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Introduction

The Department of Human Services (the Department) is committed to ensuring that Medicaid consumers enrolled in the HealthChoices Program receive the highest quality of health care. The Department requires that managed care organizations (MCOs or plans) submit performance data, which the Department uses to provide useful and timely performance comparison information to plans, consumers, and other stakeholders. This HealthChoices Performance Trending Report summarizes data collected from the MCOs for the HealthChoices Southeast, Southwest, Lehigh/Capital, Northeast and Northwest zones for the period January 1, 2016 through December 31, 2018 [Healthcare Effectiveness Data and Information Systems (HEDIS)1] 2017, 2018, 2019). This document supports measures that are important areas of focus for the Department.

The Department uses three formal sources of performance data: HEDIS®, Consumer Assessment of Healthcare Providers and Systems (CAHPS2), and Pennsylvania Performance Measures (PAPMs). HEDIS® is the most widely used set of clinical performance measures in the managed care industry. CAHPS includes both adult and child survey components and is used to assess consumer experiences with various components of health care quality. The surveys are currently the standard consumer satisfaction measurement instruments used by plans seeking National Committee for Quality Assurance (NCQA) accreditation. All the Adult and Child CAHPS® measures reported in the 2019 HealthChoices Performance Trending Report can be compared to their previous years’ data.

States are mandated to obtain an external quality review organization to perform an independent, external annual review evaluating the timeliness of, quality of, and access to services provided by the MCOs. The Department selected the PAPMs for the external quality review studies to enhance and expand the areas covered by other quality studies. The Department obtained input regarding the choice of measures from the Medical Assistance Advisory Committee (MAAC), the individual MCOs, and a variety of other stakeholders.

This Performance Trending Report documents ratings for measures focusing on areas that are important to the Department’s initiatives. The HealthChoices Program reports aggregate plan results either as a HealthChoices weighted average for HEDIS or a HealthChoices average for CAHPS and PAPM’s. Trending charts rank MCOs in order of performance.

1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 2 CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Pennsylvania HealthChoices, 2019 i Southeast, Southwest, Lehigh/Capital, Northeast and Northwest


HealthChoices Average Graphs

Note: The scale for this graph ranges from 50 to 90 percent.

The information provided for each measure includes a brief description of the measure above the weighted average graph. Using the above “Satisfaction with Health Plan” graph as an example, we describe each component of the weighted average graphs:

The average performance of all the HealthChoices plans is indicated by the blue columns, which show the weighted average for each of the past three years.

2017, 2018, and 2019 Trending Charts

The performance trending charts appear below the graphs and provide data reported in 2017, 2018, and 2019. MCOs above the Weighted Average/Average row in the trending charts indicate those plans that met or exceeded the HealthChoices Program Weighted Average/Average.

Pennsylvania HealthChoices, 2019 ii Southeast, Southwest, Lehigh/Capital, Northeast and Northwest


Analysis

The table below summarizes the results of the measures presented in the 2019 Performance Trending Report.

No. Assessment Criteria Number of Measures 1. For the 32 Performance Trending Report measures*, the number of measures where the 2019 HealthChoices Weighted

Average/Average:

a. Improved between 2018 and 2019 18

b. Remained the same between 2018 and 2019 2

c. Declined between 2018 and 2019 12

2. For the 28 measures in the Performance Trending Report with 2019 national benchmarks3, the number of measures where the 2019 HealthChoices Weighted Average/Average is:

a. Below (or worse than) the 50th percentile 6

b. At or above the 50th percentile and below the 75th percentile 19

c. At or above the 75th percentile 3

Detailed analysis of the information presented in this report is a work in progress. Evaluation of quality improvement data requires extensive investigations to ascertain the sources of variation in the data. The Department has provided useful and timely feedback to the MCOs to guide future quality improvements and engage the plans in dialogue about improvement approaches and opportunities. While measuring quality in the HealthChoices Program is complex and labor intensive, it has proven to be a meaningful exercise.

As evidenced by the Consumer Guide format and this performance report, both of which the Department developed in response to consumer and stakeholder recommendations, the Department is committed to continuing its quality measurement efforts and improving the quality of its reporting. More importantly, the Department is committed to using reports, such as this report, as powerful tools to improve the clinical quality of its managed care program, which will, in turn, improve the health of our communities.

Acknowledgements

National Committee for Quality Assurance (NCQA) - The National Committee for Quality Assurance develops and publishes HEDIS 2019, Volume 2: Technical Specifications.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS), version 5.0H for HEDIS 2019, is sponsored by the Agency for Healthcare Research and Quality (AHRQ), and appears in HEDIS 2019, as Volume 3. This report contains question text from CAHPS 5.0H Adult and 5.0H Child Medicaid Questionnaires.

3 Performance of HealthChoices Weighted Averages compared to national benchmarks is derived from Quality Compass 2019. Quality Compass if a registered trademark of NCQA. *Due to the age band being different for the ADV 2-21 and 2-20 we do not have a weighted average for both measures.

