Moda Health. Healthcare from your head to your toes. Delta Dental | Moda Health

What we measure

How do we know we're doing our job? We use a Plan, Do, Study, Act process to develop programs and projects. This helps us measure how well we are taking care of members. It also helps us find out how members feel about our services. We use this information to make improvements.

Our health coaching and population health programs follow this quality improvement process. Our goal with these programs is to achieve the Triple Aim:

  • Improve the patient experience of care
  • Improve the health of populations
  • Reduce the cost of healthcare per person

We use this complete and integrated suite of programs and services for members at all stages of life and health status. Our programs and services cover many health topics to help members make informed decisions. Please click on the links below to see the 2017 outcomes for these programs:

Health coaching programs

Our health coaching programs support members at all stages of life and health. We review medical and pharmacy claims data to help identify the need for programs, which:

  • Deliver preventive services to keep members healthy
  • Offer the latest treatments and interventions for serious illnesses and to help improve members’ health
  • Maintain a quality care delivery system that helps members manage chronic diseases
  • Provide members with the right treatment and testing

Health coach services

Our health coaches help members manage chronic conditions. Members get personal support from health coaches by phone or email. Coaches send reminder mailings, worksheets, workbooks and online support tools. For example, members with diabetes learn why regular exams and lab testing are so important. They also get tips for taking medications correctly.

Member satisfaction with health coaching

We survey members to measure their experience and satisfaction with their health coaching. Our goal is to receive “strongly agree” or “agree” responses from at least 95 percent of members who respond. In 2017, 95.7 percent of survey participants strongly agreed or agreed with all positively framed survey statements compared with 95.1 percent in 2016. Since we met our member experience goal, we did not change the program.

Cardiac Care program

In the U.S., heart disease is the No. 1 cause of death for adults. However, there are many lifestyle changes you can make to reduce your risk and feel better. Our Cardiac Care program offers Moda Health members a chance to take charge of their health by working with a trained health coach by phone or email. In 2017, we measured outcomes for cardiac medication adherence and blood pressure and cholesterol control in members who participated in our Cardiac Care program.

Cardiac Care program clinical outcomes1
Disease state Outcome Members enrolled2 (%) Comparison group3 (%) p-value
Cardiac % members on medicine to help control high cholesterol who filled their prescription more than 80% of the time 88.4% 82.5% 0.0089*
% members on medicine to help control high blood pressure who filled their prescription more than 80% of the time 93.5% 89.3% 0.0042*

1 Based on medical and pharmacy claims

2 Members who engaged in ≥ 2 sessions with a health coach

3 Members who were invited during the same period and did not engage with a health coach

* ≤ 5% indicates a statistical significance using the Chi-square test.

Cardiac Care health coaching results
Medication possession ratio (MPR) is the rate at which a member refills medication their provider prescribes. Our goal is to achieve a greater than 80 percent refill rate. We measure MPRs for medicines to help control high cholesterol and high blood pressure. As in the prior year, members who enrolled in coaching (84.28 percent) had a higher MPR rate than the comparison population (84.86 percent). Members enrolled in coaching (93.37 percent) had a higher rate of meeting the MPR goal for medicine to help control high blood pressure than the comparison population (90.90 percent). Since we met our goals for each outcome measure above, we did not make any program changes.

Diabetes Care program

Living with diabetes can be challenging. You can feel good one day and out of control the next. Our Diabetes Care program is specially created to help members manage their diabetes and keep complications in check. When Moda Health members enroll, they get free one-on-one access to a health coach. In 2017, we measured two clinical outcomes: eye exam rates and hemoglobin A1c screening rates for members who participated in the Diabetes Care program.

Diabetes Care program clinical outcomes 1
Disease state Outcome Members enrolled2 (%) Comparison group3 (%) p-value
Diabetes Dilated eye exam 60.62% 59.47% <0.6940*
HbA1c screening rate 36.27% 34.94% <7024*

1 Based on medical and pharmacy claims

2 Members who engaged in ≥ 2 sessions with a health coach

3 Members who were invited during the same period and did not engage with a health coach

* ≤ 5% indicates a statistical significance using the Chi-square test.

Diabetes Care health coaching results
Moda compares outcomes for members enrolled in health coaching to those members who are eligible, but choose not to join coaching. The goal of these measures is to see the enrolled members with a higher rate than the non-enrolled members. We measured the success of our Diabetes Care program by using two measurement guidelines recommended by the American Diabetes Association: an annual dilated eye exam and an annual HbA1c test.

