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 2018 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, Nebraska Relay Service 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 | HEDIS® 2018 CY2017 | HEDIS® 2019 CY2018 | HEDIS® 2020 CY2019 | 2019 National Average | Goal Quality Compass 66.66th Percentile |
|---|---|---|---|---|---|
| AAB - Avoidance of Antibiotic Treatment for Acute Bronchitis | 38.33% | 25.24% | 50.91% | 36.39% | 37.67% |
| ABA - Adult BMI Assessment | -- | 90.51% | 92.45% | 86.61% | 92.93% |
| ADD - Follow-Up Care for Children Prescribed ADHD Medication- Initiation Phase | 58.19% | 42.81% | 42.02% | 44.17% | 48.0% |
| ADD - Follow-Up Care for Children Prescribed ADHD Medication- Continuation and Maintenance (C&M) Phase | -- | 54.02% | 53.73% | 54.63% | 59.7% |
| AMM - Antidepressant Medication Management - Acute Phase Treatment | 58.19% | 48.74% | 48.63% | 53.42% | 54.87% |
| AMM - Antidepressant Medication Management- Continuation Phase Treatment | 47.04% | 36.09% | 34.37% | 37.89% | 39.14% |
| APP - Use of First Line Psychosocial Care For Children and Adolescents on Anti-Psychotics | 56.51% | 64.12% | 65.19% | 57.59% | 64.66% |
| AMR - Asthma Medication Ratio | -- | 68.67% | 72.17% | 62.97% | 66.57% |
| AWC - Adolescent Well Care Visit | 47.90% | 48.89% | 50.36% | 53.2 | 60.34% |
| BCS - Breast Cancer Screening | -- | -- | 54.04% | 58.41% | 62.48% |
| CBP - Controlling High Blood Pressure | 44.28% | 57.42% | 63.28% | 58.87% | 64.96% |
| CCS - Cervical Cancer Screening | 39.17% | 57.66% | 64.23% | 59.34% | 63.99% |
| CDC - Comprehensive Diabetic Care- HbA1c Testing | 88.32% | 87.10% | -- | -- | -- |
| CDC - Comprehensive Diabetic Care- HbA1c Poor Control (>9%) | 45.74% | 42.58% | -- | -- | -- |
| CDC - Comprehensive Diabetic Care- HbA1c Control (<8%) | 45.26% | 46.47% | 46.47% | 48.68% | 54.2% |
| CDC - Comprehensive Diabetic Care- Eye Exam | 53.77% | 64.96% | 64.96% | 57.34% | 62.29% |
| CDC - Comprehensive Diabetic Care- Nephropathy | 87.59% | 88.32% | -- | -- | -- |
| CDC - Comprehensive Diabetic Care- Blood Pressure Control (<140/90 mm Hg) | 56.93% | 65.21% | 65.21% | 62.12% | 64.69% |
| CIS - Childhood Immunization Status: Combo 2 | 37.97% | 65.69% | 70.80% | 70.91% | 75.67% |
| CIS - Childhood Immunization Status: Combo 10 | 20.00% | 37.71% | 45.01% | 35.22% | 39.17% |
| CWP - Appropriate Testing for Children with Pharyngitis | 66.7% | 66.49% | 69.36% | 79.56% | 84.74% |
| FUA - Follow-Up After ED Visit for Substance Abuse Issue (within 7 days) | 5.77% | 7.92% | 9.02% | 12.95% | 14.91% |
| FUA - Follow-Up After ED Visit for Substance Abuse Issue (within 30 days) | 7.97% | 11.67% | 14.66% | 19.12% | 22.84% |
| FUH - Follow-Up After Hospitalization for Mental Illness (within 7 days) | 44.24% | 42.28% | 40.86% | 35.74% | 39.43% |
| FUH - Follow-Up After Hospitalization for Mental Illness (within 30 days) | 67.05% | 62.51% | 60.87% | 56.77% | 62.51% |
| FUM - Follow-Up After ED Visit for Mental Illness (within 7 days) | 46.27% | 48.15% | 47.79% | 40.28% | 45.77% |
| FUM - Follow-Up After ED Visit for Mental Illness (within 30 days) | 68.44% | 66.62% | 65.34% | 54.76% | 61.68% |
| IMA - Adolescent Immunization: Combo 1 | 72.37% | 81.02% | 81.02% | 79.19% | 85.16% |
| IMA - Adolescent Immunization: Combo 2 | 10.09% | 23.11% | -- | -- | -- |
| LBP - Use of Imaging for Low Back Pain (avoid) | 75.44% | 76.67% | 76.52% | 71.72% | 74.32% |
| LSC - Lead Screening in Children | 68.50% | 66.21% | 72.02% | 69.61% | 78.83% |
| MMA - Medication Management Asthma | -- | 32.46% | 34.92% | 37.64% | 40.93% |
| MPM - Annual Monitoring for Patients on Persistent Medications: ACE or ARB/Diuretics Total | 90.52% | 90.21% | -- | -- | -- |
| NCS - Non-Recommended Cervical Cancer Screening in Adolescent Females | 1.27% | 1.14% | -- | -- | -- |
| PCE -Pharmacotherapy Management of COPD Exacerbation - Bronchodilators | 47.40% | 88.2% | 83.67% | 81.33% | 86.71% |
| PCE - Pharmacotherapy Management of COPD Exacerbation - Systemic Corticosteroids | 39.79% | 79.7% | 70.61% | 68.32% | 74.31% |
| PPC - Prenatal Care Timeliness | 76.89% | 73.45% | 82.73% | 81.54% | 86.37% |
