Our mission is to improve the health
and quality of life of our members
2012
Complex Case Management
Program Evaluation
2012 Complex Case Management Program Evaluation
Table of Contents
Introduction Page 1 Objectives Page 1 Goals Page 1 EvaluationMember Discharge Status Page 2
Goals Met/ Not Met Page 3
Member Survey Results for Satisfaction with Case Management Services
Received Page 3
Member Satisfaction Results for Improvement of Health or Quality of Life Page 4
Barriers/Opportunities Page 5
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2012 Complex Case Management Program Evaluation
Program Title: Complex Case Management (CM) Program Evaluation
Evaluation Period: January 1, 2012 – December 31, 2012
Introduction: To improve the health status and quality of life of members with multiple complex medical conditions while decreasing unnecessary hospitalizations and emergency room (ER) visits by improving member self-management skills, and by increasing adherence of both members and providers with Passport Health Plan’s (PHP) Clinical Practice Guidelines, which are based on current scientific data.
To proactively provide coordination of care and services to members who have experienced a critical event or diagnosis needing the extensive use of resources and who need assistance navigating the health care system.
Program Objectives: • Provide for the collaborative process in assessing, planning, implementing, coordinating, monitoring and evaluating the options and services needed to meet the members’ health and human service needs.
• Improve the health status and quality of life of members with multiple complex medical conditions.
• Decrease unnecessary hospitalizations and ER visits.
• Improve member self-management skills and self-advocacy.
• Provide coordination of care and services to members who have experienced a critical event or diagnosis needing the extensive use of resources and who need assistance navigating the health care system.
Program Goals: • Members who either improved or reached their optimal level of health at discharge for CM.
• Meet or exceed a rate of 90% of goals partially or completely met for members enrolled in CM.
• Maintain a goal of 90% or above in member satisfaction with all areas of CM services.
• Maintain a goal of 75% or above in member's perception of improved overall health status and quality of life.
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Evaluation
I. Member Discharge Status
Goal: Members who either improved or reached their optimal level of health at discharge for CM.
Analysis of Findings:
The graph above represents reasons for member’s discharge from CM during 2011. The top three reasons were:
1) Independent Management of Illness or Condition 2) Optimal Level for Member
3) Medically Stable
There were 55 members discharged due to Case Manager losing contact with the member; 6 members were deceased; and 11 members disenrolled.
0% 10% 20% 30% 40% 50% 60% 70% 1st Qtr 12 2nd Qtr 12 3rd Qtr 12 4th Qtr 12
Member Discharge Status Medically Stable
Independent Mgmt.
Optimal Level
Functional Improvement Unknown
Lost Contact w/Member
Disenrolled Utilization of Resources Other Deceased Resolution Improved Engages Exhausted Resources
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II. Goals Met / Not Met
Goal: Meet or exceed a rate of 90% of goals partially or completely met for members enrolled in CM.
Analysis of Findings:
The graph above represents the percentage of members completing or partially completing their treatment plan goals. Result totals for 2012 for “completed / partially completed” were 97%. The departmental goal of 90% was met.
III. Member Survey Results for Satisfaction with CM Services Received
Goal: Maintain or exceed the goal of 90% or above in member satisfaction with all areas of CM services. 55% 41% 92% 100% 41% 58% 0% 0% 4% 1% 8% 0% 96% 99% 92% 100% 0% 20% 40% 60% 80% 100% 1st Qtr 12 2nd Qtr 12 3rd Qtr 12 4th Qtr 12 P er cen tag e M et Goals Met
Completed Partially Completed Incomplete Completed/Partially Completed
96% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 100% 100% 90% 90% 90% 100% 100% 94% 0% 20% 40% 60% 80% 100% Frequency of Contact Coordination of Care Value of Information Overall Effectiveness Professional Manner Total Member Satisfaction Results for Case Mgmt. Services Received
1st Qtr 12 2nd Qtr 12 3rd Qtr 12 4th Qtr 12
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Analysis of Findings:
The graph above represents member satisfaction with CM. Areas surveyed include: 1) Frequency of contact 2) Professional manner 3) Coordination of care 4) Value of information 5) Overall effectiveness
The goal is 90% for each area. 175 member surveys were distributed, of which 47 were returned yielding a 27% return rate. Results indicate 99% of members who responded to the survey reported satisfaction with frequency of contact, 95% reported professional and courteous manner, 98% reported ability of case manager to help coordinate their care, 98% reported usefulness of information, and 98% reported overall helpfulness. The goal was met in all areas.
IV. Member Satisfaction Results for Improvement of Health or Quality of Life
Goal: Maintain or exceed the goal of 75% or above in member's perception of improved overall health status and quality of life.
Analysis of Findings:
The graph above represents the members’ satisfaction regarding improvement in health or quality of life. Areas surveyed include:
1) Goals set by case manager and member 2) Quality of life
3) Overall health 4) Control of pain
The goal is 75% for all areas. Results indicate 86% of members who responded to the survey reported improvement in quality of life, 83% reported improvement in overall health, and 52% reported better pain control. The goal was not met in all areas.
92% 88% 100% 100% 88% 75% 100% 80% 77% 63% 100% 90% 58% 50% 50% 50% 0% 20% 40% 60% 80% 100% 1st Qtr 12 2nd Qtr 12 3rd Qtr 12 4th Qtr 12
Member Satisfaction Results for Improvement of Health and Quality of Life
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Barriers and Opportunities
Barrier: Inability to locate member for initial assessment or ongoing contact.
Opportunity: • Collaborate with practitioners to encourage member participation and locate additional demographics.
• Member education regarding the benefits of CM through the Member Newsletter.
Barrier: Member unwilling to comply with treatment plan and its completion.
Opportunity: • Member education regarding the benefits of CM through the Member Newsletter.
• Member education regarding the benefits of CM through individualized contact with the member.
• Collaborate with practitioners to encourage member participation.
Barrier: Limited member response to the CM survey.
Opportunity: • Encourage member response to survey at the time of discharge.
• Evaluate question content for ease of understanding.
• Consider a follow-up phone call to complete survey if not returned timely.
Activities for 2013: • Continue all 2012 interventions.
• The Case Managers exhaust all measures to establish and maintain contact with members including calling provider offices, utilizing IMAX to locate current address and phone numbers, and mailing unable to contact letters with business cards attached.
• Review the results of quarterly reporting to identify opportunities to improve the CM process.
• Evaluate satisfaction survey question content for ease of understanding.
• Consider a follow-up phone call to complete satisfaction survey if not returned timely.
• Continue reviewing surveys as received and conduct outreach to those members who indicate “fair” or “poor” responses on their survey (if the member fills out contact information section of the survey tool).
• Monitor for trends, provide feedback both positive and negative to individual staff and address any identified areas that need improvement.
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• Educate members on the benefits of CM services.
• Encourage practitioner involvement with CM.
• Educate members/caregivers regarding CM services through telephonic outreach, member newsletters, on-hold SoundCare messages, the Plan’s website, and member educational material.
• Continue utilizing other reports such as Case Alert, PIF, ER Utilization, Kosair ER, and Hospital admission reports to identify members who could potentially benefit from CM services.
• Collaborate with other departments such as Utilization Management, Member Services, and Provider Relations to identify members who could potentially benefit from CM services.
