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Quality improvement projects

Quality improvement projects are activities we implement to help improve the health status of our members and the services we provide. These run the gamut of alerting members about important medications to take for a medical condition, sending personalized prompts about needed tests and routine screenings, and improving our website so members find information they need easily and quickly.

Diabetes quality improvement project

Our member care projects aim to engage members to manage chronic disease and prevent the development and progression of complications and co-morbidities. Our diabetes quality improvement project promotes self-management in members with diabetes with reminders about important diabetes-related screenings such as dilated eye exam, HbA1c screening and monitoring kidney health. We use Healthcare Effectiveness Data and Information Set (HEDIS) benchmarks to evaluate the success of our outreach. HEDIS is a registered trademark of NCQA. The table below shows our rates for these screenings compared with the HEDIS regional and national benchmarks. Our 2016 rates are mixed compared with the benchmarks. We will continue to monitor and work to be better.

2016 HEDIS Diabetes screening rates
HEDIS measure Moda Health HEDIS regional mean HEDIS national mean
OR AK
Average blood sugar levels over a period of weeks or months (HbA1c) 92.5% 84.7% 90.1% 88.8%
Dilated eye exam performed 64.5% 48.8% 51.4% 47.1%
Kidney disease monitored 87.8% 81.2% 87.5% 87.4%

Men's and women's preventive health screening quality improvement project

We encourage members to receive important age- and gender-appropriate preventive screenings. We mail gender-specific reminder cards about screenings for cervical, breast and colorectal cancer, and chlamydia.

While our rates for these screenings have improved year over year, they are mixed compared with the HEDIS national and regional benchmarks. We will continue to monitor and improve our outcomes.

2016 HEDIS preventive health rates
HEDIS measure Moda Health HEDIS regional mean HEDIS national mean
OR AK
Colorectal cancer screening 62.2% 46.1% 57.0% 57.1%
Cervical cancer screening 75.0% 66.1% 67.4% 71.7%
Breast cancer screening 75.2% 64.6% 67.1% 69.6%
Chlamydia screening 36.7% 36.1% 39.2% 43.4%

Other quality improvement projects

We also use HEDIS benchmarks to evaluate the success of activities we establish to improve member care. The following table shows the 2016 effectiveness-of-care rates for Oregon based on specific activities that we implemented in 2015. Activities included:

  • Clearly defined performance metrics with our established HEDIS vendor regarding the timelines to bolster an advantageous medical record review process
  • Targeted age-stratified asthma initiative promoting member partnership with physician and asthma action plan
  • Process modifications to existing contracts with mental health providers to ensure Oregon members received follow-up care with a behavioral health specialist within seven days of discharge from mental health hospitalization
  • Phone outreach by member health advocates to parents and prescribing providers about follow-up visits within 90 days for children prescribed ADHD medications
HEDIS 2016 Commercial PPO
Measure/data element 2015 OR (%) 2016 OR (%) 2015 AK (%) 2016 AK (%) 2016 regional mean2 (%) 2016 national mean3 (%)
Adult body mass index (BMI) assessment 73.5 75.3 2.71 4.01 63.8 56.7
Asthma medication ratio, total 78.7 81.8 80.5 83.6 75.9 77.6
Follow-up after hospitalization for mental illness, 7-day 59.0 66.7 LD4 LD 46.1 48.6
Follow-up care for children prescribed attention deficit/hyperactivity disorder (ADHD) medication, Initiation phase 42.2 47.1 LD LD 37.3 38.6
Follow-up care for children prescribed ADHD medication, maintenance phase 50.0 48.7 LD LD 46.3 45.0
Persistent use of beta-blocker after a heart attack 74.6 76.5 LD LD 79.2 81.0
Weight assessment and counseling for nutrition and physical activity — BMI percentile 43.1 50.9 1.01 1.11 43.4 46.0
Weight assessment and counseling for nutrition and physical activity — nutritional counseling 37.5 45.5 1.21 1.21 45.9 46.6
Weight assessment and counseling for nutrition and physical activity — physical activity counseling 33.3 41.9 01 0.11 42.9 42.4

1 Data administrative only

2 Regional mean = mean for commercial PPO plans in Alaska, Idaho, Oregon and Washington (CMS Region 10)

3 National mean = mean for all commercial PPO plans reporting to NCQA

4 LD = Low denominator fewer than 30 members

While we saw significant improvement in these measures, we continue to see improvement opportunities in persistent use of beta-blocker after a heart attack, and weight assessment and counseling for nutrition and physical activity (BMI, nutritional counseling, and physical activity monitoring).

Member survey quality improvement projects

CAHPS survey

Sometimes it's best to directly ask our members what they think. Depending upon state and medical plan type, each year we send out the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. It invites members to tell us about their experience with our healthcare services, providers and benefits. The survey shows us areas we can improve on to better serve our members. Our goal is to meet or exceed the NCQA national and regional means. In 2016, we were short of meeting our goals. Therefore, significant CAHPS projects included:

  • Completing in-depth one-on-one member interviews to gain insights on how we can communicate better with our members to improve their experience with our health plan
  • Developing and implementing a work plan to update our online provider directory to offer the best, most relevant results
  • Exploring options for a new cost transparency tool

Survey about our web-based services

Each year we ask members in Oregon and Alaska to assess their experience with our web-based services. In both 2015 and 2016, our improvement opportunities were about looking up the cost for a specific service and finding prior authorization information. In 2016, we explored options for a new cost transparency tool. The improvement in member experience looking for prior authorization information is due to simplifying the online information and improving visibility and access in 2016. We continue to invite and monitor member feedback about our web-based services.

Member experience with web-based services
Survey item 2015 (%) 2016 (%) Goal1 (%)
Requested and received a new member ID card or accessed my digital ID card 93.1 97.2 75
Looked up and found information on a prior authorization for a specific service 64.1 69.5 75
Looked up and found cost I would pay for a specific service or treatment 66.4 65.6 75

1 % rated 3 or above on a 1 to 5 scale

Survey about helpfulness of our Customer Service

Each year we ask members in Oregon and Alaska to assess their experience with our Customer Service teams by having them use a one to five scale to rate their experience with our Customer Service team's help with finding information or using myModa. Customer service for finding prior authorization information improved in 2016 to meet our goal, while finding cost information remains an improvement opportunity. In 2016, we explored options for a new cost transparency tool. Customer Service continuously trains team members to assure accurate information about cost estimates and benefits.

Member experience with Customer Service helpfulness
Survey item 2015 (%) 2016 (%) Goal1 (%)
Got information about a prior authorization for a specific service 73.0 97.2 75
Customer service representative guided the member to use the cost finder tool or find their cost for a service or treatment 59.9 69.5 75

1 % rated 3 or above on a 1 to 5 scale

Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

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