NEW YORK STATE DEPARTMENT OF HEALTH
Office of Quality and Patient Safety
Plan – Technical Report
For
Catholic Health LIFE
Reporting Years 2013 and 2014
February 2017
Table of Contents Section One: About This Report ................................................................................................................... 1 Section Two: Plan Profile ............................................................................................................................. 3 Section Three: Enrollment ........................................................................................................................... 4 Section Four: Member Satisfaction .............................................................................................................. 5 Section Five: SAAM and UAS ........................................................................................................................ 8 Section Six: Performance Improvement Projects ...................................................................................... 12 Section Seven: Summary/Overall Strengths and Opportunities ................................................................. 17 Section One: About This Report New York State (NYS) is dedicated to providing and maintaining the highest quality of care for enrollees in managed long term care (MLTC) plans. MLTC enrollees are generally chronically ill, often elderly enrollees and are among the most vulnerable New Yorkers. The New York State Department of Health’s (NYSDOH) Office of Quality and Patient Safety (OQPS) employs an ongoing strategy to improve the quality of care provided to plan enrollees, to ensure the accountability of these plans and to maintain the continuity of care to the public. The MLTC Plan‐Technical Reports are individualized reports on the MLTC plans certified to provide Medicaid coverage in NYS. The reports are organized into the following domains: Plan Profile, Enrollment, Member Satisfaction, SAAM and UAS Clinical Assessment Data, and Performance Improvement Projects (PIPs). When available and appropriate, the plans’ data in these domains are compared to statewide benchmarks. The final section of the report provides an assessment of the MLTC plan’s strengths and opportunities for improvement in the areas of service quality, accessibility, and timeliness. For areas in which the plan has opportunities for improvement, recommendations for improving the quality of the MLTC plan’s services are provided. During the review period of this report (2013‐14), there were three (3) MLTC plan types: a) Partially Capitated b) Program of All‐inclusive Care for the Elderly (PACE) c) Medicaid Advantage Plus (MAP) A description of each of the plan types follows: Partially capitated ‐ A Medicaid capitation payment is provided to the plan to cover the costs of long term care and selected ancillary services. The member’s ambulatory care and inpatient services are paid by Medicare if they are dually eligible for both Medicare and Medicaid, or by Medicaid if they are not Medicare eligible. For the most part, those who are only eligible for Medicaid receive non MLTC services through Medicaid fee for service, as members in partially capitated MLTC plans are ineligible to join a traditional Medicaid managed care plan. The minimum age requirement is 18 years. PACE‐ A PACE plan provides a comprehensive system of health care services for members 55 and older, who are otherwise eligible for nursing home admission. Both Medicaid and Medicare pay for PACE services on a capitated basis. Members are required to use PACE physicians. An interdisciplinary team develops a care plan and provides ongoing care management. The PACE plan is responsible for directly providing or arranging all primary, inpatient hospital and long term care services required by a PACE member. The PACE is approved by the Centers for Medicare and Medicaid Services (CMS). Medicaid Advantage Plus (MAP)‐ MAP plans must be certified by the NYSDOH as MLTC plans and by CMS as a Medicare Advantage plan. As with the PACE model, the plan receives a capitation payment from both Medicaid and Medicare. The Medicaid benefit package includes the long term care services and the Medicare benefit package includes the ambulatory care and inpatient services. An MLTC plan can service more than one of the above products and where applicable, the report will present data for each product. 