Quality Highlights

Quality Matters at UCare

Our Quality Program supports our mission to improve our members' health through innovative services and community partnerships. Every year, our Quality Program is evaluated to make sure it is effective and meaningful, and that is meets regulatory standards and guidelines. Results from our annual evaulation help us develop, prioritize and track our progress toward our quality plan goals/

 Thanks to strong collaboration with our providers and community partners, UCare delivers measurably high-quality care to every one of our members. Quality monitoring and program initiatives continue to demonstrate positive outcomes.

Medicare Star Ratings

The Centers for Medicare and Medicaid Services (CMS) evaluates overall health plan performance using a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. Star Ratings are based on five health service categories:

  • Keeping healthy through screenings, tests and vaccines
  • Managing chronic conditions
  • Satisfaction
  • Operational performance
  • Customer service

For the third year in a row, UCare Medicare Plans achieved an Overall Rating of 4.5 out of 5 Stars, which equates to the "Very Good" category of the Medicare Plan Performance Ratings. UCare Medicare Plans ranks 21st out of over 360 Medicare Advantage plans in the nation! UCare's Minnesota Senior Health Options (MSHO) maintained an Overall Rating of 3.5 out of 5 stars in 2017.

Health plans receiving 4 or more Stars earn a quality bonus payment to be reinvested in product benefits and premium reduction.

How can you help?

  • Schedule an Annual Wellness visit every year
  • Receive your screenings & preventive care
  • Complete and return all member surveys
  • Discuss and monitor your physical and mental health with your doctor
NCQA Excellent Health Plan Badge

NCQA "Excellent" Ratings and More

In 2017, UCare Medicare Plans Medicare Advantage plans and our Individual and Family Plans commercial plans received highly rated accreditations from the National Committee for Quality Assurance (NCQA) for the second time. UCare was awarded an "Excellent" rating for its submission of our Minnesota UCare Medicare Plans and its Individual and Family plans available through MNsure also received the highest possible status of "Accredited" from NCQA for new Marketplace plans.

Learn More About Our Quality Programs

The Quality Management Department annually reviews the quality work from the previous year, analyzes the progress toward our goals, and identifies new focus areas and goals for the upcoming year.

Quality Management Program Description 2018

Quality Management Program Evaluation 2017

Quality Management Program Work Plan2018

Member Satisfaction

The Centers for Medicare & Medicaid Services (CMS) gauges member satisfaction of Medicare Advantage plans through an annual survey called the CAHPS survey (Consumer Assessment of Healthcare Providers and Systems). The CAHPS survey helps health plans identify opportunities to improve quality and services, and helps CMS monitor the quality and performance of these plans.

UCare scored above the national average on several 2017 CAHPS measures for UCare Medicare Plans. See how our measures are trending and compare to national averages below:

CMS CAHPS CAHPS 2016 CAHPS 2017 National Average
Response Rate 55.20% 58.00% 47.4%**
Rating of All Health Care* 8.9

8.80

↑8.60
Rating of Personal Doctor 9.2

9.20

9.1
Rating of Specialist 8.9 9.2 ↑ 9.00
Rating of Health Plan* 8.8

8.80

↑ 8.60
Getting Needed Care* 3.57

3.65

↑ 3.52
Getting Care Quickly* 3.42

3.46

↑ 3.35
Customer Service* 3.71

3.72

3.71

Green = Significantly above the National average.
Red= Significantly below the National average.

* CMS Star Measure
** Average response rate for all MA contracts in Minnesota.

UCare scored a 5 Star rating on several 2016 CMS CAHPS measures for Minnesota Senior Health Options. These measures were:

Minnesota Senior Health Options Star Rating CAHPS Star Rating Measure
5 Annual Flu Vaccine
5 Care Coordination
5 Overall Rating of Plan

 

CMS evaluates qualified health plans (QHPs) offered through the Marketplaces using QHP Enrollee Survey response data. The table below shows UCare’s 2016 and 2017 QHP Enrollee Survey results. Responses to composite measures are scored on a 1-4 scale (1=never, 2=sometimes, 3=usually and 4=always). The overall ratings measures were single questions where respondents chose from 0-10, with 0 being lowest and 10 highest scores. Currently, there is no national average for the QHP Enrollee Survey due to fluctuation in the marketplace; therefore UCare has set an internal threshold until the national averages are released.

