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, 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 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, Nebraska Relay Service 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% |
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.
- Initiation of 17-Hydroxyprogesterone in Pregnant Women with a History of Spontaneous Preterm Birth
- Providing hormone shots to help baby get to full term.
- 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.