Quality Improvement Program

L.A. Care Health Plan monitors practitioner network availability and accessibility and telephone access to member services on an annual basis. L.A. Care, along with the California Department of Health Care Services (DHCS) has established quantifiable standards for both the number and geographic distribution of practitioners and drive distances to pharmacies and access standards for services.

In 2009, the study found L.A. Care to exceed availability standards in all categories for Healthy Families, Healthy Kids, and Medicare Advantage HMO members. This included Provider to member ratios, drive distances, plus pharmacy drive distance.  L.A. Care met all of the same standards for Medi-Cal members with the exception of access to Dermatology and ENT specialists, where provider to member ratios exceeded our standard of 1 provider for every 5,000 members.

How did we do?

L.A. Care has met all of its performance standards for PCP appointment accessibility. Improvements were evidenced in access to specialty care in 2009, despite not meeting all provider to member ratio standards for Medi-Cal members.  The specialists’ appointment wait-day (median = 7 days, mean = 13 days) falls within DHCS’ and L.A. Care’s 30-day standard.    The average number of wait-days to see a specialist for a routine appointment has decreased from 14.4 days in 2008 to 13 days in 2009, an improvement from 16.1 days in 2007.   Pediatric subspecialty access improved as well, with a reduction in the length of time that a patient will wait to receive routine care. Although internal analysis found L.A. Care to be beyond the rate of compliance, CAHPS data revealed different findings from the member’s perspective. See CAHPS for further details.

L.A. Care requires that primary care physicians or designated on-call providers be available to coordinate patient care beyond normal hours. Our goal is that 92% of all PCPs will be compliant with after hours’ access. In the 2009 survey, only 57% of PCPs were found to be compliant with this standard, leaving much room for improvement on the part of network providers.

Next Steps…

To improve access to care for our members, L.A. Care has new and ongoing interventions.  Interventions include:

• Extended Hours Grant Program
• Bi-Annual Joint Operations Meetings
• Focused Provider Office Visits

L.A. Care has identified asthma and diabetes for its disease management programs. 

The asthma program is administered internally. The diabetes program has been delegated to an NCQA accredited vendor. L.A. Care achieved 100% for its disease management program during the NCQA accreditation survey.

Asthma Disease Management Program
Who’s eligible?
Healthy Families, Healthy Kids, Medi-Cal Direct, and Medicare Advantage HMO members.

What does the program entail?

L.A. Care sends educational materials to all members enrolled in the asthma disease management program.  Physicians are notified of any members identified in the highest level of care and are asked to fax back a confirmation of the member's diagnosis.  Members in the highest level of care receive quarterly monitoring and may be considered for case management.

How did we do?

The 2009 HEDIS rate for appropriate use of medications for people with asthma was 88%. This is slightly lower than the 2008 HEDIS rate of 88.7%.

 

What is CAHPS?

CAHPS is an acronym for Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was conducted for adults and children.  L.A. Care Health Plan demonstrates its commitment to improving member satisfaction by our annual assessment of CAHPS data, as well as complaints and appeals data. This assessment is followed by a process to identify opportunities for improvement, set priorities and decide which opportunities to pursue.

The CAHPS survey includes the following four rating questions designed to distinguish among important aspects of care. These questions ask adult enrollees to rate their experience in the past 6 months. The table below summarizes compares 2006, 2007, and 2008 data:

CAHPS survey questions ask respondents to report on their experience with various aspects of their care. Survey questions that address the same area or domain of care are combined into four summary measures or “composites”.  The questions that comprise the four composite scores, each ask members how often a positive service occurred in the past six months. The table below compares 2007, 2009, and 2008 data:

How did we do?

The authors of CAHPS have noted that the largest driver of member satisfaction is member health; and the next two drivers are arguable provider service and member perception. All three drivers are factors that are fairly slow to change. The trend over time suggests that L.A. Care's performance on service quality is fairly flat for adult members, and the rises and falls are statistical noise.

CAHPS 4.0H analysis highlights that members expressed concern with getting needed care and getting care quickly. 2009 complaints and appeals data further substantiates that this is an area in need of improvement.

Next Steps…

Key findings suggested that L.A. Care should focus improvement efforts on Getting Needed Care and Getting Care Quickly.  L.A. Care has implemented targeted interventions aimed at provider groups to encourage better access to care. Interventions include:

• Cultural Competency Course
• Health Care Interpreting Program
• Customer Service Success Program
• Provider Office Customer Service Training
• Member Education Programs

What does the 2009 study results tell us?
A study of providers indicated that a higher percentage of primary care providers (72.1%) and specialists (67.3%) were satisfied with coordination of inpatient care compared to last year.  Approximately 46% of primary care providers and 47% of specialty care providers said they received information “always” and “often” from the hospital after their patient was discharged.

What are we doing to improve?

We educate providers and hospitals on the importance of follow up and how it can improve quality of care. L.A Care will be addressing these issues at different committee meetings that involve physicians and their office staff. 

L.A. Care has identified asthma and diabetes for its disease management programs. 

The asthma program is administered internally. The diabetes program has been delegated to an NCQA accredited vendor. L.A. Care achieved 100% for its disease management program during the NCQA accreditation survey.

Diabetes Disease Management

Who’s eligible?

Healthy Families, Healthy Kids, Medi-Cal Direct, and Medicare Advantage HMO members

What does the program entail?

L.A. Care delegates its members to an NCQA accredited vendor for its diabetes disease management program. All diabetic members receive a welcome letter, a welcome call, and health education materials.

How did we do?

There are four main indicators for Diabetes HEDIS measures.  L.A. Care's rates for these indicators were 57.2% for retinal eye exam, 79.3% for A1C testing, 76.2% for LDL-C screening, and 74.1% for nephropathy screening.  The goal for retinal eye exams was met, but not for A1C screening, LDL-C screening and nephropathy screening. 

 

What is HEDIS?
HEDIS is an acronym for Healthcare Effectiveness Data and Information Set. It is the most widely used standardized set of performance measures in the managed care industry.  HEDIS is designed to facilitate comparisons of health plan access, effectiveness, administration, and performance related to a variety of routine health service indicators.  Every year, L.A. Care participates in an annual audit of HEDIS measures. 

How did we do?
Graphs below compares HEDIS rates for 2007, 2008, and 2009.

 

 

Notes: statistically significant improvements in specific clinical measures are indicated with an upward arrow (­)

L.A. Care has developed and implemented a number of interventions over the last year to continue improving HEDIS measures. Some of these activities include:

• Introduction of the postpartum incentive program for providers.
• Contracted with an outreach vendor to provide visit reminders for breast cancer and cervical cancer screenings.
• Improved the Asthma Disease Management program and distributed the asthma and upper respiratory infections toolkit.
• Launched the Diabetes Recognition Program.

How do we find out about safety issues?

Information about safety issues is received from multiple sources, including member and practitioner grievances, adverse issues, pharmacy data such as polypharmacy, facility site reviews, continuity of care activities, member satisfaction survey results and Leapfrog survey results. 

Many of the ongoing QI Program measurement activities, including measures for accessibility, availability, adherence to clinical practice guidelines and medical record documentation, include safety components.  When performance is analyzed for these measures, patient safety is considered, opportunities are identified, prioritized and actions are taken to improve safety.

Pharmacy safety measures include edits at the point of service.  Each prescription filled is subject to a prospective drug utilization review.  This review includes a search for possible drug interactions and previous known allergies to reduce the risk of dispensing medications with potential adverse consequences.