 (N=2,522)a Symbol a
b
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 part cap/statewide rate (p < .001) Represents a significantly lower rate versus the part cap/statewide rate (p < .001) Item based on a skip pattern Significance testing could not be performed due to small sample size (n<30) ◊ c A lower percentage of CenterLight Select members had completed advance directives, when compared with members in other partially capitated plans and all members statewide, in both the 2012 and 2014 surveys. There were also a lower percentage of members who indicated that the plan discussed appointing someone to make decisions for them in both years, however the difference was only statistically significant in 2012. CenterLight Select members rated the quality and timeliness of their care manager less favorably in 2014, when compared with members in other partially capitated plans and all plans statewide. 7 Figure 2b: Satisfaction Survey Results CenterLight Compared with all PACE Plans, and all Plans Statewide CenterLight 2012‐2013 (N=168)a Overall PACE 2012‐2013 (N=446)a Description nb % nb 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 150
87%
‐
Statewide 2012‐2013 (N=2,522)a Overall PACE 2014‐2015 (N=574)a Statewide 2014‐2015 (N=4,592)a nb nb % nb % % nb % 381
88%
2,197
88%
132
94%
432
92%
3,702
94% ‐
‐
‐
‐
‐
98
77%▲
267
58%
2,495
75% 162
84%
430
86%
2,458
84%
132
84%
453
86%
3,739
87% 157
97
131
102
132
135
153
127
142
87%
58%
77%
78%
85%
87%
88%
90%
80%
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%
134
94
118
92
121
125
137
120
126
89%
66%
75%
79%
81%
83%
85%
84%
87%▲
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% 116
128
153
141
140
76%
68%
73%
63%
61%
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%
123
117
130
116
116
91%
85%
82%
83%
78%
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% 136
80
105
83
65%
43%
38%
40%
343
229
282
223
70%
42%
45%
48%
2,104
1,234
1,647
1,390
59%
46%
43%
45%
125
75
98
82
87%
57%
71%
70%
383
253
300
255
86%
70%
74%
73%
3,328
1,873
2,486
2,220
88% 73% 79% 80% 122
65
79
61
48%
15%
13%
15%
324
173
200
163
49%
15%
13%
23%
1,755
920
1,195
1,039
45%
26%
22%
26%
111
68
91
75
49%
22%
34%
31%
368
221
278
235
50%
20%
27%
30%
2,885
1,526
2,165
1,912
50% 29% 33% 34% 8 CenterLight 2014‐2015 (N=163)a % 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
139
83%▲
389
82%
2,087
68%
136
69%
497
78%
3,757
67% 144
71%
395
83%
2,145
61%
127
68%
494
84%
3,722
58% 86
87%
269
91%
956
77%
67
90%
348
94%
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 PACE/statewide rate (p < .001) Represents a significantly lower 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 ◊ c A higher percentage of CenterLight members indicated their plan explained the consumer directed personal assistance option, when compared with members in other PACE plans, and in all plans statewide (this difference was statistically significant when compared with the PACE average). Additionally, a higher percentage of members rated their transportation service as good or excellent, when compared with members in other PACE plans and in all plans statewide (this difference was statistically significant when compared with the PACE average). Although not statistically significant, a lower percentage of CenterLight members rated the quality of their dental provider as good or excellent in both 2012 and 2014, when compared with members enrolled in other plans. This may be correlated to the lower percentage of members that indicate they have access to routine dental care in 2014. 9 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 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 CenterLight’s July 2013 SAAM results for their partially capitated line, and Figure 3b contains CenterLight’s January‐June and July‐December 2014 UAS results. Figure 4a contains CenterLight’s July 2013 SAAM results for their PACE line, and Figure 4b contains CenterLight’s January‐June and July‐December 2014 UAS results.
