Quality Improvement Program Evaluation
Nebraska Total Care works to make health care better for you. Our Quality Improvement (QI) Program is a valuable part of your plan. We want to help you get healthy.
We want to make sure:
- Services are good quality
- Services are safe
Anyone who gets coverage from Nebraska Total Care is a “member”. As of August 2024, we had more than 92,847 Medicaid members. Our job is to help you get the services you needed to be healthy.
Our Quality Department is in charge of the QI Program. Our Medical Director supervises the QI activities. Nebraska Total Care staff helps to make services better.
QI activities look at your health in different ways. Some of our activities focus on:
- Care to keep you from getting sick.
- Care in serious situations.
- Long-term care.
- Behavioral health.
- Making sure that you get the right kind of services.
- Make sure your services work together.
- Safety.
You can have more information about the QI Program. Call Member Services at 1-844-385-2192 TTY: 711. Talk to the Quality Department
We can:
- Answer questions about the QI Program
- Tell you about our goals
- Tell you how we are meeting our goals
- Give you a copy of our QI Program description.
The 2024, Medicaid Quality Improvement (QI) Annual Program Evaluation by Nebraska Total Care provides a comprehensive review of initiatives, outcomes, and strategic efforts undertaken. The timeline is from January 1 to December 31, 2024. The report evaluates the effectiveness of Nebraska Total Care’s QI Program in enhancing healthcare delivery, improving member outcomes, and ensuring regulatory compliance across its Medicaid population.
Nebraska Total Care’s Quality Improvement Program applies a Continuous Quality Improvement methodology to advance preventive care, chronic disease management, behavioral health integration, and member satisfaction. The program is guided by strong governance through the Board of Directors and the Quality Assessment and Performance Improvement Committee (QAPIC), ensuring accountability and alignment with organizational and regulatory priorities.
Key Organizational Achievements
- NCQA Health Plan Rating at 4 out of 5 stars
- Maintained NCQA Health Plan HMO and Health Equity Accreditations
- Further expanded to a sustainable continuous improvement culture through targeted quality strategy reviews and workstreams
- Continued education and outreach with staff, providers, and members
- Expanded partnerships with community groups, providers, and members to improve health outcomes.
Population Health:
Nebraska Total Care strengthened its population health approach in 2024 by expanding in-person case management across additional hospitals, with a focus on behavioral health support. Partnerships were enhanced through regular collaboration with social detox and residential facilities to improve care transitions and communication. Stronger relationships with hospital teams supported safe discharges and seamless transitions of care, complemented by the sharing of updated case management tools and resources with hospitals, shelters, and community partners.
Targeted outreach efforts contributed to improved follow-up after hospitalization and emergency department visits for mental health (FUA/FUM). The Start Smart for Your Baby® program was enhanced through predictive modeling to better identify and support high-risk members. Additional progress included strengthened collaboration with Child Protective Services to support foster care populations and expanded outreach to dually eligible members through coordinated services and Centene partnerships.
Performance Measures & Outcomes:
Nebraska Total Care demonstrated overall strong performance across HEDIS® and CAHPS® metrics, including notable improvement in 12 HEDIS measures. Opportunities remain to enhance Hybrid measure processes and improve outcomes in prenatal and postpartum care, Chlamydia screening, immunizations, and member experience. To support continued progress, the organization expanded the role of Quality Practice Advisors, strengthening provider engagement through targeted education, collaboration, and ongoing performance monitoring.
Behavioral Health Integration:
Nebraska Total Care strengthened behavioral health integration in 2024 by enhancing the use of Admission, Discharge, and Transfer (ADT) data to support timely outreach and follow-up care for members with mental health and substance use needs after hospitalizations and emergency visits. Access to care was expanded through the launch of Brightside telehealth services, providing convenient, timely mental health support. In addition, members received ongoing support through case management clinical programs, including access to mental health resources and suicide prevention initiatives.
Social Determinants of Health (SDoH):
Nebraska Total Care advanced its efforts to address social determinants of health by supporting members with housing, food access, and behavioral health needs. The organization strengthened partnerships with community-based organizations to enhance referral coordination, tracking, and follow-through. In addition, provider education was expanded to increase awareness and utilization of case management services, ensuring members receive comprehensive support for their social and health-related needs.
