TennCare Managed Care Organizations Receive High Marks in Behavioral Health

Sunday, October 25, 2009 | 11:00 pm
NASHVILLE — The Bureau of TennCare today announced the results of the 2009 HEDIS/CAHPS Report: A Comparative Analysis of Audited Results from TennCare Managed Care Organizations (MCOs). The report shows that TennCare’s Middle Tennessee MCOs performed above – and in many cases significantly exceeded – the 2008 national Medicaid average for measures related to behavioral health as well as drug and alcohol dependence treatment.
This is the first HEDIS/CAHPS report that looks at behavioral health measures, given that 2008 was the first full calendar year for TennCare to have fully-integrated health plans that provided both physical and behavioral health coverage for enrollees in Middle Tennessee. The report demonstrates that the MCOs performed well in behavioral health measures including, antidepressant medication management, follow-up care for children prescribed to attention-deficit hyperactivity disorder medication and follow up after hospitalization for mental illness.
“I’m pleased that as a result of integration, we now have the ability to track performance related to behavioral health using objective measures that have been validated by a nationally recognized external quality assurance authority,” said Darin Gordon, Director of TennCare. “This report provides encouraging news about the current status of care in middle Tennessee and will provide a baseline for measuring future improvements. We look forward to next year when, as a result of recently integrating behavioral and physical health in East and West Tennessee, we will have access to statewide data.”
Performance related to initiation and ongoing treatment of alcohol and drug dependence treatment were also significantly higher than the 2008 national Medicaid average. For example, the weighted state rate for initiation of alcohol and drug treatment in 13-17-year olds was 56.4 percent – well above the national Medicaid average of 39.9 percent.
“Research has shown that integration of physical and behavioral health coverage has a positive effect on overall health of a population because it creates more opportunities for prevention, education, assessment, and early intervention for mental illnesses and substance abuse disorders,” said Virginia Trotter Betts, Commissioner of the Tennessee Department of Mental Health and Developmental Disabilities. “I am very pleased with the outcome of this survey and we will continue to work with TennCare and the MCOs to continue to provide a quality array of services for TennCare enrollees.”
Since TennCare’s inception, the Bureau has implemented a number of efforts to enhance the quality of health care provided by the state of Tennessee. Many of these efforts involve evaluating the state’s managed care organizations to make sure they are meeting the needs of TennCare’s enrollees—relying upon objective measurements to drive innovation and value. Although widely used in the commercial market, in 2006 Tennessee became the first state in the country to require National Committee on Quality Assurance (NCQA) certification across its Medicaid managed care network.
NCQA is an independent, nonprofit organization that assesses and scores managed care organization performance in the areas of quality improvement, utilization management, provider credentialing and member rights and responsibilities. As part of the NCQA accreditation process, TennCare MCOs are also required to report a full Health Care Effectiveness Data and Information Set (HEDIS). HEDIS is a set of standardized performance measures that makes it possible to track performance over time, compare MCO performance to national benchmarks and compare performance across MCOs on an “apples-to-apples” basis.
Included in HEDIS, is the Consumer Assessment of Health Care Providers and Systems (CAHPS), which is a set of standardized surveys used to measure members’ satisfaction with their care. It is a survey tool used widely for measuring consumer satisfaction with the quality of care and customer service provided by health plans.
To view the full report, visit http://www.tn.gov/tenncare/forms/hedis09.pdf.