1 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 Catholic Health LIFE is a regional health plan, servicing the Programs of All‐inclusive Care for the Elderly (PACE) population. The plan is an affiliate of the Catholic Health Systems of Western New York. The following report presents plan‐specific information.  Plan ID: 03072740  Managed Long‐term Care Start Date: 2009  Product Line(s): PACE  MLTC Age Requirement: 55 and older  Contact Information: 2121 Main Street, Suite 300 Buffalo, NY 14214 (716) 819‐5433 Participating Counties and Programs Erie PACE 3 Section Three: Enrollment Figure 1 depicts membership for Catholic Health LIFE’s PACE 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 PACE plan grew over this period, increasing by 38.3% from 2012 to 2013 and by 17.6% from 2013 to 2014. Figure 1a trends the enrollment for the PACE product line. Figure 1: Membership: PACE 2012‐2014 2012 2013 2014 PACE
115 159 187
17.6%
Number of Members % Change From Previous Year 59.7% 38.3% Figure 1a: Enrollment Trends 2012‐2014 Catholic Health LIFE Enrollment 2012‐2014
187
Number of Members
200
159
150
115
100
PACE
50
0
2012
2013
2014
Year
4 Section Four: Member Satisfaction IPRO, in conjunction with the NYSDOH, conducted a member satisfaction survey 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 Catholic Health LIFE’s partially capitated product line was 46.9% (60 respondents out of 128 members in the sample). IPRO had previously conducted a similar satisfaction survey that was mailed between December 2012 and May 2013. Figure 2 represents these two satisfaction survey results from Catholic Health LIFE’s PACE product line, 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 Catholic Health LIFE 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 CHS Buffalo LIFE 2012‐2013 (N=19)a nb % c
16
94%
Overall PACE 2012‐2013 (N=446)a Statewide 2012‐2013 (N=2,522)a nb 381
% 88%
nb 2,197
% 88%
CHS Buffalo LIFE 2014‐2015 (N=60)a nb % 53
93%
Overall PACE 2014‐2015 (N=574)a Statewide 2014‐2015 (N=4,592)a nb 432
% 92%
nb 3,702
% 94% ‐
‐
‐
‐
‐
‐
42
41%
267
58%
2,495
75% 18c
78%
430
86%
2,458
84%
54
98%▲
453
86%
3,739
87% 16c
16c
16c
15c
12c
15c
10c
15c
14c
81%
69%
56%
67%
75%
87%
100%
80%
79%
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%
53
37
39
46
38
45
49
50
47
94%
95%▲
87%
94%
90%
96%▲
98%▲
96%▲
92%▲
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% Home Health Aide, Personal Care Aide 13c
85%
319
77%
1,897
78%
100%
374
90%
3,385
93% 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 12c
10c
12c
13c
67%
90%
92%
77%
341
340
370
366
68%
71%
71%
68%
1,876
2,027
1,766
1,742
69%
69%
69%
67%
36
41
45
39
38
93%
98%▲
95%▲
87%
380
368
370
370
86%
86%
90%
84%
3,144
3,177
2,515
2,505
83% 81% 81% 78% 15c
12c
13c
13c
73%
42%
54%
69%
343
229
282
223
70%
42%
45%
48%
2,104
1,234
1,647
1,390
59%
46%
43%
45%
48
31
29c
41
92%
81%
83%
90%▲
383
253
300
255
86%
70%
74%
73%
3,328
1,873
2,486
2,220
88% 73% 79% 80% 15c
12c
8c
13%
8%
0%
324
173
200
49%
15%
13%
1,755
920
1,195
45%
26%
22%
51
23c
26c
77%▲
22%
23%
368
221
278
50%
20%
27%
2,885
1,526
2,165
50% 29% 33% 6 ▲
Figure 2: Satisfaction Survey Results Catholic Health LIFE Compared with all PACE Plans, and all Plans Statewide Foot Care/Podiatry Description 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 ◊ CHS Buffalo LIFE 2012‐2013 (N=19)a 9c
0%
b
n % Overall PACE 2012‐2013 (N=446)a Statewide 2012‐2013 (N=2,522)a 163
nb 23%
% 1,039
nb 26%
% CHS Buffalo LIFE 2014‐2015 (N=60)a 37
57%
b
n % Overall PACE 2014‐2015 (N=574)a 235
n 30%
% 1,912
nb 34% % b
17c
88%
389
82%
2,087
68%
56
93%▲
497
78%
3,757
67% 16c
100%
395
83%
2,145
61%
59
98%▲
494
84%
3,722
58% 15c
100%
269
91%
956
77%
54
98%▲
348
94%
1,506