Dental and Preventive Care:
Nebraska Total Care expanded access to preventive services through the successful implementation of Medicaid dental benefits and targeted member outreach campaigns. Dental Quality Committees were established to guide ongoing improvement efforts. In addition, community-based engagement efforts helped connect members to needed dental and vision services, improving access to essential care.
Provider Engagement & Alternative Payment Models:
Nebraska Total Care continued to advance value-based care by strengthening collaboration with providers and promoting shared accountability for quality outcomes. Education efforts were enhanced to support provider understanding of Pay-for-Performance and Quality Bonus Programs. Ongoing improvements to supplemental data processes further supported the timely exchange of clinical information and informed care delivery.
Appeals, Grievances & Member Satisfaction:
Nebraska Total Care met established goals for member grievances, achieving a 35% reduction in complaints compared to the prior year. Appeals volume increased slightly (6%), highlighting opportunities to further support providers in authorization processes and documentation practices.
CAHPS® survey results identified opportunities to enhance customer service, overall healthcare ratings, and member-provider communication. In response, targeted provider education and collaborative review of survey insights were initiated to drive improvements in member experience.
Compliance & Delegation Oversight:
Nebraska Total Care strengthened oversight of delegated vendors, including dental, pharmacy, and transportation partners. Identified compliance gaps were addressed through timely implementation of Corrective Action Plans. Additionally, enhancements to credentialing and recredentialling.
Strategic Priorities for 2025
- Enhance data quality and reliability by advancing data validation processes and strengthening file submission practices to support accurate, timely decision-making.
- Sustain national quality recognition through renewal of NCQA Health Plan (HMO) and Health Equity accreditations, reinforcing our commitment to high standards of care.
- Invest in our workforce by optimizing roles and responsibilities, supporting staff development, and ensuring effective use of resources to meet member needs.
- Advance HEDIS® performance by leveraging data insights to improve Hybrid measures and expanding year-round medical record retrieval efforts.
- Strengthen provider partnerships through enhanced data-sharing and targeted strategies that support high-quality, coordinated care delivery.
- Continue to evolve the quality strategy with ongoing performance reviews and proactive, year-round engagement to drive measurable improvement.
- Promote health literacy by expanding community-based education and resources that empower members to better understand and manage their health.
- Expand access to preventive services, including dental and vision care, through continued outreach and member engagement.
- Deepen community partnerships to address key health and social needs, improving outcomes across diverse populations.
- Strengthen and grow the provider network to ensure members have access to high-quality, accessible care across Nebraska.
There is a tool that sets goals for health plans. The tool is called the Healthcare Effectiveness Data and Information Set, or HEDIS®. Each year, Nebraska Total Care will be graded on HEDIS goals. This will tell us where to do better.
Each year, Nebraska Total Care reviews the services members use. We will use gather this informationinfo to set goals to and improve your healthcare for our members.
Measure | HEDIS Measure Description | MY2023 | MY2022 | 2023 QC National Average |
|---|---|---|---|---|
AAB | AAB - Avoidance of Antibiotic Treatment for Acute Bronchitis | 63.49 | 63.17 | 62.23 |
AAP | AAP - Adults Access to Preventive / Ambulatory Health Services (Total) | 83.10 | 82.40 | 72.74 |
ADD-m | ADD-m - Initiation phase follow-up visits after initiation of ADHD medications | 47.19 | 43.99 | 43.62 |
ADD-m | ADD-m - Continuation and Maintenance follow-up visits after initiation of ADHD medications | 53.82 | 54.15 | 53.14 |
AMM-c | AMM-c - Antidepressant Medication Management - Continuation phase | 44.41 | 45.37 | 43.90 |