Pennsylvania HealthChoices, 2019 iii Southeast, Southwest, Lehigh/Capital, Northeast and Northwest


Table of Contents

Asthma Medication Management for People with Asthma - 75% Compliance* ........................................ 1

Children’s Dental

Annual Dental Visit 2-20*............................................................................................................. 2 Annual Dental Visits for Members with Developmental Disabilities ............................................. 3

Children’s Health

Children’s and Adolescents’ Access to Primary Care Practitioners, Ages 12 to 24 Months .......... 4 Children’s and Adolescents’ Access to Primary Care Practitioners, Ages 25 Months to 6 Years ..5 Children’s and Adolescents’ Access to Primary Care Practitioners, Ages 7 to 11 Years .............. 6 Children’s and Adolescents’ Access to Primary Care Practitioners, Ages 12 to 19 Years ............ 7 Well-Child Visits in the First 15 Months*........................................................................................ 8 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life* .............................................. 9 Developmental Screening in the First Three Years of Life*......................................................... 10 Adolescent Well-Care Visits*....................................................................................................... 11 Lead Screening in Children*........................................................................................................ 12

Cholesterol

Controlling High Blood Pressure* .............................................................................................. 13

Diabetes

Hemoglobin A1c Screening for People with Diabetes................................................................ 14 Hemoglobin A1c Poor Control (<9%)* ....................................................................................... 15 Eye Exams for People with Diabetes......................................................................................... 16 Medical Attention for Nephropathy............................................................................................. 17

Maternity

Frequency of Ongoing Prenatal Care ........................................................................................ 18 Timeliness of Prenatal Care* ..................................................................................................... 19 Postpartum Care* ...................................................................................................................... 20

*Represents measures that are part of the Pennsylvania Pay for Performance Programs.

Pennsylvania HealthChoices, 2019 iv Southeast, Southwest, Lehigh/Capital, Northeast and Northwest


Women’s Health

Breast Cancer Screening........................................................................................................... 21

Getting Needed Care Right Away (Adult)

Getting Needed Care Right Away.............................................................................................. 22 Getting Appointment with Specialist .......................................................................................... 23 Getting Care You Need ............................................................................................................. 24 Appointment for Routine Care When Needed............................................................................ 25

Getting Needed Care Right Away (Child)

Getting Needed Care Right Away for Your Child ....................................................................... 26 Getting Appointment with Specialist for Your Child.................................................................... 27 Getting Care You Think Your Child Needs ................................................................................ 28 Appointment for Routine Care When Needed ........................................................................... 29

Satisfaction (Adult)

Satisfaction with Health Plan ..................................................................................................... 30

Satisfaction (Child)

Satisfaction with Child’s Health Plan.......................................................................................... 31

Readmissions

Reducing Potentially Preventable Readmissions* ..................................................................... 32

*Represents measures that are part of the Pennsylvania Pay for Performance Programs.

Pennsylvania HealthChoices, 2019 v Southeast, Southwest, Lehigh/Capital, Northeast and Northwest

Performance Area - Asthma Medication Management for People with Asthma - 75% Compliance

(HEDIS®)

This measure shows the percentage of members 5 to 64 years of age who remained on an asthma controller medication for at least 75% of their treatment period.

2017 2018 2019 Health Plan 53.88% 56.30% 53.85% AmeriHealth Caritas Northeast

54.27% 55.15% 51.45% AmeriHealth Caritas Pennsylvania

47.55% 47.86% 51.19% Geisinger Health Plan

46.25% 44.54% 46.73% UPMC for You

43.25% 44.46% 44.35% HealthChoices Weighted Average

37.68% 38.02% 42.96% Gateway Health

37.34% 39.43% 42.60% Health Partners Plans

43.84% 46.73% 41.46% Keystone First

42.70% 36.16% 40.64% Aetna Better Health

35.64% 37.37% 38.50% United Healthcare

Medication Management for People with Asthma - 75% Compliance

2017 2018 2019 HealthChoices Weighted

Average 43.25% 44.46% 44.35%

10%

20%

30%

40%

50%

60%

Medication Management for People with Asthma - 75% Compliance


Pennsylvania HealthChoices, 2019 1 Southeast, Southwest, Lehigh/Capital, Northwest and Northeast

Performance Area - Children's Dental Annual Dental Visit 2 - 20 Years

(HEDIS®)

This measure shows the percentage of members 2 to 20 years of age who had at least 1 dental visit during the measurement year.

2017 2018 2019 Health Plan 69.34% 69.35% 71.16% Keystone First 64.51% 66.51% 67.90% Health Partners Plans 62.49% 64.30% 65.36% AmeriHealth Caritas Northeast 65.53% 65.90% 64.85% AmeriHealth Caritas Pennsylvania 56.36% 63.70% 64.04% Gateway Health

63.97% HealthChoices Weighted Average 55.30% 58.60% 60.79% UPMC for You 56.27% 57.88% 59.34% Aetna Better Health 57.71% 57.85% 58.49% Geisinger Health Plan 58.20% 58.80% 58.10% United Healthcare

Annual Dental Visit 2 - 20 Years1

2017 2018 2019 HealthChoices Weighted Average 60.77% 63.00% 63.97%

20%

30%

40%

50%

60%

70% Annual Dental Visit 2 - 20 Years


1NCQA revised the age bands for ADV in 2016 from 2-21 years to 2-20 years.


Performance Area - Children's Dental Annual Dental Visits for Members with Developmental Disabilities

(PAPM)

This measure shows the percentage of members 2 to 21 years of age with a developmental disability who had at least 1 dental visit during the measurement year. Individuals were identified with congenital or acquired disabilities or conditions affecting the central nervous system and significantly impairing cognition. The cognitive impairments of interest are those that create barriers to effective dental care.

