Health Net is a Health Maintenance Organization with 1.3 million members, maintains its role as a leader in the health care industry by recognizing quality of care as the foundation of our medical delivery system. By working together with our provider network, employers and members in a variety of interventions, we are better able to measure and manage quality of care.
Program Description
Narrative Description of Program
Health Net a Health Maintenance Organization with 1.3 million members, maintains its role as a leader in the health care industry by recognizing quality of care as the foundation of our medical delivery system. By working together with our provider network, employers and members in a variety of interventions, we are better able to measure and manage quality of care.
Through the Health Net Quality Initiatives Division, we continue to develop innovative programs to improve quality of care within a cost-effective system. One example, our Quality of Care Improvement Program (QCIP), is a program that rewards providers for delivering high quality of care.
Elements of the QCIP and other Health Net quality improvement programs are highlighted within.
For more detailed information on Health Net's Quality Initiatives Program contact: Dr. Antonio P. Legorreta, M.D., M.P.H. (818) 719-6819
Childhood Immunization Reminder Program
The goal of our Childhood Immunization Reminder Program is to remind parents about the importance of childhood immunizations and to encourage them to get their children fully immunized. To this effort, Health Net sends parents an immunization record to document immunizations (based upon the American Academy of Pediatrics recommended schedule for childhood immunizations). Health Net also mails reminders shortly after birth and at 6, 12 and 18 months. A gift is mailed to parents who submit a copy of their child's completed immunization record to Health Net.
There is evidence suggesting that this type of mail-based program is an effective and efficient way of improving compliance with recommended immunization schedules.
Maternity Report Card
The Maternity Report Card is an instrument that allows us to provide information on obstetric care at the health plan, provider and employer level. This report provides normative data for each of these components which sets benchmarks of performance and targets, as well as monitors, improvements in prenatal care, delivery, outcomes and member satisfaction. The collection of these data is achieved through a written maternity survey instrument with a 75% response rate. This instrument allows us not only to measure prenatal and delivery levels of satisfaction, but also to determine the validity of existing claims an public data bases.
1996 Quality of Care Improvement Program (QCIP)
The Quality of Care Improvement Program (QCIP), is designed to identify and measure specific quality of service, quality of care and data management performance categories at the Participating Medical Group (PMG) level and to financially reward those PMGs that achieve a designated level of performance.
This financial bonus is distributed to PMGs that qualify, based on achieving a minimum benchmark in performance; each PMG must be ranked at least in the 60th percentile for any category measured. Each category is comprised of components that are scored to rank the PMG.
This program not only gives Health Net the opportunity to provide academic feedback at the PMG level, but also serves as an incentive to improve and achieve a sustained effect on quality of care and member satisfaction.
Diabetes Management Care Program (DMCP)
The Diabetes Management Care Program (DCMP) is an intensive intervention integrating a specialized diabetes management team with the support of computer-assisted scheduling, tracking and record-keeping. The DMCP utilizes clinical protocols covering the management and tracking of diabetic patients and also guiding the treatment of diabetes and its complications.
Two provider medical groups participated in this study. Patients were randomly selected for two cohorts: experimental and control. Glycated hemoglobin and health status questionnaire among other data elements were collected at baseline and follow-up.
The experimental cohort at both sites demonstrated a significant decrease in patient glycated hemoglobin levels as depicted on the above graph. Comparison with a control group will be included in a final manuscript.
Existing research suggests that appropriate education and intervention programs such as this one can prevent a substantial number of diabetic-related complications and improve quality of care.
