20-980m Stay Informed on Quality Goals and Activities to Improve the Health of Members
Date: 11/30/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Check out the progress made and improvements still needed from 2020 HEDIS® quality performance results
The Health Net Quality Improvement Program monitors performance of clinical care and service measures using many internal and external health care data collection systems. The national benchmarks from year to year allow us to compare our results and identify areas of improvement.
- Commercial and Marketplace plans are compared to the National Committee for Quality Assurance (NCQA) Quality Compass® percentiles and Centers for Medicare & Medicaid Services (CMS) Quality Rating System (QRS) benchmarks.
- Medicare plans are compared to the CMS Five-Star Quality Rating System,1 when applicable.
- Medi-Cal plans are compared to the Department of Health Care Services (DHCS) 50th percentile Minimum Performance Level (MPL) for Managed Care Accountability Set (MCAS) measures, and the NCQA Quality Compass national HMO 75th percentile, if applicable.
Quality Improvement support for members and providers to improve health outcomes
Quality Improvement supports you and our members to help make access to care easier with the following programs:
- Directs contact with members to address care gaps. Partners with the Health Care Effectiveness Data and Information Set (HEDIS®) team to conduct live calls across all product lines to members with many care gaps.
- Provides information about the importance of scheduling yearly wellness visits, and completing screenings and tests. Also sends members resources on how to overcome access to care barriers.
- Mails in-home test kits to members to help close care gaps for the comprehensive diabetes control sub-measures. Partners with a vendor to mail kits, and helps address common barriers to health care for transportation, limited availability to visits and minimal access to lab centers.
- Continues to participate in the University of Best Practice’s Right Care Initiative. This aims to improve performance on cardiovascular disease, hypertension, and diabetes measures.
- Creates and sends educational resources and trainings for member services staff. This enables them to better address member questions.
- Launches a robust flu campaign across all plans called Fluvention. Educates members and promotes the importance of getting a flu shot during the current flu season and address concerns members may have due to the COVID-19 pandemic.
Quality Improvement supports CAHPS improvements
These ongoing programs support you in closing care gaps.
- Develops a member-facing Consumer Assessment of Healthcare Providers and Systems (CAHPS®) mailer to urge participation in the 2020 CAHPS Survey.
- Partners with a survey vendor to launch the yearly regulatory survey to a random sample of membership from all plans. Final results shared with stakeholders to identify member pain points and to identify opportunities to improve.
- Deploys off-cycle mock surveys for Medicare and Medi-Cal members to assess performance with high volume providers and at provider offices.
- Conducts yearly CAHPS participating physician group (PPG) training webinars.
- Manages CAHPS action plan and met routinely with many Health Net departments to discuss how to incorporate the needs of our members to improve and track progress of programs.
Program | Description |
|---|---|
Diabetes Forecast magazine | Educational American Diabetes Association (ADA) mailing to members. Note this magazine has been discontinued by ADA in Quarter 4 2020. |
Educational campaigns | Text reminders to educate and empower members to stay healthy by completing screenings, adhering to screenings for diabetes and cardiovascular conditions, or timely behavior health care on:
|
Text campaign for vaccinations | Reminder to parents of teens who need to complete their HPV vaccine series. |
Outreach campaigns via email, text and/or IVR | Multi-modal outreach to encourage members to schedule visits. Includes diabetic screenings, blood pressure monitoring, postpartum visits, well-child visits and immunizations, and those to address co-morbid chronic conditions. |
Program | Description |
|---|---|
Rewards program | Incentives urge dual-eligible members to get recommended screenings and chronic care. |
Partner with ADA and the American Heart Association (AHA) | Inform, educate and empower members to take action about their health. |
Educate members and providers | Includes topics such as telehealth’s availability and value, resources for chronic disease self-management, fall prevention and osteoporosis management. |
Multimodal flu campaign (mailers, emails, texts, proactive outreach manager) | Encourages members to get their flu shot and hosted free drive-thru flu clinics. |
Program | Description |
|---|---|
Outreach campaigns to address gaps in care | The goal is to improve compliance for:
|
Member incentive programs to close care gaps | Incentives for breast cancer screening, cervical cancer screening, chlamydia screening, diabetes testing and well-care visits. |
Weekend and extended-hour clinics | Engages with providers/clinic sites with added support of clinical staff and on-site services for members who need care outside of provider’s normal business hours). |
Outreach calls for high-risk members | Interviews members to address social concerns, link them to needed resources and remove barriers to care. |
Cozeva deployment | Enhances the data exchange with providers to support and improve quality measures, reporting, and customer service. |
Our response to the pandemic
COVID-19 has had a large impact on utilization, especially at the beginning of the pandemic (March-July). Health Net responded quickly to provide alternative service-delivery modes, such as telehealth, to mitigate the drop of in-person visits. Health Net’s Provider Network Management team conducted a provider readiness survey to evaluate providers’ ability to accommodate members’ needs during the pandemic. There were major technical changes for most of the HEDIS measures due to COVID-19. The data based on the updates will not be added into the HEDIS system until later this year.
