Program Evaluation
Nebraska Total Care is always working to make health care better for you. Our Quality Improvement (QI) Program is an important part of your plan. We want to help you get healthy. We want to help you stay healthy.
We want to make sure:
- Services are good quality
- Services are safe
Anyone who gets coverage from Nebraska Total Care is a “member”. In 2023 we had more than 130,000 Medicaid members. Our job was to help them get the services they needed to be healthy.
Our Quality Department is in charge of the QI Program. Our Medical Director supervises all of the QI activities. All of the Nebraska Total Care staff help make services better.
Quality activities look at your health in different ways. Some of our activities focus on:
- Care to prevent illness
- Care in serious situations
- Long-term care
- Behavioral health
- Making sure that everyone gets the right amount of services
- Make sure all of your services work together
- Safety
All of these activities are to make sure that you get the highest quality of care.
You can have more information about the QI Program. Call Member Services. The phone number is 1-844-385-2192 (TTY 711). Ask to talk to the Quality Department.
We can:
- Answer questions about the QI Program
- Tell you about our goals
- Tell you how well we are meeting our goals
- Give you a copy of Nebraska Total Care's Quality Improvement 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®. Every year, Nebraska Total Care will be measured on HEDIS goals. This will tell us where to do better.
Nebraska Total Care reviews the services members got. We will use this information to set goals to improve healthcare for our members.
Measure | HEDIS Measures | MY2022 FINAL | MY2021 FINAL | 2022 QC National Average |
|---|---|---|---|---|
AAB | AAB- Avoidance of Antibiotic Treatment for Acute Bronchitis | 10.11 | 53.06 | 55.67 |
AAP | Adults Access to Preventive / Ambulatory Health Services (total) | 82.40 | 85.75 | 75.81 |
ADD-m | ADD- Initiation phase - follow up visits after initiation of ADHD medications | 43.99 | 40.68 | 39.67 |
ADD-m | ADD- Continuation and Maintenance - follow up visits after initiation of ADHD medications | 54.15 | 48.39 | 50.00 |
AMM-c | Antidepressant Medication Management - Continuation phase | 45.37 | 47.12 | 44.06 |
AMM-A | Antidepressant Medication Management - Acute Phase | 62.14 | 64.57 | 60.8 |
AMR | AMR -Asthma Medication Ratio (total) | 75.92 | 71.99 | 64.86 |
APM | APM- Metabolic Monitoring for Children and Adolescents on Antipsychotics (Glucose & Cholesterol) | 28.97 | 25.92 | 36.57 |
APP | APP- First Line Psychosocial Care for Children and Adolescents on Antipsychotics | 56.22 | 57.23 | 58.62 |
BCS | BCS- Breast Cancer Screening | 54.65 | 54.48 | 51.00 |
CBP | CBP- Controlling High Blood Pressure | 67.64 | 61.31 | 58.63 |
CCS | CCS- Cervical Cancer Screening | 61.80 | 58.39 | 56.26 |
CDC eye | CDC- Comprehensive Diabetes Care - Eye Exam | 58.39 | 57.66 | 50.81 |
CDC HbA1C <8 | CDC- Comprehensive Diabetes Care - HbA1c controlled (<8%) | 52.07 | 51.82 | 48.33 |
CDC-BP | CDC- Comprehensive Diabetes Care- BP Control <140/90 | 69.59 | 66.91 | 60.29 |
CHL | Chlamydia Screening in Women (total) | 36.07 | 34.22 | 55.25 |
CIS 10 | CIS-Childhood Immunization Status: Combo 10 | 42.82 | 47.45 | 35.86 |
COU | COU- Continued Opioid Use -31 days rate | 4.02 | 4.10 | 3.64 |
CWP | Appropriate Testing for Pharyngitis (total) | 67.15 | 68.15 | 67.61 |
FUA | FUA - follow up after ED visit for substance abuse issue – 7 day / 30 day | 29.34 | 16.20 | 13.35 |
FUH | FUH – follow up after acute inpatient psych inpatient stay - 7day / 30 day | 42.09 | 34.49 | 38.44 |
FUI | Follow-up After High-Intensity Care for Substance Use Disorder - 7 Day / 30 day | 29.56 | 25.08 | 30.36 |
FUM | FUM - follow up after ED visit for mental health issue - 7 day / 30 day | 39.42 | 43.33 | 40.08 |
HDO | HDO - Use of Opioids at High Dosage (smaller % is better) | 2.04 | 2.39 | 6.64 |
IET-e | IET Engagement in treatment for alcohol/drugs (total) | 12.82 | 13.35 | 11.26 |
IET-i | IET Initiation in treatment for alcohol/drugs (total) | 39.14 | 43.62 | 44.16 |
IMA 2 | IMA - Adolescent Immunization: Combo 2 | 27.49 | 33.33 | 36.11 |
KED | Kidney Health Evaluation for Patients with Diabetes | 31.69 | 30.76 | 33.45 |
LBP | Use of Imaging studies for low Back pain | 74.09 | 73.55 | 74.53 |
LSC | Lead Screening in Children | 68.15 | 68.94 | 62.26 |
PBH | Persistence of Beta – Blocker | 87.23 | 76.67 | 80.74 |
PCE | PCE -Pharmacotherapy Management of COPD Exacerbation | 82.50 | 87.89 | 82.65 |
POD | Pharmacotherapy for Opioid Use Disorder | 40.18 | 37.82 | 28.00 |
