By: Anthony Matrisciano
October 7, 2011
Annual HEDIS® report shows improvements in key health areas
Wilkes-Barre, PA, October 7, 2011, - The First Priority Health (FPH) HMO plans offered by Blue Cross of Northeastern Pennsylvania (BCNEPA) have once again achieved high marks from our members as part of the 2011 annual health plan assessment by the National Committee for Quality Assurance (NCQA), as part of the NCQA’s 2011 annual assessment of health plans. Member Satisfaction is a measure of how quickly and easily members have access to care, how satisfied members are with their physicians and how pleased members are with the health plan’s services, such as handling claims and customer service. Overall, FPH plans received a ‘Commendable’ Accreditation rating from NCQA.
Since 1987, FPH has offered employers cost-effective heath care solutions through a comprehensive network of physicians and facilities that meet the health care needs of their employees.
“Our customers look to FPH to provide access to high quality care at affordable prices for their employees,” said Leo M. Hartz, MD, MHM, Vice President and Interim Chief Medical Officer forBCNEPA. “At FPH, we are always working to ensure that members do receive the best care, and that their claims are handled efficiently. To achieve the highest ranking for Member Satisfaction demonstrates that we were successful.”
Areas of Improvement
In addition to ranking highest in member satisfaction, the plans were found to have improved in several key measures of health care quality.
Prevention & Screening
Among FPH’s key areas of improvement were prevention and screening activities. According to the HEDIS data, FPH members showed improvements in the rate of colorectal cancer screenings, which increased by 5.65 percentage points, and the rate of flu shots for adults ages 50-64, which increased by 3.98 percentage points.
Screenings for women, such as breast cancer and cervical cancer screenings, remained stable, with rates increasing less than 1 percentage point.
“Preventive measures and early detection through screenings can help improve the chances of avoiding a disease or treating a disease successfully,” said Dr. Hartz. “We know that with cancer specifically, the earlier the cancer is found, the better the outcome for the patient.”
BCNEPA communicates directly with FPH members to encourage them to get regular screenings and tests. According to Dr. Hartz, “We send letters to female members to remind them when it’s time for their annual mammograms. We also let physicians know if any of their patients have not gotten a recommended mammogram so the physician can remind the patient as well.”
To help better manage respiratory conditions, the use of spirometry testing in the assessment and diagnosis of COPD increased 7.43 percentage points. “Spirometry is a simple, yet effective, test that can be done in a doctor’s office,” said Dr. Joseph Koval, Medical Director for Quality Management and a Board Certified Specialist in Pulmonary Medicine at BCNEPA. “It is very useful in diagnosing lung disease, such as ChronicObstructivePulmonaryDisease(COPD), which can be successfully treated when caught early.”
Additionally, the number of children with FPH coverage who received a strep test increased 2.61 percentage points, and those who received appropriate treatment for upper respiratory infection remained stable, increasing by 1 percentage point.
Cardiovascular Disease Management
According to Dr. Hartz, controlling LDL, or bad cholesterol, and high blood pressure are important for managing cardiovascular disease. The HEDIS data is showing that FPH members who are keeping their LDL number below 100 increased 2.89 percentage points, and members who are controlling their high blood pressure increased 4.81 percentage points. This is important, said Dr. Hartz, “Because higher numbers of LDL put you at greater risk for blockages in your arteries, which could lead to a stroke or heart attack. High blood pressure puts more strain on the heart and is also a risk factor for a heart attack,” added Dr. Hartz.
Diabetes is a disease that is becoming more and more prevalent. “The good news is that diabetes can be treated and controlled,” said Dr. Hartz. “And a good way to help control diabetes and its complications is through regular testing, such as with HbA1c tests, cholesterol screenings and eye exams.”
HbA1c testing among FPH members remained stable, the number of diabetics with FPH coverage with an LDL less than 100 increased by 3.49 percentage points and those controlling their blood pressure increased 2.94 percentage points. FPH members who are diabetic also increased their rate for receiving eye exams by 3.63 percentage points.
FPH Members Benefiting from Results
Overall, Dr. Hartz says he is very encouraged to see more members taking advantage of screenings and testing that can help improve their health. “That is why the HEDIS data is important,” he says. “Not only can we see where we are being successful, but also what we need to do better to help our members stay healthy.”
Some of the steps that BCNEPA is planning to implement as a result of the latest HEDIS data include working closely with physicians to help members receive preventive screenings and better manage chronic diseases, as well as more frequent and targeted outreach to members with conditions such as diabetes and heart disease and reminders to parents about recommended childhood immunizations.
About Blue Cross of Northeastern Pennsylvania
Blue Cross of Northeastern Pennsylvania is an independent licensee of the Blue Cross and Blue Shield Association headquartered in Wilkes-Barre. It offers a comprehensive portfolio of health insurance products and administrative services to approximately 600,000 individuals in 13 counties in northeastern and north central Pennsylvania. The company’s mission is to provide innovative solutions that support more affordable health care, promote personal accountability for health and wellness, and offer superior service and partnership to employers, members, and providers.
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.