Tables to compare performance goals
The following tables indicate whether clinical care and service measures improved or declined from Reporting Year 2019 to Reporting Year 2020 using HEDIS and CAHPS data.
The tables also show how our performance compares to national benchmarks. While we have made improvements over the prior year, many measures remain below the 75th percentile goal. Where appropriate, N/A means not applicable and NR means not reported due to a small denominator.
Due to the COVID-19 pandemic, DHCS and NCQA waived the RY 2020 requirements for hybrid measures with alternative reporting options. Refer to provider update 20-697, Help Your Patients Achieve Better Health Outcomes, for more on
COVID-19 impacts to Health Net’s performance reporting.
Measures of clinical care | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass® National | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Breast cancer screening | 76.23% | 76.96% | ↑ | 78.63% | ↓ |
Childhood immunization status – combo 10 | 54.77% | 54.77%R | ↔ | 66.42% | ↓ |
Colorectal cancer screening | 60.64% | 65.06% | ↑ | 72.50% | ↓ |
Comprehensive diabetes care – HbA1c poor control (> 9%) Note: inverse measure - lower rate indicates improvement | 19.60% | 19.60%R | ↔ | 24.33% | ↑ |
Comprehensive diabetes care – medical attention for nephropathy | 92.96% | 92.96%R | ↔ | 92.46% | ↑ |
Follow-up after ADHD diagnosis (ADD) – continuation phase | 35.44% | 41.11% | ↑ | 51.89% | ↓ |
Statin therapy for patients with cardiovascular disease – received therapy – total | 80.64% | 83.24% | ↑ | 85.87% | ↓ |
Measures of service1 | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass®National | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Customer service | 75.61% | 82.7% | ↑ | 92.1% | ↓ |
Getting care quickly | 78.57% | 79.3% | ↑ | 88.0% | ↓ |
How well doctors communicate | 92.83% | 94.2% | ↑ | 96.5% | ↓ |
Measures of clinical care | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass® National Commercial | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Antidepressant medication management – acute phase | 70.77% | 66.02% | ↓ | 75.03% | ↓ |
Breast cancer screening | 72.87% | 74.02% | ↑ | 74.31% | ↓ |
Controlling high blood pressure | 57.66% | 67.25% | ↑ | 62.04% | ↑ |
Colorectal cancer screening | 65.16% | 67.55% | ↑ | 67.01% | ↑ |
Follow-up after hospitalization for mental illness – within 30 days | 56.82% | 62.79% | ↑ | 73.18% | ↓ |
Immunization for adolescents – HPV | 30.41% | 30.41%R | ↔ | 31.14% | ↓ |
Statin therapy for patients with diabetes – statin adherence 80% | 71.20% | 70.12% | ↓ | 76.41% | ↓ |
Measures of service1 | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass® National Commercial | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Customer service | 67.16% | 70.6% | ↑ | 92.3% | ↓ |
Getting care quickly | 83.24% | 82.0% | ↓ | 88.3% | ↓ |
How well doctors communicate | 95.32% | 96.1% | ↑ | 96.6% | ↓ |
Measures of clinical care | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass® National Commercial | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Antidepressant medication management – acute phase | 60.35% | 63.11% | ↑ | 74.91% | ↓ |
Childhood immunization status – combo 3 | 57.61% | 69.23% | ↑ | 84.91% | ↓ |
Colorectal cancer screening | 51.09% | 62.29% | ↑ | 72. 50% | ↓ |
Controlling high blood pressure | 62.77% | 62.77% | ↔ | 70.10% | ↓ |
Comprehensive diabetes care – medical attention for nephropathy | 93.92% | 94.16% | ↑ | 92.46% | ↓ |
Measures of service1 | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass® National Commercial | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Access to care | 66.2% | 67.8% | ↓ | N/A | N/A |
Care coordination | 76.3% | 80.1% | ↑ | N/A | N/A |
