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.

Heritage Health - Nebraska Total Care 

We want to make sure:

  • Services are good quality
  • Services are safe

Anyone who gets coverage from Nebraska Total Care is a “member”. In 2022 we had more than 122,000 Medicaid 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 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. We will use this information to set goals to improve healthcare for our members.

HEDIS® Measures

Measure

HEDIS® Measures

MY 2020 Final

MY 2021 Final

 

2022 QC National Average*

AAB

AAB - Avoidance of Antibiotic Treatment for Acute Bronchitis

58.66

53.06

55.67

AAP

Adults Access to Preventive / Ambulatory Health Services (Total)

88.1

85.75

75.81

ADD-m

ADD - Initiation phase_ follow up visits after initiation of ADHD medications

46.33

40.68

39.67

ADD-m

ADD - Continuation and Maintenance follow up visits after initiation of ADHD medications

61.05

48.39

50.00

AMM-c

Antidepressant Medication Management - Continuation phase

39.41

47.12

44.06

AMM-A

Antidepressant Medication Management - Acute Phase

52.05

64.57

60.8

AMR

AMR - Asthma Medication Ratio (total)

73.71

71.99

64.86

APM

APM - Metabolic Monitoring for Children and Adolescents on Antipsychotics (Glucose & Cholesterol)

26.46

25.92

36.57

APP

APP - First Line Psychosocial Care for Children and Adolescents on Antipsychotics

62.10

57.23

58.62

BCS

BCS - Breast Cancer Screening

47.94

54.48

51.00

CBP

CBP - Controlling High Blood Pressure

63.75

61.31

58.63

CCS

CCS - Cervical Cancer Screening

63.16

58.39

56.26

CDC eye

CDC - Comprehensive Diabetes Care- Eye Exam

57.18

57.66

50.81

CDC<8

CDC - Comprehensive Diabetes Care- HbA1c controlled (<8%)

47.20

51.82

48.33

CDC-BP

CDC - Comprehensive Diabetes Care- BP Control <140/90

63.02

66.91

60.29

CHL

Chlamydia Screening in Women (total)

32.17

34.22

55.25

CIS 10

CIS - Childhood Immunization Status: Combo 10

49.64

47.45

35.86

COU

COU - Continued Opioid Use -31 days rate

3.87

4.10

3.64

CWP

Appropriate Testing for Pharyngitis (Total)

69.77

68.15

67.61

FUA

FUA - follow up after ED visit for substance abuse issue – (7 day / 30 day)

8.21

13.37

16.20

22.12

13.35

19.79

FUH

FUH – follow up after acute inpatient psych inpatient stay – (7day / 30 day)

40.52

62.45

34.49

53.92

38.44

58.73

FUI

Follow-up After High-Intensity Care for Substance Use Disorder – (7 Day / 30 day)

28.31

45.18

25.08

45.52

30.36

49.12

FUM

FUM- follow up after ED visit for mental health issue – (7 day / 30 day)

48.36

65.37

43.33

61.39

40.08

53.43

HDO

HDO - Use of Opioids at High Dosage (smaller % is better)

5.59

2.39

6.64

IET-e

IET Engagement in treatment for alcohol/drugs

10.64

13.35

11.26

IET-i

IET Initiation in treatment for alcohol/drugs

37.64

43.62

44.16

IMA 2

IMA - Adolescent Immunization: Combo 2

25.79

33.33

36.11

KED

Kidney Health Evaluation for Patients with Diabetes

29.74

30.76

33.45

LBP

Use of Imaging studies for low Back pain

76.94

73.55

74.53

LSC

Lead Screening in Children

69.97

68.94

62.26

PBH

Persistence of Beta – Blocker

66.67

76.67

80.74

PCE

PCE - Pharmacotherapy Management of COPD Exacerbation – Bronchodilators / Systemic Corticosteroids