2017 2018 2019 HealthChoices Average 57.31% 62.50% 62.44%

0%

10%

20%

30%

40%

50%

60%

70%

Annual Dental Visits for Members with Developmental Disabilities


Annual Dental Visits for Members with Developmental Disabilities

2017 2018 2019 Health Plan 68.16% 68.67% 70.63% Keystone First 64.76% 66.53% 68.32% AmeriHealth Northeast 61.30% 64.74% 67.10% Health Partners Plans 68.26% 67.97% 66.77% AmeriHealth Caritas Pennsylvania 48.02% 63.82% 63.99% Gateway Health 60.95% 61.09% 62.82% Aetna Better Health 57.31% 62.50% 62.44% HealthChoices Average 57.36% 55.66% 58.78% Geisinger Health Plan 49.50% 55.57% 55.39% UPMC for You 53.38% 56.24% 54.37% United Healthcare


Performance Area - Children's Health Children's and Adolescents' Access to Primary Care Practitioners, Ages 12 to 24 Months

(HEDIS®)

This measure shows the percentage of children 12 to 24 months of age who had a visit with an MCO primary care practitioner (PCP) during the measurement year.


Average 96.32% 95.98% 96.40%

70%

80%

90%

100% Note: The scale for this graph ranges from 70 to 100 percent.

Children's and Adolescents' Access to PCPs (Ages 12 to 24 Months)

Children's and Adolescents' Access to PCPs (Ages 12 to 24 Months)

2017 2018 2019 Health Plan 97.51% 97.37% 98.95% UPMC for You 96.33% 95.66% 97.09% AmeriHealth Caritas Northeast 97.21% 97.24% 96.95% Geisinger Health Plan 95.63% 92.95% 96.92% AmeriHealth Caritas Pennsylvania 97.06% 96.96% 96.91% Gateway Health

96.40% HealthChoices Weighted Average 96.51% 96.18% 96.37% Keystone First 95.37% 95.63% 94.77% Health Partners Plans 93.96% 94.64% 94.32% Aetna Better Health 95.47% 94.65% 93.21% United Healthcare


Performance Area - Children's Health Children's and Adolescents' Access to Primary Care Practitioners, Ages 25 Months to 6 Years

(HEDIS®)

This measure shows the percentage of children 25 months to 6 years of age who had a visit with an MCO primary care practitioner (PCP) during the measurement year.

2017 2018 2019 Health Plan 89.69% 90.69% 96.89% UPMC for You 91.81% 89.70% 91.75% Geisinger Health Plan 89.64% 87.27% 90.59% AmeriHealth Caritas Northeast

90.19% HealthChoices Weighted Average 87.95% 84.64% 89.89% AmeriHealth Caritas Pennsylvania 88.60% 89.26% 88.86% Gateway Health 88.22% 88.18% 88.48% Keystone First 87.26% 88.13% 88.00% Health Partners Plans 87.31% 86.40% 87.37% Aetna Better Health 87.84% 87.40% 86.01% United Healthcare

Children's and Adolescents' Access to PCPs (Ages 25 Months to 6 Years)


Average 88.62% 88.36% 90.19%

50%

60%

70%

80%

90%

100% Note: The scale for this graph ranges from 50 to 100 percent.

Children's and Adolescents' Access to PCPs (Ages 25 Months to 6 Years)


Performance Area - Children's Health Children's and Adolescents' Access to Primary Care Practitioners, Ages 7 to 11 Years

(HEDIS®)

This measure shows the percentage of children 7 to 11 years of age who had a visit with an MCO primary care practitioner (PCP) during the measurement year or the year prior to the measurement year.

2017 2018 2019 Health Plan 94.13% 94.28% 94.87% Geisinger Health Plan 92.25% 90.37% 94.06% AmeriHealth Caritas Northeast 92.35% 89.69% 93.78% AmeriHealth Caritas Pennsylvania 93.74% 93.57% 93.49% Keystone First 92.20% 93.23% 93.38% UPMC for You

92.98% HealthChoices Weighted Average 90.72% 93.34% 92.86% Gateway Health 92.42% 92.60% 92.69% Health Partners Plans 90.23% 90.74% 91.11% Aetna Better Health 92.17% 91.30% 90.32% United Healthcare

Children's and Adolescents' Access to PCPs (Ages 7 to 11 Years)


60%

70%

80%

90%

100%


Note: The scale for this graph ranges from 60 to 100


Performance Area - Children's Health Children's and Adolescents' Access to Primary Care Practitioners, Ages 12 to 19 Years

(HEDIS®)

This measure shows the percentage of children 12 to 19 years of age who had a visit with an MCO primary care practitioner (PCP) during the measurement year or the year prior to the measurement year.


60%

70%

80%

90%

100%




2017 2018 2019 Health Plan 91.93% 90.00% 94.42% AmeriHealth Caritas Northeast

93.09% 93.37% 94.35% Geisinger Health Plan 91.40% 88.98% 93.20% AmeriHealth Caritas Pennsylvania 92.61% 92.67% 93.13% Keystone First 90.32% 91.58% 92.29% UPMC for You 90.77% 91.46% 92.17% HealthChoices Weighted Average 88.85% 92.03% 91.83% Gateway Health 89.92% 90.27% 90.65% Health Partners Plans 88.64% 89.49% 90.27% Aetna Better Health 90.84% 91.11% 90.06% United Healthcare


Performance Area - Children's Health Well-Child Visits in the First 15 Months of Life

(HEDIS®)

This measure shows the percentage of children who turned 15 months old during the measurement year who had 6 or more well-child visits with a primary care practitioner (PCP) during their first 15 months of life.