Measures of clinical care | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass® National Commercial | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Adult BMI assessment | 73.73% | 82.93% | ↑ | 83.16% | ↓ |
Annual Dental Visit - Total | 34.68% | 37.95% | ↑ | -N/A | -N/A |
Antidepressant medication management – acute phase | 62.64% | 66.56% | ↑ | 75.03% | ↓ |
Breast cancer screening | 64.91% | 57.56% | ↓ | 74.31% | ↓ |
Comprehensive diabetes care – medical attention for nephropathy | 87.83% | 89.29% | ↑ | 90.30% | ↓ |
Postpartum care | 66.12% | 79.41% NT | - | 83.21% | ↓ |
Measures of service1 | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass® National Commercial | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Access to care | 63.5% | 63.9% | ↑ | N/A | N/A |
Care coordination | 72.6% | 71.6% | ↓ | N/A | N/A |
Access to information | 38.9% | 40.9% | ↑ | N/A | N/A |
Measures of clinical care | RY2019 score | RY2019 score | Compared to previous year | 2020 Quality Compass® National Commercial | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Immunization for adolescents – combo 2 | 14.29% | 28.57% | ↑ | 29.44% | ↓ |
Breast cancer screening | 58.16% | 52.07% | ↓ | 74.31% | ↓ |
Comprehensive diabetes care – medical attention for nephropathy | 91.18% | 91.18%R | ↔ | 90.30% | ↑ |
Controlling high blood pressure | 59.26% | 59.26%R | ↔ | 62.04% | ↓ |
Measures of service1 | RY2019 score | RY2020 score | Compared to previous year | 2020 Quality Compass® National Commercial | 2020 score compared to 75th percentile |
|---|---|---|---|---|---|
Access to care |
|
| ↑ | N/A | N/A |
Care coordination |
|
| ↓ | N/A | N/A |
Access to information | 37.5% | 45.6% | ↑ | N/A | N/A |
Measures of clinical care | RY2019 | RY2020 | Rates compared to previous year | 2020 DHCS MPL | 2020 score compared to DHCS MPL |
|---|---|---|---|---|---|
Adult body mass index (BMI) assessment | 85.16% | 91.78% | ↑ | 90.27% | ↑ |
Antidepressant medication management – acute phase | 50.05% | 51.04% | ↑ | 52.33% | ↓ |
Antidepressant medication management – continuation phase | 34.63% | 35.38% | ↑ | 36.51% | ↓ |
Asthma medication ratio | 60.71% | 60.73% | ↑ | 63.58 % | ↓ |
Breast cancer screening | 59.00% | 58.73% | ↓ | 58.67% | ↑ |
Cervical cancer screening | 59.12% | 59.12%R | ↔ | 60.65% | ↓ |
Childhood immunization – combo 10 | 28.71% | 29.20% | ↑ | 34.79% | ↓ |
Chlamydia screening in women | 65.00% | 65.80% | ↑ | 58.34% | ↑ |
Comprehensive diabetes care: hemoglobin A1c testing | 88.56% | 88.81% | ↑ | 88.55% | ↑ |
Comprehensive diabetes care – HbA1c poor control > 9%
| 37.47% | 34.06% | ↑ | 38.52% (inverted rate) | ↑ |
Controlling high blood pressure | 61.31% | 63.27% | ↑ | 61.04% | ↑ |
Immunizations for adolescents – combination 2 | 37.71% | 42.34% | ↑ | 34.43% | ↑ |
Timeliness of prenatal care | 79.32% | 88.56% NT | - | 83.76% | ↑ |
Postpartum care | 55.96% | 77.37% NT | - | 65.69% | ↓ |
Weight assessment and counseling for nutrition and physical activity for children/adolescents: BMI assessment | 84.43% | 86.29% | ↑ | 79.09%. | ↑ |
Well-child visits in the first 15 months of life: six or more well-child visits | 27.30% | Not reported at product level | - | 65.83% | - |
Well-child visits in 3rd, 4th, 5th, and 6th years of life | 68.72% | Not reported at product level | - | 72.87% | - |
Customer service | 85.7% | 83.2% | ↓ | 91.0% | ↓ |
Getting care quickly | 75.3% | 76.1% | ↑ | 85.1% | ↓ |
How well doctors communicate | 88.0% | 92.0% | ↑ | 93.4% | ↓ |
Medicare Advantage
The following tables provide select HEDIS®, CAHPS® and Medicare Health Outcomes Survey (HOS) measures associated with the CMS Five-Star Quality Rating System. Medicare results are compared to the previous year and whether they meet or exceed four stars. Per CMS guidance, RY 2019 HEDIS rates are shown for all RY 2020 rates, due to COVID-19 impacts and exceptions.
