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First Priority Health Improves in Key Health Areas Annual HEDIS® report shows health plan maintains ‘Commendable’ Accreditation

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By: Anthony Matrisciano
October 1, 2012

The First Priority Health (FPH) HMO plans offered by Blue Cross of Northeastern Pennsylvania (BCNEPA) have once again improved in key health areas as part of the annual health plan assessment by the National Committee for Quality Assurance (NCQA).  FPH improved its score in nine categories:

  • Members receiving comprehensive diabetes care
  • Childhood immunizations
  • Infant, Pediatric and Adolescent Well Visits
  • Treatment of children with pharyngitis and upper respiratory infection
  • Cancer screenings and cholesterol screening
  • 7-day follow-up after a behavioral health hospitalization
  • Follow-up for children with ADHD
  • Use of imaging for low-back pain
  • Medical assistance with tobacco use cessation for patients.

FPH continues to do very well in the Consumer Assessment of Healthcare Providers and System (CAHPS) measures and received a four-star rating for member satisfaction.  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.

“At FPH, we’re always working to ensure that members receive the best care,” said Dr. Nina Taggart, BCNEPA’s vice president of clinical operations and Chief Medical Officer.  “To see that we improved in such critical areas as prevention and screening, cardiovascular disease management and diabetes management shows that our efforts are successful.”  

Areas of Improvement

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, medical assistance with smoking and tobacco use cessation, adult BMI assessment, and screenings for women (such as breast cancer, cervical cancer and Chlamydia screenings).

Key health areas for children, such as well visits, weight assessment (BMI) and counseling for physical activity, combination 2 childhood immunizations (all immunizations except the pneumococcal vaccines), appropriate testing for pharyngitis (Strep Test) and appropriate treatment of upper respiratory infections also showed improvement.

“Preventive measures and early detection through screenings improve the chances of avoiding a disease or treating a disease successfully,” said Dr. Taggart.  “And well visits, weight assessment and immunizations for children ensure that they are growing up healthy.”

BCNEPA communicates directly with FPH members to encourage them to get regular screenings and tests.  According to Dr. Taggart, “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.”

Cardiovascular Disease Management

The HEDIS data shows that the number of FPH members with cardiovascular disease who received LDL screenings and the persistence of beta-blocker treatment after a heart attack improved.  “LDL is often referred to as ‘bad’ cholesterol.  When members know their numbers through screening, they can better manage their cholesterol, which is a key risk factor for cardiovascular disease,” said Dr. Taggart.

Diabetes Management

Diabetes is a disease that is becoming more and more prevalent.  “The good news is that diabetes can be treated and controlled,” said Dr. Taggart.  “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.”

The HEDIS data shows that FPH improved in HbA1c testing, eye exams, LDL screening, LDL control and medical attention for nephropathy for diabetes patients.

FPH Members Benefiting from Results

Overall, Dr. Taggart is encouraged to see more members taking advantage of screenings and testing that can help improve their health.  “That’s why the HEDIS data is so important,” she says.  “Not only can we see where we are being successful, but we also see what we can do better to help our members stay healthy.”

As a result of the latest HEDIS data, BCNEPA’s ongoing improvement plan includes working more closely with physicians to help members receive preventive screenings and better manage chronic diseases, as well as increasing targeted outreach to members with conditions such as diabetes and heart disease and to parents about recommended childhood immunizations.  The use of Blue Health Solutions health coach and disease management programs will also be promoted to support and educate members about wellness and/or chronic disease.

About Blue Cross of Northeastern Pennsylvania

Headquartered in Wilkes-Barre, Blue Cross of Northeastern Pennsylvania is an independent licensee of the Blue Cross and Blue Shield Association.  BCNEPA offers a comprehensive portfolio of health insurance products and administrative services to more than 540,000 individuals in 13 counties in northeastern and north central Pennsylvania.  The company’s mission is to provide integrated health care services and products to improve the quality, accessibility and affordability of health care in the populations we serve. 

About NCQA

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.