1
NYS Department of Health, 2014 Managed Long Term Care Report. http://health.ny.gov 10 Figure 3a: CenterLight Partially Capitated and Statewide SAAM Data 2013 July 2013 Plan Statewide SAAM SAAM N=8,707 N=103,005 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 Health Conditions Frequency of Pain – % experiencing no pain, or pain less than daily 11 94%
92%
92%
89%
91%
87%
87%
78%
93%
91%
91%
87%
100%
99%
22%
27%
82%
79%
47%
40%
18%
36%
24%
39%
77%
74%
53%
44%
July 2013 Plan Statewide SAAM SAAM N=8,707 N=103,005 SAAM Items Falls Resulting in Medical Intervention – % of members experiencing no falls requiring medical intervention 48%
Prevention Influenza Vaccine – 77%
% who had influenza vaccine in last year Partially Capitated SAAM July 2013 CenterLight members had higher levels of ability when performing all six ADLs, as represented in Figure 3a. It should be noted that for feeding/eating, 100% of CenterLight members were able to perform this task independently, with set up help, or supervision. In contrast, a lower percentage of CenterLight members reported no confusion compared to members statewide (18% vs. 36%, respectively). Similarly, a lower percentage reported no anxiety compared to members statewide (24% vs. 39%, respectively). 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 behavioral/attitude exhibited solely at the time of the assessment visit.
12 55%
72%
Figure 3b: CenterLight Partially Capitated and Statewide UAS Data 2014 Jan‐June 2014 July‐Dec 2014 UAS Items Statewide Plan Statewide Plan UAS UAS UAS UAS N=132,429 N=7,840 N=125,702 N=9,067 Activities of Daily Living (ADL) Ambulation/Locomotion – % of members who could perform task 57%
55%
50%
53%
independently, with setup help/device, or with supervision Bathing – % of members who could perform task 24%
19%
17%
16%
independently, with setup help/device, or with supervision Upper Body Dressing – % of members able to perform task 39%
33%
30%
30%
independently, with setup help or with supervision Lower Body Dressing – % of members able to perform task 24%
18%
17%
16%
independently, with setup help or with supervision Toileting – % of members able to perform task 64%
63%
56%
57%
independently, with setup help or with supervision Feeding/Eating – % of members able to eat/drink 90%
87%
87%
85%
independently, with setup help or with supervision Continence Urinary Continence – % who are continent, have control with 31%
36%
30%
36%
catheter/ostomy, or were infrequently incontinent Bowel Continence – % who are continent, have control with 83%
83%
82%
83%
ostomy, or were infrequently incontinent Cognition Cognitive functioning – 32%
39%
26%
34%
% with intact functioning Mood and Behavior Anxiety – 74%
76%
71%
75%
% with no feelings of anxiety Depressed – 73%
71%
67%
68%
% with no feelings of depression 13 UAS Items Health Conditions Frequency of Pain – % experiencing no severe daily pain Falls Resulting in Medical Intervention – % of members experiencing no falls requiring medical intervention Jan‐June 2014 Plan Statewide UAS UAS N=9,067 N=125,702 July‐Dec 2014 Plan Statewide UAS UAS N=7,840 N=132,429 35%
25%
30%
21%
93%
88%
94%
91%
Prevention Dental Exam – 54%
49%
54%
% who had dental exam in last year Eye Exam – 73%
71%
75%
% who had eye exam in last year Hearing Exam – 34%
33%
36%
% who had hearing exam in last 2 years Influenza Vaccine – 72%
75%
73%
% who had influenza vaccine in last year UAS January‐June 2014 Compared with members statewide, there was a lower percentage of CenterLight members with intact cognitive functioning, (32% vs. 39% respectively). However, there were a higher percentage of CenterLight members who experienced no severe daily pain and who had no falls requiring medical intervention. UAS July‐December 2014 Compared with members statewide, there was a higher percentage of CenterLight members who experienced no severe daily pain (30% vs. 21%, respectively), and a slightly higher percentage of members with no falls requiring medical intervention (94% vs. 91%, respectively). Additionally, rates were higher among CenterLight members compared with members statewide for all of the prevention measures reported in Figure 3b (with the exception of the influenza vaccine, where the rate among CenterLight members was three percentage points lower). 14 50%
73%
33%
76%
Figure 4a: CenterLight PACE and Statewide SAAM Data 2013 July 2013 SAAM Items Plan SAAM N=3,449 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 or 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 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 15 Statewide SAAM N=74,820 91%
93%
87%
90%
86%
88%
82%
81%
90%
91%
86%
89%
99%
99%
13%
27%
79%
79%
40%
42%
16%
38%
24%
39%
81%
76%
54%
46%
46%
54%
July 2013 SAAM Items Plan SAAM N=3,449 Statewide SAAM N=74,820 Prevention Influenza Vaccine – 87%