As in the previous year, the dilated eye exam rate was higher for Moda Health members enrolled in coaching (60.62 percent) compared with members not enrolled (59.47 percent). Likewise, the hemoglobin A1c test rate was lower for Moda Health members enrolled in health coaching (36.27 percent) compared with those not enrolled (34.94 percent). As such, we continue to look into new ways to engage members to do appropriate testing. We are also looking into how our data collection methodologies may have impacted the A1c rate.

Depression Care program

If members are struggling with depression, we can help. Our Depression Care program allows members to work one-on-one, by phone or email, with a health coach. The health coach will listen to concerns and help decide on the best care. In 2017, we measured how often members took their depression medication and change in the level of depression.

Depression Care program clinical outcomes 1
Disease state Outcome Members enrolled2 (%) Comparison group3 (%) p-value
Depression % members on medicine for depression who filled their prescription more than 80% of the time 81.7% 81.8% 0.97*

1 Based on medical and pharmacy claims

2 Members who engaged in ≥ 2 sessions with a health coach

3 Members who were invited during the same period and did not engage with a health coach

* ≤ 5% indicates a statistical significance using the Chi-square test.

Depression Care health coaching results
Medication possession ratio (MPR) is the rate at which an individual member refills medication their provider prescribes. Our goal is to achieve a greater than 80 percent refill rate. We measure MPRs for medicines to help control depression. The MPR for antidepressants was about the same for Moda Health members enrolled in coaching (84.62 percent) and the comparison population (82.76 percent). Since we met our goal for the outcome measure above, we did not make any program changes.

Participants in health coaching complete a patient health questionnaire (PHQ-9). They do this when they enroll so we can measure the severity of their depression. The PHQ-9 results help clinicians diagnose depression, and select and monitor treatment. We have members take the survey again at an interim point and when they are discharged from the program. Scores can range from zero to 27. The higher the score, the more severe the depression. Our goal is for at least 75 percent of participants with clinically significant depression to decrease their PHQ-9 score by at least 50 percent. In 2017, we saw improvement from our baseline and 2016 scores. Our hope is to continually improve and attain our goal.

PHQ-9 results (self-reported)
2015 (baseline) 2016 Moda Health goal
% of members with ≥ 50% decrease in PHQ-9 score 39.0% 40.0% ≥ 75%

Population health programs

We apply population health program quality improvement projects to help enhance our members’ health and our services. Projects include letting members know they need to take medications for a medical condition, sending personalized prompts about needed tests and routine screenings, and improving our website so members find what they need easily.

Diabetes quality improvement project

Our member care projects help members manage chronic disease, and prevent complications and co-morbidities. Our diabetes quality improvement project helps members take care of themselves. Through the program, we remind members about screenings. These include dilated eye exams, HbA1c testing and kidney health checkups. We use Healthcare Effectiveness Data and Information Set (HEDIS) benchmarks to see how successful our outreach was. 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 2017 rates are mixed compared with the benchmarks. We will continue to monitor and work to be better.

2017 HEDIS Diabetes screening rates
HEDIS measure Moda Health OR Moda Health AK HEDIS regional mean HEDIS national mean
Hemoglobin A1c tested
(HbA1c)
91.97% 83.24% 90.66% 89.30%
Dilated eye exam performed 68.61% 44.51% 51.67% 47.55%
Kidney disease monitored 91.48% 82.66% 88.05% 88.08%

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 many of 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.

2017 HEDIS preventive health rates
HEDIS measure Moda Health OR Moda Health AK NCQA regional mean NCQA national mean
Colorectal cancer screening 64.95% 34.41% 57.90% 58.31%
Cervical cancer screening 79.23% 61.97% 70.71% 72.96%
Breast cancer screening 74.58% 61.95% 68.29% 70.16%
Chlamydia screening 37.51% 30.00% 40.16% 44.93%

Other quality improvement projects

We also use HEDIS benchmarks to evaluate the success of our member care activities. The following table shows the 2017 effectiveness-of-care rates for Oregon based on specific activities that we put into place in 2016. Activities included:

