Michigan Department of Community Health

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• Michigan Department of Community Health
• CAHPS Final Report
• Medicaid Adult Survey (MAS)
• 2008 Results

Presented by The Myers Group
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Presentation Topics

• Participating Michigan Department of Community
  Health (MDCH) health plans and response rates
• Demographic comparisons
• CAHPS 4.0H Changes and Impact
• Comparison of MDCH plans and national benchmarks
• Key Drivers of Rating of Health Plan, Health
  Care, and Personal Doctor
• Conclusions/Recommendations

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2008 Medicaid Adult CAHPS Results

• Participating Plans and Response Rates

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Plans Included in Aggregate Results

• BlueCaid of Michigan (BCD)
• Care Source Michigan (CSM)
• Great Lakes Health Plan (GLH)
• Health Plan of Michigan (HPM)
• HealthPlus Partners (HPP)
• McLaren Health Plan (MCL)
• Midwest Health Plan (MID)
• Molina Healthcare of Michigan (MOL)
• OmniCare Health Plan (OCH)
• Physicians Health Plan of Mid Michigan Family
  Care (PMD)
• Priority Health Government Programs (PRI)
• Total Health Care (THC)
• Upper Peninsula Health Plan (UPP)

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NCQA Protocol

• NCQA allows for a mixed (mail and phone) or mail
  only protocol.
• Mixed 2 questionnaires, postcard reminders
  after each questionnaire mailing, and telephone
  follow-up.
• Mail-Only 3 questionnaires with 2 postcard
  reminders after the first two questionnaire
  mailings.
• All MDCH health plans, except Priority Health
  chose to administer the mixed protocol.

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Samples and Response Rates

• The NCQA required sample size for the Medicaid
  Adult Survey is 1,350. NCQA allows plans to
  over-sample.
• Response Rates are calculated as total completed
  surveys divided by sample size (less ineligible
  surveys).Completed mail and telephone surveys
  Response rate
• Sample size Ineligible surveys
• Ineligible surveys include the deceased, those
  who do not meet the eligible population criteria,
  respondents with a language barrier, and
  respondents who are mentally or physically
  incapacitated.
• The 2008 MDCH Medicaid Adult Aggregate response
  rate was 30.6.

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Sample Size and Response Rates
Indicates over-sampled
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2008 Medicaid Adult Survey CAHPS Results

• Demographics

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Demographic Observations

• The Myers Group has observed that the
  demographics of a response group may have an
  effect of the overall satisfaction results
• Older members tend to give higher ratings of
  overall satisfaction.
• More educated members tend to give lower ratings
  of overall satisfaction.
• Members who report better health status tend to
  give higher ratings of overall satisfaction.

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Demographic Comparisons
h i indicates significant difference between 2008
results and benchmarks and/or 2007 results 1
indicates no significant difference between 2008
results and benchmarks and/or 2007 results.
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Demographic Trending

• In comparing 2008 demographics to those from 2007
  and 2006, we see the following significant
  changes.
• Gender Increase in proportion of male
  respondents (2006) Decrease in proportion of
  female respondents (2006)
• Age Increase in 18-34 (2007) Decreases in 35-44
  (2007, 2006) Increase in 55 or older (2006)
• Health Status Decrease in Excellent/Very good
  status (2007) Increase in Good status (2007)

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2008 Medicaid Adult Survey CAHPS Results

• CAHPS 4.0H Changes and Impact

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2008 CAHPS 4.0H Changes

• Question 29 was removed from the Customer Service
  composite.
• The Shared Decision Making composite will not be
  calculated using rolling average methodology.
  Additionally, the Summary Rate for the Shared
  Decision Making composite and attributes is now
  the percentage of respondents answering
  Definitely Yes.

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Impact on 2008 Medicaid Adult Survey CAHPS

• The Customer Service composite will now only
  include two questions getting information or
  help needed from customer service as well as
  being treated with courtesy and respect.
• Trending for the Customer Service and Shared
  Decision Making composites and attributes will be
  recalculated based on 2008 results.