% who had influenza vaccine in last year PACE SAAM July 2013 A slightly higher percentage of CenterLight members had no feelings of depression, no feelings of pain, and indicated they had received an influenza vaccine within the past year. In contrast, a lower percentage demonstrated urinary continence, had no confusion, no anxiety, and experienced no falls resulting in medical intervention, when compared with members statewide. 16 69%
Figure 4b: CenterLight PACE and Statewide UAS Data 2014 Jan‐June 2014 UAS 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 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 Statewide UAS N=125,702 Plan UAS N=3,766 Statewide UAS N=132,429 Plan UAS N=3,624 59%
55%
57% 53%
26%
19%
21% 16%
40%
33%
36% 30%
29%
18%
25% 16%
67%
63%
63% 57%
88%
87%
87% 86%
25%
36%
23% 36%
80%
83%
78% 83%
31%
39%
29% 34%
79%
76%
77% 75%
17 July‐Dec 2014 Jan‐June 2014 UAS Items Statewide UAS N=125,702 Plan UAS N=3,766 July‐Dec 2014 Plan UAS N=3,624 Statewide UAS N=132,429 Depressed – 77%
71%
75% % with no feelings of depression Health Conditions Frequency of Pain – 35%
26%
32% % experiencing no severe daily pain Falls Resulting in Medical Intervention – % of members experiencing no falls 90%
88%
91% requiring medical intervention Prevention Dental Exam – 54%
49%
55% % who had dental exam in last year Eye Exam – 74%
71%
77% % who had eye exam in last year Hearing Exam – 34%
33%
36% % who had hearing exam in last 2 years Influenza Vaccine – 83%
74%
83% % who had influenza vaccine in last year UAS January‐June 2014 Compared with members statewide, there were a lower percentage of CenterLight members with urinary and bowel continence and intact cognitive functioning. In contrast, a higher percentage of CenterLight members had the ability to perform the six ADLs, represented in Figure 4b. UAS July‐December 2014 Compared with members statewide, there were a lower percentage of CenterLight members with urinary and bowel continence and intact cognitive functioning. Rates were higher among CenterLight members for all of the preventive measures (dental exam, eye exam, hearing exam and the influenza vaccine). Similarly, a higher percentage of CenterLight members indicated no feelings of depression when compared with members statewide (75% vs. 68%, respectively).
18 68%
21%
91%
50%
73%
33%
75%
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 CenterLight’s 2013‐2014 PIPs for its partially capitated and PACE product lines: 2013 Partially Capitated PIP: Emergency Preparedness Based on member experience through the various weather emergencies that affected NYS in 2012, Centerlight decided their members would benefit from additional information and guidance on how to be prepared and plan for an emergency. The project’s objectives were to provide CenterLight Healthcare members, their families and caregivers with useful information on how to prepare for an emergency and optimize their safety and well being, and encouraging members to create a personal emergency preparedness plan. Interventions: 1) Mailing the New York City Office of Emergency Management; Ready New York: Emergency Preparedness Guide to each member household in their preferred language as indicated on their enrollment file. Centerlight downloaded the guide in five languages to meet the language preferences of our members and created a corresponding letter, identifying the purpose of the mailing and the Membership Services contact phone number for additional healthcare information if needed. 2) During routine outbound telephone calls to members, a member of the Care Management team discussed with the member and or caregiver the mailing of the Emergency Preparedness Guide and the importance of developing their own personal emergency plan. 3) The Membership Services team was provided with copies of the Ready New York: Emergency Preparedness Guide and the website to fulfill any requests for additional mailings or changes in language preference of the guide. Results: Due to system limitations, the Plan was unable to effectively aggregate the Care Management team responses and determine the percent of member households that acknowledged receiving the emergency guide. During follow‐up with the Care Management team they expressed that the majority of the members acknowledged the receipt of the emergency guide. Many members that acknowledged receiving the guide, expressed that it would be helpful in the event of an emergency. There was a small percentage of the membership that expressed not being aware of the mailing or that they had no intention of reviewing the guide. For those members that were not able to determine if they received the guide an additional guide was offered. The Care Management team made the request for additional guides via email to Membership Services directly or to the Assistant Director of Quality for follow‐up. The Membership Services team reported a low volume of requests for duplicate mailings, but did not formally document the number of additional guides mailed. CenterLight Healthcare only received approximately two dozen undeliverable emergency guides. 