Health New England, How Can We Help?

Each year, HNE conducts a Provider Survey. Some of the survey questions relate to experiences physicians encounter with regard to receiving information from other physicians, hospitals and skilled nursing facilities that provide care to their patients. This year the study was conducted in the first quarter of 2005 and reflects opinions about 2004.

The survey indicated physicians are satisfied with the feedback they receive from specialists and hospitals, but not with skilled nursing facility communications.

To address this, we’ve contacted each HNE contracted SNF and asked that they obtain the name of the patient’s PCP on admission, and then, at time of discharge, send a copy of the official discharge summary to the PCP.

We hope this helps to improve the feedback you receive from skilled nursing facilities.
We’d also like to thank providers who took the time to respond to the survey.

CAHPS™^[1] Results Are In

Just as patient satisfaction is important to a physician's practice, member satisfaction is important to our business as a managed care organization.

Each year, we survey a random sample of HNE members to assess satisfaction. The 2005 survey was conducted from February to May 2005 using the Consumer Assessment of Health Plans Survey (CAHPS™). This survey is used by health plans across the country to assess member satisfaction with both the health plan and network providers. This standardized survey has proven reliable as a predictor of member satisfaction and helps us compare our performance with other plans in Massachusetts and across the country.

The responses are grouped to create composite scores. The table provides the composite scores for 2004 and 2005 results for those portions of the survey regarding physician practices. The percentages reflect members who responded, "Not a Problem."

	2005 Survey (2004 Experience)	2004 Survey (2003 Experience)
Getting Needed Care Greatest opportunity to improve score: Member finding a personal doctor or nurse with whom he/she is happy.	86.3%	83.7%
Getting Care Quickly Greatest opportunity to improve score: Meeting member expectation of being taken to the exam room within 15 minutes of their appointment.	82.3%	81.6%
How Well Doctors Communicate Greatest opportunity to improve score: Explaining things to the member in an understandable way.	93.5%	92.6%
Courteous and Helpful Office Staff Members are satisfied with office staff in their physician's offices.	95.7%	95.2%

HNE congratulates our providers for the improvements in member satisfaction. Thank you for continually working to improve service and care to our members.

HEDIS™ 2005 Measures: Effectiveness of Care

The Health Plan Employer Data and Information Set (HEDIS™^[2]) is a group of standardized measures of health plan performance. It is designed to report information that purchasers and consumers can use to compare managed healthcare plans.

Sponsored by the National Committee for Quality Assurance (NCQA), HEDIS includes the following categories:

Effectiveness of care
Access/availability of care
Satisfaction with the care experience
Health plan stability
Use of services
Health plan descriptive information

The Effectiveness of Care measures address significant issues related to patient health. Currently, this information is used to quantify the overall performance of health plans, as well as review individual physician performance.

As a stakeholder in this process, you should be aware of HEDIS and the importance of paying attention to specific HEDIS measures. Much of what we report to NCQA concerning HEDIS measures is based on our review of physician records. Shown below are HNE's current HEDIS measures with an explanation of what each measure examines. Pat Scheer, our Quality Operations Manager (413-233-3435), can answer questions you might have about HEDIS measures and/or NCQA accreditation. You can also obtain information at the NCQA Web site: www.ncqa.org.

Measure	Performance Year 2004	Performance Year 2003	Description
Breast Cancer Screening	80%	79%	Women, ages 52 to 69, who had at least one mammogram during the past two years.
Cervical Cancer Screening	83%	84%	Women, ages 21 to 64, who had at least one Pap test during the past three years.
Prenatal Care	97%	93%	Women who received prenatal care in the first trimester or within 42 days of enrollment in HNE.
Postpartum Care	95%	97%	Women who received a postpartum checkup between the 21st and 56th day after delivery.
Chlamydia Screening	37%	38%	Women, ages 16 to 25, identified as sexually active, who had at least one test for chlamydia during the measurement year.
Beta Blocker after Heart Attack	99%	100%	Members, 35 and older, discharged with the diagnosis of AMI who received (filled) a prescription for beta blockers.
Use of Appropriate Medications for Asthmatics	78%	78%	Members, ages 5 to 56, with persistent asthma who received an appropriate anti-inflammatory medication.
Management of Hypertension	62%	62%	Members, ages 46 to 85, diagnosed with hypertension who bring their blood pressure within an acceptable range (defined as systolic < 140 mmHg, diastolic < 90mmHg) in the measurement year.

Measure	Performance Year 2004	Performance Year 2003	Description
Comprehensive Diabetes Care:			Members, ages 18 to 75, diagnosed with diabetes who received: HbA1C test and control ( >9.0) LDL-C test and control (<130) Eye exam Kidney disease monitor
HbA1c test	92%	90%
HbA1C Poor Control (lower number =better)	12%	27%
Eye Exam	76%	67%
Lipid Test	92%	88%
Lipid Control	79%	64%
Nephropathy monitored	75%	69%
Colorectal Cancer Screening	64%	64%	Members, ages 50 to 80, who had one or more appropriate screenings for colorectal cancer: fecal occult blood test during the measurement year; flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year; double contrast barium enema during the measurement year or the four years prior to the measurement year; and/or, colonoscopy during the measurement year or the nine years prior to the measurement year.
Follow-Up after MH Hospitalization			Members, 6 and older, hospitalized for selected mental health disorders, who were seen by a mental health provider within 7 days and 30 days of hospital discharge.
Within 7 days	69%	68%
Within 30 days	84%	85%
Antidepressant Management			Members, 18 and older, diagnosed with depression and treated with antidepressant medication who:
3- contacts in 84 days	36%	24%	had at least 3 follow-up contacts with a PCP or MH practitioner during the 84-days acute treatment phase
84-day	65%	68%	remained on the antidepressant during the entire 84-day phase
180 days	46%	55%	remained on the antidepressant drug for at least 180 days

[1] CAHPS™ is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)

[2] HEDIS™ is a registered trademark of The National Committee for Quality Assurance (NCQA)

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