| PPC - Postpartum Care | 57.66% | 62.03% | 74.21% | 63.59% | 68.36% |
| SAA - Adherence to Antipsychotic Medications for Individuals with Schizophrenia | 56.36% | 71.33% | 71.04% | 59.68% | 64.84% |
| SMC -Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia | -- | 35.71% | 71.43% | 77.13% | 82.22% |
| SMD – Diabetes Monitoring for People with Diabetes and Schizophrenia | 56.28% | 60.74% | 61.54% | 70.53% | 74.58% |
| SPC - Statin Therapy for Patients With Cardiovascular Disease- Received Statin Therapy: Total | -- | 79.40% | 76.62% | 76.22% | 80.0% |
| SPC - Statin Therapy for Patients With Cardiovascular Disease- Statin Adherence 80%: Total | -- | 64.56% | 72.08% | 64.53% | 67.86% |
| SPC - Statin Therapy for Patients With Cardiovascular Disease- Received Statin Therapy: 21-75 Years (Male) | -- | 80.91% | -- | -- | -- |
| SPC - Statin Therapy for Patients With Cardiovascular Disease- Statin Adherence 80%: 21-75 Years (Male) | -- | 64.04% | -- | -- | -- |
| SPC - Statin Therapy for Patients With Cardiovascular Disease- Received Statin Therapy: 40-75 Years (Female) | -- | 77.53% | -- | -- | -- |
| SPC - Statin Therapy for Patients With Cardiovascular Disease- Statin Adherence 80%: 40-75 Years (Female) | -- | 65.22% | -- | -- | -- |
| SPD - Statin Therapy for Patients With Diabetes- Received Statin Therapy | -- | 63.64% | 65.98% | 62.2% | 65.38% |
| SPD - Statin Therapy for Patients With Diabetes- Statin Adherence 80% | -- | 63.87% | 67.36% | 61.07% | 64.64% |
| SSD - Diabetes Screening for Schizophrenia or Bipolar Disorder Using Antipsychotic Medications | 75.72% | 78.42% | 82.81% | 80.64% | 83.06% |
| URI - Appropriate Treatment for Children with Upper Respiratory Infection | 83.09% | 86.18% | 83.76% | 90.45% | 93.78% |
| W15 - Well Child 15 Months 6+visits | -- | 60.37% | 72.26% | 62.84% | 68.37% |
| WCC - Weight Assessment for Children/Adolescents –BMI | 52.07% | 56.93% | 63.02% | 74.27% | 83.45% |
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 2018, Nebraska Total Care achieved the first survey accreditation status. We received 3.5 rating out of 5 in NCQA®’s Health Insurance Plan Ratings. We will be checked again for the Renewal Accreditation. We are living the rules each and every day to help protect members.
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:
- Customer Service: Members get the help they need. They are treated with courtesy and respect.
- Coordination of Care: How well the doctor is informed and up-to-date about the care received from other health providers and doctors.
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, Nebraska Relay Service 711. Ask to talk to the Quality Department.
| CAHPS® Measure - ADULT | 2017 | 2018 | 2019 | 2020 |
|---|---|---|---|---|
| Getting Needed Care Quickly | 88.56% | 89.19% | 88.35% | 88.40% |
| Shared Decision Making | 77.31% | 78.57% | 80.77% | -- |
| How Well Doctors Communicate | 91.70% | 94.03% | 95.18% | 93.50% |
| Getting Needed Care | 87.03% | 87.00% | 86.94% | 89.50% |
| Customer Service | 87.50% | 89.26% | 92.22% | 90.22% |
| Rating of Health Care | 78.20% | 75.42% | 77.00% | 80.60% |
| Rating of Personal Doctor | 85.94% | 86.05% | 84.33% | 87.90% |
| Rating of Specialist | 78.29% | 85.45% | 84.21% | 85.60% |
| Rating of Health Plan | 79.04% | 78.83% | 75.92% | 86.30% |
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:
- Tdap Immunization during Pregnancy
- Giving a vaccination during pregnancy to protect mom and baby.
- Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
- Ensuring members with Schizophrenia, Schizophrenia Disorder, or Bipolar Disorder who are using an antipsychotic medication, receive a diabetic screening (glucose test or HbA1c).
- Follow Up after Emergency Department (ED) Visitor for Mental Health or Substance Use Disorder
- Ensuring that members see a doctor within seven days after being in an ED. ED visit is due to mental or substance use reason.
- Ensuring that members see a doctor within thirty days after being in an ED. ED visit is due to mental or substance use reason.
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, Nebraska Relay Service 711. Ask to talk to the Quality Department.