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SNP Results 2013

SNP Results 2013 . SNP Educational Session - January 13, 2014 Brett Kay, AVP, SNP Assessment, NCQA. Objectives. Present key findings from 2012-2013 SNP assessment program-major contract tasks 2012 S&P m easures review 394 SNP reviews 2013 (CY 2014) MOC reviews 210 SNP reviews

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SNP Results 2013

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  1. SNP Results2013 SNP Educational Session - January 13, 2014 Brett Kay, AVP, SNP Assessment, NCQA

  2. Objectives • Present key findings from 2012-2013 SNP assessment program-major contract tasks • 2012 S&P measures review • 394 SNP reviews • 2013 (CY 2014) MOC reviews • 210 SNP reviews • 104 MMP review • 2013 SNP HEDIS • 415 SNP submissions

  3. S&P Measures Assessment • Six areas of focus: • SNP 1: Complex case management • SNP 2: Member satisfaction • SNP 3: Clinical quality improvement • SNP 4: Care Transitions • SNP 5: Institutional SNP relationship with facilities • SNP 6: Coordination of Medicare and Medicaid

  4. S&P Key Findings • Wide range of performance within and across S&P measures • SNPs showed improvement on majority of measures that did not change between 2011 and 2012 • D-SNPs compose majority of plans and enrollment, so drive overall performance results • 262 of 394 SNPs (66.5%) • 1.12 million enrollees of 1.35 million total SNP members (83%)

  5. S&P Key Findings Continued • I-SNPs tend to outperform other SNP types • Smallest # of plans (58), overall enrollment (46,000) and avg. # of members (793) • Dominated by a few organizations • 5 organizations comprise nearly ¾ of I-SNP plans • One organization has >40% of the I-SNP market: their results drive overall I-SNP performance • C-SNPs had lowest performance across all measures

  6. SNP 1 & 2 Findings • SNP 1: Complex Case Management • Raised the bar in 2012 • Overall performance was strong • Added 3 new elements(Satisfaction with case management; Analyzing effectiveness/Identifying opportunities; Implementing interventions and follow-up evaluation) • Lower performance than existing elements (78%, 48% and 43 % achieved benchmark • SNP 2: Member Satisfaction • Added new element: implementing interventions—performance was relatively low (52.9 percent achieved benchmark)

  7. SNP 3 Findings • SNP 3: Clinical Quality Improvements • Show statistically significant improvement on HEDIS measures year-to-year • Duals outperformed other SNP types; percentage of plans achieving improvement on at least two measures: • D-SNPs = 93.2% • C-SNPs = 86.8% • I-SNPs = 67.6% • Larger plans outperform smaller plans • Ranged from 75% to 94.9%

  8. SNP 4 Findings • SNP 4: Care Transitions • Improvement over time; however, still presents difficulties for some SNPs • 4 of the 6 elements improved from 2011 • Analysis of communication/coordination activities rose dramatically (51.9% vs. 39.3%) • Many plans have documented processes pertaining to requirements, but cannot show actual evidence of implementation • e.g., transition notifications across settings; identifying/coordinating care for at-risk members

  9. SNP 5 Findings • SNP 5: Institutional Relationship with Facility • SNP 5 is for I-SNPs only • Excludes I-SNPs that care for all members in community (Institutional equivalent) • Performance high across all elements • Element C had highest scores • Larger plans had higher scores

  10. SNP 6 Findings • SNP 6: Coordination of Medicare/Medicaid • Slight improvement from 2011 • D-SNPs and I-SNPs perform well • Many plans still do not conduct network adequacy assessments for Medicaid providers • All three SNP types showed improvement from 2011 to 2012.

