Program Evaluation
Nebraska Total Care works to make health care better for you. Our Quality Improvement (QI) Program is a valuable part of your plan. We want to help you get healthy.
We want to make sure:
- Services are good quality
- Services are safe
Anyone who gets coverage from Nebraska Total Care is a “member”. As of August 2024, we had more than 92,847 Medicaid members. Our job is to help you get the services you needed to be healthy.
Our Quality Department is in charge of the QI Program. Our Medical Director supervises the QI activities. Nebraska Total Care staff helps to make services better.
QI activities look at your health in different ways. Some of our activities focus on:
- Care to keep you from getting sick.
- Care in serious situations.
- Long-term care.
- Behavioral health.
- Making sure that you get the right kind of services.
- Make sure your services work together.
- Safety.
You can have more information about the QI Program. Call Member Services at 1-844-385-2192 (TTY 711). Talk to the Quality Department
We can:
- Answer questions about the QI Program
- Tell you about our goals
- Tell you how we are meeting our goals
- Give you a copy of our QI Program description.
There is a tool that sets goals for health plans. The tool is called the Healthcare Effectiveness Data and Information Set, or HEDIS®. Each year, Nebraska Total Care will be graded on HEDIS goals. This will tell us where to do better.
Each year, Nebraska Total Care reviews the services members use. We will use gather this informationinfo to set goals to and improve your healthcare for our members.
Measure | HEDIS Measure Description | MY2023 | MY2022 | 2023 QC National Average |
|---|---|---|---|---|
AAB | AAB - Avoidance of Antibiotic Treatment for Acute Bronchitis | 63.49 | 63.17 | 62.23 |
AAP | AAP - Adults Access to Preventive / Ambulatory Health Services (Total) | 83.10 | 82.40 | 72.74 |
ADD-m | ADD-m - Initiation phase follow-up visits after initiation of ADHD medications | 47.19 | 43.99 | 43.62 |
ADD-m | ADD-m - Continuation and Maintenance follow-up visits after initiation of ADHD medications | 53.82 | 54.15 | 53.14 |
AMM-c | AMM-c - Antidepressant Medication Management - Continuation phase | 44.41 | 45.37 | 43.90 |
AMM-A | AMM-A - Antidepressant Medication Management - Acute Phase | 62.91 | 62.14 | 60.91 |
AMR | AMR - Asthma Medication Ratio (total) | 76.50 | 75.92 | 65.53 |
APM | APM - Metabolic Monitoring for Children and Adolescents on Antipsychotics (Glucose & Cholesterol) | 35.53 | 28.97 | 37.89 |
APP | APP - First Line Psychosocial Care for Children and Adolescents on Antipsychotics | 61.91 | 56.22 | 57.29 |
BCS | BCS - Breast Cancer Screening | 56.96 | 54.65 | 52.43 |
CBP | CBP - Controlling High Blood Pressure | 63.99 | 67.64 | 60.86 |
CCS | CCS - Cervical Cancer Screening | 63.02 | 61.80 | 55.92 |
EED | EED - Eye Exam for Patients with Diabetes | 56.20 | 58.39 | 51.47 |
HBD | HBD - HbA1c controlled (<8%) for Patients with Diabetes | 60.58 | 52.07 | 50.87 |
BPD | BPD - Blood Pressure Control for Patients with Diabetes <140/90 | 76.16. | 69.59 | 63.55 |
CHL | CHL - Chlamydia Screening in Women (total) | 36.24 | 36.07 | 55.80 |
CIS 10 | CIS 10 - Childhood Immunization Status: Combo 10 | 42.09 | 42.82 | 31.86 |
