Quality Improvement Interview: Scott & White Health Plan

For 2012-2013, Scott & White Health Plan received five stars – the highest rating possible – on the Centers for Medicare and Medicaid Services’ (CMS) Medicare Advantage Star Ratings for their Part D plan. The Medicare Part D plan includes prescription drug coverage and is rated on measures such as customer service, member complaints, member experience with the drug plan and patient safety.

According to Charlotte Luebbert, director of Pharmacy Medicare Part D Services at Scott & White, the health plan is excelling in the areas of customer service, member experience and resolving member complaints. Scott & White is an integrated health system, meaning that in addition to a health plan, the organization includes a hospital and clinical provider network. Introducing new initiatives works well in this structure, as there are built-in lines of communication with members and providers.

Communication is integral to efficiency, coordinated efforts and physician buy-in. The plan corresponds with primary care physicians on a quarterly basis, with clinical messaging related to all lines of business. The method is well-received by all providers, Luebbert affirms.

Aided by an in-house customer service department, Scott & White is demonstrating success in improving customer service and keeping member complaints low. Service representatives are well educated on the plan’s Medicare Part D product, and provide members with efficient, accurate and personalized attention.

Another advantage to the plan’s pharmacy customer service department is the background of the representatives: All pharmacy call service agents are pharmacy technicians, meaning they possess a comprehensive understanding of pharmaceutical issues. Luebbert repeatedly emphasizes the importance of understanding to the representatives – the need to understand benefits, how to help members and alternatives at the point of service.

For example, member complaints are routed to specialized agents who are well versed in dealing with Medicare complaints, and who work with members to identify the roots of the issues. With such personalized service complaints are addressed efficiently and quickly.

In the Patient Safety domain, Scott & White has earned five stars on all of the medication adherence measures. These measures relate to Part D benefit design; Scott & White offers a generous maintenance benefit in which members are eligible for reduced copays for 90-day supplies of maintenance medications. Vice President of Pharmacy John Chaddick believes that this serves as an incentive for adherence. The plan’s clinical initiatives focus on making sure benefit designs are cost-conscious and give seniors benefits that encourage compliance.

Chaddick and Luebbert also highlight the plan’s focus on the High Risk Medication (HRM) measure, on which Scott & White’s rating improved from 2012 to 2013. A new initiative identifies and addresses the use of HRMs in the Medication Therapy Management (MTM) population, and provides targeted member and physician education to encourage use of alternative medications. Thanks to the plan’s direct communication with pharmacists, primary care physicians and patients, the initiative will be fully implemented in the next one to two months.

Effective communication is key to a quality member experience, emphasizes Luebbert. It is especially important to make sure that people have access to ample information during the open enrollment period, in which seniors can switch Medicare coverage options.

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ACHP Members Rated Among Top Medicare Plans in the Country

Today, the Centers for Medicare and Medicaid Services (CMS) released its annual Medicare Advantage Star Ratings, a program intended to provide Medicare beneficiaries with additional information about health plans in their area and make quality data more transparent. Twenty-five percent of Medicare enrollees are enrolled in Medicare Advantage plans, which are rated on more than 50 quality measures, derived from multiple sources of data: CMS administrative data on plan quality and member satisfaction; the Consumer Assessment of Healthcare Providers and Systems (CAHPS®); the Healthcare Effectiveness Data and Information Set (HEDIS®); and the Health Outcomes Survey (HOS).

There are 580 Medicare Advantage plans, 46 of which are ACHP members. All Medicare Advantage plans are rated on a one- to five-star scale, with five stars representing excellent performance on the quality measures. Each year, ACHP member plans demonstrate superior performance on the ratings: Of the 11 plans that are rated five stars, eight of them are ACHP members. Thirty Medicare plans operated by ACHP members received five, 4.5 and four stars in the combined 2013 Medicare Advantage and Medicare Part D Star Ratings.

Patricia Smith, ACHP president and CEO, states that “by providing high-quality care and service to millions of Medicare beneficiaries, ACHP members are making sure the federal government – and American taxpayers – are getting the value they demand from Medicare Advantage plans.”

For more information, look to the CMS stars technical guide, released in early September, which includes measure thresholds with which plans can interpret raw scores. A blog post by Health Dialog offers some useful, distilled information on the six key points from the technical guide – in case you would prefer not to read the entire 113-page document. CMS released their latest version in conjunction with the Star Ratings release today.

We will also be releasing additional blog posts in the coming weeks that will focus on specific plans’ performances and other elements of the Star Ratings.