PPC-pp | PPC- Postpartum Care | 83.45 | 76.16 | 76.18 |
PPC-t | PPC- Prenatal Care timeliness | 79.08 | 77.86 | 83.53 |
SAA | SAA- Adherence to Antipsychotic Medications for Individuals with Schizophrenia | 61.39 | 64.82 | 59.65 |
SMC | Cardiovascular Monitoring for People with Schizophrenia | 77.78 | 75.00 | 74.92 |
SMD | Diabetes Monitoring for People with Schizophrenia | 61.82 | 65.48 | 67.13 |
SPC-a | SPC - Statin Therapy for patients with cardiovascular disease – 80% adherence | 74.93 | 74.30 | 70.21 |
SPC-t | SPC - Statin Therapy for patients with cardiovascular disease - initial | 82.06 | 86.89 | 78.48 |
SPD-a | SPD - Statin Therapy 80% adherence for patients with diabetes | 70.96 | 69.31 | 66.19 |
SPD-t | SPD - Statin Therapy for patients with diabetes - received | 69.13 | 69.46 | 64.70 |
SSD | SSD - Diabetes Screening for Schizophrenia or Bipolar Disorder Using Antipsychotic Medications | 79.60 | 80.94 | 79.20 |
SPR | Use of Spirometry Testing | 28.03 | 22.41 | 24.80 |
UOP | UP - Use of Opioids from Multiple Providers/Pharmacies (smaller % is better) | 2.14 | 2.16 | 2.11 |
URI | Appropriate Tx for Upper Respiratory Infection | 88.04 | 87.74 | 89.56 |
W30 | Well-Child Visits in the First 30 Months of Life (age 15mo / age 15 to 30 months) | 67.06 | 65.23 | 54.10 |
WCV | Child and Adolescent Well-Care Visits | 46.14 | 47.73 | 49.49 |
WCC-BMI | WCC - Weight Assessment for Children/Adolescents –BMI Total | 70.80 | 69.34 | 76.11 |
WCC-Counseling Nutrition | WCC - Weight Assessment for Children/Adolescents –Counseling Nutrition (total) | 65.59 | 55.96 | 69.18 |
WCC-Counseling Physical | WCC - Weight Assessment for Children/Adolescents –Counseling Physical Activity (total) | 67.64 | 57.18 | 66.72 |
*National Average based on NCQA Quality Compass 2022 National Benchmark
There are groups that make rules for health plans. Those rules are to protect members. They help you get good care.
One group that looks at our plan is called National Committee for Quality Assurance Accreditation (NCQA®). They check to see if we meet their rules. If we do, they say we have “accreditation.”
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 2023
The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS® is the most widely used performance measurement tool in health care. The NCQA website contains information to help consumers, employers and others make informed health care choices
.Nebraska Total Care received a score of 5 out of 5 for Patient Experience and was rated 4 out of 5 overall in NCQA’s Medicaid Health Plan Ratings 2023.
Nebraska Total Care needs to know what members think about our plan. This helps us meet your needs.
We do a member survey every year. The survey is called 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.
We do a CAHPS® survey every year. The areas we are trying to improve the most are:
- Treat With Courtesy and Respect
- Rating of Health Care: how members perceive their care received
Results
These are some of the results of the survey. If you need help understanding the results call Member Services. The phone number is 1-844-385-2192 (TTY 711). Ask to talk to the Quality Department.
Survey Composite or Question | 2021 | 2022 | 2023 | Benchmark* |
|---|---|---|---|---|
Getting Needed Care Composite | 91.4% | 87.2% | 87.7% | 81.9% |
Getting Care Quickly Composite | 92.4% | 86.0% | 87.1% | 80.2% |
How Well Doctors Communicate Composite | 94.6% | 95.6% | 96.0% | 92.5% |
Customer Service Composite | 92.3% | 92.4% | 91.1% | 88.9% |
Coordination of Care | 91.6% | 87.7% | 92.7% | 84.0% |
Rating of health care | 84.0% | 73.2% | 80.5% | 75.4% |
Rating of Personal Doctor | 89.3% | 84.6% | 87.5% | 82.4% |
Rating of Specialist | 85.9% | 83.3% | 85.7% | 83.5% |
Rating of health plan | 84.6% | 76.8 | 81.0% | 78.0% |
*Benchmark based on NCQA National Percentiles from 2022 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 Nebraska’s Heritage Health Program and partners on projects to make improvements. These projects target key issues in healthcare. The goal is to improve the health and wellness of the population. Below are the projects:
- Plan All Cause Readmission
- Assisting members after a hospitalization to follow the discharge and follow up plan of care to reduce an avoidable hospital readmission.
- Notification of Pregnancy (NOP)
- Increasing Notification of Pregnancy (NOP) for Nebraska Total Care pregnant Members.
Our goal
Our goal is to improve our members’ health. We do this by improving services. We will use many different 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
The phone number is 1-844-385-2192 (TTY 711). Ask to talk to the Quality Department.