SNP Results
2013
SNP Educational Session - January 13, 2014
Brett Kay, AVP, SNP Assessment, NCQA
SNP Educational Session – January 13, 2014
1
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
SNP Educational Session, January 13, 2014
2
2
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
SNP Educational Session, January 13, 2014
3
3
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%)
SNP Educational Session, January 13, 2014
4
4
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 Educational Session, January 13, 2014
5
5
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 Educational Session, January 13, 2014
6
6
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 Educational Session, January 13, 2014
7
7
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 Educational Session, January 13, 2014
8
8
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 Educational Session, January 13, 2014
9
9
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 Educational Session, January 13, 2014
10
10
SNP 6 Results
Element E: Network Adequacy,
by Type (2011 vs. 2012)
Element E: Network Adequacy,
by enrollment size, 2012
80.00%
80.00%
70.00%
70.00%
60.00%
60.00%
50.00%
50.00%
40.00%
40.00%
30.00%
30.00%
20.00%
20.00%
10.00%
10.00%
0.00%
0.00%
D-SNPS
I-SNPs
2011
C-SNPs
2012
Element E
0-99%
100-499
SNP Educational Session, January 13, 2014
11
500-999
1,000-2,499
>2,500
11
Model of Care Results
CY 2014 Submissions
SNP Educational Session, January 13, 2014
12
12
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
SNP Educational Session, January 13, 2014
13
13
Results for SNPs
Final Score by SNP Type and MOC Element
4.00
3.50
3.00
2.50
Final Score for Chronics
2.00
Final Score for Duals
Final Score for Institutionals
1.50
1.00
0.50
0.00
MOC 1
MOC 2
MOC 3
MOC 4
MOC 5
MOC 6
MOC 7
MOC 8
MOC 9
SNP Educational Session, January 13, 2014
14
MOC10
MOC11
14
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
SNP Educational Session, January 13, 2014
15
15
MMP Results by State
Average Total Score
100%
95%
90%
85%
80%
75%
70%
AZ
ID
MI
NY
RI
SC
TX
VT
VA
WA
Ave. Score
SNP Educational Session, January 13, 2014
16
16
Overall MMP Results
Average Element Score
96.00%
94.00%
92.00%
90.00%
88.00%
86.00%
84.00%
82.00%
MOC 1
MOC 2
MOC 3
MOC 4
MOC 5
MOC 6
MOC 7
MOC 8
MOC 9 MOC 10 MOC 11
Average Element Score
SNP Educational Session, January 13, 2014
17
17
SNP HEDIS Results
2013
SNP Educational Session, January 13, 2014
18
18
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 Educational Session, January 13, 2014
19
19
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
SNP Educational Session, January 13, 2014
20
20
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
SNP Educational Session, January 13, 2014
21
21
SNP Versus MA Performance
SNP Higher than MA
No Statistically Significant
Difference
SNPs Lower than MA
PCE-Dispensed Bronchodilator within
30 Days of Event
GSO
COL
MPM-ACE/ARB Monitoring
PBH
SPR
MPM-Digoxin Monitoring
OMW
PCE-Dispensed Systemic
Corticosteroid Within 14 Days of
Event
MPM-Diuretic Monitoring
FUH-Within 30 Days of Discharge
CBP
MPM-Anticonvulsant Monitoring
FUH-Within 7 Days of Discharge
AMM-Acute Phase
MPM-Total Rate
BCR-Internal Medicine
AMM-Continuation Phase
BCR-Geriatrics
BCR-Family Medicine
BCR-Other Physician Specialists
DDE-History of Falls
DDE-Dementia
DDE-Chronic Renal Failure
DDE-Total Rate
DAE-At Least One High-Risk
Medication
DAE-At Least Two High-Risk
Medications
SNP Educational Session, January 13, 2014
22
22
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
SNP Educational Session, January 13, 2014
23
23
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
SNP Educational Session, January 13, 2014
24
24
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 PostDischarge
SNP Educational Session, January 13, 2014
25
25
DISCUSSION
SNP Educational Session, January 13, 2014
26
26