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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.

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 2023 we had more than 130,000 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

MY2022 FINAL

MY2021

FINAL

2022 QC National Average

AAB

AAB- Avoidance of Antibiotic Treatment for Acute Bronchitis

10.11

53.06

55.67

AAP

Adults Access to Preventive / Ambulatory Health Services (total)

82.40

85.75

75.81

ADD-m

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

43.99

40.68

39.67

ADD-m

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

54.15

48.39

50.00

AMM-c

Antidepressant Medication Management - Continuation phase

45.37

47.12

44.06

AMM-A

Antidepressant Medication Management - Acute Phase

62.14

64.57

60.8

AMR

AMR -Asthma Medication Ratio (total)

75.92

71.99

64.86

APM

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

28.97

25.92

36.57

APP

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

56.22

57.23

58.62

BCS

BCS- Breast Cancer Screening

54.65

54.48

51.00

CBP

CBP- Controlling High Blood Pressure

67.64

61.31

58.63

CCS

CCS- Cervical Cancer Screening

61.80

58.39

56.26

CDC eye

CDC- Comprehensive Diabetes Care - Eye Exam

58.39

57.66

50.81

CDC HbA1C <8

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

52.07

51.82

48.33

CDC-BP

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

69.59

66.91

60.29

CHL

Chlamydia Screening in Women (total)

36.07

34.22

55.25

CIS 10

CIS-Childhood Immunization Status: Combo 10

42.82

47.45

35.86

COU

COU- Continued Opioid Use -31 days rate

4.02

4.10

3.64

CWP

Appropriate Testing for Pharyngitis (total)

67.15

68.15

67.61

FUA

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

29.34
43.47

16.20
22.12

13.35
19.79

FUH

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

42.09
61.43

34.49
53.92

38.44
58.73

FUI

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

29.56
47.50

25.08
45.52

30.36
49.12

FUM

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

39.42
59.61

43.33
61.39

40.08
53.43

HDO

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

2.04

2.39

6.64

IET-e

IET Engagement in treatment for alcohol/drugs (total)

12.82

13.35

11.26

IET-i

IET Initiation in treatment for alcohol/drugs (total)

39.14

43.62

44.16

IMA 2

IMA - Adolescent Immunization: Combo 2

27.49

33.33

36.11

KED

Kidney Health Evaluation for Patients with Diabetes

31.69

30.76

33.45

LBP

Use of Imaging studies for low Back pain

74.09

73.55

74.53

LSC

Lead Screening in Children

68.15

68.94

62.26

PBH

Persistence of Beta – Blocker

87.23

76.67

80.74

PCE

PCE -Pharmacotherapy Management of COPD Exacerbation
Bronchodilators
Systemic Corticosteroids

82.50
72.50

87.89
72.20

82.65
69.92

POD

Pharmacotherapy for Opioid Use Disorder

40.18

37.82

28.00

PPC-pp

PPC- Postpartum Care

83.45

76.16

76.18

PPC-t

PPC- Prenatal Care timeliness

79.08

77.86 

83.53

SAA

SAA- Adherence to Antipsychotic Medications for Individuals with Schizophrenia

61.39

64.82

59.65

SMC

Cardiovascular Monitoring for People with Schizophrenia

77.78

75.00

74.92

SMD

Diabetes Monitoring for People with Schizophrenia

61.82

65.48

67.13

SPC-a

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

74.93

74.30

70.21

SPC-t

SPC - Statin Therapy for patients with cardiovascular disease - initial

82.06

86.89

78.48

SPD-a

SPD - Statin Therapy 80% adherence for patients with diabetes

70.96

69.31

66.19

SPD-t

SPD - Statin Therapy for patients with diabetes - received

69.13

69.46

64.70

SSD

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

79.60

80.94

79.20

SPR

Use of Spirometry Testing

28.03

22.41

24.80

UOP

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

2.14

2.16

2.11

URI

Appropriate Tx for Upper Respiratory Infection

88.04

87.74

89.56

W30

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

67.06
70.09

65.23
67.85

54.10
65.93

WCV

Child and Adolescent Well-Care Visits

46.14

47.73

49.49

WCC-BMI

WCC - Weight Assessment for Children/Adolescents –BMI Total

70.80

69.34

76.11

WCC-Counseling Nutrition

WCC - Weight Assessment for Children/Adolescents –Counseling Nutrition (total)

65.59

55.96

69.18

WCC-Counseling Physical

WCC - Weight Assessment for Children/Adolescents –Counseling Physical Activity (total)

67.64

57.18

66.72

*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.”

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 2023

The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS® is the most widely used performance measurement tool in health care. The NCQA website contains information to help consumers, employers and others make informed health care choices

.Nebraska Total Care received a score of 5 out of 5 for Patient Experience and was rated 4 out of 5 overall in NCQA’s Medicaid Health Plan Ratings 2023.

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

2021

2022

2023

Benchmark*

Getting Needed Care Composite

91.4%

87.2%

87.7%

81.9%

Getting Care Quickly Composite

92.4%

86.0%

87.1%

80.2%

How Well Doctors Communicate Composite

94.6%

95.6%

96.0%

92.5%

Customer Service Composite

92.3%

92.4%

91.1%

88.9%

Coordination of Care

91.6%

87.7%

92.7%

84.0%

Rating of health care

84.0%

73.2%

80.5%

75.4%

Rating of Personal Doctor

89.3%

84.6%

87.5%

82.4%

Rating of Specialist

85.9%

83.3%

85.7%

83.5%

Rating of health plan

84.6%

76.8

81.0%

78.0%

*Benchmark based on NCQA National Percentiles from 2022 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 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.