COU | COU - Continued Opioid Use -31 days rate | 3.82 | 4.02 | 3.61 |
CWP | CWP - Appropriate Testing for Pharyngitis (Total) | 78.78 | 67.15 | 70.99 |
FUA | FUA - Follow-up after ED visit for substance abuse issue – 7 day / 30 day | 26.23 | 29.34 | 25.00 |
FUH | FUH – Follow-up after acute inpatient psych inpatient stay - 7day / 30 day | 52.15 | 42.09 | 36.61 |
FUI | FUI – Follow-up After High-Intensity Care for Substance Use Disorder 7 Day / 30 day | 26.94 | 29.56 | 31.01 |
FUM | FUM - Follow-up after ED visit for mental health issue 7 day / 30 day | 40.22 | 39.42 | 41.53 |
HDO | HDO- Use of Opioids at High Dosage (smaller % is better) | 1.53 | 2.04 | 6.09 |
IET- e | IET-e - Engagement in treatment for alcohol/drugs | 10.80 | 12.57 | 14.91 |
IET -i | IET-i - Initiation in treatment for alcohol/drugs Total | 35.85 | 38.98 | 45.01 |
IMA 2 | IMA 2 - Adolescent Immunization: Combo 2 | 31.14 | 27.49 | 35.55 |
KED | KED - Kidney Health Evaluation for Patients with Diabetes | 33.62 | 31.69 | 34.54 |
LBP | LBP - Use of Imaging studies for low Back pain | 71.89 | 74.09 | 73.35 |
LSC | LSC - Lead Screening in Children | 69.88 | 68.15 | 59.36 |
PBH | PBH - Persistence of Beta – Blocker | 65.38 | 87.23 | 79.9 |
PCE | PCE - Pharmacotherapy Management of COPD Exacerbation Bronchodilators Systemic Corticosteroids |
84.53 71.82 |
82.50 72.50 |
82.96 70.81 |
POD | POD - Pharmacotherapy for Opioid Use Disorder | 36.64 | 40.18 | 27.48 |
PPC-pp | PPC-pp - Postpartum Care | 76.89 | 83.45 | 76.96 |
PPC-t | PPC-t - Prenatal Care timeliness | 81.32 | 79.08 | 82.95 |
SAA | SAA - Adherence to Antipsychotic Medications for Individuals with Schizophrenia | 62.79 | 61.39 | 59.83 |
SMC | SMC - Cardiovascular Monitoring for People with Schizophrenia | 66.67 | 77.78 | 75.95 |
SMD | SMD - Diabetes Monitoring for People with Schizophrenia | 73.74 | 61.82 | 67.94 |
SPC-a | SPC-a - Statin Therapy for patients with cardiovascular disease – 80% adherence | 68.18 | 74.93 | 69.94 |
SPC-t | SPC-t - Statin Therapy for patients with cardiovascular disease -received therapy | 85.38 | 82.06 | 78.48 |
SPD-a | SPD-a - Statin Therapy 80% adherence for patients with diabetes | 68.18 | 70.96 | 66.07 |
SPD-t | SPD-t - Statin Therapy for patients with diabetes - received | 67.18 | 69.13 | 63.77 |
SSD | SSD - Diabetes Screening for Schizophrenia or Bipolar Disorder Using Antipsychotic Medications | 84.65 | 79.60 | 79.00 |
SPR | SPR - Use of Spirometry Testing | 23.42 | 28.03 | 22.93 |
UOP | UOP - Use of Opioids from Multiple Providers/Pharmacies (smaller % is better) | 2.44 | 2.14 | 1.85 |
URI | URI - Appropriate Tx for Upper Respiratory Infection | 87.01 | 88.04 | 89.85 |
W30 | W30 - Well-Child Visits in the First 30 Months of Life (age 15mo / age 15 to 30 months) | 71.10 | 67.06 | 56.76 |
WCV | WCV - Child and Adolescent Well-Care Visits | 50.54 | 46.14 | 48.61 |
WCC-BMI | WCC-BMI - Weight Assessment for Children/Adolescents –BMI Total | 71.53 | 70.80 | 76.75 |
WCC-Counseling Nutrition | WCC - Weight Assessment for Children/Adolescents –Counseling Nutrition Total | 64.96 | 65.59 | 68.12 |
WCC-Counseling Physical | WCC - Weight Assessment for Children/Adolescents –Counseling Physical Activity Total | 62.04 | 67.64 | 64.75 |
*National Average is based on NCQA Quality Compass 2023 National Benchmark.