Contact Summary
| General Information | |
|---|---|
| Program Name | Health Net Wellness Program |
| Company Name and Address | Health NetP.O. Box 9103
Van Nuys, CA 91409-9103 |
| Contact Person | Cindy KeitelDirector of Wellness
(818) 719-6832 |
| Program Information | |
| Program Category | Insurance |
| Year begun | 1984 |
| Total number of individual participants | 82,924 (Medical Group Programs)526,826 (Health Net News subscribers) |
| Number of currently actively enrolled | N/A |
| Number of companies/groups involved | 228 Medical Groups750 Employer groups |
| Access to Program | Restricted to developing organizations |
| Data available to external reviewers or investigators | Yes |
| Program targeted at Healthy People 2000 goals |
Yes |
| Program goals (in priority order) | (1) Risk Factor Reduction(2) Health outcome improvement
(3) Cost-effectiveness (4) Cost-benefit |
Evaluation Summary
Narrative Description of Evaluation Results
Health Net provides a wide variety of health promotion and disease management programs and services to over 1.3 million health plan members in California. This comprehensive approach to wellness reaches members at their worksites, their medical providers, their homes and in their communities. Health Net wellness programs have helped thousands of people reach their health goals, whether those goals are to lose weight, handle stress or quit smoking.
Health Net maintains its role as an industry leader in the management and measurement of quality of care through participation in projects such as the NCQA Report Card Pilot and the California Cooperative HEDIS Reporting Initiative (CCHRI). Health Net also leads the way in innovative provider programs which provide information, feedback and incentives for delivering high quality of service, quality of care and wellness programs.
Statistical Highlights
- Perinatal education participants showed expected net savings of $119,000 or $2.9 per targeted woman.
- Breathe Easy smoking cessation program showed a 30% smoking quit rate with only 45% recidivism.
- Rockwell, with an institutionalized wellness program, showed average sick days decline from 2.2 to 1.3 saving $259 per person.
- HIV case management patients had four fewer hospitals days than non-case management.
Wellness Programs at the Medical Group
Health Net and its participating medical groups offer members one of the most extensive networks of health promotion and patient education programs in California. We call our program Aim for Wellness for commercial members and Healthy Aging for Seniority Plus members.
AIM for Wellness
Health Promotion--These programs promote health and prevent disease through seminars, classes, support groups, and screenings. Examples of topics include: Smoking Cessation, Weight Management, Nutrition and Back Care.
Patient Education--These programs help patients to manage their conditions which frequently leads to medical cost reductions. Examples of programs include: Asthma, Diabetes, Early Prenatal Education, Hypertension and Cholesterol Management.
Healthy Aging
Senior Programs--mew programs meet specific lifestyle and health needs of our expanding older population. Participating Medical Groups who are Seniority Plus providers must offer programs specifically designed for older adult members. Topics include: Arthritis, Memory Enhancement, Aging and Sexuality, Loss and Grieving, and Osteoporosis.
Evaluation Documentation
Critique
The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.
Evaluation
Health Net's "Quality Improvement" fifteen point risk reduction program, at 750 client sites and 228 medical locations reaches 1.3 million members. Education helped patients better manage conditions such as asthma, hypertension, high cholesterol and diabetes, produced results such as a 35 percent decrease in the use of oral agents by diabetics. Counseled HIV patients in their Mt. Zion hospital program had 85 hospital days compared to 248 for non-participants.
A largescale and quite comprehensive program. The 30 percent quit rate (of selected smokers) is impressive. They are undertaking what appears to be a well designed evaluation. Targeted toward Healthy People 2000 goals and reducing need and demand for services. Identified cost-savings from prenatal programs are supported by a study. The Rockwell Palmdale Program has good data supporting health risk reduction. They are planning a randomized trial of self-care materials. Overall this is a very good program with evaluation data conducted on three levels (process, impact, and outcome) and is of good quality. There is a broad service mix and emphasis on prevention. There is a well-developed and extensive interaction with participating medical groups, which is excellent as is building wellness requirements and value based incentives into contracts. The program focuses on the most important high cost, high utilization illness and health behaviors.
Evaluation of some program initiatives is not yet complete. The smoke-free program reaches only a small number of the potential people available and results were not exemplary. Presentation of data is somewhat disjointed. There is absence of longitudinal study focusing on risk reduction and medical care costs. There are no good estimates of program cost or saving.