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2008 Medicaid Adult Survey CAHPS Results

• Understanding Benchmarks and Results

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National Benchmarks

• Quality Compass 2007 (Medicaid Adult Public
  Report) is the collection of CAHPS 4.0H mean
  summary ratings of the 108 Medicaid Adult samples
  that chose to report their score publicly in
  2007.
• The 2008 Myers Group Medicaid Book of Business
  (TMG BoB) includes all Medicaid adult samples
  (38) that contracted with TMG to administer the
  2008 CAHPS 4.0H survey and submitted data to NCQA.

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Summary Rate

• Throughout this report, results are shown as
  Summary Rates. Summary Rates represent the
  percentage of respondents who answer in the most
  positive way, as defined by NCQA.
• 8-10
• Definitely yes
• Always Usually

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2008 Medicaid Adult Survey CAHPS Results

• Benchmarks and Composite Results

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Getting Needed Care

• The Getting Needed Care composite measures the
  experience patients had in the last 6 months when
  attempting to get care from doctors and
  specialists.
• The Summary Rate represents the percentage of
  Always or Usually responses.
• This composite includes the following survey
  items
• Q23. Ease of getting appointment with specialist
• Q27. Getting care, tests, or treatments you
  thought you needed

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Getting Needed Care
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Getting Care Quickly

• The Getting Care Quickly composite measures the
  patient experience with receiving care and
  getting appointments in a responsible time.
• The Summary Rate represents the percentage of
  Always or Usually responses.
• This composite includes the following survey
  items
• Q4. Obtaining needed care right away
• Q6. Obtaining care when needed, not when needed
  right away

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Getting Care Quickly
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How Well Doctors Communicate

• The How Well Doctors Communicate composite
  measures how well providers listen, explain,
  spend enough time with, and show respect for what
  patients have to say.
• The Summary Rate represents the percentage of
  Always or Usually responses.
• This composite includes the following survey
  items
• Q15. Doctors explaining things in an
  understandable way
• Q16. Doctors listening carefully to you
• Q17. Doctors showing respect for what you had to
  say
• Q18. Doctors spending enough time with you

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How Well Doctors Communicate
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Customer Service

• The Customer Service composite measure patient
  experiences with getting information and customer
  service staff in the last 6 months.
• The Summary Rate represents the percentage of
  Always or Usually responses.
• In 2008, the Customer Service composite only
  includes two questions. Trending for this
  composite will be recalculated based on 2008
  results.
• Due to composite revisions, this composite was
  not publicly reported in Quality Compass 2007.
• This composite includes the following survey
  items
• Q31. Getting information/help from customer
  service
• Q32. Treated with courtesy and respect by
  customer service staff

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Customer Service
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Shared Decision Making

• The Shared Decision Making composite measures the
  patients experience with doctors or providers
  discussing the pros and cons of treatments, and
  asking the patient which choice is best for them.
• The Summary Rate represents the percentage of
  Definitely yes responses.
• This composite was introduced on the 2007 4.0H
  tool and therefore was not publicly reported in
  Quality Compass 2007. The Shared Decision Making
  benchmark will be available in Quality Compass
  2008.
• The Shared Decision Making composite was not
  calculated using rolling average methodology as
  originally projected.
• Due to changes the composite Summary Rate
  definition made in 2008, trending for this
  composite has been recalculated based on 2008
  results.
• This composite includes the following survey
  items
• Q10. Health provider talked about pros and cons
  of choice of treatment
• Q11. Doctor/provider asked which choice was best
  for you

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Shared Decision Making
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Health Promotion and Education

• The Health Promotion and Education measure gauges
  patient experiences with doctor discussion of
  specific actions to prevent illness (Question 8).
• The Summary Rate represents the percentage of
  Always or Usually responses.
• This measure was introduced on the 2007 4.0H tool
  and was not publicly reported in Quality Compass
  2007.

