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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
SNP Results2013

SNP Educational Session - January 13, 2014

Brett Kay, AVP, SNP Assessment, NCQA

objectives
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
s p measures assessment
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
s p key findings
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%)
s p key findings continued
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
snp 1 2 findings
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)
snp 3 findings
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%
snp 4 findings
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
snp 5 findings
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
snp 6 findings
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.
snp 6 results
SNP 6 Results

Element E: Network Adequacy, by Type (2011 vs. 2012)

Element E: Network Adequacy, by enrollment size, 2012

model of care results snps
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
moc results mmp
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
hedis measures for snp submission
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
snp hedis 2013 overview
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
key findings
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
improvement trend
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
performance by snp type
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
plan benefit package level performance
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