Progress on meeting quality goals

Each year, Prominence Health Plan measures how close it is to meeting its goals. The goal is to be better than 75% of other health plans in HEDIS and CAHPS measures. While goals were not met in 2017, improvements were observed as a result of the many initiatives that were put in place throughout the year.

HEDIS Progress

There were a total of 36 measures for the commercial line of business. Due to small denominators, Prominence Health Plan was unable to report data for seven of these measures. Overall, Prominence Health Plan observed improvements in 14 of the 36 measures (39%) when compared to the previous year. The goal was met for five of these measures (13%).

For the Medicare line of business, in addition to the goal stated above, Prominence Health Plan also monitors STAR rating measures that are based on specifications from the Centers for Medicare and Medicaid Services (CMS). The goal is to achieve four stars or above.

There were a total of 23 measures of which 11 were also STAR measures. The results were as follows:

  • The 75th percentile goal was met in four of the 23 measures in Nevada and in two of the 23 measures in Texas.
  • Improvements were observed in all measures except for two (91%) in Nevada.
  • Improvements were observed in 10 out of 23 measures (43%) in Texas.
  • Four of 11 measures (36%) achieved three stars in Nevada and in Texas.

CAHPS Progress

Prominence Health Plan contracted with an NCQA-certified vendor to field the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for both commercial and Medicare plans. The survey is sent to members’ homes during the spring of every year.

For 2017, Prominence Health Plan’s results were as follows:

  • There were nine measures for the commercial line of business. The goal was not met on any of the measures; however, improvements were observed in seven of the nine measures (78%).
  • For the Medicare line of business, there were ten measures of which eight were also STAR measures. Two measures in Nevada met the goal while one in Texas met the goal.
  • Six of the ten measures (60%) improved in Nevada when compared to the previous year. No trending data was available for Texas.
  • Only one measure in Texas achieved three stars.

Prominence Health Plan has an aggressive plan in place to continue its improvements on these areas.