19 2014 Partially Capitated PIP: Flu Immunizations CenterLight has determined that ensuring its members receive the influenza vaccination annually will prevent illness, including pneumonia. The Plan’s goal was to create a database to capture the flu immunization status of its entire membership for analysis and to develop strategies to improve membership‐wide immunization rates for the previous flu season (9/1/2013 to 3/31/2014) and for the current flu season (9/1/2014 to 3/31/2015). Interventions: 1) Strategy Planning: An interdisciplinary team consisting of the Medical Director, the AVP of Quality Management, the VP of Care Management and several Care Management Team Leaders met to develop a comprehensive approach to improving vaccination rates in the upcoming 2014‐2015 flu season. 2) Member Education: The Care Management team advised members of the benefits of annual influenza immunization during outbound calls. Continued outreach to initial refusals was recommended to encourage vaccination and explore reasons for refusal. 3) Staff Education: Encouraged the Care Management team to provide reinforcement of the importance of immunization throughout the season and not just as an early season campaign. This included in‐services on flu prevention and reminders throughout the season. In addition, the Quality Management staff periodically sent updates from the NYS Department of Health and the CDC regarding the status of influenza throughout the state and the country. 4) Community Physician Outreach: In September of 2014, CenterLight sent correspondence to community based physicians reminding them of the importance of immunizing their patients against influenza. 5) Database Development: A database was developed so that the Care Managers could record member self‐reported information regarding whether or not the member received the flu vaccination. The information would be captured as part of the Care Managers’ telephonic conversations with members during the flu season. Results: The influenza vaccination rate for the re‐measurement period of 9/2014 – 3/2015 was 72.5%. While this appears to be a very significant increase over the previous flu season rate of 49.9%, the data should be loosely interpreted; specifically, because the UAS was a new assessment tool as of 10/1/2013. Implementation of the UAS‐NY and the ability to obtain the data from it was slow and included a learning curve on the part of the nurse reviewers. The influenza vaccination rate of 72.5% at the end of 20 March 2015, was aligned with the state‐wide average for this population in 2014 which was 75% (self‐
reported). Conclusions: The objective of developing a database to record and track influenza vaccinations was accomplished; however, additional training for the Care Management staff and monitoring reports are needed to increase compliance with recording the members’ influenza immunization status in the database. Due to the discussed limitations with the data capture, and limitations with the October 2013 implementation of the UAS‐NY, it is not possible to determine if our interventions during the 2014‐2015 flu season had any direct impact on improving the flu immunization rate for CenterLight Select’s membership. 2013 PACE PIP: Infection Control Program CenterLight identified the need to improve its infection control program. The objective of the Plan’s improvement was to identify both corporate‐level and site‐level personnel, responsible for the implementation of the infection control program, to promote standard, reproducible data, to create an electronic, online method of reporting and to improve the rate of reported infections. Interventions: 1) Educate members of the Interdisciplinary Team on revised Infection Control Program, surveillance definitions, policies and procedures and their roles and responsibilities. 2) Teach assigned Center staff how to enter infections and run reports. 3) Quality oversight at the PACE Center level during morning report to ensure that participants with infections had the infections entered into the online system. Results: Rate of Reported Infections Quarter Numerator Denominator % Q3 2012 71 3,230 2.20% Q1 2013 53 3,272 1.62% Q2 2013 245 3,499 7.00% Q3 2013 263 3,596 7.31% Q4 2014 255 3,798 6.71% The rate of reported infections has greatly increased since the program was implemented in Q2 of 2013. Although the rate of reported infections has increased from Q3 2012 to Q3 2014, the rate did see a decrease by more than half of a percentage point from Q3 2013 to Q4 2014 (7.31% vs. 6.71%, respectively). Conclusions: The program implementation was a success and the objectives were met. The electronic online system was created, and the PACE Center staff has taken an increased role in the review of participants with infections and following the progress of the treatment to ensure the resolution. In addition, when indicated, the Quality department has been able to intervene when individual patterns of infection have been identified to ensure optimal care.
