It’s not unusual for an overwhelmed parent to forget a child’s immunization appointment, for someone living with diabetes to skip an exam, or for a busy woman to lose track of when she last had a mammogram. The case management team at Hudson Health Plan knows this all too well. That’s why we send postcards to our members reminding them it’s time to see a doctor, or sometimes call them directly and stay on the phone with them while they set up an appointment.

Our strategy of helping members take care of themselves is the key reason Hudson ranked highest in the 2009 Quality Incentive Program, the annual grading of Medicaid managed care plans by the New York State Department of Health (DOH). The top ranking underscores both the professionalism of Hudson’s health care providers, and the hard work and dedication every member of our staff performs daily. Hudson’s model is to deliver cost-effective care—in a culturally appropriate way—to nearly 100,000 members in the six New York state counties we serve.

The DOH’s Office of Health Insurance program annually measures the performance of all 20 Medicaid managed care plans in New York. Hudson scored 135.5 out of 150 points, for a final grade of 90 percent, well above the next highest grade of 79 percent. The emphasis of this annual assessment is on quality of care, and this year’s benchmarks focused on 17 measures, broken into three categories: quality measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures; and compliance measures.

Case Management at Work

The success of the outreach programs Hudson has put into place over the years, including mailings, phone calls to members, and education programs for health care professionals, are reflected in our high Quality Incentive Program scores. In addition, each of our initiatives contributes to the overall health and well-being of our members. The culture at Hudson is always to aim above the norm, and not be content with the status quo. Each day our clinical staff looks for ways to streamline processes to give members access to the best care possible.

Hudson also helps its provider network deliver the same. We know each one of our providers wants to provide quality care; unfortunately, some medical offices do not have adequate systems in place. We began pay-for-performance (P4P) bonus incentives a decade ago to offer financial support to physicians so they can invest in processes and technology that facilitate best practices. Every physician receives an incentive for participating, and since P4P began, we’ve invested more than $3 million in bonus incentives.

We also recognized that P4P might discourage some physicians from treating low-income and minority patients (often their sicker patients, who are less likely to comply with regular testing and examinations), fearing that it could drag down a practice’s quality scores. To fight that, Hudson began a pioneering study on P4P, in which physicians are rewarded when a patient’s health status improves, even if that status falls short of optimal levels. The study is focusing on diabetes management and is funded in part by a grant from the Robert Wood Johnson Foundation.

Hudson’s other quality measures include:

Post-hospital calls. When a member leaves the hospital, we follow up with them within 24 hours to be sure they understand the care instructions they received at checkout. One of the greatest compliments we receive is when a member tells us, “I can’t believe an insurance company is taking such as active role in my care.”

Antibiotic use. Hudson compensates our primary care professionals who take the time to teach their patients about the risks of overuse of antibiotics. It has become common for patients to demand antibiotics for themselves or their children, perhaps because they saw an ad on TV that promised an immediate cure, or their friends told them they need a drug to get better. Many patients do not understand that an antibiotic is not effective for a viral infection. And still others feel that the doctor is not paying attention to their needs if they leave the office without a prescription in hand. To save time, many doctors just write a prescription. We reward our doctors with incentive bonuses for taking the time to teach their patients about proper antibiotic use, explaining how harmful improper prescribing can ultimately be for them, and that overuse of antibiotics has become a public health threat. Our focus is simple: we go that extra step to make it easier for our doctors to provide good care, and in doing so we make it more lucrative for them to provide this care.

Asthma. For children with asthma, Hudson piloted a report to their doctors, detailing certain benchmarks: the child’s hospital stays and emergency room visits; history of prescriptions filled; overuse of asthma rescue medications; and the date the child was last seen in the doctor’s office. Because the hospital bills Hudson directly, in many cases the primary physician is not aware that the child was in the hospital or what type of medication was prescribed. These reports gave the doctors up-to-date information, thereby providing better care for the children.

Work flow. Our physician outreach often extends to helping the doctors optimize their administrative workflow and processes. For instance, Hudson educates providers about how to successfully submit a claim in order to accurately reflect the quality of care delivered to their patients. Many doctors provide great care; they just are not filling out the forms correctly.

When good practices are put into place, Hudson’s providers receive a well-deserved bonus for a job well done. Now, Hudson has been similarly honored by the New York State Department of Health. We expect our approach will become the standard in many other managed care organizations.

Margaret Leonard is Senior Vice President for Clinical Services at Hudson Health Plan, President of CMSA, and member of the National Quality Forum Steering Committee for Care Coordination. (mleonard@hudsonhealthplan.org)