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 evaluation 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 26th out of over 400 Medicare Advantage plans in the nation! UCare's Minnesota Senior Health Options (MSHO) maintained an Overall Rating of 4 out of 5 stars in 2018.

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 and 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 2018, UCare's Medicare Advantage plans and Individual & Family Plans received highly rated accreditation from the National Committee for Quality Assurance (NCQA). UCare was awarded an "Excellent" rating for its submission of our Minnesota UCare Medicare Plans and its Individual & Family Plans available through MNsure also received the highest possible status of "Accredited"  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 2019

Quality Management Program Evaluation 2018

Quality Management Program Work Plan 2019

Member Satisfaction

The Centers for Medicare & Medicaid Services (CMS) and Department of Human Services (DHS) gauges member satisfaction of Medicare Advantage and Medicaid plans through an annual survey called the CAHPS survey (Consumer Assessment of Healthcare Providers and Systems). CMS also administers a member experience survey to market place health plans called the Qualified Health Plan Survey (QHP). The CAHPS/QHP survey helps health plans identify opportunities to improve quality and services, and helps CMS and DHS monitor the quality and performance of these plans.

UCare scored above the national average on several 2018 measures and have identified focus areas that are highlighted below.

Measure Product 2017 Rate 2018 Rate National Average Interventions
Customer Service Individual & Family Plan 2.84 3.30 3.21
  • Increased focus on communication and customer service delivery excellence to drive positive interactions with our members and drive member trust.
  • Continue to work with CS representatives on motivational interviewing techniques by teaching them how to roll with resistance and remove themselves from the outcome, while still being able to connect with the individuals to understand their wants and needs.
UCare Medicare 3.72 3.75 3.71
UCare's MSHO 3.67 3.63 3.71
UCare Connect + Medicare NA 3.69 3.71
Product 2017 Rate 2018 Rate National Average
Families & Children 62% 62% 67%
MinnesotaCare 52% 63% 67%
UCare Connect 67% 68% 69%
Measure Product 2017 Rate 2018 Rate National Average Interventions
Rating of Plan Individual & Family Plan 6.10 6.90 7.40
  • Continue member outreach strategies including, but not limited to: IVR calls, telephonic outreach after interim surveys, member mailings (e.g. survey and formulary changes), etc.
  • UCare will continue to partner with culturally competent community service providers to improve member health, healthcare and health insurance literacy.
UCare Medicare 8.80 8.90 8.70
UCare's MSHO 8.50 8.60 8.70
UCare Connect + Medicare NA 8.60 8.70
Product 2017 Rate 2018 Rate National Average
Families & Children 63% 64% 60%
MinnesotaCare 57% 55% 55%
UCare Connect 61% 60% 62%
Measure Product 2017 Rate 2018 Rate National Average Interventions
Rating of Drug Plan UCare Medicare 8.10 8.40 8.50
  • Continued work with analyzing the formularies and prescription drugs applicable to these members. Review feedback from the interim CAHPS surveys and appeals and grievance data to better understand the needs of these populations.
UCare's MSHO 8.40 8.50 8.50
UCare Connect + Medicare NA 8.50 8.50
Measure Product 2017 Rate 2018 Rate National Average Interventions
Getting Needed Care Individual & Family Plan 3.25 3.34 3.14
  • Annually conduct network adequacy assessments to assess the availability of providers/practitioners and their ability to provide needed care and getting care quickly from a member standpoint.
  • Identify providers to contract with UCare to improve greater access and convenience of care for members.
  • Expand and educate members on various levels of services to provide quick and timely access to care. These services may include: virtual care, Telehealth, etc.
UCare Medicare 3.65 3.64 3.51
UCare's MSHO 3.50 3.42 3.51
UCare Connect + Medicare NA 3.46 3.51
Product 2017 Rate 2018 Rate National Average
Families & Children 57% 55% 54%
MinnesotaCare 61% 57% 54%
UCare Connect 57% 53% 55%

 

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.

Antidepressant Medication Management

Product Measure Goal Interventions Lessons Learned Member Resources 2016 Rate 2017 Rate 2018 Rate Goal NCQA 75th

- Families & Children

- MinnesotaCare

- Individual & Family Plan

- UCare’s MSHO

- UCare Medicare

Antidepressant medication management

Continuation Phase

Increase the number of members who stay on their antidepressant medication for six months

- Health coaching

- MTM program

- Provider webinar series on best practices

- Member letter proiding educatin on the use of antidepressants

- Tailor 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

Follow-up after hospitalization

35.39%

49.53%

51.52%

51.43%

65.36%

34.87%

40.57%

66.23%

57.66%

66.55%

42.70%

45.45%

72.02%

63.08%

66.64%

42.34%

42.34%

56.34%*

60.94%

60.94%

*NCQA 75th percentile for Individual and Family Plan uses the commercial rate since there is not reported rate for Marketplace plans.

Opioid – New User

Product Measure Goal Interventions Lessons Learned Member Resources

- Families & Children

- MinnesotaCare

- Individual & Family Plan

- UCare's MSHO

- UCare Medicare

- UCare Connect

- UCare Connect + Medicare

Members who are newly prescribed opioids Decrease the number of members being prescribed opioids

- Provider education

- Provider & pharmacy alignment

- Provider toolkit & webinar series

- Consistent messaging for community outreach: opioid brochure

- Tailor interventions to increase member engagement

- Work collaboratively with prescribers & pharmacy and/or pharmacists on intervention strategies

- Create a member toolkit

- Provide webinars for care coordinators and pharmacists

Taking Action on Opioid Epidemic

Priority Plan on Opioid Use

Opioid Education Brochure

Free Drug Disposal Pouch

 

Product Rate of New Chronic Users
  2016 (Baseline) 2017 2018
UCare Connect 9.48% 9.71% 9.76%
UCare Connect + Medicare - 34.88% 24.43%
EssentiaCare 22.92% 10.47% 6.84%
UCare Medicare Plans 8.73% 8.37% 7.95%
MinnesotaCare 3.39% 5.95% 2.95%
Minnesota Senior Care Plus 7.69% 7.37% 9.66%
UCare's MSHO 16.15% 17.83% 17.23%
Families & Children 3.22% 3.44% 4.11%
Individual & Family Plans 7.27% 11.21% 7.95%

 

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. 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.

Product Measure Goal Interventions Lessons Learned Member Resources

- UCare Connect

- UCare Connect + Medicare
Dental access & dental rates Increase access to dental services & improve dental rates for our members

- Care Coordination training & education

- Telephonic outreach to members

- Provider surveys conducted in 2017 & 2018 to obtain knowledge & feedback regarding dental access interventions

- Provider education on referring members for dental exams

- Medicaid Dental Service Grid
- Education to both members & providers on using UCare’s Dental connection to schedule and coordinate dental needs.

- UCare Connect

- Results of the dental surveys

- Delta Dental Connection

 


April 2019

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