Please note: 2020 CAHPS (Measures of service) scores are internally calculated; case-mixed adjusted scores are not provided in 2020 due to COVID-19. RY2019 CAHPS survey results will carry over for CY2021 Star Ratings due to COVID-19.
Measures of clinical care | 2019 score | 2020 score | Compared to previous year | Meets or exceeds 4 star goals |
|---|---|---|---|---|
Colorectal cancer screening |
80% |
80% | ↔ | Yes |
Annual flu vaccine |
77% |
77% | ↔ | Yes |
Statin therapy for patients with cardiovascular disease |
76% |
76% | ↔ | No |
Osteoporosis management in women who had a fracture |
49% |
49% | ↔ | No |
Diabetes care – blood sugar controlled |
87% |
87% | ↔ | Yes |
Rheumatoid arthritis management |
77% |
77% | ↔ | No |
Measures of service1 | 2019 score | 2020 score | Compared to previous year | Meets or exceeds 4-star goal |
|---|---|---|---|---|
Getting needed care | 82% | 81% | ↓ | No |
Getting appointments and care quickly | 77% | 78% | ↑ | No |
Care coordination | 83% | 83% | ↔ | No |
Measures of health outcomes | 2019 score | 2020 score | Compared to previous year | Meets or exceeds 4-star goal |
|---|---|---|---|---|
Reducing the risk of falling | 62% | 63% | ↑ | Yes |
Monitoring physical activity | 55% | 53% | ↓ | Yes |
Measures of clinical care | 2019 score | 2020 score | Compared to previous year | Meets or exceeds 4 star goals |
|---|---|---|---|---|
Colorectal cancer screening | 74% | 74% | ↔ | Yes |
Annual flu vaccine | 75% | 75% | ↔ | No |
Statin therapy for patients with cardiovascular disease | 79% | 79% | ↔ | No |
Osteoporosis management in women who had a fracture | 43% | 43% | ↔ | No |
Diabetes care – blood sugar controlled | 84% | 84% | ↔ | Yes |
Rheumatoid arthritis management | 77% | 77% | ↔ | No |
Measures of service1 | 2019 score | 2020 score | Compared to previous year | Meets or exceeds 4-star goal |
|---|---|---|---|---|
Getting needed care | 80% | 79% | ↓ | No |
Getting appointments and care quickly | 75% | 70% | ↓ | No |
Care coordination | 83% | 83% | ↔ | No |
Measures of health outcomes | 2019 score | 2020 score | Compared to previous year | Meets or exceeds 4-star goal |
|---|---|---|---|---|
Reducing the risk of falling | 70% | 67% | ↓ | Yes |
Monitoring physical activity | 59% | 64% | ↑ | Yes |
Care of older adults | 2019 score | 2020 score | Compared to previous year | Meets or exceeds 4 star goal |
|---|---|---|---|---|
Annual medication review | 99% | 99% | ↔ | Yes |
Annual functional status assessment | 79% | 79% | ↔ | No |
Annual pain assessment | 92% | 92% | ↔ | Yes |
1 SPH Analytics CAHPS survey results. Note: 2020 CAHPS (measures of service) scores are scaled mean score provided by the vendor; case-mixed adjusted scores not provided in 2020 due to COVID-19.
2 Medicare scores provided in whole numbers only.
NTNot trendable year over year due to significant differences in NCQA technical specifications.
RRY 2019 rates reported due to COVID-19 impact as an exception.
If you have questions regarding the information above, contact the applicable Health Net Provider Services Center at:
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
EnhancedCare PPO (IFP) | 1-844-463-8188 |
| |
EnhancedCare PPO (SBG) | 1-844-463-8188 |
| |
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 |
| |
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 |
| |
Medicare (individual) | 1-800-929-9224 |
| |
Medicare (employer group) | 1-800-929-9224 |
| |
Medi-Cal | 1-800-675-6110 |
| N/A |