Quality improvement strategies - Anthem Inc. · Quality improvement strategies . 22 ... Members are given a variety of options to complete the HNS : ... Healthy Indiana Plan

Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect

Quality improvement strategies

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Learning objectives

Managed care products and eligible populations

Member incentives to improve outcomes

Provider bonus programs

At the conclusion of this session, participants will be able to describe:

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Risk-based managed care delivery system

• Office of Medicaid Policy and Planning (OMPP) contracts with managed care entities (MCEs) to arrange, administer and pay for the deliveries of health care services to their members.

• The MCE is paid a capitated monthly premium for each Indiana

Health Coverage Programs (IHCP) member enrolled with the plan.

• The MCE assumes financial risk for services rendered to its members.

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Risk-based managed care delivery system (cont.)

Hoosier Healthwise

Healthy Indiana Plan (HIP)

Hoosier Care Connect

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HIP Plus offers an enriched benefit package

HIP Plus gives members additional health care benefits:

• Dental care

• Vision services

• Adding chiropractic services beginning January 1, 2018

• No copays for Plus members (unless they seek nonemergency care in the emergency department [ED])

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HIP Basic offers fewer benefits

HIP Basic members get fewer health care benefits:

• No dental care

• No vision services

• Copays for services

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Who runs the Medicaid program in Indiana?

• Provides regulatory framework and oversight for all state Medicaid programs

Centers for Medicare & Medicaid Services (CMS)

• Office of Medicaid Policy and Planning (OMPP) — policy and oversight of vendors

Indiana Family and Social Services Administration (FSSA)

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• Umbrella for state health care programs administered by OMPP

Indiana Health Coverage Programs (IHCP)

• Fiscal agent — fee-for-service: DXC • Four managed care entities (MCEs): Anthem Blue Cross

and Blue Shield (Anthem)

Delegated entities

Who runs the Medicaid program in Indiana? (cont.)

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State incentives for quality improvement HHW

Adolescent Well-Care Visits

Ambulatory Care — outpatient visit/1000

Follow-Up After Hospitalization (FUH) — within 7 days of behavioral health discharge

Frequency of Prenatal Care (FPC) — 81+ percent

Postpartum Care (PPC)

Well Child 0-15 months (W15)

Well-Child Visit in the Third, Fourth, Fifth and Sixth Years of Life (W34)

HIP

Follow-Up After Hospitalization (FUH) — within 7 days of behavioral health discharge

Adult Access to Preventive Care (AAP)

Ambulatory Care — ER visit/1000 (inverted rate)

HCC

FUH — within 30 days of discharge

FUH — within 7 days of discharge

Adult Preventive Care (AAP)

Ambulatory Care — ER visit/1000 (inverted rate)

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Provider incentive programs

2017 Negotiated Shared Savings

PQIP

BHQIP

Provider Bonus Program

2018 Negotiated Shared Savings

PQIP BHQIP BHFIP PAQCP OBQIP

New for

2018

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Provider collaboration continuum

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Mutual goals of a shared savings program

Improve clinical quality results

Empowering providers to

reach members for preventive services and

chronic condition

management

Improve medical cost management

Providing incentives and

tools so providers reduce

unnecessary utilization and

costs

Improve provider operational efficiency

Developing sustainable

workflows and processes

Promote quality, safe and effective

patient care

Improving the overall health care delivery

system


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2017 Provider Bonus Program

Incentive attributed to performance of specific HEDIS measures and scaled to membership — continues through Measurement Year 2017 (three installments)

Hoosier Healthwise/ Hoosier Care Connect/

HIP Emergency Room Visits (AMB-ER)

Preventive Care/ Well-Care Visits (W15, W34, AWC & AMB-OP)

Pregnancy measures for OB (FPC & PPC)

HHW/ HCC Emergency

Room Visits (AMB-ER)

Preventive Care/ Well-Care Visits (AAP)

Percentages of members seen within 90 days of enrollment

HIP

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Provider Quality Incentive Program (PQIP)

Eligibility

• 1,000 members assigned to group • Begin in January of each year

Quality measures

• Preventive care • Chronic disease management — diabetes, asthma

Access • Panel size contributes to scores


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Behavioral Health Quality Incentive Program (BHQIP)

Behavioral health providers and community mental health centers (CMHCs)

