1 SNP Educational Session – January 13, 2014 SNP Results 2013 SNP Educational Session - January 13, 2014 Brett Kay, AVP, SNP Assessment, NCQA

2 SNP Educational Session, January 13, Objectives Present key findings from SNP assessment program-major contract tasks – 2012 S&P measures review 394 SNP reviews – 2013 (CY 2014) MOC reviews 210 SNP reviews 104 MMP review – 2013 SNP HEDIS 415 SNP submissions

3 SNP Educational Session, January 13, Six areas of focus: – SNP 1: Complex case management – SNP 2: Member satisfaction – SNP 3: Clinical quality improvement – SNP 4: Care Transitions – SNP 5: Institutional SNP relationship with facilities – SNP 6: Coordination of Medicare and Medicaid S&P Measures Assessment

4 SNP Educational Session, January 13, Wide range of performance within and across S&P measures SNPs showed improvement on majority of measures that did not change between 2011 and 2012 D-SNPs compose majority of plans and enrollment, so drive overall performance results – 262 of 394 SNPs (66.5%) – 1.12 million enrollees of 1.35 million total SNP members (83%) S&P Key Findings

5 SNP Educational Session, January 13, I-SNPs tend to outperform other SNP types – Smallest # of plans (58), overall enrollment (46,000) and avg. # of members (793) – Dominated by a few organizations 5 organizations comprise nearly ¾ of I-SNP plans One organization has >40% of the I-SNP market: their results drive overall I-SNP performance C-SNPs had lowest performance across all measures S&P Key Findings Continued

6 SNP Educational Session, January 13, SNP 1: Complex Case Management – Raised the bar in 2012 – Overall performance was strong – Added 3 new elements (Satisfaction with case management; Analyzing effectiveness/Identifying opportunities; Implementing interventions and follow-up evaluation) – Lower performance than existing elements (78%, 48% and 43 % achieved benchmark SNP 2: Member Satisfaction – Added new element: implementing interventions— performance was relatively low (52.9 percent achieved benchmark) SNP 1 & 2 Findings

7 SNP Educational Session, January 13, SNP 3: Clinical Quality Improvements – Show statistically significant improvement on HEDIS measures year-to-year – Duals outperformed other SNP types; percentage of plans achieving improvement on at least two measures: D-SNPs = 93.2% C-SNPs = 86.8% I-SNPs = 67.6% – Larger plans outperform smaller plans Ranged from 75% to 94.9% SNP 3 Findings

8 SNP Educational Session, January 13, SNP 4: Care Transitions – Improvement over time; however, still presents difficulties for some SNPs – 4 of the 6 elements improved from 2011 – Analysis of communication/coordination activities rose dramatically (51.9% vs. 39.3%) – Many plans have documented processes pertaining to requirements, but cannot show actual evidence of implementation e.g., transition notifications across settings; identifying/coordinating care for at-risk members SNP 4 Findings

9 SNP Educational Session, January 13, SNP 5: Institutional Relationship with Facility – SNP 5 is for I-SNPs only – Excludes I-SNPs that care for all members in community (Institutional equivalent) – Performance high across all elements – Element C had highest scores – Larger plans had higher scores SNP 5 Findings

10 SNP Educational Session, January 13, SNP 6: Coordination of Medicare/Medicaid – Slight improvement from 2011 – D-SNPs and I-SNPs perform well – Many plans still do not conduct network adequacy assessments for Medicaid providers – All three SNP types showed improvement from 2011 to SNP 6 Findings

11 SNP Educational Session, January 13, SNP 6 Results Element E: Network Adequacy, by Type (2011 vs. 2012) Element E: Network Adequacy, by enrollment size, 2012

12 SNP Educational Session, January 13, Model of Care Results CY 2014 Submissions

13 SNP Educational Session, January 13, SNP Results – CMS raised the bar in 2013—One cure; only for SNPs scoring <70% after initial review (receive 1-year approval) – Many SNPs submitted same/similar MOC as in previous years – 3-year approval (85+%): 149 plans – 2-year approval (75%-84%): 20 plans – 1-year approval (70%-74%): includes cure 1 plan scores): 6 plans – Not approved (<70%): 2 plans – Withdrew application: 33 Model of Care Results-SNPs