21 2014 PACE PIP: Flu Immunizations CenterLight has determined that ensuring its members receive the influenza vaccination annually will prevent illness, including pneumonia. The Plan’s goal, for Flu Season 2014‐2015, was to increase the flu immunization rate among the PACE membership to 85%. This is in line with the CDC’s goal of a 90% flu vaccine compliance rate by 2020. Interventions: 1) Strategy Planning: An interdisciplinary team consisting of the VP of Clinical Operations, the Medical Director, the AVP of Quality Management, and several Medical Practice nurses was convened to develop a comprehensive approach to improving vaccination rates in the upcoming flu season. 2) Policy Development: One of the primary interventions implemented was to develop a standing order for flu immunization administration. As part of the new policy, the nurse administering the vaccine screened the participant for contraindications. The nurse then obtained written consent from the participants prior to immunization. As part of this process each participant received the most current federal vaccine information sheet in English or their native language if available. 3) Participant Education: Medical Practice nurses addressed the participants attending the Day Health Centers advising them of the benefits of influenza immunization. Additionally, at each of the PACE sites educational resources were posted to increase the awareness of the importance of influenza vaccination. These resources were posted throughout flu season and included educational information in appropriate languages as each site has a variety of participants whose primary language is not English. 4) Staff Education: The nursing and medical staffs were encouraged to provide reinforcement of the importance of immunization throughout the season and not just as an early season campaign. This included in‐services on flu prevention and reminders throughout the season. In addition the Quality Management staff periodically sent updates from e.g. the NYS Department of Health and the CDC regarding the status of influenza throughout the state and the country. 5) Site Level Clinician: The Medical Practice nurse and the PACE Site physician continued to reach out to initial refusals to encourage vaccination and explore reasons for refusal. 6) Community Physician Outreach: In September of 2014, CenterLight sent correspondence to community based physicians reminding them of the importance of immunizing their patients against influenza. This communication included information about our new standing orders policy. The physicians were also informed that this new policy includes a process for sending documentation of the immunization for the patient record. Results: 22 Results for the re‐measurement period (2014‐2015 flu season) were subpar, with flu vaccination rates decreasing by 3.1 percentage points from 82.7% (9/13‐3/14) to 79.6% (9/14‐3/15). However, this exceeds the 2014 statewide average of 75% for MLTC programs. Conclusions: The objective of improving the flu immunization rate to 85% for the 2014 – 2015 flu season was not met. Missteps in implementation of the interventions may account for the small decrease in the rates from the 2013‐2014 flu immunization rates. Evidently, the interventions must be sustained over the course of the entire seven‐month flu season if the Plan is to effect positive results for its diverse elderly, frail and chronically‐ill participants.
