Member First Quality Healthcare

Hometown Health & Senior Care Plus have a robust quality improvement program aimed at enhancing the overall efficiency and effectiveness of its services. At its core, the program focuses on proactive measures to address various aspects of healthcare delivery, including patient outcomes, satisfaction, and cost containment. We find ways to help our members improve their health.

One key component of Hometown Health’s Quality Improvement Program is its emphasis on preventive care and early intervention. By promoting wellness initiatives and encouraging regular screenings and check-ups, the company aims to mitigate health risks and prevent the onset of chronic conditions. This proactive approach not only improves individual health outcomes but also contributes to long-term cost savings by reducing the need for expensive treatments and hospitalizations.

Hometown Health prioritizes patient-centered care by actively soliciting feedback from members and incorporating their perspectives into program development via surveys such as the CAHPS Survey as well as the many member forums we hold throughout the year. This customer-centric approach ensures that the quality improvement efforts align with the needs and preferences of the individuals they serve.

A formal evaluation of the Quality Improvement Program is performed annually. You can request a copy of our quality improvement program description to learn how we are improving care and services for members by contacting Customer Service. You’ll also see the progress we are making toward our quality improvement goals.

The Quality Improvement Committee at Hometown Health serves as a forum for driving continuous improvement initiatives across the organization. Comprising interdisciplinary members including healthcare providers, administrators, quality analysts, and patient representatives, the committee is tasked with overseeing the development, implementation, and evaluation of quality improvement strategies.   By proactively addressing areas for improvement and promoting evidence-based interventions, the committee plays a vital role in advancing the organization’s mission to deliver high-quality, patient-centered care while driving positive outcomes for members and the community at large.

Your health and satisfaction is our main focus. We do this in many ways.

• We are obtaining NCQA accreditation for our Commercial, Exchange and Medicare Advantage plans to ensure we meet the industry standards for quality throughout our organization.
• HEDIS and Stars, which measure Health Plan quality, provide data that compares how we rank nationally and regionally.
• We continuously monitoring standards to see how long it takes our members to get the appropriate care at the appropriate time.
• We monitor phone calls to make sure a member’s needs are met quickly and effectively.
• We also review complaints from our members.
• Focus on annual Targeted Performance Improvement Projects. 2024 PIPs Include:
  • Annual Diabetic Screenings
  • Well Child Checks / Physical Activity & Nutrition Counselling
  • Follow up after ED Visits for patients with Multiple Chronic Conditions
  • Follow up after ED Vistos for Behavioral Health
  • Pediatric Immunizations
  • Statin Use for Members with Cardiovascular Disease
  • Acute Care Readmissions
  • Medication Adherence
• Annual Quality Audits, such as HEDIS and Star Ratings
• Member Experience Surveys
• Annual Review of Provider Quality Performance

Measuring Network Quality Performance:

In addition to focusing on internal quality improvement, Hometown Health places great emphasis on measuring and improving the performance of its network providers.  By evaluating provider performance, the plan can identify high-performing providers and areas for improvement within its network.

Moreover, Hometown Health actively collaborates with its network providers to align efforts with the Quadruple Aim of healthcare, which emphasizes improving patient experience, population health, provider satisfaction, and reducing healthcare costs. This approach involves fostering partnerships with providers to enhance care coordination, promote preventive care initiatives, and implement value-based payment models that incentivize quality and efficiency.

To ensure that its network is working toward the Quadruple Aim, Hometown Health engages in ongoing communication and collaboration with providers. This includes providing support and resources to help providers deliver patient-centered care, implementing data-sharing initiatives to facilitate care coordination, and offering training opportunities to enhance clinical skills and knowledge. By working closely with its network providers, the plan aims to create a healthcare ecosystem that prioritizes the needs of patients while also supporting the well-being and satisfaction of providers

Healthcare Effectiveness Data and Information Set (HEDIS)

Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures developed by the National Committee for Quality Assurance (NCQA) to assess their clinical quality and effectiveness in delivering care. Hometown Health undergoes regular HEDIS audits.  These audits provide an additional layer of validation, focusing on specific metrics related to preventive care, chronic disease management, and patient safety.

For Hometown Health members, the HEDIS audit serves as an assurance of the plan’s commitment to meeting nationally recognized standards of care. The results of these audits are instrumental in identifying areas for improvement and driving targeted interventions to enhance the quality of care provided. By adhering to HEDIS measures, the company ensures that members receive evidence-based, high-quality care that aligns with industry best practices.

HEDIS audits play a crucial role in promoting transparency and accountability within the healthcare system. By publicly reporting their HEDIS results, Hometown Health Insurance Company demonstrates its dedication to transparency and fosters trust among members, providers, and stakeholders. Members can use this information to make informed decisions about their healthcare choices, knowing that their plan is held to rigorous standards of quality and performance.

To learn more about HEDIS, visit NCQA.org.

Centers for Medicare and Medicaid Services (CMS) Star Ratings

The Centers for Medicare and Medicaid Services (CMS) uses a five-star rating system to measure the performance of Medicare Advantage and Part D plans. A plan’s overall star rating is determined by health services such as screenings and vaccines, managing chronic conditions, member experience, member complaints, and customer service. As such, achieving high CMS Star Ratings indicates a commitment to excellence in healthcare delivery.