UCare QHP (Individual and Family Plans) Enrollee Survey

  Individual and Family Plans 2016 Individual and Family Plans 2017 UCare Benchmark
Overall Ratings Measures
Rating of all Health Care 8.57 8.41 ↑8
Rating of Personal Doctor 8.1 9.08 ↑8
Rating of Specialist 8.98 8.85 ↑8
Rating of Health Plan 6.02 6.07 ↓8
Composite Measures
Access to Care 3.31 3.25 ↑3
Coordination of Care 3.52 3.56 ↑3
Cultural Competence 2.39 3.83 ↑3
Access to Information 2.4 2.06 ↓3
Plan Administration 3.17 3.17 ↓3

 

UCare's Quality Improvement Initiatives

UCare's Quality Improvement Initiatives

The Quality Program is a commitment to innovation, affordability, professional competence and continuous learning, and teamwork and collaboration. Quality of care and services are optimized and continuously improved while maintaining cost-effective utilization of health care resources. This is accomplished by systematic monitoring and evaluation of provided services and by actively pursuing opportunities for improvement. The table below provides some examples of projects that both monitor services and pursue improvements.

Product Measure Goal Interventions Lessons Learned Member Resources 2015 Rate 2016 Rate 2017 Rate Goal NCQA 75th
Individual and Family Plans,
MSHO,
MnCare,
PMAP,
UCare Medicare
Antidepressant medication management – Continuation Phase Increase the number of members who stay on their antidepressant medication for six months. - Health coaching available to all members with new prescription.
-MTM program
- Webinar series offering provider education on depression care best practices.
-Tailor member interventions to increase member engagement.
- Work more collaboratively with the pharmacy and/or pharmacist on intervention strategies.
- Create tip sheets on depression management for members.

My Health Decisions

NAMI MN

UCare Mental Health Resources

NA
55.21%
46.93%
33.79%
65.10%
 
51.52%
51.43%
49.53%
35.39%
65.36%
 
66.23%
57.66%
40.57%
34.87%
66.55%
 
40.79%*
61.46%
40.79%
40.79%
61.46%
 
Connect Follow up After Hospitalization after Mental Illness – 30 day Increase the number of members who have timely follow-up visits with a mental health provider after a hospitalization for mental illness -Added prompt for Care Coordinators (CC) in assessment form for transitions of care.
-Provide education to CCs on importance of follow-up appointments.
-Work more collaboratively with hospital discharge planners.
-Improve the process and work flow with hospital staff and behavioral health team for follow-up after hospitalization.
69.66% 69.59% 69.78% 75.19%

*NCQA has not set national benchmarks for Marketplace. The 75th NCQA percentile is based on the PMAP 75th percentile.

SNBC Dental Access Project

UCare is working together with a collaborative group of Minnesota Managed Care Organizations (MCO) and the Department of Human Services (DHS) to improve access to dental services for Special Needs BasicCare (SNBC) enrollees. The project began in 2017 and will continue over the next 3 to 5 years. In the spring of 2017, we surveyed members to gain knowledge and feedback in regards to dental access. Results to this survey are posted on the UCare Connect page.

Intervention focus will be on the following three topics:

  • Dental Case Management
  • Special Needs Community Dentist and Staff Mentoring Program
  • Teledentistry Demonstration Project

If you need assistance in finding or locating a dental provider, please call Delta Dental at 651-768-1415 or 1-855-648-1415 (toll free), or TTY: 711, from 7 a.m. to 7 p.m., Monday- Friday. Additional Customer Service hours and days of operation, and phone numbers are here.


September 2018