79% 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 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 (n<30) c 7 Statewide 2014‐2015 (N=4,592)a Satisfaction survey results from 2012‐2013 should be interpreted with caution, due to the small sample size (n=19). Due to the larger sample size in the 2014‐2015 satisfaction survey, statistical analysis was able to be conducted, highlighting some interesting differences between CHS members and members enrolled in other plans throughout the state;  A lower percentage of CHS members indicated that the plan had explained the Consumer Directed Personal Assistance option (41% compared with 58% of PACE members and 75% of all other members statewide).  A higher percentage of members (98%) rated their plan as good or excellent compared with other PACE members (86%) and all other members statewide (87%).  Quality of care ratings were higher among CHS members for their dentist, care manager, regular visiting nurse, medical supplies and transportation services.  CHS members rated the timeliness of their home health aide, regular visiting nurse, and transportation services to the doctor more favorably than members enrolled in other PACE plans and all other MLTC plans statewide.  A higher percentage of CHS members indicated having access for routine podiatry care, and urgent care from a PCP.  A higher percentage of CHS members indicated that the plan had discussed advance directives with them, that they had a legal document appointing someone, and that the plan had a copy of this document. 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: Falls Diagnosis/Prognosis/Surgeries Neuro/Emotional Behavioral Status Living arrangements ADL/IADLs Supportive assistance 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 Catholic Health LIFE’s July 2013 SAAM results, and Figure 3b contains Catholic Health LIFE’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: Catholic Health LIFE PACE and Statewide SAAM Data 2013‐2014 July 2013 SAAM Items Plan SAAM N=157 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 10 Statewide SAAM N=111,555 92% 92%
85% 89%
90% 87%
81% 79%
91% 91%
86% 88%
99% 99%
25% 27%
68% 79%
20% 40%
25% 34%
18% 38%
July 2013 SAAM Items Plan SAAM N=157 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 Prevention Influenza Vaccine – % who had influenza vaccine in last year Statewide SAAM N=111,555 53% 74%
46% 44%
69% 55%
92% 73%
SAAM July 2013 Catholic Health LIFE members had a higher percentage of members with cognitive impairment, confusion, anxiety, and depression as compared to statewide averages. However, it should be noted that a higher percentage of members reported no falls requiring medical intervention. It should also be noted that a higher percentage of members reported having a flu vaccination in the past year. 11 Figure 3b: Catholic Health LIFE PACE and Statewide UAS Data 2013‐2014 Jan‐June 2014 UAS Items Plan UAS N=148 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 12 July‐Dec 2014 Statewide UAS N=125,702 Plan UAS N=175 Statewide UAS N=132,429 74%
56% 74%
53%
27%
19% 33%
16%
63%
33% 61%
30%
43%
19% 39%
16%
68%
63% 68%
57%
92%
87% 91%
86%
35%
36% 29%
36%
73%
83% 67%
83%
26%
39% 26%
34%
49%
76% 50%
75%
58%
71% 60%
68%
Jan‐June 2014 UAS Items Plan UAS N=148 Statewide UAS N=125,702 July‐Dec 2014 Plan UAS N=175 Statewide UAS N=132,429 Health Conditions Frequency of Pain – 27%
26% 29%
% experiencing no severe daily pain Falls Resulting in Medical Intervention – % of members experiencing no falls requiring 85%
88% 82%
medical intervention Prevention Dental Exam – 60%
49% 61%
% who had dental exam in last year Eye Exam – 70%
71% 73%
% who had eye exam in last year Hearing Exam – 27%
33% 30%
% who had hearing exam in last 2 years Influenza Vaccine – 89%
75% 88%
