[
As part of Independence's annual review process, we obtain data from the
Healthcare Effectiveness Data and Information Set (HEDIS®) and
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
to help evaluate utilization for our Medicare Advantage HMO and PPO members.
The results showed that utilization remains within national standards and
members do not perceive significant barriers to getting appropriate care.
HEDIS® data evaluation
Independence used the data from HEDIS® to evaluate hospital
discharges and the frequency rates of select cardiac procedures.
Hospital
utilization
Hospital utilization comparisons of acute discharges per 1,000 (Table 1) show
that Keystone 65 HMO and Personal Choice 65℠ PPO rates continue to
improve and remain within the relevant national 10th and 90th percentiles as
the appropriate thresholds for over/under utilization. Comparison of
HEDIS® rates for Keystone 65 HMO reports a point change from
2013 – 2014 of 2.71 but an overall downward trend for the last three
measurement years; comparison of HEDIS® rates for Personal
Choice 65℠ PPO reports a point change of -20.01 from HEDIS 2013 to 2014,
with a downward trend over the last three measurement years.
Table 1: Hospital utilization comparison acute discharges per 1,000
| HEDIS® year | 2012 | 2013 | 2014 | Point
change 2013 – 2014 | R–squared | Trending per 1000 members |
| Rate | Rate | Rate | Threshold | Threshold status | | | |
| Keystone 65 HMO
members | 346.31 | 286.89 | 289.60 | 170.83 ?
334.11 | Within | 2.71 | 71.42% | Down |
| Personal Choice 65
PPO | 301.65 | 277.40 | 257.39 | 170.83 ?
334.11 | Within | -20.01 | 99.70% | Down |
Use of services
Independence also measured the frequency of selected procedure rates for
cardiac angioplasty, cardiac catheterization, and coronary artery bypass graft
(CABG). Based on a comparison of 2014 HEDIS® utilization rates
with respect to established thresholds, utilization for use of services for
these identified indicators fell within the established threshold for most
age/gender cohorts. There were two cohorts that did not fall within national or
regional thresholds and one cohort that fell above national, but within
regional thresholds. These rates are measured according to age group and
gender, and Independence recognizes the probability of unequal variance as an
issue with the cardiac procedure rates.
CAHPS data evaluation
Independence used CAHPS data to evaluate composite care, including member
perception of getting needed care in a timely manner and specialty care.
Keystone 65 HMO
members
The rates for Keystone 65 HMO members getting needed care during 2014 (Table 2)
remains within the national average. The point difference for members with
Keystone 65 HMO CAHPS from 2013 to 2014 reports a change of -0.09 for all
indicators measured for this report and shows a downward trend over the last
three reporting years (2012 – 2014). The plan recognizes the difficulty
in obtaining care and continues to actively recruit health care providers
within the region, including reaching out to network providers via the Clinical
Quality Committee for input into barriers to care that the plan may
influence.
Table 2: CAHPS member satisfaction data — Keystone 65 HMO
| HEDIS® year |
2012 | 2013 | 2014 | Point
change 2013 – 2014 | R–squared | Three–year trend |
| Rate | Rate | Rate | National
average | Threshold
status | | | |
| In the last six months, how often was it easy to get care, tests, or
treatment you thought you
needed? | 3.64 | 3.67 | 3.58 | 3.57 | Within | <
td>-0.0942.86% | Down |
| In the last six months, how often was it easy to get appointments with
a
specialist? | 3.61 | 3.64 | 3.55 | 3.53 | Within | -0.09 | 42.86% | Down |
| Getting needed care
composite | 3.64 | 3.67 | 3.34 | 3.29 | Within | -0.09 | 42.86% | Down |
Personal Choice 65
PPO
The rate for Personal Choice 65 PPO members during 2014 (Table 3) for obtaining
needed care, tests, and treatment and overall care composite increased from
CAHPS 2013 – 2014 and fell significantly above the national average as
reported by the Centers for Medicare & Medicaid Services.
The rate for Personal Choice 65 PPO members during 2014 (Table 3) for
obtaining needed care, tests, and treatment and overall care composite
increased from CAHPS 2013 to 2014 and is significantly above the national
average as reported by the Centers for Medicare & Medicaid Services.
Personal Choice 65 PPO members are not required to identify a primary care
physician, and many PPO members with chronic conditions use a specialist as
their primary physician. However, based on member responses regarding the ease
of care and care composite, there were no significant barriers to members
receiving appropriate care noted.
Table 3: CAHPS member satisfaction data — Personal Choice 65 PPO
| HEDIS® year | 2012 | 2013 | 2014 | Point
change 2013 – 2014 | R–squared | Three–year trend |
| Rate | Rate | Rate | National
average | Threshold
status | | | |
| In the last six months, how often was it easy to get care, tests, or
treatment you thought you
needed? | 3.61 | 3.64 | 3.73 | 3.57 | Above* | <
td>0.0992.31% | Up |
| In the last six months, how often was it easy to get appointments with
a
specialist? | 3.61 | 3.61 | 3.52 | 3.53 | Within | -0.09 | 75.00% | Down |
| Getting needed care
composite | 3.61 | 3.61 | 3.37 | 3.29 | Above* | 0.03 | 75.00% | Up |
*Threshold
status significantly better/worse than the national average
For more information
To learn more about HEDIS®, go to our Highlighting HEDIS® page to view
Highlighting HEDIS® articles that have been published in
Partners in Health Update℠. These articles are educational
resources for understanding HEDIS® measures. If you have
feedback about the Highlighting HEDIS® series or topic requests,
please email us.
HEDIS is a registered trademark of the National Committee
for Quality Assurance (NCQA). Used with permission.
]