Preventive care

• Preventive visits • Unnecessary ER use

Medication adherence

• Depression • ADHD

BH care

• Readmission prevention • Outpatient follow-up


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Provider Access and Quality Care Program (PAQCP) New for 2018

Eligibility

• Membership level > 250 members • Availity adoption • Open-panel status • Appointment availability

Quality measures

• Preventive visits • Nonemergent ED use • Follow-up after inpatient stay

Access to care

• Nonemergent ER visits • Inpatient utilization

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Obstetric Quality Incentive Program (OBQIP) New for 2018

Overview • Incentives to participating OB providers for improved quality of care • Health plan chooses percentage of incentive to be offered

Participation criteria • Contracted and in good standing • OBQIP Letter of Agreement • Minimum of 10 attributed members

Objectives • Improved clinical quality indicators • Improved member maternity outcomes • Improved access to prenatal and postpartum care and education • Improved efficient and appropriate utilization of benefits

2018 performance indicators • Timeliness of first prenatal care visit • Overall c-section rate • Preterm birth rate • Low birth weight rate • Postpartum visit rate • Other health plan-variable indicators


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Obstetric Quality Incentive Program (OBQIP) (cont.)

• OBQIP Incentive Payments earned by OB providers will be made within six months after the end of the Performance Measurement Period.

• A Year-End OBQIP Performance Scorecard showing the OB provider’s performance versus targets, incentive points earned and incentive payment percentage calculations will be generated five months after the end of the Performance Measurement Period to allow for claims runout and report production.

• Interim OBQIP reports will be generated periodically (no less than quarterly) and sent to the OB provider.

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PAQCP and OBQIP next steps

• Discuss program details with your quality staff.

• Sign and return Letter of Agreement to Anthem by December 31.

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Behavioral Health Facility Quality Incentive Program (BHFIP) New for 2018

Overview

• Designed for behavioral health inpatient facilities that serve our Medicaid members with behavioral health care needs: psychiatric hospitals, freestanding mental health facilities and acute care hospitals with psychiatric units

• Rewards both absolute performance and year-over-year improvement • Year-end bonus driven by Performance Indicators

Participation criteria

• Contracted and in good standing • BHFIP Letter of Agreement • The facility must have a total of at least 100 discharged members during the Performance Measurement Period

Objectives

• Improved member outcomes • Improved member continuum of care • Improved clinical quality indicators • Improved efficient and appropriate utilization of benefits

2016 performance indicators

• 30-day readmission • Behavioral health spend per inpatient episode • Seven day follow-up visit after mental health Inpatient discharge (FUH7) • Thirty day follow-up visit after mental health inpatient discharge (FUH30) — optional • Multiple antipsychotic medications at discharge with appropriate justification overall rate (Joint Commission HBIPS-5) • Assessment of violence risk, substance use disorder, trauma and patient strengths completed overall rate (Joint Commission HBIPS-1)

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Member incentives

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Member incentive program

Engages members in their own self-care

• Receiving preventive care • Following up with care appropriately • Adhering to chronic disease care • Developing healthy habits (like smoking

cessation and exercise)

Rewards members for:

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Anthem Rewards New in 2017

Anthem will manage rewards through our claims systems. As members complete services, they are automatically entered for the reward.

Members will earn rewards for completing preventive care.

Members will receive reminders to complete preventive and follow-up care.

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Incentives for new members

Members receive $10 to complete a Health Needs Screening (HNS) within 90 days of enrollment

Members are given a variety of options to complete the HNS: • Phone • Online • Walmart Pharmacy kiosk

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Preventive visits

Members from 3 to 85 years old can receive $20 for completing their annual wellness visit.

Infants can receive an additional $50 for completing six visits by 15 months.

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Expectant mothers

• Prenatal care — Pregnant women who complete a prenatal visit in the first trimester receive $25.

• Postpartum care — Mothers who complete a postpartum visit between 21 and 56 days after birth receive the equivalent of $50.

• Smoking cessation — Pregnant women who engage and complete Indiana QuitLine sessions can earn the equivalent of up to $40.

To encourage prenatal care and promote a healthy start for a new baby, we offer multiple incentives.

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Chronic diseases

Diabetes vision screenings

$20 will be awarded annually for the completion of eye exams for members with diabetes.

HIV care Members engaged with Anthem Care Management who adhere to their medication regimen and reduce their viral load can receive up to $20 annually.