2017 2018 2019 Health Plan 71.96% 74.85% 74.14% Geisinger Health Plan 70.83% 75.43% 73.97% AmeriHealth Caritas Northeast 69.91% 72.51% 72.75% AmeriHealth Caritas Pennsylvania 69.88% 68.36% 72.50% Health Partners Plans 72.26% 68.06% 72.22% UPMC for You 68.66% 69.90% 71.63% HealthChoices Weighted Average 65.28% 69.10% 71.53% Keystone First 67.88% 74.45% 70.72% United Healthcare 66.59% 68.37% 70.32% Gateway Health 65.97% 65.69% 67.40% Aetna Better Health

Well-Child Visits in the First 15 Months of Life


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40%

50%

60%

70%

80%

Well-Child Visits in the First 15 Months of Life



Performance Area - Children's Health Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life

(HEDIS®)

This measure shows the percentage of children three to six years of age who had one or more well-child visits with a primary care practitioner (PCP) during the measurement year.

2017 2018 2019 Health Plan 80.23% 82.59% 81.20% Health Partners Plans 76.68% 77.70% 79.73% UPMC for You 70.37% 82.00% 79.32% AmeriHealth Caritas Pennsylvania 77.52% 77.57% 77.66% HealthChoices Weighted Average 78.13% 76.40% 77.62% Gateway Health 78.66% 79.86% 77.06% Geisinger Health Plan 80.09% 75.18% 75.91% Keystone First 76.16% 74.70% 75.43% AmeriHealth Caritas Northeast 79.81% 77.13% 75.34% United Healthcare 72.22% 72.99% 74.70% Aetna Better Health

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life


Average 77.52% 77.57% 77.66%

30%

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50%

60%

70%

80%

90%

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life



Performance Area - Developmental Screening Developmental Screening in the First Three Years of Life (Use of CPT code 96110 limited)

(PAPM)

The percentage of children screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months preceding or on their first, second, or third birthday.


40%

50%

60%

Developmental Screening First Three Years of Life


Developmental Screening in the First Three Years of Life (Use of CPT code 96110 limited)

2017 2018 2019 Health Plan 66.88% 67.43% 67.03% UPMC for You 65.75% 62.06% 57.74% Geisinger Health Plan 56.80% 56.68% 57.37% Aetna Better Health 54.18% 55.69% 57.12% HealthChoices Average 51.20% 52.93% 56.64% Keystone First 58.83% 57.11% 55.12% AmeriHealth Caritas Northeast 54.13% 55.01% 54.97% United Healthcare 49.73% 52.73% 54.45% Gateway Health 40.07% 45.86% 51.20% Health Partners Plans 45.71% 47.71% 50.84% AmeriHealth Caritas Pennsylvania


Performance Area - Children's Health Adolescent Well-Care Visits

(HEDIS®)

This measure shows the percentage of enrolled members 12 to 21 years of age who had at least 1 comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.


30%

40%

50%

60%

70% Adolescent Well-Care Visits


Adolescent Well-Care Visits

2017 2018 2019 Health Plan 58.39% 62.29% 67.27% United Healthcare 54.17% 63.99% 66.91% Keystone First 61.81% 65.21% 65.94% AmeriHealth Caritas Northeast 53.01% 66.18% 64.48% AmeriHealth Caritas Pennsylvania 62.04% 65.21% 63.03% Health Partners Plans 55.96% 61.98% 62.39% HealthChoices Weighted Average 55.37% 60.69% 61.01% Geisinger Health Plan 53.33% 61.46% 59.69% UPMC for You 58.41% 61.56% 57.42% Gateway Health 49.31% 47.93% 54.26% Aetna Better Health


Performance Area - Children's Health Lead Screening in Children

(HEDIS®)

This measure shows the percentage of children two years of age who had one or more capillary or venous lead blood tests for lead poisoning by their second birthday.


30%

40%

50%

60%

70%

80%

90% Lead Screening in Children


Lead Screening in Children

2017 2018 2019 Health Plan 82.00% 86.86% 86.37% UPMC for You 81.02% 77.62% 83.94% Keystone First 80.12% 80.32% 82.30% HealthChoices Weighted Average 84.92% 81.75% 82.24% Geisinger Health Plan 77.36% 82.73% 81.27% Health Partners Plans 82.97% 81.51% 80.29% United Healthcare 77.89% 75.43% 79.32% Gateway Health 82.41% 81.75% 78.88% AmeriHealth Caritas Northeast 78.01% 77.62% 77.86% Aetna Better Health 75.23% 75.43% 75.24% AmeriHealth Caritas Pennsylvania


Performance Area - Cholesterol Controlling High Blood Pressure

(HEDIS®)

This measure shows the percentage of persons 18 to 85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled during the measurement year. Adequate control is defined as a blood pressure reading in the member’s record taken by a provider in the past year that indicates a systolic rate <140 and a diastolic rate <90.

2017 2018 2019 Health Plan 71.96% 70.47% 71.78% Geisinger Health Plan 66.43% 65.94% 68.37% AmeriHealth Caritas Pennsylvania 64.79% 68.13% 68.13% AmeriHealth Caritas Northeast 65.50% 69.68% 68.13% Health Partners Plans 63.61% 65.89% 66.42% UPMC for You 63.23% 64.35% 66.40% HealthChoices Weighted Average 56.32% 52.31% 65.45% Gateway Health 64.48% 65.69% 65.21% United Healthcare 58.95% 62.77% 63.99% Keystone First 66.07% 60.83% 61.80% Aetna Better Health

Controlling High Blood Pressure


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40%

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60%

70%

80%

Controlling High Blood Pressure Note: The scale for this graph ranges from 30 to 80 percent.