23 Section Seven: Summary/Overall Strengths and Opportunities Strengths Partially Capitated Quality of Care Rating (2014 Satisfaction Survey) Although not statistically different from the partially capitated and statewide averages, a higher percentage of CenterLight Select members rated the quality of their home health aide as good or excellent (94% compared with 87% of partially capitated and statewide members). Health Conditions (July‐Dec 2014 UAS) Compared with members statewide, there were a higher percentage of CenterLight members who experienced no severe daily pain (30% vs. 21%, respectively), and a slightly higher percentage of members with no falls requiring medical intervention (94% vs. 91%, respectively). Preventive Screenings (Jan‐June and July‐Dec 2014 UAS) Rates for most of the prevention categories were higher for CenterLight Select members compared to members statewide. Rates for dental exam, eye exam and hearing exam were higher for CenterLight Select members. PACE Consumer Directed Personal Assistance Option (Satisfaction Survey 2014) A significantly higher percent of CenterLight PACE members indicated that the Consumer Directed Personal Assistance Option was discussed and explained, compared with members enrolled in other PACE plans (77% vs. 58, respectively). Mood and Behavior (July‐Dec 2014 UAS) A higher percentage of CenterLight PACE members had no feelings of depression, compared with members statewide (75% vs. 68%, respectively). Preventive Screenings (Jan‐June and July‐Dec 2014 UAS) A higher percentage of CenterLight PACE members reported having preventive screenings/immunizations for all of the preventive care measures reported in Figure 4b compared to statewide. This demonstrates CenterLight’s focus on preventive care for their members which can help improve their quality of life. Opportunities Partially Capitated Quality of Care‐Care Management (Satisfaction Survey 2012 and 2014) CenterLight Select members rated their care managers less favorably compared with members enrolled in other partially capitated plans and all other plans statewide. 24 CenterLight may consider administering a separate focused survey to a sample of members, to help in determining if quality issues do in fact exist. Timeliness (Satisfaction Survey 2014) Sixty two percent (62%) of CenterLight Select members indicated that their care manager is always or usually on time, which is significantly lower compared with other partially capitated members (83%) and other plan members statewide(83%). This may be contributing to the poor quality rating for care managers as well. It is recommended that CenterLight conduct a focused member survey to determine the nature of these timeliness issues. Advance Directives (Satisfaction Survey 2014) The satisfaction survey results indicate that CenterLight should consider taking a more proactive role with regard to advance directives. Of those members who responded to the survey, 54% indicated they had been approached by the plan to appoint a healthcare proxy, 39% indicated they had a healthcare proxy, and 60% claimed that a copy of this healthcare proxy was on file with the plan. The rate for CenterLight Select members with a healthcare proxy is significantly lower than other partially capitated plans and statewide. CenterLight is in the process of conducting a Performance Improvement Project targeted for advance directives to improve participation and compliance. This PIP is scheduled to take place from 2015 through 2016, and should hopefully improve the rate of members with a completed advance directive. Performance Improvement Project –Emergency Preparedness – 2013 CenterLight developed an educational initiative to provide members, families and caregivers with useful information on how to prepare for an emergency and optimize safety and well being. The initiative aimed to encourage members to create a personal emergency preparedness plan. A key intervention for the project was the mailing of the Ready New York: Emergency Preparedness Guide to the membership, with the intent to follow up with each member to insure that the guide was received, understood, and would be used in setting up an individualized emergency plan. It appears, however, that only the mailing of these materials was accomplished to any degree. The other goals involving one‐
on‐one outreach to members to determine their understanding of the materials and their use was not emphasized. No quality indicators were established for these goals or for the setting up of individualized, member specific emergency plans. It is unclear if this PIP was pursued in subsequent years. It is recommended that this critical topic continue to be addressed by the plan, with a focus on individual emergency plan development for each member, spearheaded by key CenterLight staff. PACE Quality of Care‐Dentists (Satisfaction Survey 2014) CenterLight PACE members did not rate the quality of care they received from their dentist as favorably as members enrolled in other plans. Sixty six percent (66%) of CenterLight PACE members rated their dentist as good or excellent, compared to 77% for other PACE members and 73% statewide. 25 It is recommended that CenterLight consider conducting additional focused surveys to a subset of members, to determine if quality issues do in fact exist with these providers. Opportunities‐Partially Capitated and PACE Cognitive Functioning (Jan‐June and July‐Dec 2014 UAS) A lower percentage of CenterLight PACE members had intact cognitive functioning compared with members statewide. In the January‐June reporting period, 31% of CenterLight members had intact cognitive functioning, compared with 39% statewide, and in the July‐December reporting period, 29% of CenterLight members had intact cognitive functioning, compared with 34% of members statewide. A similar observation was noted with the CenterLight Select membership for the July –December 2014 period, with a lower percentage of membership reporting intact cognitive functioning (26% vs 34% statewide). It would appear as though the scores for these questions can rely heavily upon assessor observation at the time of the UAS visit and may be subjectively scored based upon the observations of the same assessor. It is therefore recommended that CenterLight 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. 26