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Healthy habits

Smoking cessation — engagement • Members who engage can earn up to $20

annually.

Smoking cessation — completion • All members who smoke who engage and

complete the Indiana QuitLine sessions can earn up $20 (one time).

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Blue Ticket to Health

• Blue Ticket to Health educates families on the importance of seeing their primary medical provider (PMP) once a year, even when they are not feeling sick.

• This program is for Anthem members ages three years and older.

• Upon completion of an annual preventive visit and Anthem’s receipt of the claim from the provider, the member is automatically entered into the Blue Ticket to Health incentive program.

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Blue Ticket to Health (cont.)

Prizes

Members are eligible for over 500 prizes including:

• Visits to Lucas Oil Stadium.

• Invitations to training camps.

• Tickets to the game.

• Signed jerseys.

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Value-added benefits

Enhanced member benefits Hoosier Healthwise

HIP Plus

HIP Basic

Hoosier Care Connect

Home-delivered meals X X X

Weight Watchers® X X

No-cost pregnancy tests X X X X

High School Equivalency (HSE) test assistance

X

Boys and Girls Club membership X X

Healthy Families Program X

YMCA membership X

Personal exercise kit X

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Value-added benefits (cont.)

Enhanced member benefits Hoosier Healthwise

HIP Plus

HIP Basic Hoosier Care Connect

Retrofit X

Cellphone with 350 minutes X X X X

Community Resource Link X X X X

Youth and adult dental hygiene kits X X X

Hypoallergenic bedding X X X

Magazine subscriptions X X X X

Rides X X X X

Assistive devices X

Anthem ombudsman program X X X X

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New team to assist members • Locate and Engage: community-

based support for members with serious behavioral needs who are most at risk for disengagement from the health care system; engages members using a person-centered approach to address key social determinants and health risk factors

• Member Liaison: helps find answers to questions members may have; serves as a mediator between members, their doctors and Anthem

• Community Health Workers: community-based support for members with chronic diseases who have unmet needs; offers education about benefits, community resources; helps members better manage their health

• Concierge Unit: call center connects members to services

• Health Educators: provide education to individuals and groups; topics range from healthy habits to chronic disease management

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Enhanced member outreach in 2017

Health education, tips and reminders and text messages —improved and new in 2017

• New technology of text campaigns added to promote preventive visits for various chronic diseases and annual preventive care such as diabetes screenings and adult preventive care

• Additional campaigns presented throughout the year with goals of enhancing member engagement

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Pregnancy care

New Baby, New Life™

Healthy pregnancy educational materials My Advocate https://www.MyAdvocateHelps.com Text for Baby Free health text messaging service Baby and Me Tobacco Free Smoking-cessation program Baby showers Events to educate pregnant women

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Member support Community Resource Link: an innovative community resource tool on the web that helps members find and apply for community and social services throughout Indiana

Transportation Services: transportation for doctor appointments, health education, WIC appointments and redetermination appointments New transportation vendor December 1, 2017

Anthem Concierge Unit: a service that helps members complete HNS, schedule appointments with their PMP, connect with community services and more

Health education: free classes available at [email protected].

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Special help

Interpreter services

• Written materials: Available in 37 languages

• Telephonic help: Call Member Services

• Face-to-face/sign language: Call Member Services to request help

• Hearing or speech loss: Call 711

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24/7 NurseLine

The key is access: • Helps members understand their

medical condition and treatment • Helps members connect with their

doctor • NurseLine can help connect

members to an array of health care services

The goal is to promote: • Self care with information and

education • Support and care by PMP • Care coordination services • 24/7 NurseLine Hoosier Health Wise/Healthy

Indiana Plan: 1-866-408-6131 Hoosier Care Connect:

1-844-284-1797

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Member POWER Account payment assistance

• An employer or nonprofit group, like a church or foundation, can pay some or all of the member’s contribution.

• Payments can be made online at www.anthem.com/Pay4HIP.

• Just ask them to call Member Services at 1-866-408-6131 (TTY 711).

• For more information, members may visit our website at www.anthem.com/inmedicaid.

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Access and availability standards

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Questions/comments

www.anthem.com/inmedicaiddoc Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

AINPEC-1538-17 October 2017

Documents

Quality improvement strategies - Anthem Inc. · Quality improvement strategies . 22 ... Members are given a variety of options to complete the HNS : ... Healthy Indiana Plan