TennCare Managed Care Organizations Receive High Marks in Child Health and Pregnancy-Related Measures

Friday, September 03, 2010 | 12:49 pm

NASHVILLE — A new report shows continued improvement in the overall quality of health care provided to TennCare members through their managed care organizations. 
 
The report, 2010 HEDIS/CAHPS Report: A Comparative Analysis of Audited Results from TennCare Managed Care Organizations (MCOs), shows an increase in all child health measures, including childhood immunization status, lead screening in children, appropriate treatment for children with upper respiratory infection, and well-child and adolescent visits. 

The weighted state rate for children and adolescents’ access to primary care practitioners also exceeded the national Medicaid average in all age groups. Rates for prenatal and postpartum care also improved, with timeliness of prenatal care improving to 81 percent in 2010 from 77 percent in 2008.

“This report is a valuable tool in evaluating the quality and performance of our managed care organizations, which helps us ensure the best possible health care coverage for TennCare members,” said Darin Gordon, Director of TennCare. “I’m pleased to see continued improvement in performance, especially in the areas of child health indicators and pregnancy- related measures. It has long been a goal of the Bureau to provide the highest quality of care to this vulnerable population.”

The HEDIS/CAHPS 2010 report marks the first year of statewide reporting of behavioral health measures following the integration of medical-behavioral health services among TennCare’s health plans. The measures included in the report will serve as a baseline for ongoing evaluation of the integrated care model.  These early results indicate strong performance by the MCOs, with rates exceeding the national Medicaid average for measures related to antidepressant medication management, follow-up care for children prescribed to attention-deficit hyperactivity disorder medication and initiation and ongoing treatment of substance abuse.

Improvement was also seen in cholesterol management for patients with cardiovascular conditions, controlling high blood pressure, annual monitoring for patients on persistent medications, and medical assistance with smoking and tobacco use cessation. Additionally, every comprehensive diabetes care measure for adults improved from HEDIS 2008.

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/hedis10.pdf.

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