There are groups that make rules for health plans. Those rules protect members. They help you get good care.
One group is called National Committee for Quality Assurance Accreditation (NCQA®). They check to see if we meet their rules.
Nebraska Total Care maintains the following Accreditations from NCQA®
- Health Plan Accreditation, Medicaid and Commercial HMO
- Health Equity Accreditation, Medicaid HMO
NCQA’s Medicaid Health Plan Ratings 2024
The National Committee for Quality Assurance (NCQA®) is a private, nonprofit organization. They help to improve health care quality. NCQA accredits and certifies a wide range of health care organizations. They also recognize providers in key clinical areas. NCQA HEDIS is the most widely used performance measurement tool in health care. Info to help consumers, employers and others make health care choices can be found at NCQA.org.
Nebraska Total Care scored of 3 out of 5 for Patient Experience. Nebraska Total Care was rated 3.5 out of 5 overall in NCQA Medicaid Health Plan Ratings 2024.
Nebraska Total Care needs to know what members think about our plan. This helps us meet your needs.
We do a member survey each year. It is the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).
The results show us how members feel about Nebraska Total Care. It shows us how they feel about providers. We use the results to help improve care.
The areas we are trying to improve the most are:
- Care coordination.
- Rating of personal doctor.
- Rating of health plan.
Results
These are results of the survey. If you need help understanding the results call Member Services. Call 1-844-385-2192 (TTY 711). Talk to the Quality Department.
Survey Composite or Question | 2022 | 2023 | 2024 | Benchmark* |
|---|---|---|---|---|
Getting Needed Care Composite | 87.2% | 87.7% | 85.7% | 84.5% |
Getting Care Quickly Composite | 86.0% | 87.1% | 84.9% | 84.9% |
How Well Doctors Communicate Composite | 95.6% | 96.0% | 93.1% | 94.0% |
Customer Service Composite | 92.4% | 91.1% | 89.6% | 91.1% |
Coordination of Care | 87.7% | 92.7% | 83.5% | 87.2% |
Rating of health care | 73.2% | 80.5% | 75.0% | 77.7% |
Rating of Personal Doctor | 84.6% | 87.5% | 84.8% | 84.9% |
Rating of Specialist | 83.3% | 85.7% | 84.8% | 84.4% |
Rating of health plan | 76.8 | 81.0% | 78.5% | 80.9% |
*Benchmark is based on NCQA National Percentiles from 2023 Quality Compass 75th percentile. Based on rating of questions (% 8, 9 or 10).
We know better healthcare is important to you. Nebraska Total Care works with the Heritage Health Program. We partner on projects to make services better. The goal is to improve the health and wellness of all members. Below are the PIP projects:
- Increasing Chlamydia Screening Rates in Sexually Active Women Ages 16-24 Years
- Implementing targeted interventions in sexually active women ages 16-24 years to increase chlamydia screening rates by 3% over the 2024 baseline measurement year by 12/31/2026.
- Health Risk Screen Completion in Pregnant Members
- Implementing targeted interventions for pregnant members to increase the completion rate of state required HRS forms within the first 21 calendar days of MCO assignment or confirmed pregnancy by 20% over the 2024 baseline measurement year by 12/31/2026.
*Baseline data is collected in 2024. Interventions will begin in 2025-2026.
Our goal
Our goal is to improve your health. We use many programs to improve services.
Please call Member Services if you:
- Have questions about this report
- Have questions about our programs
- Have ideas about how we can do better
Call 1-844-385-2192 (TTY 711). Talk to the Quality Department.