  • The Moda HEDIS team performed the largest, most successful medical record review process to date while improving chase selections. The increased chart data helped bolster many hybrid rates.
  • Targeted age-stratified asthma initiative promoting member partnership with physician and asthma action plan
  • Continuous process enhancements with mental health providers to make sure 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. This outreach took place within 90 days for children prescribed ADHD medications.
HEDIS 2017 Commercial PPO
Measure/data element 2016 OR (%) 2017 OR (%) 2016 AK (%) 2017 AK (%)
Adult body mass index (BMI) assessment 75.3 83.1 4.0 1 7.0 2
Asthma medication ratio, total 81.8 81.0 83.6 LD
Follow-up after hospitalization for mental illness, 7-day 66.7 58.4 LD LD
Follow-up care for children prescribed ADHD medication, maintenance phase 48.7 49.3 LD LD
Weight assessment and counseling for nutrition and physical activity - BMI percentile 50.9 57.7 1.1 3 2.6 4

1 Data administrative only

2 Regional mean = mean for commercial PPO plans in Alaska, Idaho, Oregon and Washington

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

4 LD = Low denominator fewer than 30 members

We saw a big improvement in these measures. But, we also 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. Members use the survey to tell us about their experience with our healthcare services, providers and benefits. Our goal is to meet or exceed the NCQA national and regional means. Though our overall 2017 ratings increased significantly from the 2016 survey, we were short of our goals. Our 2017 CAHPS projects included:

  • Updating the member letters for claims processing with plain language
  • Making the Prescription Price Check tool in myModa more visible and including a tutorial about it
  • Starting an enterprise project on a new cost transparency tool. We did this to improve members’ ability to find accurate pre-service cost information. Vitals Choice launched in Q1 2018.
  • Improving Find Care, our provider directory, to reduce guest entries and make sure members choose in-network providers. The improvement also reduced “no results” occurrences.
  • Reviewing of the member handbook by the review committee to continually clarify and simplify language about benefits and how to use them
  • Implementing Customer Service post-call member surveys. We did this to evaluate the knowledge and helpfulness of the Customer Service representative, and help us respond to issues and concerns more quickly.

Survey about our web-based services
Each year we ask members in Oregon and Alaska to rate their experience with our medical and pharmacy web-based services. Our goal is to have 75 percent of members give a rating of 5 or above. The following table shows our survey results:

Member experience with myModa web-based services
Survey item Goal (%) 2017 Member usage (%)
I was able to request a new member ID card or see my digital ID card 75 79.1
I easily found how to obtain a preauthorization for a specific service 75 49.3
I was able to look up covered services 75 79.9
I looked up costs and found what I would pay for a specific service or treatment 75 44.0
I found my out-of-pocket cost for a drug based on my pharmacy benefit 75 75.9
Mail-order refill for an existing, unexpired prescription 75 39.7
I found the location and proximity of an in-network pharmacy 75 55.2
I found potential drug interactions 75 37.9
I looked up a drug's side effects and risks 75 43.1
I found generic drugs that can replace brand-name drugs 75 53.4

In both 2016 and 2017, our improvement opportunities were about looking up the cost for a specific service and finding prior authorization information. In addition to the new medical cost transparency tool and handbook committee improvements, we implemented the following opportunities for improvement for the survey items that did not meet our goals:

  • We now update medical criteria at least annually and post updates on the website
  • We continue to better our member experience by focusing on making sure prior authorization turnaround times meet regulatory and accrediting timelines

Survey about helpfulness of our Customer Service
Each year we ask members in Oregon and Alaska to tell us about their customer service experience. Using a scale of 1-to-5, they rate their experience with our Customer Service team’s help finding information or using myModa. Our goal is to have 75 percent of members rate us at 5 or above. The following table displays our survey results:

Member experience with medical and pharmacy Customer Service
Survey item Goal (%) 2017 Member usage (%)
Getting information about a prior authorization for a specific service 75 69.9
Getting information on covered benefits 75 91.6
Using the Treatment Cost Navigator tool to find out of pocket cost for a specific service or treatment 75 41.0
Using the prescription price check tool to find a drug cost, based on your pharmacy benefit 75 47.4
Learning about our mail-order refill process for an existing, unexpired prescription 75 36.8
Finding the location and proximity of an in-network pharmacy 75 36.8
Understanding other drug interactions with a prescription 75 36.8
Finding out a medication's common side effects and risks 75 36.8
Using web tools to see if generic substitutes can help save money 75 31.6

In addition to the new medical cost transparency tool, we implemented the following opportunities for improvement for the customer service categories above that did not meet our goal:

  • Developed real-time updates for members who inquire about their prior authorization status
  • Installed more direct access to our prior authorization coordinators for members and providers
  • Developed Customer Service training to make sure members who inquire receive information about pharmacy cost estimates, the location of an in-network pharmacy and drug interactions

Hello.

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

Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.

Together, we can be more, be better.

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