% who had influenza vaccine in last year UAS January‐June 2014 Compared with members statewide, there were higher percentages of members performing the ADLs either independently or with minimal assistance. There were, however, notably higher percentages of members with impaired cognitive functioning, and with feelings of anxiety and depression. Higher percentages of members reported having an annual dental exam, and a higher percentage reported having a flu vaccination in the past year. UAS July‐December 2014 A similar trend was observed for this period as in January‐June 2014. Higher percentages were reporting independent ADL performance, or performance with minimal assistance. Higher percentages than statewide reflected impaired cognitive functioning, anxiety and depression. In the area of preventive screenings, dental exams and flu immunizations were reported as above statewide averages. 13 22%
91%
50%
73%
33%
76%
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 Catholic Health LIFE’s PIP for 2013‐2014: Catholic Health Life used an individualized multi‐factorial exercise program modeled on the Otago exercise program which was scripted for each participant in an attempt to reduce falls, improve TUG (Timed Up and Go Test), step and chair stand test scores. Interventions included the following: The Plan sought to prevent falls by creating an on‐going intervention which delivered a total of at least 2.5 hours of scripted exercise weekly for 6 months. An individualized multi‐factorial exercise program modeled on the Otago exercise program was scripted for each participant. The program was adapted for use at home and in groups at the PACE center. Nurses, nursing aides, and activity professionals were trained on the exercise program so that a standard program of real‐time cuing for each participant was implemented. Results are summarized as follows: Table 1 Changes in Balance and Strength (N=29) Variables Pretest Mean (SD)
Posttest Mean (SD)
Difference
Berg 36.3 (10.71)
36.9 (11.45)
t= 0.000 (p=.50) Knee flexion R 3.8 (0.90)
3.8 (0.54)
Z= ‐0.333 (p=.37)
Knee flexion L 3.8 (0.89)
3.8 (0.54)
Z= ‐0.707 (p=.24)
Knee extension R 3.9 (0.53)
3.9 (0.52)
Z= ‐1.000 (p=.16)
Knee extension L 4.0 (0.50)
3.9 (0.52)
Z= ‐1.732 (p=.42)
Hip flexion R 3.6 (0.90)
3.7 (0.55)
Z= ‐0.175 (p=.43)
Hip flexion L 3.6 (0.91)
3.7 (0.55)
Z= ‐0.333 (p=.37)
Hip extension R 3.7 (0.59)
3.7 (0.55)
Z= ‐0.556 (p=.29)
Hip extension L 3.7 (0.60)
3.7 (0.55)
Z= ‐0.447 (p=.33)
Falls 1.8 (2.87)
1.8 (2.39)
Z= ‐0.192 (p=.42)
t= parried t‐test z= Wilcoxon signed ranks test 14 Table 2 High Risk (n=3) Variables Pretest M (SD) 18.7 (2.52)
3.3 (.58)
3.3 (.58)
3.3 (.58)
3.3 (.58)
3.0 (.00)
3.0 (.00)
3.0 (.00)
3.0 (.00)
1.3 (.58)
Berg Knee flexion R Knee flexion L Knee extension R Knee extension L Hip flexion R Hip flexion L Hip extension R Hip extension L Falls Table 3 Medium Risk (n=14) Variables Pretest M (SD) Berg 32.6 (7.74)
Knee flexion R 3.9 (.48)
Knee flexion L 4.0 (.39)
Knee extension R 3.9 (.48)
Knee extension L 4.0 (.39)
Hip flexion R 3.6 (.63)
Hip flexion L 3.6 (.65)
Hip extension R 3.6 (.63)
Hip extension L 3.6 (.65)
Falls 2.4 (4.09)
Table 4 Low Risk (n=12) Variables Pretest M (SD) Berg 45.2 (5.61)
Knee flexion R 3.8 (1.29)
Knee flexion L 3.8 (1.29)
Knee extension R 4.1 (.52)
Knee extension L 4.1 (.51)
Hip flexion R 3.7 (1.23)
Hip flexion L 3.7 (1.23)
Hip extension R 4.0 (.43)
Hip extension L 4.0 (.43)
Falls 1.2 (.58)
Posttest
M (SD)
16.0 (2.65)
3.0 (.00)
3.0 (.00)
3.0 (.00)
3.0 (.00)
3.0 (.00)
3.0 (.00)
3.0 (.00)
3.0 (.00)
2.0 (1.73)
Difference
(Post‐Pre)
‐2.67
‐0.33
‐0.33
‐0.33
‐0.33
0
0
0
0
0.67
Statistical difference
Posttest
M (SD)
32.2 (5.67)
3.9 (.54)
3.9 (.54)
3.9 (.48)
3.9 (.48)
3.6 (.63)
3.6 (.63)
3.6 (.63)
3.6 (.63)
2.8 (2.99)
Difference
(Post‐Pre)
‐0.36
‐0.07
‐0.14
0
‐0.07
0.04
0.07
0.04
0.07
0.43
Statistical difference
Posttest
M (SD)
47.7 (4.56)
4.0 (.43)
4.0 (.43)
4.0 (.43)
4.0 (.43)
3.8 (.39)
3.8 (.39)
3.8 (.39)
3.8 (.39)
0.5 (.52)
Difference
(Post‐Pre)
2.50
0.25
0.25
‐0.08
‐0.08
0.17
0.17
‐0.17
‐0.17
0.67
Statistical difference
15 t=1.220 (p=.17)
Z=‐1.000 (p=.16)
Z=‐1.000 (p=.16)
Z=‐1.000 (p=.16)
Z=‐1.000 (p=.16)
Z=.000 (p=.50)
Z=.000 (p=.50)
Z=.000 (p=.50)
Z=.000 (p=.50)
Z=‐1.000 (p=.16)
t=0.382 (p=.35)
Z= ‐0.577 (p=.28)
Z= ‐1.414 (p=.08)
Z= 0.000 (p=.50)
Z= ‐1.000 (p=.16)
Z= ‐0.378 (p=.35)
Z= ‐0.577 (p=.28)
Z= ‐0.378 (p=.35)
Z= ‐0.577 (p=.28)
Z= ‐1.036 (p=.15)