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Health Promotion and Education
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Coordination of Care

• The Coordination of Care measure gauges patient
  perceptions that their personal doctor seemed
  informed and up-to-date about the care the
  patient received from other doctors and health
  providers in the last six months (Question 20).
• The Summary Rate represents the percentage of
  Always or Usually responses.
• This measure was introduced on the 2007 4.0H tool
  and was not publicly reported in Quality Compass
  2007.

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Coordination of Care
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Adult Plan Comparison - Composites
Highest score highlighted Green
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2008 Medicaid Adult Survey CAHPS Results

• Benchmarks and Rating Question Results

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Rating Questions

• There are four rating questions with responses
  scaled 0 to 10 in the Medicaid Adult CAHPS 4.0H
  survey.
• Rating of Health Care (Q12)
• Rating of Personal Doctor (Q21)
• Rating of Specialist (Q25)
• Rating of Health Plan (Q35)
• Zero represents worst possible and 10
  represents best possible. The Summary Rate
  represents the percentage of respondents who
  rated the question an 8, 9, or 10.

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Rating of Health Care
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Rating of Personal Doctor
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Rating of Specialist
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Rating of Health Plan
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Adult Plan Comparison Rating Questions
Highest score highlighted Green
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2008 Medicaid Adult Survey CAHPS Results

• Benchmarks and Effectiveness of Care Measures
  Results

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Effectiveness of Care Measures

• The Effectiveness of Care Measures on the
  Medicaid Adult CAHPS 4.0H survey include the
  Medical Assistance with Smoking Cessation
  measures.
• The Medical Assistance with Smoking Cessation
  measure evaluates three components
• The percentage of smokers who receive advice to
  quit smoking from their practitioner
• The percentage whose practitioner discussed
  smoking cessation medications
• The percentage whose practitioner discussed
  smoking cessation strategies
• The Summary Rate for these measures is the
  percentage of respondents indicating their
  practitioner has advising them to quit smoking
  (ASTQ) or discussed a smoking cessation
  medication or strategy with them on at least one
  occasion in the past 6 months.
• The Summary Rate for these measures is a rolling
  average, which is the combination of two
  consecutive years of data.

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Advising Smokers to Quit (ASTQ)
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Smoking Cessation Medication
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Smoking Cessation Strategies
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Adult Effectiveness of Care Measures
Highest score highlighted Green
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2008 Medicaid Adult Survey CAHPS Results

• Key Driver Analysis

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Key Drivers of Health Plan Rating

• Some composites will impact the overall health
  plan rating among health plan members more than
  others. These are considered Key Drivers.
• Two composites have been identified as Key
  Drivers based on regression analysis of the 2008
  Myers Group Book of Business for Medicaid adult
  plans
• Customer Service (56th percentile, 79.7)
• Getting Needed Care (56th percentile, 77.7)

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Key Driver Rating of Health Plan Comparison to
TMG National Benchmark
h i indicates significant difference between 2008
results and benchmark 1 indicates no significant
difference between 2008 results and benchmark.
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Key Drivers of Health Care Rating

• Some composites will impact the overall health
  care rating among health plan members more than
  others and are considered Key Drivers.
• Three composites have been identified as Key
  Drivers of Rating of Health Care based on
  regression analysis of the 2008 Myers Group Book
  of Business for Medicaid Adult plans
• How Well Doctors Communicate (33rd percentile,
  85.4)
• Shared Decision Making (36th percentile, 59.2)
• Customer Service (56th percentile, 79.7)

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Key Drivers of Rating of Health Care Comparisons
to TMG National Benchmark
h i indicates significant difference between 2008
results and benchmark 1 indicates no significant
difference between 2008 results and benchmark.
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Key Drivers of Personal Doctor Rating

• Some composites will impact the overall personal
  doctor rating among health plan members more than
  others and are considered Key Drivers.
• Two composites have been identified as Key
  Drivers of Rating of Personal Doctor based on
  regression analysis of the 2008 Myers Group Book
  of Business for Medicaid Adult plans
• How Well Doctors Communicate (33rd percentile,
  85.4)
• Coordination of Care (58th percentile, 76.2)