Performance Area - Diabetes Comprehensive Diabetes Care, Hemoglobin A1c (HbA1c) Screening

(HEDIS®)

This measure shows the percentage of members 18 to 75 years of age with diabetes (type 1 and type 2) who were continuously enrolled during the measurement year and had an HbA1c screening.

2017 2018 2019 Health Plan 88.72% 87.40% 88.83% Gateway Health 89.97% 89.06% 88.59% Health Partners Plans 87.60% 84.91% 88.53% United Healthcare 85.25% 86.13% 87.05% Geisinger Health Plan 87.49% 87.23% 86.58% HealthChoices Weighted Average 86.57% 87.10% 86.46% AmeriHealth Caritas Northeast 86.90% 86.52% 86.23% AmeriHealth Caritas Pennsylvania 89.11% 89.54% 86.07% UPMC for You 84.41% 83.24% 84.39% Aetna Better Health 85.26% 86.24% 83.83% Keystone First

Comprehensive Diabetes Care: HbA1c Screening


60%

70%

80%

90%

100%

Comprehensive Diabetes Care: HbA1c Screening



Performance Area - Diabetes Comprehensive Diabetes Care, Hemoglobin A1c (HbA1c) Poor Control (>9%)

(HEDIS®)

This measure shows the percentage of members 18 to 75 years of age with diabetes (type 1 and type 2) who were continuously enrolled during the measurement year and had an HbA1c level greater than 9.0%. Note: A lower rate indicates better performance for this measure.

2017 2018 2019 Health Plan 34.53% 32.30% 29.14% Geisinger Health Plan 31.31% 33.13% 31.41% Health Partners Plans 36.98% 36.04% 32.81% AmeriHealth Caritas Northeast 36.82% 34.24% 34.25% AmeriHealth Caritas Pennsylvania 35.66% 35.49% 34.33% Keystone First 36.35% 34.69% HealthChoices Weighted Average 37.87% 37.12% 35.13% United Healthcare 41.29% 38.86% 35.26% Aetna Better Health 34.66% 30.69% 35.49% UPMC for You 43.14% 39.87% 42.38% Gateway Health

Comprehensive Diabetes Care: HbA1c Poor Control (>9%)1


0%

10%

20%

30%

40%

50% Comprehensive Diabetes Care: HbA1c Poor Control (>9%)


1 Rates sorted in ascending order as lower rates depict better performance.


Performance Area - Diabetes Comprehensive Diabetes Care, Eye Exam Performed

(HEDIS®)

This measure shows the percentage of members 18 to 75 years of age with diabetes (type 1 and type 2) who were continuously enrolled during the measurement year and who had a dilated retinal examination. This category includes services provided by ophthalmologists and optometrists. The type of diabetes and the presence and degree of retinopathy influence the frequency of retinal screening for people with diabetes.

2017 2018 2019 Health Plan 64.21% 64.78% 66.55% Geisinger Health Plan 66.00% 63.21% 62.48% AmeriHealth Caritas Pennsylvania 63.88% 62.06% 61.36% UPMC for You 57.14% 62.66% 60.47% Health Partners Plans 57.60% 57.14% 59.32% United Healthcare 59.38% 58.98% 58.63% HealthChoices Weighted Average 57.32% 55.82% 56.91% Gateway Health 47.10% 43.67% 52.98% Aetna Better Health 58.32% 55.89% 52.67% Keystone First 55.89% 58.83% 52.60% AmeriHealth Caritas Northeast

Comprehensive Diabetes Care: Eye Exam Performed


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40%

50%

60%

70%

Comprehensive Diabetes Care: Eye Exam Performed



Performance Area - Diabetes Comprehensive Diabetes Care, Medical Attention for Nephropathy

(HEDIS®)

This measure shows the percentage of members 18 to 75 years of age with diabetes (type 1 and type 2) ages 18 to 75 years who were continuously enrolled during the measurement year and received a nephropathy screening or showed evidence of nephropathy.


20%

40%

60%

80%

100% Comprehensive Diabetes Care: Medical Attention for Nephropathy


Comprehensive Diabetes Care: Medical Attention for Nephropathy

2017 2018 2019 Health Plan 90.13% 88.52% 90.86% United Healthcare 90.93% 90.73% 90.22% UPMC for You 90.27% 91.56% 90.16% Health Partners Plans 88.56% 89.93% 89.93% AmeriHealth Caritas Northeast 87.41% 89.05% 89.75% Geisinger Health Plan 89.92% 89.63% 88.97% HealthChoices Weighted Average 90.65% 89.22% 88.33% Keystone First 88.39% 87.52% 87.19% Aetna Better Health 89.79% 90.59% 86.88% Gateway Health 89.39% 85.79% 86.57% AmeriHealth Caritas Pennsylvania


Performance Area - Maternity Frequency of Ongoing Prenatal Care

(PAPM)

This measure shows the percentage of Medicaid deliveries between November 6th of the year prior to the measurement year and November 5th of the measurement year that had ≥81 percent of expected prenatal visits.

