TennCare Managed Care Organizations Show Continued Improvement in 2011 Report

NASHVILLE — The Bureau of TennCare today announced the results of the 2011 HEDIS/CAHPS Report: A Comparative Analysis of Audited Results from TennCare Managed Care Organizations (MCOs). Once again, the state performed well in the area of child health, with statewide weighted average scores exceeding the 2010 national Medicaid average for measures such as childhood immunization status, lead screening in children, appropriate testing for children with pharyngitis, use of appropriate medications for people with asthma and children and adolescents’ access to primary care practitioners.

Improvement was also noted in measures related to women’s health, including timeliness and frequency of prenatal care and rates of screening for breast cancer, cervical cancer and chlamydia.

Following the integration of behavioral and physical health care services, TennCare continues to experience improved performance related to a variety of behavioral health measures including rates of follow-up for children prescribed ADHD medications, follow-up after hospitalization for mental illness and initiation and ongoing treatment of alcohol and drug dependence treatment. For example, the weighted state rate for initiation of treatment in 13-17-year olds newly diagnosed with alcohol or other drug dependence was 63.6 percent – an improvement over last year’s 59.3 percent and well above the national Medicaid average of 42.5 percent.

“We are pleased to continue to see improvements in many health measures reported by our MCOs. Our continuous goal is to provide high-quality cost-effective care in order to meet the health care needs of our members while getting the best value for tax-payer dollars. Public reporting of these measures allows us to track our considerable progress, while identifying ongoing areas for improvement,” said TennCare Director Darin Gordon.

Since TennCare’s inception, the Bureau has implemented a number of efforts to enhance the quality of health care provided by the state of Tennessee. Many of these efforts involve evaluating the state’s managed care organizations to make sure they are meeting the needs of TennCare’s enrollees—relying upon objective measurements to drive innovation and value. Although widely used in the commercial market, in 2006 Tennessee became the first state in the country to require National Committee on Quality Assurance (NCQA) certification across its Medicaid managed care network.

NCQA is an independent, nonprofit organization that assesses and scores managed care organization performance in the areas of quality improvement, utilization management, provider credentialing and member rights and responsibilities. As part of the NCQA accreditation process, TennCare MCOs are also required to report a full Health Care Effectiveness Data and Information Set (HEDIS). HEDIS is a set of standardized performance measures that makes it possible to track performance over time, compare MCO performance to national benchmarks and compare performance across MCOs on an “apples-to-apples” basis.

Included in HEDIS is the Consumer Assessment of Health Care Providers and Systems (CAHPS), which is a set of standardized surveys used to measure members’ satisfaction with their care. It is a survey tool used widely for measuring consumer satisfaction with the quality of care and customer service provided by health plans.