Quality Improvement Interview: Capital Health Plan

Since 2009, Tallahassee-based Capital Health Plan has been ranked among the top five commercial plans by NCQA. Capital came in as the third-highest ranked commercial plan in the nation for 2012-2013, continuing its trend of consistently exceptional quality performance. The health plan is also demonstrating marked quality improvement on the Medicare side:  It has been ranked among the top ten Medicare plans since 2008.

Nancy Van Vessem, M.D., Capital’s chief medical officer, attributes the plan’s performance to a range of factors, one of the most important being the maintenance of a focused and coordinated approach.

A health plan must have the desire to strive for high quality as measured by the NCQA standards,” and this focus must be written into a strategic plan, she says.

Every year, Capital staff and physicians reprioritize their performance strategy, focusing on measures that are most important to the health of their members. Many of these measures, relating to conditions such as diabetes and ischemic vascular disease, focus on disease management. The health plan’s extensive attention to these measures is evidenced in its performance – among diabetes measures, the plan is at or above the 90th percentile.

Chronic disease registries have been instrumental in maintaining adherence to quality measures by facilitating consistent screenings, leading to early detection and disease avoidance and ensuring that the most relevant, up-to-date information is available to physicians and specialists.

These registries — accessible through CHPConnect, Capital’s electronic portal — provide detailed lab information on patients, enabling physicians to coordinate care and monitor patients’ statuses. Thirty-five percent of patients are seen within Capital’s staff model, while the electronic medical record provides further assistance in reminding staff about needed care – both during the course of office visits and reminders between visits.

If patients are not getting the advised labs and have not responded to reminders, Capital will directly contact the patients with a letter, followed by a lab slip. If the patients use the lab slip and have their testing done, both the member and the primary care physician receive the results of the tests. This type of intervention, exhibiting a level of engagement unusual for a health plan, is central to keeping patients’ chronic conditions under control and preventing serious complications.

Many of these processes were already in play when NCQA started publishing their rankings in 2005, says Dr. Van Vessem. The plan has been highly-ranked since then on a variety of measures, including colorectal cancer screening, for which Capital has been ranked number one for all but one year that measure has been used. The colorectal cancer screening program started in 2002 – several years before the actual HEDIS® screening measure was developed – when physicians and staff noticed that screening rates were low (NCQA rankings are based upon HEDIS measures).

Dr. Van Vessem emphasizes that Capital follows a logical approach of monitoring HEDIS® measures throughout the year, identifying potential areas of improvement and communicating priorities to staff. By using EHRs to monitor patients, pull relevant data and follow up with patients, Capital has organized a work plan that prioritizes members’ health and wellness.

The evidence of its success is in the numbers.

Photograph courtesy of Capital Health Plan.


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