14 SNP Educational Session, January 13, Results for SNPs

15 SNP Educational Session, January 13, MMP Results – 10 states (AZ, ID, MI, NY, RI, SC, TX, VT, VA, WA) – Many MMPs submitted similar MOCS to SNPs from same organization – Additional state requirements not reviewed by NCQA (NY, RI, SC, VA, WA) – 3-year approval (85+%): 75 plans – 2-year approval (75%-84%): 17 plans – 1-year approval (70%-74%): includes cure 1&2 plan scores): 8 plans – Withdrew application: 4 MOC Results--MMP

16 SNP Educational Session, January 13, MMP Results by State

17 SNP Educational Session, January 13, Overall MMP Results

18 SNP Educational Session, January 13, SNP HEDIS Results 2013

19 SNP Educational Session, January 13, Required SNP Measures (COL) Colorectal Cancer Screening (GSO) Glaucoma Screening in Older Adults (COA) Care for Older Adults (SPR) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (PCE) Pharmacotherapy of COPD Exacerbation (CBP) Controlling High Blood Pressure (PBH) Persistence of Beta-Blocker Treatment After a Heart Attack (OMW) Osteoporosis Management in Older Women (AMM) Antidepressant Medication Management (FUH) Follow-Up After Hospitalization for Mental Illness (MPM) Annual Monitoring for Patients on Persistent Medications (DDE) Potentially Harmful Drug-Disease Interactions (DAE) Use of High-Risk Medications in the Elderly (MRP) Medication Reconciliation Post-Discharge (PCR) Plan All-Cause Readmissions (BCR) Board Certification HEDIS Measures for SNP Submission

20 SNP Educational Session, January 13, SNPs Eligible to Report (>30 members) 40 HEDIS measures reported – 28 clinical performance measures – 4 board certification measures – 8 utilization measures Audited by NCQA-Certified HEDIS Compliance Auditors Reflects care provided in 2012 Compares performance among SNPs and to non-SNP MA plans SNP HEDIS 2013 Overview

21 SNP Educational Session, January 13, Steady improvement from Performance gap between SNP and MA plans continues to narrow – 6 measures-SNP performance is higher – 8 measures-no statistically significant difference in performance – 13 measures – SNP performance is lower Performance differences among SNP types – D-SNPs-most measures with statistically significant improvement from Key Findings

22 SNP Educational Session, January 13, SNP Higher than MANo Statistically Significant Difference SNPs Lower than MA PCE-Dispensed Bronchodilator within 30 Days of Event GSOCOL MPM-ACE/ARB MonitoringPBHSPR MPM-Digoxin MonitoringOMWPCE-Dispensed Systemic Corticosteroid Within 14 Days of Event MPM-Diuretic MonitoringFUH-Within 30 Days of DischargeCBP MPM-Anticonvulsant MonitoringFUH-Within 7 Days of DischargeAMM-Acute Phase MPM-Total RateBCR-Internal MedicineAMM-Continuation Phase BCR-GeriatricsBCR-Family Medicine BCR-Other Physician SpecialistsDDE-History of Falls DDE-Dementia DDE-Chronic Renal Failure DDE-Total Rate DAE-At Least One High-Risk Medication DAE-At Least Two High-Risk Medications SNP Versus MA Performance

23 SNP Educational Session, January 13, Three-year trend: improvement – 31 of 40 measures showed statistically significant improvement between More than 2X the measures that showed statistically significant improvement from —27 measures with statistically significant improvement Care for Older Adults—average increase of 18.4% for the four indicators ( ) – Three-Year Reporters ( ) outperformed SNP program overall Higher results across all measures in each year, on average Improvement Trend

24 SNP Educational Session, January 13, percentage point average difference between all types in 2013 D-SNPs had the largest number of measures (9) with statistically significant improvement from C-SNPs & I-SNPs had statistically significant improvement in 2 measures Care for Older Adults indicators showed largest performance improvements from all SNP types – C-SNPs—39 percentage point increase Performance by SNP Type

25 SNP Educational Session, January 13, Wide variation in performance ranges – 9 measures had >40 point differences between 10 th and 90 th percentiles – Large difference (>20 points) between mean score and 90 th percentile—represents opportunity for improvement 50+% of SNPs improved on 25 HEDIS measures – 70% increased performance on 5 of these measures – COL had the most SNPs show improvement (~80%) Greatest variation: Care for Older Adults, Board Certification and Medication Reconciliation Post- Discharge Plan Benefit Package Level Performance

26 SNP Educational Session, January 13, DISCUSSION