Quality Initiative Update

Uniform Medical Plan Plus

Sara Rutherford

As a member of the Puget Sound High Value Network, we are excited to participate in the new Accountable Health Program contract with the Health Care Authority, beginning in January 2016 and providing coverage for publicly-employed individuals and families in the five county Puget Sound region. This new benefit is called “Uniform Medical Plan Plus”, and recently completed open enrollment on November 30. To date, 3,093 lives are covered under UMP Plus.

The Puget Sound High Value Network (comprised of EvergreenHealth Partners, Virginia Mason, Overlake Medical Center, MultiCare Connected Care, Edmonds Family Practice, and Seattle Children’s Hospital) and the UW Medicine Network are the only two networks participating in this new plan offered by the Health Care Authority and Regence.

The quality requirements within this contract are ambitious. However, preparations are currently underway to coordinate and improve performance on 19 quality metrics, concentrated around diabetes management, cardiovascular disease management, prevention, and member satisfaction, and nine quality improvement plans – the first two of which, related to care coordination for high risk members and prevention of hospital readmissions, were submitted to the Health Care Authority on September 30.  The third quality improvement plan concerning obstetrics and maternity care is being finalized and will be submitted to the Health Care Authority by December 31.  Stay tuned for more updates as we look forward to 2016.

Aetna

As we prepared to wrap up 2015, we made one last push to close care gaps for patients with coverage under Aetna.  The care gaps in focus for this effort were:

Measure Description Breast Cancer Screening, 50-74 Years Women 50-74 years of age who had a mammogram to screen for breast cancer within the past 27 months. Cervical Cancer Screening, 21-64 Years Women 21-64 years of age who were screened for cervical cancer using either of the following criteria: Women age 21-64 who had cervical cytology performed every 3 years. Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years Colorectal Cancer Screening, 50-74 Years The percentage of patients 50-75 years of age who had appropriate screening for colorectal cancer, defined as: Fecal occult blood test (FOBT Value Set) during the measurement year. Flexible sigmoidoscopy every 5 years. Colonoscopy every 10 years. Diabetes Mellitus: HbA1c Testing, 18-75 Years Patients 18-75 years of age with diabetes that had a hemoglobin A1c test in the past 12 months. Lab Monitoring for ACE-I/ARB Patients on a ACE-I or ARB that have had a serum potassium and either a serum creatinine or blood urea nitrogen lab in the past 12 months Based on the quality reports we have received from Aetna, through June 30, 2015, we are trending well on Colorectal Cancer Screening and Diabetes Mellitus: Medical Attention for Nephropathy.  We are working hard to maintain this performance!  We have room to improve on Breast Cancer Screening, Cervical Cancer Screening, Diabetes Mellitus: Hemoglobin A1c Testing, and Lab Monitoring for Patients on ACE-Inhibitors and ARB Therapy.   Cigna We received news in early December that the first year of our Cigna contract has been settled and we succeeded in meeting our quality targets!  We needed to reach a quality index score 3 percent better than other networks in our market, and doing so earns us 100 percent of our eligible shared savings based on our excellent cost figures.  This outstanding news is the direct result of our EHP practices’ hard work closing care gaps for our patients this past April, May, and June.  It is gratifying to achieve this milestone, and we thank you for all of your incredible work and commitment!  Stay tuned for more detail about our first year quality metric performance at our upcoming meetings.