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Key Drivers of Rating of Personal Doctor
Comparisons to TMG National Benchmark
h i indicates significant difference between 2008
results and benchmark 1 indicates no significant
difference between 2008 results and benchmark.
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2008 Medicaid Adult Survey CAHPS Results

• Conclusions and Recommendations

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Conclusions/Recommendations

• When compared to Quality Compass, the MDCH adult
  aggregate scores are
• Significantly above in the composite
  Effectiveness of Care areas of Getting Needed
  Care, Getting Care Quickly, Advising Smokers to
  Quit (ASTQ), and Smoking Cessation Medication.
• Significantly below in the composite rating
  areas of How Well Doctors Communicate, Rating of
  Health Care, Rating of Personal Doctor.
• When compared to TMG Book of Business, the MDCH
  adult aggregate scores are
• Significantly above in the composite, measure,
  Effectiveness of Care areas of Getting Needed
  Care, Getting Care Quickly, Health Promotion and
  Education, Advising Smokers to Quit (ASTQ),
  Smoking Cessation Medication, and Smoking
  Cessation - Strategies.
• Significantly below in the composite rating
  areas How Well Doctors Communicate, Rating of
  Health Care, Rating of Personal Doctor, and
  Rating of Health Plan

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Conclusions/Recommendations (Continued)

• Getting Needed Care is an area for focus. Some
  aspects of this composite should be marketed and
  maintained and others should be monitored.
• Ease of getting appointment with a specialist
  (Q23) was identified as moderately correlated
  (0.350) with rating of health plan.
• Getting care, tests, or treatment necessary (Q27)
  was identified as highly correlated (0.551) with
  rating of health plan.
• Summary Rates for Q23 are significantly above the
  TMG Book of Business benchmark.
• Getting Needed Care has been identified as a Key
  Driver for the Rating of Health Plan when using
  regression analysis of The Myers Groups Book of
  Business (Medicaid).

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Conclusions/Recommendations (Continued)

• Customer Service is an area for focus. Some
  aspects of this composite should be marketed and
  maintained and others should be monitored.
• Q31. Getting information/help from customer
  service (0.532) and Q32. Treated with courtesy
  and respect by customer service staff (0.502) are
  highly correlated with rating of health plan.
• Customer Service has been identified as a Key
  Driver for Rating of Health Plan and Rating of
  Health Care when using regression analysis of The
  Myers Group Book of Business (Medicaid).

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Conclusions/Recommendations (Continued)

• How Well Doctors Communicate is an area for focus
  and improvement.
• When compared to the TMG Book of Business and
  Quality Compass, the MDCA How Well Doctors
  Communicate composite aggregate results are
  significantly below the benchmarks.
• The attributes (questions 15 through 18) are all
  highly correlated to the overall rating of health
  care (0.449 to 0.485) and the overall rating of
  personal doctor (0.637 to 0.705).
• Summary Rates for the following attributes are
  significantly below the TMG Book of Business and
  Quality Compass benchmarks
• Q16. Doctors listening carefully to you
• Q17. Doctors showing respect for what you had to
  say
• The How Well Doctors Communicate composite has
  been identified as a Key Driver for the Rating of
  Health Care and Personal Doctor when using
  regression analysis of The Myers Group Book of
  Business (Medicaid).

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Conclusions/Recommendations (Continued)

• Rating of Personal Doctor is highly correlated
  with overall member satisfaction of health care
  (0.628) and health plan (0.411). This is an area
  for focus.
• The MDCH aggregate Summary Rate for Rating of
  Personal Doctor is significantly lower than the
  TMG Book of Business and Quality Compass
  benchmarks.
• The MDCH aggregate Summary Rate for Rating of
  Personal Doctor is in the 28th and 23rd
  percentiles when compared to the TMG Book of
  Business and Quality Compass benchmarks.

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Conclusions/Recommendations (Continued)

• In an effort to improve member satisfaction with
  health plan, MDCH plans should focus on the areas
  of Getting Needed Care, Customer Service, How
  Well Doctors Communicate, and Rating of Personal
  Doctor. Analysis shows these areas to be most
  closely associated with member satisfaction among
  Medicaid adult survey results.