20-981m 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.
Check out the progress made and improvements still needed from 2020 HEDIS® quality performance results
The Health Net Quality Improvement (QI) 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 results and identify areas for improvement.
Results for Cal MediConnect are compared to the Medicare-Medicaid Plan (MMP) state/national averages when available.
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 member to address care gaps. Partners with the HEDIS® team to conduct live calls to members with many care gaps.
- Provides information about the importance of scheduling yearly wellness visits, completing screenings and tests. Also sent 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 help members address common barriers to 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.
- Continues a member rewards program to encourage them to get recommended screenings and care for chronic health issues.
- Educates members and providers on health topics. These include the value of using telehealth services, resources for chronic disease self-management, preventive screenings, fall prevention and osteoporosis management.
- Launches the multimodal flu campaign (mailers, emails, proactive outreach manager). 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. We also worked with a vendor to provide in-home flu shots.
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 members to participate in the 2020 CAHPS Survey.
- Partners with a survey vendor to launch the yearly regulatory survey to a random sample of membership. Shares final results 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 annual 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 programs.
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 to the HEDIS system until later this year.
Tables to compare performance goals
The following tables provide select HEDIS, CAHPS and Medicare Health Outcomes Survey (HOS) measures associated with the CMS Five-Star Quality Rating System and CMS Medicare-Medicaid Reporting Requirements. Results are also compared to the previous year to identify if benchmarks were met. Per CMS guidance, Reporting Year 2019 HEDIS and CAHPS rates are used for Reporting Year (RY) 2020.
Please note: RY 2020 CAHPS (measures of service) scores are internally calculated; case-mixed adjusted scores are not provided in 2020 due to COVID-19.
Measures of clinical care | 2019 score | 2020 score | Compared to previous year |
|---|---|---|---|
Colorectal cancer screening | 48% | 48% | ↔ |
Annual flu vaccine | 66% | 66% | ↔ |
Controlling blood pressure | 65% | 65% | ↔ |
Breast cancer screening | 53% | 53% | ↔ |
Follow-up after hospitalization for mental illness – 30 day follow-up | 37% | 37% | ↔ |
Osteoporosis management in women who had a fracture | 29% | 29% | ↔ |
Measures of service2 | 2019 score | 2020 score | Compared to previous year |
|---|---|---|---|
Getting needed care | 77% | 79% | ↑ |
Getting care quickly | 74% | 73% | ↓ |
Care coordination | 81% | 84% | ↑ |
Measures of health outcomes | 2019 | 2020 score | Compared to previous year |
|---|---|---|---|
Reducing the risk of falling | 70% | 71% | ↑ |
1For Medicare-Medicaid specific HEDIS 2020 MMP Analysis.
2SPH Analytics CAHPS survey results.
Additional information
If you have questions regarding the information above, contact the Health Net Provider Services Center at:
Line of Business | Telephone Number | Email Address |
|---|---|---|
Cal MediConnect – Los Angeles County | 1-855-464-3571 | |
Cal MediConnect – San Diego County | 1-855-464-3572 |