t= ‐1.410 (p=.09)
Z= ‐0.447 (p=.33)
Z= ‐0.447 (p=.33)
Z= ‐1.000 (p=.16)
Z= ‐1.000 (p=.16)
Z=.000 (p=.50)
Z=.000 (p=.50)
Z= ‐1.414 (p=.08)
Z= ‐1.414 (p=.08)
Z= ‐2.530 (p=.01)
1) Overall Changes in Balance and Strength: Although three out of the four strength of knee and hip extensor improved without being statistically significant, knee extensor (Left) weakened with statistical significance. 2) Changes in Balance and Strength for those labeled as High Risk: The sample size for this indicator was too small for testing (n=3). 3) Changes in Balance and Strength for those labeled as Medium Risk: The mean of BERG score decreased by 0.4. Although knee strength decreased, all hip strength (flexor and extensor for both R and L) increased. The number of falls increased from 2.4 to 2.8. Mean scores for this indicator showed insignificant changes.
4) Changes in Balance and Strength for those labeled as Low Risk: The number of falls decreased by 0.7, from 1.2 to 0.5. This difference was statistically significant. Conclusions: The exercise was effective for the Low Risk group in reducing the number of falls but not for High and Medium Risk groups. The magnitude of improvement in muscle strength is larger for the Low Risk group. The types of exercise for the High and Medium Risk groups may be revised by Catholic Health LIFE for future improvement. 16 Section Seven: Summary/Overall Strengths and Opportunities Strengths Overall Plan Rating Satisfaction survey results indicated that Catholic Health LIFE members rated their health plan more favorably than members enrolled in other plans throughout the state. Of the members who responded to this question, 98% rated the plan as good or excellent, compared to 86% of other PACE plan members and 87% of statewide plan members. Quality of Care Satisfaction survey results indicate that a significantly higher percentage of Catholic Health LIFE members rated the quality of their dentist, care manager, regular visiting nurse, and the quality of their medical supplies and transportation services , as good or excellent compared to PACE and statewide averages. Activities of Daily Living (ADL) Catholic Health Life members had higher rates, compared to members statewide in their ability to perform each ADL (locomotion, bathing, upper and lower body dressing, toileting and eating). Rates for bathing and upper body dressing for Catholic Health LIFE members were notably higher than the statewide rates (33% vs. 16% and 61% vs. 30%, respectively). Preventive Screenings The percentage of members having annual dental visits and the percentage obtaining flu vaccinations were higher than statewide averages for both UAS submission periods. Performance Improvement Project (PIP) The plan conducted a well focused PIP over the 2013‐14 year period to reduce falls occurrence. Although the population size was small and results were statistically insignificant, the PIP was a commendable effort to address this major health concern across the MLTC population. Opportunities Access to Urgent Care (Same Day) There were lower rates reported among Catholic Health LIFE members for same day access to an optometrist. Twenty three percent (23%) of Catholic Health LIFE members reported having access to an optometrist, compared with members in the other PACE plans, and members statewide (27% vs. 33%, respectively). It is recommended that Catholic Health LIFE consider a focused member survey, to determine if access issues exist with these providers. Behavioral Health A higher percentage of Catholic Health LIFE members had impaired cognition, in addition to feelings of anxiety and depression, when compared with members in other PACE plans and other plans statewide. The scores for these questions can rely heavily upon assessor observation at the time of the assessment visit and may be subjectively scored based upon the observations of the same assessor. It is therefore recommended that the plan conduct an inter‐rater reliability project for clinical assessments, to aid in 17 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. 18