2017 2018 2019 HealthChoices Average 70.60% 73.43%

30%

40%

50%

60%

70%

80%

90%

Frequency of Ongoing Prenatal Care


Frequency of Ongoing Prenatal Care

2017 2018 2019 Health Plan 0.0% 70.07% 77.86% AmeriHealth Caritas Pennsylvania 0.0% 72.99% 77.37% Gateway Health 0.0% 71.53% 77.13% AmeriHealth Caritas Northeast 0.0% 79.08% 76.89% Geisinger Health Plan 0.0% 72.51% 75.18% UPMC for You 0.0% 76.89% 74.45% Health Partners Plans 0.0% 70.60% 73.43% HealthChoices Average 0.0% 60.10% 71.78% Keystone First 0.0% 63.99% 67.40% United Healthcare 0.0% 68.17% 62.77% Aetna Better Health

NOTE: FPC was a HEDIS measure in 2017. FPC was a PA Performance Measure beginning in 2018.


Performance Area - Maternity Prentatal and Postpartum Care: Timeliness of Prenatal Care

(HEDIS®)

This measure shows the percentage of women who had a live birth during the measurement year, who were continuously enrolled at least 43 days prior to delivery through 56 days after delivery and who had a prenatal care visit in the first trimester or within 42 days of enrollment in the MCO.


60%

70%

80%

90%

100% Timeliness of Prenatal Care


Timeliness of Prenatal Care

2017 2018 2019 Health Plan 89.31% 85.40% 91.00% AmeriHealth Caritas Northeast 92.08% 90.02% 90.51% AmeriHealth Caritas Pennsylvania 90.75% 91.24% 89.05% UPMC for You 84.89% 84.91% 88.81% Keystone First 89.86% 89.29% 88.32% Health Partners Plans 88.07% 86.56% 87.01% HealthChoices Weighted Average 90.51% 86.62% 85.16% Geisinger Health Plan 85.16% 84.43% 84.90% United Healthcare 86.15% 81.51% 83.45% Gateway Health 84.91% 82.00% 79.81% Aetna Better Health


Performance Area - Maternity Prenatal and Postpartum Care: Postpartum Care

(HEDIS®)

This measure shows the percentage of women who were continuously enrolled at least 43 days prior to delivery through 56 days after delivery and had a postpartum visit on or between 21 and 56 days after delivery.


40%

50%

60%

70%

80% Postpartum Care


Postpartum Care

2017 2018 2019 Health Plan 71.27% 67.88% 74.94% AmeriHealth Caritas Pennsylvania 75.25% 74.45% 72.75% Health Partners Plans 70.67% 64.96% 69.34% Keystone First 65.94% 70.32% 68.61% Geisinger Health Plan 67.26% 65.94% 68.37% AmeriHealth Caritas Northeast 68.11% 67.71% 67.72% HealthChoices Weighted Average 70.56% 71.78% 66.18% UPMC for You 60.10% 63.26% 65.10% United Healthcare 63.38% 66.18% 63.02% Gateway Health 62.74% 58.15% 60.34% Aetna Better Health


Performance Area - Women's Health Breast Cancer Screening

(HEDIS®)

This measure shows the percentage of women 52 to 74 years of age who had a mammogram to screen for breast cancer during the measurement year or the year prior to the measurement year.


30%

40%

50%

60%

70% Breast Cancer Screening


Breast Cancer Screening

2017 2018 2019 Health Plan 64.14% 63.08% 62.56% AmeriHealth Caritas Pennsylvania 66.13% 63.29% 61.13% Health Partners Plans 61.42% 58.91% 59.84% Geisinger Health Plan 63.90% 62.73% 59.48% Keystone First 59.36% 58.41% 57.31% HealthChoices Weighted Average 56.77% 57.49% 57.09% UPMC for You 58.40% 58.04% 55.90% AmeriHealth Caritas Northeast 53.10% 54.53% 55.02% Gateway Health 51.85% 50.88% 50.52% United Healthcare 50.21% 45.72% 45.61% Aetna Better Health


Performance Area - Needed Care, Adult Getting Needed Care Right Away

(CAHPS®)

Plan members were asked, "In the last six months, when you needed care right away, how often did you get care as soon as you needed?" Plan members responded, "Never," "Sometimes," "Usually" or "Always." Responses of "Usually or Always" were used to assess plan performance.


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80%

90%

Getting Needed Care Right Away - Adult


Getting Needed Care Right Away Adult

2017 2018 2019 Health Plan 91.36% 89.60 % 88.89% AmeriHealth Caritas Pennsylvania

87.39% 87.36 % 87.06% Gateway Health 87.60% 84.55 % 86.46% Aetna Better Health 83.13% 86.28 % 85.98% AmeriHealth Caritas Northeast 83.19% 83.46 % 85.83% Geisinger Health Plan

86.05% 92.12 % 85.78% UPMC for You 85.80% 82.81 % 85.71% United Healthcare

85.66% HealthChoices Average 87.74% 85.98 % 82.35% Health Partners Plans 83.45% 84.03 % 80.45% Keystone First


Performance Area - Needed Care, Adult Getting Appointment with Specialist

(CAHPS®)

Plan members were asked, "In the last six months, how often did you get an appointment to see a specialist as soon as you needed?" Plan members responded, "Never," "Sometimes," "Usually" or "Always." Responses of "Usually or Always" were used to assess plan performance.


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90%

100%

Getting Appointment with Specialist Note: The scale for this graph ranges from 40 to 100 percent.

