Provider News (Fall 2007)

HEDIS® highlights

HEDIS measures

HEDIS 2007 data has been submitted to Metastar, Security Health Plan's auditor, and the National Committee for Quality Assurance (NCQA®). Security Health Plan's quality improvement staff is in the process of evaluating the results and determining areas where improvement is needed. Barrier analysis is being done and interventions are being planned. Clinical quality of care interventions will be driven by HEDIS results. Security Health Plan will make you aware of these clinical interventions through Provider News.

A summary of several HEDIS® measures:

Diabetes comprehensive care

Thank you for your diligence regarding diabetes care for our members. Our Comprehensive Diabetes Care showed an improvement in LDL control <100 mg/dL for both commercial and Advocare.

The HEDIS diabetes care indicator and results are indicated in Table 1 for HEDIS 2006 and HEDIS 2007.

As noted in Table 1:

• Two of six diabetes care indicators in the commercial population showed an improvement.
• Four of six diabetes care indicators in the Advocare population also showed improvement.
• 17.52 percent of our commercial population and 8.52 percent of our Advocare population have a HbA1c >9.0 percent
• Despite an increase for both, only 47percent of our commercial members and 52 percent of our Advocare members have a LDL <100 mg/dL
• Nephropathy monitoring increased for both commercial and Advocare, likely due to measurement changes.

Security Health Plan encourages you to continue partnering with us to improve these measures. Initiatives over the next year will focus on improving HbA1c control and LDL testing. We will also encourage our members to have an eye exam and report results to providers.

Cholesterol management

This HEDIS measure has changed over the last two years. It now assesses LDL screening performed and LDL control (< 100mg/dL) for members age 18 to 75 who were discharged following an event (AMI, PTCA or CABG) or those who have a diagnosis of Ischemic Vascular Disease (IVD) during the measurement year and the year prior to the measurement year. The LDL value must be the most recent LDL-screening in the measurement year — which is the year following the event or diagnosis reported.

We are extremely pleased to see increases in both our commercial and Advocare populations as follows:

• Commercial population
• LDL screening scored @ 93 percent, a significant increase of 6.81 percent from HEDIS 2006
• LDL control (<100 mg/dl) scored @ 67 percent, an increase of 4.38 percent from prior year
• Advocare population
• LDL screening scored @ 92 percent, a significant increase of 9.39 percent from HEDIS 2006
• LDL control (<100 mg/dl) scored @ 64 percent, an increase of 4.16 percent from prior year

Thank you for your continued support in making sure these members, who are your patients, are having an annual LDL and are being controlled. Security Health Plan is currently developing a mail and telephonic disease management program for members with these conditions. We will be tracking members closely to make sure most, if not all, members for this HEDIS measure have an LDL checked at least annually and are controlled at < 100mg/dL.

Behavioral health measures

There are two behavioral health (BH) HEDIS measures. The following is a brief description of each measure and the 2007 results for our commercial population.

The Antidepressant Medication Management measure is comprised of three components. The target population is the percentage of members, ages 18 and older, who were diagnosed with a new episode of depression and treated with an antidepressant medication (AD) and:

• Optimal contacts: Had at least three follow-up contacts with a primary care provider or mental health provider during the 84 day (12-week) Acute Treatment Phase. One contact can be a telephone consultation which is also reimbursed for qualifying members.
• 2007 result — 20.88 percent
• 2006 result — 17.24 percent
• Acute Treatment Phase: Remained on an AD medication during the entire 84 days (12 weeks)
• 2007 result — 78.24 percent
• 2006 result — 78.68 percent
• Continuation Phase: Remained on an AD medication for at least 180 days (6 months)
• 2007 result — 65.29 percent
• 2006 result — 61.44 percent

The Follow-up after Hospitalization for Mental Illness measure is comprised of two components. The target population is the percentage of members age 6 and older and:

• Had an ambulatory follow-up encounter with a mental health provider within seven days of hospital discharge.
• 2007 results — 58.43 percent
• 2006 results — 49.70 percent
• Had an ambulatory follow-up encounter with a mental health provider within 30 days of hospital discharge.
• 2007 results — 80.90 percent
• 2006 results — 78.79 percent

Our admitting facilities and providers had an enormous impact on the improvement that we experienced for 2007 in that 85 percent of our members were discharged from the facility with a scheduled appointment.

According to a report from the National Institute of Mental Health, nearly 19 million Americans over the age of 18 suffer from major depression. Depression remains the top BH diagnosis for both inpatient and outpatient services.