AMM-A | AMM-A - Antidepressant Medication Management - Acute Phase | 62.91 | 62.14 | 60.91 |
AMR | AMR - Asthma Medication Ratio (total) | 76.50 | 75.92 | 65.53 |
APM | APM - Metabolic Monitoring for Children and Adolescents on Antipsychotics (Glucose & Cholesterol) | 35.53 | 28.97 | 37.89 |
APP | APP - First Line Psychosocial Care for Children and Adolescents on Antipsychotics | 61.91 | 56.22 | 57.29 |
BCS | BCS - Breast Cancer Screening | 56.96 | 54.65 | 52.43 |
CBP | CBP - Controlling High Blood Pressure | 63.99 | 67.64 | 60.86 |
CCS | CCS - Cervical Cancer Screening | 63.02 | 61.80 | 55.92 |
EED | EED - Eye Exam for Patients with Diabetes | 56.20 | 58.39 | 51.47 |
HBD | HBD - HbA1c controlled (<8%) for Patients with Diabetes | 60.58 | 52.07 | 50.87 |
BPD | BPD - Blood Pressure Control for Patients with Diabetes <140/90 | 76.16. | 69.59 | 63.55 |
CHL | CHL - Chlamydia Screening in Women (total) | 36.24 | 36.07 | 55.80 |
CIS 10 | CIS 10 - Childhood Immunization Status: Combo 10 | 42.09 | 42.82 | 31.86 |
COU | COU - Continued Opioid Use -31 days rate | 3.82 | 4.02 | 3.61 |
CWP | CWP - Appropriate Testing for Pharyngitis (Total) | 78.78 | 67.15 | 70.99 |
FUA | FUA - Follow-up after ED visit for substance abuse issue – 7 day / 30 day | 26.23 | 29.34 | 25.00 |
FUH | FUH – Follow-up after acute inpatient psych inpatient stay - 7day / 30 day | 52.15 | 42.09 | 36.61 |
FUI | FUI – Follow-up After High-Intensity Care for Substance Use Disorder 7 Day / 30 day | 26.94 | 29.56 | 31.01 |
FUM | FUM - Follow-up after ED visit for mental health issue 7 day / 30 day | 40.22 | 39.42 | 41.53 |
HDO | HDO- Use of Opioids at High Dosage (smaller % is better) | 1.53 | 2.04 | 6.09 |
IET- e | IET-e - Engagement in treatment for alcohol/drugs | 10.80 | 12.57 | 14.91 |
IET -i | IET-i - Initiation in treatment for alcohol/drugs Total | 35.85 | 38.98 | 45.01 |
IMA 2 | IMA 2 - Adolescent Immunization: Combo 2 | 31.14 | 27.49 | 35.55 |
KED | KED - Kidney Health Evaluation for Patients with Diabetes | 33.62 | 31.69 | 34.54 |
LBP | LBP - Use of Imaging studies for low Back pain | 71.89 | 74.09 | 73.35 |
LSC | LSC - Lead Screening in Children | 69.88 | 68.15 | 59.36 |
PBH | PBH - Persistence of Beta – Blocker | 65.38 | 87.23 | 79.9 |
PCE | PCE - Pharmacotherapy Management of COPD Exacerbation Bronchodilators Systemic Corticosteroids |
84.53 71.82 |
82.50 72.50 |
82.96 70.81 |
POD | POD - Pharmacotherapy for Opioid Use Disorder | 36.64 | 40.18 | 27.48 |
PPC-pp | PPC-pp - Postpartum Care | 76.89 | 83.45 | 76.96 |
PPC-t | PPC-t - Prenatal Care timeliness | 81.32 | 79.08 | 82.95 |
SAA | SAA - Adherence to Antipsychotic Medications for Individuals with Schizophrenia | 62.79 | 61.39 | 59.83 |
SMC | SMC - Cardiovascular Monitoring for People with Schizophrenia | 66.67 | 77.78 | 75.95 |
SMD | SMD - Diabetes Monitoring for People with Schizophrenia | 73.74 | 61.82 | 67.94 |
SPC-a | SPC-a - Statin Therapy for patients with cardiovascular disease – 80% adherence | 68.18 | 74.93 | 69.94 |
SPC-t | SPC-t - Statin Therapy for patients with cardiovascular disease -received therapy | 85.38 | 82.06 | 78.48 |
SPD-a | SPD-a - Statin Therapy 80% adherence for patients with diabetes | 68.18 | 70.96 | 66.07 |
SPD-t | SPD-t - Statin Therapy for patients with diabetes - received | 67.18 | 69.13 | 63.77 |
SSD | SSD - Diabetes Screening for Schizophrenia or Bipolar Disorder Using Antipsychotic Medications | 84.65 | 79.60 | 79.00 |
SPR | SPR - Use of Spirometry Testing | 23.42 | 28.03 | 22.93 |
UOP | UOP - Use of Opioids from Multiple Providers/Pharmacies (smaller % is better) | 2.44 | 2.14 | 1.85 |
URI | URI - Appropriate Tx for Upper Respiratory Infection | 87.01 | 88.04 | 89.85 |
W30 | W30 - Well-Child Visits in the First 30 Months of Life (age 15mo / age 15 to 30 months) | 71.10 | 67.06 | 56.76 |
WCV | WCV - Child and Adolescent Well-Care Visits | 50.54 | 46.14 | 48.61 |
WCC-BMI | WCC-BMI - Weight Assessment for Children/Adolescents –BMI Total | 71.53 | 70.80 | 76.75 |
WCC-Counseling Nutrition | WCC - Weight Assessment for Children/Adolescents –Counseling Nutrition Total | 64.96 | 65.59 | 68.12 |
WCC-Counseling Physical | WCC - Weight Assessment for Children/Adolescents –Counseling Physical Activity Total | 62.04 | 67.64 | 64.75 |
*National Average is based on NCQA Quality Compass 2023 National Benchmark.
