Reassessing Intervention 4 12 9.7 81% Parameters & Strategies Performance Indicator 1 3 3 100% Parameters Performance Indicator Data 4 12 12 100% Analysis Performance Indicator Results 1 3 3 100% Member Population Analysis 2 6 3 50% Conclusions & Future PIP 3 9 7 78% Improvements Validation Rating Score for 3, 19 57 48.7 85% 2, or 1 Values Overall Validation Rating Score 26 64 55.7 87% Update on 2016 Recommendations KEPRO is required by CMS to determine the status of recommendations made in the previous reporting year. An update on recommendations made in 2016 to UnitedHealthcare follows. Calendar Year 2016 Recommendation 2017 Update Care managers telephone members at the UHC reports, to the nature of SCO “Due first and second levels of risk within seven members having a number of health, literacy, days of discharge. There may be a language, co-morbidity, frailty or subpopulation that needs more intensive socioeconomic factors, it is difficult to assess outreach because of literacy needs or which interventions yielded the highest language barriers. KEPRO recommends a effectiveness.” UHC did not provide related review of data to determine any possible data. opportunities that might exist. UHC is to use its data to drill-down on UHC reports, Plan Performance “A the population factors (demographic, clinical, Improvement Project on Health Disparities REL, hospital utilization) to identify key showed no difference in readmission by barriers and their component parts. With language or geographic location across a these assessments, UHC quality committees Massachusetts county adjacent to Boston.” will have better information about how to prioritize interventions that will have maximum impact on the key barriers driving readmission rates. Plan & Project Strengths UHC is commended for including members and pharmacists in the review of its barriers.
Reassessing Intervention Parameters & Strategies 4 12 9.7 81% Performance Indicator Parameters 1 3 3 100% Performance Indicator Data Analysis 4 12 12 100% Performance Indicator Results 1 3 3 100% Member Population Analysis 2 6 3 50% Conclusions & Future PIP Improvements 3 9 7 78% Validation Rating Score for 3, 2, or 1 Values 19 57 48.7 85% Overall Validation Rating Score 26 64 55.7 87% Update on 2016 Recommendations KEPRO is required by CMS to determine the status of recommendations made in the previous reporting year. An update on recommendations made in 2016 to UnitedHealthcare follows. Calendar Year 2016 Recommendation 2017 Update Care managers telephone members at the first and second levels of risk within seven days of discharge. There may be a subpopulation that needs more intensive outreach because of literacy needs or language barriers. KEPRO recommends a review of data to determine any possible opportunities that might exist. UHC reports, “Due to the nature of SCO members having a number of health, literacy, language, co-morbidity, frailty or socioeconomic factors, it is difficult to assess which interventions yielded the highest effectiveness.” UHC did not provide related data. UHC is to use its data to drill-down on the population factors (demographic, clinical, REL, hospital utilization) to identify key barriers and their component parts. With these assessments, UHC quality committees will have better information about how to prioritize interventions that will have maximum impact on the key barriers driving readmission rates. UHC reports, “A Plan Performance Improvement Project on Health Disparities showed no difference in readmission by language or geographic location across a Massachusetts county adjacent to Boston.” Plan & Project Strengths UHC is commended for including members and pharmacists in the review of its barriers.
2017-sco-eqr-technical-report.docx