Getting Appointment with Specialist - Adult

2017 2018 2019 Health Plan 81.87% 85.84 % 86.13% AmeriHealth Caritas Northeast

84.21% 89.08 % 85.65% UPMC for You 79.49% 84.86 % 83.33% Gateway Health 78.53% 78.53%

85.95 % 85.95 %

82.95% HealthChoices Average 82.69% Health Partners Plans

77.85% 80.00 % 82.19% Geisinger Health Plan 85.59% 79.73 % 81.99% AmeriHealth Caritas Pennsylvania 78.92% 80.92 % 81.17% Keystone First 78.69% 80.53 % 80.00% Aetna Better Health 80.63% 76.92 % 79.41% United Healthcare


Performance Area - Needed Care, Adult Getting Care You Need

(CAHPS®)

Plan members were asked, "In the last six months, how often was it easy to get the care, tests, or treatment you needed through your health plan?" Plan members responded, "Never," "Sometimes," "Usually" or "Always." Responses of "Usually or Always" were used to assess plan performance.


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Getting Care You Need Note: The scale for this graph ranges from 60 to 90 percent.

Getting Care You Need - Adult

2017 2018 2019 Health Plan 84.80% 88.48 % 90.71% UPMC for You 86.18% 87.55 % 88.57% United Healthcare 78.77% 84.04 % 87.80% Aetna Better Health 86.21% 83.91 % 87.22% AmeriHealth Caritas Pennsylvania 83.94% 89.50 % 87.17% Geisinger Health Plan 85.57% 90.45 % 87.02% AmeriHealth Caritas Northeast 84.64% 87.18 % 86.96% Health Partners Plans 84.90% 87.00% 86.65% HealthChoices Average 87.00% 85.21 % 84.14% Gateway Health 83.62% 85.65 % 79.58% Keystone First


Performance Area - Needed Care, Adult Appointment for Routine Care When Needed

(CAHPS®)

Plan members were asked, "In the last six months, not counting the times you needed care right away, how often did you get an appointment for your health care at a doctor's office or clinic as soon as you needed?" Plan members responded, "Never," "Sometimes," "Usually" or "Always." Responses of "Usually or Always" were used to assess plan performance.


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90%

Appointment for Routine Care When Needed Note: The scale for this graph ranges from 60 to 90 percent.

Appointment for Routine Care When Needed - Adult

2017 2018 2019 Health Plan 79.67% 81.74 % 86.73% Geisinger Health Plan 79.58% 84.57 % 86.20% UPMC for You 84.57% 85.76 % 85.71% AmeriHealth Caritas Pennsylvania 84.08% 84.59 % 85.08% AmeriHealth Caritas Northeast 83.57% 84.08 % 82.67% Gateway Health 79.85% 80.81 % 82.42% Health Partners Plans 81.70% 83.30% 82.42% HealthChoices Average 80.00% 78.41 % 77.18% Aetna Better Health 80.54% 85.58 % 76.44% United Healthcare 80.63% 80.25 % 73.19% Keystone First


Performance Area - Needed Care, Child Getting Needed Care Right Away for Your Child

(CAHPS®)

Plan members were asked, "In the last six months, when your child needed care right away, how often did your child get care as soon as he or she needed?" Plan members responded, "Never," "Sometimes," "Usually" or "Always." Responses of "Usually or Always" were used to assess plan performance.


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Getting Needed Care Right Away for Your Child


Getting Needed Care Right Away for Your Child

2017 2018 2019 Health Plan 89.08% 92.76 % 95.37% Aetna Better Health 91.82% 94.74 % 93.84% AmeriHealth Caritas Northeast 90.00% 92.75 % 93.48% Geisinger Health Plan 93.13% 91.41 % 92.91% AmeriHealth Caritas Pennsylvania 92.38% 91.34 % 92.59% Gateway Health 95.27% 95.52 % 91.71% UPMC for You 90.50% 91.70% 91.52% HealthChoices Average 87.12% 90.09 % 88.68% Keystone First 81.34% 85.58 % 86.96% Health Partners Plans 91.05% 88.24 % 85.38% United Healthcare


Performance Area - Needed Care, Child Getting Appointment with Specialist for Your Child

(CAHPS®)

Plan members were asked, “In the last 6 months, how often did you get an appointment for your child to see a specialist as soon as you needed?” Plan members responded, "Never," "Sometimes," "Usually" or "Always." Responses of "Usually or Always" were used to assess plan performance.


60%

70%

80%

90%

Getting Appointment with Specialist for Your Child


Getting Appointment with Specialist for Your Child

2017 2018 2019 Health Plan 83.49% 84.21 % 87.64% AmeriHealth Caritas Pennsylvania 71.09% 80.58 % 82.65% Geisinger Health Plan

70.24% 81.48 % 81.82% Health Partners Plans 82.86% 81.11 % 80.00% Gateway Health 88.73% 75.00 % 80.00% UPMC for You 80.91% 72.82 % 79.55% AmeriHealth Caritas Northeast 84.11% 78.95 % 79.45% Aetna Better Health 80.30% 79.20% 79.31% HealthChoices Average 78.02% 79.22 % 76.43% United Healthcare 79.09% 82.76 % 67.42% Keystone First


Performance Area - Needed Care, Child Getting Care You Think Your Child Needs

(CAHPS®)

Plan members were asked, “In the last 6 months, how often was it easy to get the care, tests, or treatment your child needed?” Plan members responded, "Never," "Sometimes," "Usually" or "Always." Responses of "Usually or Always" were used to assess plan performance.


