1 snp educational session – january 13, 2014 snp results 2013 snp educational session - january...

1SNP Educational Session – January 13, 2014

SNP Results2013

SNP Educational Session - January 13, 2014

Brett Kay, AVP, SNP Assessment, NCQA

2SNP Educational Session, January 13, 20142

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


• 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

S&P Measures Assessment


• 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%)

S&P Key Findings


• 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

S&P Key Findings Continued


• 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)

SNP 1 & 2 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%

SNP 3 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

SNP 4 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

SNP 5 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.

SNP 6 Findings


SNP 6 ResultsElement E: Network Adequacy, by Type (2011 vs. 2012)

D-SNPS I-SNPs C-SNPs0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

2011 2012

Element E: Network Adequacy, by enrollment size, 2012

Element E0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

0-99% 100-499 500-9991,000-2,499 >2,500


Model of Care ResultsCY 2014 Submissions


• 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

Model of Care Results-SNPs


Results for SNPs

MOC 1 MOC 2 MOC 3 MOC 4 MOC 5 MOC 6 MOC 7 MOC 8 MOC 9 MOC10 MOC110.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

Final Score by SNP Type and MOC Element

Final Score for ChronicsFinal Score for DualsFinal Score for Institutionals


• 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

MOC Results--MMP


AZ ID MI NY RI SC TX VT VA WA70%

75%

80%

85%

90%

95%

100%

Average Total Score

Ave. Score

MMP Results by State


MOC 1 MOC 2 MOC 3 MOC 4 MOC 5 MOC 6 MOC 7 MOC 8 MOC 9 MOC 10 MOC 1182.00%

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

Average Element Score

Average Element Score

Overall MMP Results


SNP HEDIS Results2013


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

HEDIS Measures for SNP Submission


• 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

SNP HEDIS 2013 Overview


• 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

Key Findings


SNP Higher than MA No Statistically Significant Difference

SNPs Lower than MA

PCE-Dispensed Bronchodilator within 30 Days of Event

GSO COL

MPM-ACE/ARB Monitoring PBH SPR

MPM-Digoxin Monitoring OMW PCE-Dispensed Systemic Corticosteroid Within 14 Days

of Event

MPM-Diuretic Monitoring FUH-Within 30 Days of Discharge

CBP

MPM-Anticonvulsant Monitoring

FUH-Within 7 Days of Discharge AMM-Acute Phase

MPM-Total Rate BCR-Internal Medicine AMM-Continuation Phase

BCR-Geriatrics BCR-Family Medicine

BCR-Other Physician Specialists

DDE-History of Falls

DDE-Dementia

DDE-Chronic Renal Failure

DDE-Total Rate

DAE-At Least One High-Risk Medication

DAE-At Least Two High-Risk Medications

SNP Versus MA Performance


• 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

Improvement Trend


• 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

Performance by SNP Type


• 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

Plan Benefit Package Level Performance


DISCUSSION

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