  11. SNP 6 Results Element E: Network Adequacy, by Type (2011 vs. 2012) Element E: Network Adequacy, by enrollment size, 2012

  12. Model of Care ResultsCY 2014 Submissions

  13. Model of Care Results-SNPs • SNP Results • CMS raised the bar in 2013—One cure; only for SNPs scoring <70% after initial review (receive 1-year approval) • Many SNPs submitted same/similar MOC as in previous years • 3-year approval (85+%): 149 plans • 2-year approval (75%-84%): 20 plans • 1-year approval (70%-74%): includes cure 1 plan scores): 6 plans • Not approved (<70%): 2 plans • Withdrew application: 33

  14. Results for SNPs

  15. MOC Results--MMP • MMP Results • 10 states (AZ, ID, MI, NY, RI, SC, TX, VT, VA, WA) • Many MMPs submitted similar MOCS to SNPs from same organization • Additional state requirements not reviewed by NCQA (NY, RI, SC, VA, WA) • 3-year approval (85+%): 75 plans • 2-year approval (75%-84%): 17 plans • 1-year approval (70%-74%): includes cure 1&2 plan scores): 8 plans • Withdrew application: 4

  16. MMP Results by State

  17. Overall MMP Results

  18. SNP HEDIS Results2013

  19. HEDIS Measures for SNP Submission Required SNP Measures • (COL) Colorectal Cancer Screening • (GSO) Glaucoma Screening in Older Adults • (COA) Care for Older Adults • (SPR) Use of Spirometry Testing in the Assessment and Diagnosis of COPD • (PCE) Pharmacotherapy of COPD Exacerbation • (CBP) Controlling High Blood Pressure • (PBH) Persistence of Beta-Blocker Treatment After a Heart Attack • (OMW) Osteoporosis Management in Older Women • (AMM) Antidepressant Medication Management • (FUH) Follow-Up After Hospitalization for Mental Illness • (MPM) Annual Monitoring for Patients on Persistent Medications • (DDE) Potentially Harmful Drug-Disease Interactions • (DAE) Use of High-Risk Medications in the Elderly • (MRP) Medication Reconciliation Post-Discharge • (PCR) Plan All-Cause Readmissions • (BCR) Board Certification

  20. SNP HEDIS 2013 Overview • 415 SNPs Eligible to Report (>30 members) • 40 HEDIS measures reported • 28 clinical performance measures • 4 board certification measures • 8 utilization measures • Audited by NCQA-Certified HEDIS Compliance Auditors • Reflects care provided in 2012 • Compares performance among SNPs and to non-SNP MA plans

  21. Key Findings • Steady improvement from 2011-2013 • Performance gap between SNP and MA plans continues to narrow • 6 measures-SNP performance is higher • 8 measures-no statistically significant difference in performance • 13 measures – SNP performance is lower • Performance differences among SNP types • D-SNPs-most measures with statistically significant improvement from 2012-2013

  22. SNP Versus MA Performance

  23. Improvement Trend • Three-year trend: improvement • 31 of 40 measures showed statistically significant improvement between 2011-2013 • More than 2X the measures that showed statistically significant improvement from 2009-2011 • 2012-2013—27 measures with statistically significant improvement • Care for Older Adults—average increase of 18.4% for the four indicators (2011-2013) • Three-Year Reporters (2011-2013) outperformed SNP program overall • Higher results across all measures in each year, on average

  24. Performance by SNP Type • 1.8 percentage point average difference between all types in 2013 • D-SNPs had the largest number of measures (9) with statistically significant improvement from 2012-2013 • C-SNPs & I-SNPs had statistically significant improvement in 2 measures • Care for Older Adults indicators showed largest performance improvements from all SNP types • C-SNPs—39 percentage point increase

  25. Plan Benefit Package Level Performance • Wide variation in performance ranges • 9 measures had >40 point differences between 10th and 90th percentiles • Large difference (>20 points) between mean score and 90th percentile—represents opportunity for improvement • 50+% of SNPs improved on 25 HEDIS measures • 70% increased performance on 5 of these measures • COL had the most SNPs show improvement (~80%) • Greatest variation: Care for Older Adults, Board Certification and Medication Reconciliation Post-Discharge

  26. DISCUSSION

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