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80%

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100%

Getting Care You Think Your Child Needs


Getting Care You Think Your Child Needs

2017 2018 2019 Health Plan 91.48% 91.67 % 93.53% Geisinger Health Plan 92.14% 88.29 % 91.98% Aetna Better Health 90.82% 89.35 % 91.97% AmeriHealth Caritas Northeast 94.30% 92.19 % 91.55% UPMC for You 84.43% 82.70 % 90.91% Health Partners Plans

#N/A #N/A 90.69% HealthChoices Average 89.62% 89.37 % 90.40% Gateway Health 88.44% 89.21 % 90.00% AmeriHealth Caritas Pennsylvania 90.87% 87.53 % 87.90% United Healthcare 89.36% 88.03 % 87.73% Keystone First


50%

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90%

ale for this aph ranges

from 50 to

scgr

100 percent.


Performance Area - Needed Care, Child Appointment for Routine Care When Needed

(CAHPS®)

Plan members were asked, “In the last 6 months, not counting the times your child needed care right away, how often did you get an appointment for health care at a doctor's office or clinic as soon as your child needed?” Plan members responded, "Never," "Sometimes," "Usually" or "Always." Responses of "Usually or Always" were used to assess plan performance.

Note: The 100%

Appointment for Routine Care When Needed

Appointment for Routine Care When Needed - Child

2017 2018 2019 Health Plan 87.76% 90.16 % 91.76% AmeriHealth Caritas Northeast 94.12% 93.26 % 90.91% UPMC for You 87.38% 87.77 % 90.80% AmeriHealth Caritas Pennsylvania 89.08% 93.00 % 89.49% Gateway Health 89.20% 88.90% 88.68% HealthChoices Average 84.74% 83.33 % 88.00% Health Partners Plans 91.72% 90.48 % 87.89% Aetna Better Health 90.85% 86.16 % 87.65% United Healthcare 88.50% 92.06 % 86.91% Geisinger Health Plan

87.80% 83.39 % 83.47% Keystone First


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80% graph ranges

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Performance Area - Satisfaction, Adult Satisfaction with Health Plan

(CAHPS®)

Plan members were asked, “What number would you use to rate your health plan?” Plan members used any number from 0 to 10 where 0 is the worst health plan possible and 10 is the best health plan possible. Responses of 8 and above were used to assess plan performance.

90% Note: The

percent.

Satisfaction with Health Plan

Satisfaction with Health Plan - Adult

2017 2018 2019 Health Plan 79.23% 77.50 % 85.30% Gateway Health 82.14% 80.71 % 83.51% AmeriHealth Caritas Pennsylvania 83.39% 81.72 % 82.64% Geisinger Health Plan 77.06% 81.11 % 82.05% AmeriHealth Caritas Northeast 79.10% 79.30% 80.72% HealthChoices Average 81.87% 83.39 % 80.07% Keystone First 84.68% 81.61 % 80.00% Health Partners Plans 81.15% 82.36 % 79.57% UPMC for You 72.93% 72.90 % 79.31% United Healthcare 68.03% 69.26 % 68.67% Aetna Better Health


Performance Area - Satisfaction, Child Satisfaction with Child's Health Plan

(CAHPS®)

Plan members were asked, “What number would you use to rate your child's health plan?” Plan members used any number from 0 to 10 where 0 is the worst health plan possible and 10 is the best health plan possible. Responses of 8 and above were used to assess plan performance.


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100% Satisfaction with Child's Health Plan


Satisfaction with Child's Health Plan - Child

2017 2018 2019 Health Plan 89.38% 88.81 % 90.32% AmeriHealth Caritas Pennsylvania 86.03% 88.19 % 90.12% AmeriHealth Caritas Northeast 89.91% 87.35 % 89.53% Keystone First 85.57% 87.86 % 89.49% Health Partners Plans 87.91% 87.75 % 89.21% Geisinger Health Plan

91.25% 89.64 % 87.79% UPMC for You 86.80% 85.65%

86.50% 84.45 %

87.41% HealthChoices Average

87.06% Gateway Health 86.82% 83.56 % 83.37% United Healthcare 79.77% 80.90 % 81.37% Aetna Better Health


Performance Area - Readmissions Reducing Potentially Preventable Readmissions

(PAPM)

This performance measure assesses the percentage of inpatient acute care discharges with subsequent readmission to inpatient acute care within 30 days of the initial inpatient acute care discharge. Note: This measure utilizes the 2019 HEDIS® Inpatient Utilization – General Hospital/Acute Care (IPU) measure methodology to identify inpatient acute care discharges.


0%

10%

20% Reducing Potentially Preventable Readmissions


Reducing Potentially Preventable Readmissions

2017 2018 2019 Health Plan 13.24% 12.60% 14.21% Keystone First

6.50% 11.63% 13.21% Health Partners Plans

10.07% 10.93% 12.55% United Healthcare

7.47% 11.42% 12.35% Aetna Better Health

9.55% 10.35% 11.89% HealthChoices Average

7.96% 8.66% 11.16% UPMC for You

9.49% 9.50% 10.70% Gateway Health

8.89% 7.87% 9.53% AmeriHealth Caritas

10.64% 9.60% 9.38% Geisinger Health Plan

8.17% 6.55% 8.53% AmeriHealth Northeast


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