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Program Evaluation

Nebraska Total Care is always working to make health care better for you.  Our Quality Improvement (QI) Program is an important part of your plan.  We want to help you get healthy.  We want to help you stay healthy.  We want to make sure:

  • Services are good quality
  • Services are safe

Anyone who gets coverage from Nebraska Total Care is a “member”.  In 2017 we had more than 80,000 members.  Our job was to help them get the services they needed to be healthy.

Our Quality Department is in charge of the QI Program.  Our Medical Director supervises all of the QI activities.  All of the Nebraska Total Care staff help make services better.

Quality activities look at your health in different ways.  Some of our activities focus on:

  • Care to prevent illness
  • Care in serious situations
  • Long-term care
  • Behavioral health
  • Making sure that everyone gets the right amount of services
  • Make sure all of your services work together
  • Safety

All of these activities are to make sure that you get the highest quality of care.

You can have more information about the QI Program.  Call Member Services.  The phone number is 1-844-385-2192 (TTY: 1-844-307-0342, Relay 711).  Ask to talk to the Quality Department.

We can:

  • Answer questions about the QI Program
  • Tell you about our goals
  • Tell you how well we are meeting our goals
  • Give you a copy of Nebraska Total Care’s Quality Improvement Program Description   

There is a tool that sets goals for health plans.  The tool is called the Healthcare Effectiveness Data and Information Set, or HEDIS®.  Every year, Nebraska Total Care will be measured on HEDIS goals.  This will tell us where to do better.  

Nebraska Total Care reviews the services members got in 2017.  This is the first information we have to review on our members.  We will use this information to set goals to improve healthcare for our members. 

HEDIS Measures HEDIS CY2017 National Average Goal Quality Compass
75th  Percentile

Antidepressant Medication Management- Acute Treatment

58.19%

53.07%

56.94%

 

Antidepressant Medication Management- Continuation Treatment

47.04%

37.92%

41.12%

Annual Monitoring for Patients on Persistent Medications:  ACE or ARB/Diuretics

90.52%

87.51%

89.97%

Comprehensive Diabetes Care- HbA1c testing

88.32%

86.65%

90.06%

Comprehensive Diabetes Care- HbA1c controlled (<8%)

45.26%

47.09%

53.65

Comprehensive Diabetes Care- Eye Exam

53.77%

54.85%

63.33%

Comprehensive Diabetes Care- Nephropathy

87.59%

89.85%

91.67%

Comprehensive Diabetes Care- BP Control

56.93%

59.69%

68.57%

Lead Screening in Children

68.50%

67.62%

80.90%

Adolescent Immunization: Combo 1

72.37%

75.07%

83.89%

Adolescent Immunization: Combo 2

10.09%

20.78%

24.62%

Childhood Immunization Status: Combo 2

37.97%

73.04%

79.08%

Childhood Immunization Status: Combo 10

20.00%

33.29%

39.66%

Appropriate Treatment for Children with Upper Respiratory Infection

83.09%

88.59%

93.54%

Prenatal Care timeliness

76.89%

81.67

88.59%

Postpartum Care

57.66%

63.75

69.44%

Chlamydia Screening in Women

35.00%

57.36%

63.73%

Cervical Cancer Screening

39.17%

58.00%

65.90%

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents

44.16%

57.61%

67.64%

  Controlling High Blood Pressure

44.28%

56.45%

64.79%

There are groups that make rules for health plans.  Those rules are to protect members. They help you get good care.

One group that looks at our plan is called National Committee for Quality Assurance Accreditation (NCQA®). They check to see if we meet their rules. If we do, they say we have “accreditation.”

In 2017 NCQA did their first check of Nebraska Total Care. We earned Interim Accreditation.  This is the first step for a new plan.  We will be checked again for Initial Accreditation.  We have not been giving services long enough for this check yet.

Nebraska Total Care needs to know what members think about our plan.  This helps us meet your needs.

We do a member survey every year.  The survey is called 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.

We did a CAHPS survey in 2017. The areas we are trying to improve the most are:

  • Shared Decision Making This means members help make decisions about their care.
  • Customer Service This means members get the help they need in a way that feels good to them.

Results

These are some of the results of the survey. If you need help understanding the results call Member Services. The phone number is 1-844-385-2192 (TTY: 1-844-307-0342, Relay 711). Ask to talk to the Quality Department.

CAHPS Measure - CHILD

2017: percent of people who said “always”, “usually”, or “yes” 2018: percent of people who said “always”, “usually”, or “yes”

Getting Needed Care Quickly

92.92%

93.02%

Shared Decision Making

84.33%

81.26%

How Well Doctors Communicate

96.24%

96.40%

Getting Needed Care

89.98%

88.40%

Customer Service

88.13%

90.91%

Rating of Health Care

86.19%

88.59%

Rating of Personal Doctor

91.94%

91.17%

Rating of Specialist

95.12%

89.47%

Rating of Health Plan

86.38%

89.04%

 

CAHPS Measure - ADULT

2017: percent of people who said “always”, “usually”, or “yes”

2018: percent of people who said “always”, “usually”, or “yes”

Getting Needed Care Quickly

88.56%

89.19%

Shared Decision Making

77.31%

78.57%

How Well Doctors Communicate

91.70%

94.03%

Getting Needed Care

87.03%

87.0%

Customer Service

87.50%

89.26%

Rating of Health Care

78.20%

75.42%

Rating of Personal Doctor

85.94%

86.05%

Rating of Specialist

78.29%

85.45%

Rating of Health Plan

79.04%

78.83%

Our goal

Our goal is to improve our members’ health. We do this by improving services. We will use many different 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

The phone number is 1-844-385-2192 (TTY: 1-844-307-0342, Relay 711). Ask to talk to the Quality Department.