There are groups that make rules for health plans. Those rules protect members. They help you get good care.
One group is called National Committee for Quality Assurance Accreditation (NCQA®). They check to see if we meet their rules.
Nebraska Total Care maintains the following Accreditations from NCQA®
- Health Plan Accreditation, Medicaid and Commercial HMO
- Health Equity Accreditation, Medicaid HMO
NCQA’s Medicaid Health Plan Ratings 2024
The National Committee for Quality Assurance (NCQA®) is a private, nonprofit organization. They help to improve health care quality. NCQA accredits and certifies a wide range of health care organizations. They also recognize providers in key clinical areas. NCQA HEDIS is the most widely used performance measurement tool in health care. Info to help consumers, employers and others make health care choices can be found at NCQA.org.
Nebraska Total Care scored of 3 out of 5 for Patient Experience. Nebraska Total Care was rated 3.5 out of 5 overall in NCQA Medicaid Health Plan Ratings 2024.
Nebraska Total Care needs to know what members think about our plan. This helps us meet your needs.
We do a member survey each year. It is the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).
The results show us how members feel about Nebraska Total Care. It shows us how they feel about providers. We use the results to help improve care.
The areas we are trying to improve the most are:
- Care coordination.
- Rating of personal doctor.
- Rating of health plan.
Results
These are results of the survey. If you need help understanding the results call Member Services. Call 1-844-385-2192 TTY: 711. Talk to the Quality Department.
Survey Composite or Question | 2022 | 2023 | 2024 | Benchmark* |
|---|---|---|---|---|
Getting Needed Care Composite | 87.2% | 87.7% | 85.7% | 84.5% |
Getting Care Quickly Composite | 86.0% | 87.1% | 84.9% | 84.9% |
How Well Doctors Communicate Composite | 95.6% | 96.0% | 93.1% | 94.0% |
Customer Service Composite | 92.4% | 91.1% | 89.6% | 91.1% |
Coordination of Care | 87.7% | 92.7% | 83.5% | 87.2% |
Rating of health care | 73.2% | 80.5% | 75.0% | 77.7% |
Rating of Personal Doctor | 84.6% | 87.5% | 84.8% | 84.9% |
Rating of Specialist | 83.3% | 85.7% | 84.8% | 84.4% |
Rating of health plan | 76.8 | 81.0% | 78.5% | 80.9% |
*Benchmark is based on NCQA National Percentiles from 2023 Quality Compass 75th percentile. Based on rating of questions (% 8, 9 or 10).
We know better healthcare is important to you. Nebraska Total Care works with the Heritage Health Program. We partner on projects to make services better. The goal is to improve the health and wellness of all members. Below are the PIP projects:
- Increasing Chlamydia Screening Rates in Sexually Active Women Ages 16-24 Years
- Implementing targeted interventions in sexually active women ages 16-24 years to increase chlamydia screening rates by 3% over the 2024 baseline measurement year by 12/31/2026.
- Health Risk Screen Completion in Pregnant Members
- Implementing targeted interventions for pregnant members to increase the completion rate of state required HRS forms within the first 21 calendar days of MCO assignment or confirmed pregnancy by 20% over the 2024 baseline measurement year by 12/31/2026.
*Baseline data is collected in 2024. Interventions will begin in 2025-2026.
Our goal
Our goal is to improve your health. We use many programs to improve services.
Please call Member Services if you:
- Have questions about this report
- Have questions about our programs
- Have ideas about how we can do better
Call 1-844-385-2192 TTY: 711. Talk to the Quality Department.