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Key Findings from the 2012-2013 SNP Assessment Program: Insights and Improvements

This report highlights crucial findings from the 2012-2013 SNP assessment program led by Brett Kay, AVP of SNP Assessment. It covers major contract tasks, key performance indicators, and reviews from the SNPs, including dual-eligible (D-SNPs), institution-specific (I-SNPs), and chronic-condition (C-SNPs) types. The assessment revealed trends in performance, improvement areas like complex case management, member satisfaction, and clinical quality, as well as challenges faced during care transitions and coordination of Medicare and Medicaid services.

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Key Findings from the 2012-2013 SNP Assessment Program: Insights and Improvements

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  1. SNP Results2013 SNP Educational Session - January 13, 2014 Brett Kay, AVP, SNP Assessment, NCQA

  2. 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

  3. 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

  4. 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%)

  5. 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

  6. 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)

  7. 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%

  8. 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

  9. 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

  10. 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.

  11. SNP 6 Results Element E: Network Adequacy, by Type (2011 vs. 2012) Element E: Network Adequacy, by enrollment size, 2012

  12. Model of Care ResultsCY 2014 Submissions

  13. 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

  14. Results for SNPs

  15. 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

  16. MMP Results by State

  17. Overall MMP Results

  18. SNP HEDIS Results2013

  19. 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

  20. 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

  21. 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

  22. SNP Versus MA Performance

  23. 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

  24. 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

  25. 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

  26. DISCUSSION

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