We continue to encourage our members to keep their scheduled follow-up appointments. Our goal is to see 100 percent of our members receive follow-up care within seven days of hospital discharge and have three provider contacts following diagnosis of depression and initiation of AD medication.

Patient compliance is often related to the number of educational messages delivered by a health care provider. Your partnership is paramount in assuring our members receive timely follow-up care and adhere to their medication treatment plan.

Colorectal cancer screening

This measure assesses the percentage of adults ages 50 to 80 who have had screening for colorectal cancer. The screening tests that meet this measure include:

• FOBT during the measurement year
• Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year
• DCBE during the measurement year or the four years prior to the measurement year
• Colonoscopy during the measurement year or the nine years prior to the measurement year

This year our commercial population scored 62.29 percent, which was a slight increase from 61.07 percent last year. The Advocare population scored 72.51 percent, which was a slight decrease from 73.24.

It was evident during chart audits that providers are doing a great job at encouraging patients to have a colonoscopy. Please continue to be vigilant in your message to patients about the importance of colorectal cancer screening and that a colonoscopy is the gold standard. We encourage you to offer the other optional screening tests to your patients that decline colonoscopy.

Use of appropriate medications for people with asthma

HEDIS describes this measure as the percentage of enrolled members ages 5 to 56 who were identified as having persistent asthma during the measurement year and the year prior and who were appropriately prescribed medication during the measurement year. Persistent asthma is based on services received and medication dispensing events rather than a clinical measure of severity. Members are identified as having persistent asthma who meet one or more of the following criteria during both the measurement year and the year prior:

• Emergency room visit with a principal diagnosis of asthma
• Inpatient discharge with a principal diagnosis of asthma
• Four or more outpatient visits with asthma as one of the listed diagnoses
• Four or more medication dispensing events for long-term controller medications:
• Inhaled corticosteroids
• Leukotriene modifiers
• Cromolyn sodium
• Nedocromil
• Methylxanthines

The percentage of members identified with persistent asthma based on the above criteria who also filled at least one prescription for a long-term controller medication listed above during the measurement year was:

• 94 percent for ages 5 to 9
• 95.18 percent for ages 10 to 17
• 91.30 percent for ages 18 to 56
• 92.22 percent combined overall rate

The combined overall rate increased from 92.18 and ages 18 to 56 had a slight increase from 90.91. The rate for ages 5 to 9 decreased 4.08 percent and the rate for ages 10 to 17 decreased 0.66 percent.

Security Health Plan encourages providers to schedule patients who have asthma-related urgent care visits, emergency room visits or hospitalization for follow-up with a primary care provider. These patients may benefit from long-term controller medication therapy.

Controlling high blood pressure

The Controlling High Blood Pressure measure changed slightly this year. This measure assesses blood pressure control for members ages 18 to 85 (change from prior years where age range was 46 to 85 years) identified as having hypertension (HTN) and whose blood pressure (BP) was adequately controlled. For the purpose of HEDIS, adequate control is both a representative systolic BP <140 mm Hg and a representative diastolic BP < 90 mm Hg (change from prior years where BP < 140/90 was considered controlled).

Our HEDIS 2007 scores for controlling high blood pressure are as follows:

• Commercial population declined by 3 percent from 74.78 percent (HEDIS 2006), to our current total score of 71.78 percent (HEDIS 2007). Age breakdown:
• 18 to 45 year olds — 73.68 percent (new component in 2007)
• 46 to 85 year olds — 71.47 percent
• Advocare population, there was a very slight increase of 0.97 percent, to our current score of 67.64 percent (HEDIS 2007).

Due to the changes in this measure, there is room for member and provider education and improvement.

With our HEDIS scores around 70 percent for all age groups, it is evident that many of our members do not have their blood pressure under adequate control. We are enlisting your help and clinical expertise in helping us increase the number of members who have adequately controlled hypertension. Consider the following suggestions:

• Consistently schedule follow-up appointments and adjust antihypertensive medication until the member's blood pressure is controlled.
• If the initial blood pressure reading is high, repeat the blood pressure reading before the patient leaves the office. Record the lowest reading in the medical record. If the member's blood pressure remains high, adjust therapy and schedule a follow-up appointment to recheck blood pressure.
• Encourage members to follow-up with a primary provider if blood pressure readings are high at unscheduled office visits.
• Consider home blood pressure monitoring or routine monitoring of blood pressure in a clinic setting, if clinically indicated.

Hypertension is the silent killer. Educate your patients on the importance of managing and treating hypertension before it leads to more serious health problems.