December 2009 MassHealth Managed Care HEDIS® 2009 Final Report Prepared by: Project Team: Center for Health Policy and Research (CHPR) in collaboration with the Mass- Health Office of Acute and Ambulatory Care (OAAC) and the MassHealth Office of Behavioral Health (OBH) Center for Health Policy and Research Terri Costanzo Paul Kirby Ann Lawthers David Tringali Jen Vaccaro Jianying Zhang Office of Acute and Ambulatory Care Louise Bannister Sharon Hanson Marlene Kane Susan Maguire Jennifer Maniates Mary Ann Mark Lana Miller MassHealth Office of Behavioral Health John DeLuca Data Analysis and Performance Measurement Khan a e
This report presents the results of the MassHealth Managed Care HEDIS 2009 project in three sections. These sections are based on the consumer report- ing domains used in NCQA’s health plan report cards (Staying Healthy, Living with Illness, and Use of Services). These domains group clinical and access to care measures with similar characteristics. REPORT SECTION DEFINITION MEASURES SELECTED BY MASSHEALTH FOR HEDIS 2007 REPORTING Staying Healthy These measures provide information about how well a plan provides ser- vices that maintain good health and prevent illness. Breast Cancer Screening Cervical Cancer Screening Frequency of Ongoing Prenatal Care Prenatal and Postpartum Care Living with Illness These measures provide information about how well a plan helps people manage chronic illness. Comprehensive Diabetes Care Controlling High Blood Pressure Follow-up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Initiation and Engagement of Alcohol and Other Drug Dependency Treatment Use of Services These measures provide information about what services health plans members utilize. Identification of Alcohol and Other Drug Services This report also includes eight appendices that provide more detailed results: Appendix A presents a list of the MassHealth regions and the service areas the regions cover. Appendix B presents additional data on Frequency of Ongoing Prenatal Care (<21%, 21-40%, 41-60% and 61-80% of expected visits, All Plans). Appendix C presents PCC Plan Breast Cancer Screening rates for members with Essential coverage. Appendix D presents PCC Plan Cervical Cancer Screening rates for members with Essential coverage. Appendix E presents age-stratified rates for Initiation and Engagement of Alcohol and Other Drug Dependency Treatment (All Plans). Appendix F presents age-stratified rates for PCC Plan members with Basic, Essential, and Non-Basic/Non-Essential Coverage for Initiation and En- gagement of Alcohol and Other Drug Dependency Treatment. Appendix G presents age and gender-stratified rates for Identification of Alcohol and Other Drug Services (All Plans). Appendix H presents Identification of Alcohol and Other Drug Services rates for PCC Plan members with Basic, Essential, and Non-Basic/Non- Essential Coverage.
Statistical Summary — LDL-C Screening * PCCP did not collect or report the Comprehensive Diabetes Care measure for HEDIS 2007. Statistical Summary — LDL-C Control (<100 mg/dL) The source of the National Medicaid 90th Percentile, National Medicaid 75th Percentile, National Medicaid Mean, and MA Commercial Mean is Quality Compass, 2007.
Diabetes is one of the most difficult chronic dis- eases to manage, because it presents with an overwhelming array of behavioral challenges and because optimal control requires a large amount of patient initiative. Currently experts feel that 95% of treatment for diabetes is carried out by the patient or their family members. An important as- pect of treatment for diabetes is communication between the physician and the patient.18 Studies have shown that enhancing patient- provider communication has resulted in improved health outcomes such as: Greater patient satisfaction, Adherence to treatment plans, Higher self-reported health status, Better emotional health, Greater symptom relief, and Physiological measures of disease control. A large survey study determined that a multifac- eted disease management program that incorpo- rates a focus on patient self-management was promising. The findings illustrated that physician efforts at providing information to patients about their illness and treatment plans were the main determinant of how well patients self-managed their diabetes. The results controlled for age and health status, which were both found not to influ- ence a patient’s self-management.19 Diabetes Association’s 2009 ver- sion of Standards of Medical Care in Diabetes recommends strategies for improving diabetes care, several of which target changes at the nexus of care between physicians and patients and include the following: A management plan should be formulated as an individual therapeutic alliance among the patient, family, physician, and other members of the health care team. Ongoing education and development of prob- lem-solving skills must be a constant aspect of the disease management strategy. The goals of the treatment plan established by the patient and physician must be reason- able. Diabetes self-management education (DSME) is an integral component of patient care.20 Studies have found that keeping A1c at normal levels in people with diabetes can greatly reduce cardiovascular disease and other comorbidities associated with diabetes. However, another study has found that despite recent trends toward im- proved glycemic control, about 40% of U.S. dia- betics fail to maintain good A1c control (<7%). Continued development of new pharmacological options is needed, in combination with efforts in- tended to support patient self-management.21
Statistical Summary — Initiation Rate (All Ages) Statistical Summary — Engagement Rate (All Ages) The source of the National Medicaid 90th Percentile, National Medicaid 75th Percentile, National Medicaid Mean, and MA Commercial Mean is Quality Compass, 2009.