89.54

75.82

87.89

72.20

82.65

69.92

POD

Pharmacotherapy for Opioid Use Disorder

25.00

37.82

28.00

PPC-pp

PPC - Postpartum Care

73.24

76.16

76.18

PPC-t

PPC - Prenatal Care timeliness

76.89

77.86

83.53

SAA

SAA - Adherence to Antipsychotic Medications for Individuals with Schizophrenia

71.11

64.82

59.65

SMC

Cardiovascular Monitoring for People with Schizophrenia

77.78

75.00

74.92

SMD

Diabetes Monitoring for People with Schizophrenia

70.20

65.48

67.13

SPC-a

SPC - Statin Therapy for patients with cardiovascular disease – 80% adherence

75.00

74.30

70.21

SPC-t

SPC - Statin Therapy for patients with cardiovascular disease -initial

82.90

86.89

78.48

SPD-a

SPD - Statin Therapy 80% adherence for patients with diabetes

71.93

69.31

66.19

SPD-t

SPD - Statin Therapy for patients with diabetes - received

70.33

69.46

64.70

SSD

SSD - Diabetes Screening for Schizophrenia or Bipolar Disorder Using Antipsychotic Medications

80.29

80.94

79.20

SPR

Use of Spirometry Testing

16.67

22.41

24.80

UOP

UOP- Use of Opioids from Multiple Providers/Pharmacies (smaller % is better)

2.45

2.16

2.11

URI

Appropriate Tx for Upper Respiratory Infection

85.98

87.74

89.56

W30

Well-Child Visits in the First 30 Months of Life (age 15mo / age 15 to 30 months)

59.60

68.47

65.23

67.85

54.10

65.93

WCV

Child and Adolescent Well-Care Visits

43.37

47.73

49.49

WCC-BMI

WCC - Weight Assessment for Children/Adolescents –BMI Total

64.39

69.34

76.11

WCC-Counseling Nutrition

WCC - Weight Assessment for Children/Adolescents –Counseling Nutrition Total

56.34

55.96

69.18

WCC-Counseling Physical

WCC - Weight Assessment for Children/Adolescents –Counseling Physical Activity Total

60

57.18

65.72

*National Average based on NCQA Quality Compass 2022 National Benchmark

 

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.”

NCQA’s Medicaid Health Plan Ratings 2022

Nebraska Total Care received 3.5 out of 5 overall in NCQA’s Medicaid Health Plan Ratings 2022.

Nebraska Total Care received at 3.5 out of 5 in the area of patient experience.

Health Plan Report Card for Nebraska Total Care

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 do a CAHPS® survey every year. The areas we are trying to improve the most are:

  • Treat With Courtesy and Respect
  • Rating of Health Care: how members perceive their care received

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 711). Ask to talk to the Quality Department.

CAHPS® Measure – Adult

Survey Composite or Question

2020

2021

2022

Benchmark*

Getting Needed Care Composite

89.5%

91.4%

87.2%

86.5

Getting Care Quickly Composite

88.4%

92.4%

86.0%

84.7

How Well Doctors Communicate Composite

93.5%

94.6%

95.6%

93.9

Customer Service Composite

90.2%

92.3%

92.4%

91.1

Coordination of Care

89.9%

91.6%

87.7%

88.4

Rating of Health Care

80.6%

84.0%

73.2%

80.7

Rating of Personal Doctor

87.9%

89.3%

71.1%

85.6

Rating of Specialist

85.6%

85.9%

83.3%

86.0

Rating of Health Plan

86.3%

84.6%

76.8%

82.0

*Benchmark based on NCQA National Percentiles from 2021 Quality Compass 75th percentile

 

We know better healthcare is important to you. Nebraska Total Care works with Nebraska’s Heritage Health Program and partners on projects to make improvements. These projects target key issues in healthcare. The goal is to improve the health and wellness of the population. Below are the projects:

  • Plan All Cause Readmission
    • Assisting members after a hospitalization to follow the discharge and follow up plan of care to reduce an avoidable hospital readmission.
  • Notification of Pregnancy (NOP)
    • Increasing Notification of Pregnancy (NOP) for Nebraska Total Care pregnant Members.

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 711). Ask to talk to the Quality Department.