Basic health plan part 1
This presentation is the property of its rightful owner.
Sponsored Links
1 / 20

Basic Health Plan: Part 1 PowerPoint PPT Presentation


  • 63 Views
  • Uploaded on
  • Presentation posted in: General

Basic Health Plan: Part 1. Preliminary Report Joint Legislative Audit and Review Committee Cynthia L. Forland Lisa Jeremiah November 30, 2005. Two-Part Study Mandated by 2005-07 Operating Budget.

Download Presentation

Basic Health Plan: Part 1

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Basic health plan part 1

Basic Health Plan: Part 1

Preliminary Report

Joint Legislative Audit and Review Committee

Cynthia L. Forland

Lisa Jeremiah

November 30, 2005


Two part study mandated by 2005 07 operating budget

Two-Part Study Mandated by 2005-07 Operating Budget

  • Part 1: To what extent do BHP policies and procedures promote or discourage the provision of appropriate, high-quality, cost-effective care?

  • Part 2: What are the characteristics of individuals enrolled in BHP, and how are they utilizing services?

Basic Health Plan: Part 1


Presentation outline

Presentation Outline

  • Background

  • Statutory and Contract Provisions

  • Monitoring and Measuring Performance of Health Plans

  • Other States

  • Findings and Recommendations

Basic Health Plan: Part 1


Bhp to make health care services available for low income residents

BHP to Make Health Care Services Available for Low-Income Residents

  • Established as a demonstration project in two counties in 1987

  • Expanded statewide and merged with the Health Care Authority in 1993

  • $500 million for benefits and $16 million for administrative costs for 2005-07

Basic Health Plan: Part 1


Enrollment in basic health plan

Enrollment in Basic Health Plan

  • Eligibility:

    • Resident of Washington State

    • Not eligible for Medicare

    • Gross family income at or below 200% of the federal poverty level

  • Average monthly enrollment of 102,400 for 2005

  • Served by 5 health plans

Basic Health Plan: Part 1


Health care authority responsible for administering basic health plan

Health Care Authority Responsible for Administering Basic Health Plan

  • Define covered basic health care services

  • Establish enrollee premiums and cost-sharing

  • Contract with health plans

  • Monitor services provided by health plans

Basic Health Plan: Part 1


Key findings

Key Findings

  • HCA-wide strategic planning and medical direction exist, but there is a lack of focus on Basic Health Plan

  • HCA requires quality health care, but provides limited specific guidelines and unclear expectations to health plans

  • Monitoring processes are in place, but they are insufficient to ensure quality health care

Basic Health Plan: Part 1


Study questions

Study Questions

  • Does Basic Health Plan promote:

    • Appropriate, high-quality, cost-effective care?

    • Evidence-based treatment strategies?

    • Use of high-quality providers?

    • Treatment of chronic care and other high-cost conditions?

    • Use of preventive services?

    • Innovative health care service delivery methods?

Basic Health Plan: Part 1


How is bhp promoting appropriate high quality cost effective care

How Is BHP Promoting Appropriate, High-Quality, Cost-Effective Care?

  • Statute:

    • HCA must assure access to good quality basic health care

  • Contract:

    • Health plans must have plan to improve quality, care delivery, satisfaction scores, and other standard measures

  • But:

    • Limited specific guidance

    • Most terms not defined

Basic Health Plan: Part 1


How is bhp promoting evidence based strategies

How Is BHP Promoting Evidence-Based Strategies?

  • Statute:

    • HCA must base policies on best available scientific and medical evidence

  • Contract:

    • Health plans must have a system to incorporate evidence-based medicine

  • But:

    • Limited specific guidance

    • Most terms not defined

Basic Health Plan: Part 1


How does bhp encourage use of high quality providers

How Does BHP Encourage Use of High-Quality Providers?

  • Statute:

    • Not specifically addressed

  • Contract:

    • Health plans must have an adequate network of providers who deliver high-quality health care services

    • Health plans provided guidance on initial and ongoing assessment of providers

Basic Health Plan: Part 1


How does bhp approach chronic conditions

How Does BHP Approach Chronic Conditions?

  • Statute:

    • HCA must explore disease management strategies

  • Contract:

    • Health plans must report top-five chronic conditions

    • Health plans must have disease management programs for two chronic conditions

  • But:

    • Limited guidance leads to inconsistent reporting

    • No link between top-five chronic conditions and disease management programs

Basic Health Plan: Part 1


How does bhp encourage use of preventive services

How Does BHP Encourage Use of Preventive Services?

  • Statute:

    • HCA must develop program of proven preventive health measures

  • Contract:

    • Health plans must provide care recommended by U.S. Preventive Services Task Force guidelines

    • Health plans can not charge co-payments for preventive care

Basic Health Plan: Part 1


How does bhp use innovative health care service delivery methods

How Does BHP Use Innovative Health Care Service Delivery Methods?

  • Statute:

    • Not specifically addressed

    • Outside of scope and intent of the program

  • Contract:

    • Health plans are not required to use innovative health care service delivery methods

Basic Health Plan: Part 1


Hca s monitoring of health plans

HCA’s Monitoring of Health Plans

  • Reviews based on Quality Improvement Standards

    • Focus is process and plans to ensure quality, not the actual quality of care

    • Interagency contract review team conducts annual reviews

  • Limited use of health care service utilization data

Basic Health Plan: Part 1


Performance measures do not focus on health care

Performance Measures Do Not Focus on Health Care

  • Performance measures focus on administrative functions:

    • Example: How quickly health plans issue identification cards to enrollees

    • Example: What percent of customer service calls HCA answers within 5 minutes

Basic Health Plan: Part 1


Other states provide examples for better ensuring quality health care

Other States Provide Examples for Better Ensuring Quality Health Care

  • Massachusetts: Aligning quality improvement goals with evidence-based practice guidelines

  • Wisconsin: Comparing health-related performance across programs and health plans

  • Oregon: Guiding and monitoring care through contracts

Basic Health Plan: Part 1


Finding lack of coordination and planning for bhp

Finding: Lack of Coordination and Planning for BHP

  • No strategic plan focused on the BHP

  • No strong integration of administrative and medical operations

  • Recommendation: HCA should develop goals and objectives for BHP focused on:

    • Assuring quality

    • Using evidence-based treatment

    • Exploring chronic disease management

Basic Health Plan: Part 1


Finding unclear expectations and limited guidelines

Finding: Unclear Expectations and Limited Guidelines

  • Terms not defined and guidance is limited

  • Focus on process, not results

    • Quality Improvement Standards

    • Performance measures

  • Recommendation: HCA should develop specific guidelines and performance requirements for contracts with health plans

Basic Health Plan: Part 1


Finding insufficient monitoring for quality

Finding: Insufficient Monitoring for Quality

  • Limited quality assessments

  • Limited use of health care service utilization data

  • Recommendation: HCA should improve its system of monitoring health plans

    • Application of quality assessment tools

    • Analysis and use of service utilization data

    • Analysis of health-related performance measures

Basic Health Plan: Part 1


  • Login