For Senior Care Plus Members, CMS Star Ratings hold significant relevance as they provide valuable insights into the quality and performance of their healthcare plan. Higher star ratings are indicative of better overall care coordination, improved access to services, and a greater focus on preventive care measures. Members can use these ratings as a guide when selecting or evaluating their healthcare coverage options, ensuring they receive the best possible care and outcomes.

CMS Star Ratings can also influence reimbursement rates and incentives for healthcare plans. Plans with higher ratings may receive additional funding or bonuses from Medicare and Medicaid, which can ultimately translate into more resources and benefits for members such as dental, vision, and hearing. By prioritizing initiatives that align with CMS quality measures, such as chronic disease management programs and care coordination services, Hometown Health Insurance Company not only improves its star ratings but also demonstrates its commitment to enhancing the health and well-being of its members. Therefore, members can trust that their healthcare plan’s performance is continuously monitored and optimized to deliver the highest standards of care.

Member experience and CAHPS ratings

In addition to CMS Star Ratings and HEDIS audits, Hometown Health actively engages in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is sent to a random sample of members between the months of March and June each year. The CAHPS survey is a standardized tool used to assess patients’ experiences with their healthcare providers and health plans. It measures various aspects of the patient experience, including communication with providers, access to care, and overall satisfaction.

The results of the CAHPS survey significantly influence CMS Star Ratings, as they reflect members’ perceptions of the care they receive. Positive feedback from CAHPS surveys can contribute to higher star ratings, indicating that Senior Care Plus is meeting or exceeding members’ expectations in terms of service quality and patient experience. Conversely, negative feedback may signal areas for improvement that could impact the plan’s ratings and reputation, but provides Senior Care Plus with information and the opportunity to improve your overall experience

Recognizing the importance of member experience, Hometown Health has implemented several initiatives to enhance satisfaction and engagement. These efforts include improving communication channels with members, streamlining access to care through digital platforms and telehealth services, and providing personalized support for navigating the healthcare system. By actively listening to member feedback and responding to their needs, the plan aims to foster stronger relationships and trust with its members while also improving its CAHPS scores and overall star ratings.

Furthermore, Hometown Health regularly evaluates and adjusts its processes based on CAHPS survey results and other feedback mechanisms. This continuous improvement approach ensures that member experience remains a top priority and that the plan is responsive to evolving needs and expectations. Ultimately, by prioritizing member satisfaction and engagement, Hometown Health aims to not only improve its star ratings but also deliver a more positive and impactful healthcare experience for its members.

Health Outcomes Survey (HOS)

In addition to the CAHPS Survey, Hometown Health Insurance Company also utilizes the Medicare Health Outcomes Survey (HOS) to evaluate and improve the health outcomes of its Medicare Advantage members. The HOS is a national survey administered by the Centers for Medicare & Medicaid Services (CMS) to assess the physical and mental health status of Medicare beneficiaries. By collecting data on various health-related quality of life measures, such as physical functioning, pain, and emotional well-being, the HOS provides valuable insights into the overall health and well-being of members. Senior Care Plus leverages this data to identify areas for intervention and implement targeted programs and services aimed at improving the health outcomes and quality of life for its Medicare Advantage members.

National Committee for Quality Assurance (NCQA)

Hometown Health is actively pursuing accreditation from the National Committee for Quality Assurance (NCQA). NCQA accreditation is a rigorous evaluation process that assesses health plans based on a comprehensive set of quality standards and performance measures. Achieving NCQA accreditation demonstrates a commitment to providing high-quality care and adhering to best practices in healthcare management.

The NCQA accreditation process evaluates various aspects of health plan operations, including clinical quality, member satisfaction, care coordination, and network management. It involves a thorough review of policies, procedures, and performance data to ensure that the health plan meets or exceeds NCQA’s standards for quality and effectiveness.

For Hometown Health members, NCQA accreditation provides assurance that their health plan meets nationally recognized benchmarks for quality and performance. Accredited plans are held to high standards of care and are required to continually monitor and improve their operations to maintain accreditation status. Members can trust that their health plan has undergone a rigorous evaluation process and is committed to delivering excellent care and service.

To learn more about health plan accreditation, visit NCQA.org.

Senior Care Plus Plan Year Performance

For Plan Year 2023: Senior Care Plus Performed well in the following areas (Based on a 5 Star Scale):

5 Star Rating:

• Colorectal Cancer Screening
• Annual Flu Vaccine
• SNP Medication Review
• SNP Pain Assessment
• Diabetic Eye Exam
• Diabetic A1c in Control
• Controlling High Blood Pressure
• Improving Bladder Control
• Medication Reconciliation Post Discharge
• Getting Appointments and Care Quickly
• Health Plan Customer Service
• Member Retention

4 Star Rating

• Call Center Interpretation and TTY services
• Care Coordination
• Complaints to Medicare
• Rating of Health Care Quality
• Statin Therapy for Patients with Cardiovascular Disease
• SNP Health Risk Assessment Completion
• Breast Cancer Screening
• Monitoring Physical Activity

Hometown Health Performance

For Plan Year 2023: Hometown Health Performed above National Averages the following areas:

• Breast Cancer Screening
• Colorectal Cancer Screening
• Blood Pressure Management
• Diabetes A1c Control
• Diabetes Kidney Screening
• Use of Opioids from Multiple Providers
• Antidepressant Management
• Appropriate Testing for Upper Respiratory Infection

Contact Us

For more information about Hometown Health’s Quality Improvement program please contact Customer Service at 775-982-3232.