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CHP Medicare Advantage (HMO) Plans Receive 5 Stars

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The Center for Medicare and Medicaid Services (CMS) has published the 2010 health plan star ratings for health plans at www.medicare.gov on the Health Plan Finder. Capital Health Plan is the only Medicare Advantage plan in Florida, and one of only three in the nation, to receive 5 stars for the summary rating of health plan quality from CMS.

Stars for each plan show how well the plan performs in that particular category. Star ratings range from 1 star to 5 stars, where 1 star means "poor" quality and a rating of 5 stars means "excellent" quality.

“These rankings are based on clinical performance, member satisfaction and accreditation information. CHP is always finding ways to improve the quality of the health care services we provide, and we are honored to receive this prestigious recognition,” said CHP Chief Medical Officer Dr. Nancy Van Vessem. “It is a reflection of the commitment of our physicians and clinical staff to consistently deliver quality service.”

If you have questions please contact our local Member Services.

 

Ask Dr. Nancy: Osteoarthritis

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

My knees hurt more and more as the years go by. How would I know if I have osteoarthritis?

Osteoarthritis (OA), also called degenerative joint disease, is the most common type of arthritis. It is caused by a breakdown of the cartilage that cushions the ends of bones. As that cushion wears down, the tendons and ligaments around the joint may weaken and the bones may rub together which causes pain, stiffness and swelling.

Because cartilage wears down over time, osteoarthritis is more common in older people and in people who have had a previous injury to a joint. Joints that bear the weight of the body such as knees and hips are affected the most. Finger joints at the middle and ends of your fingers can also be affected. Unlike other types of arthritis, osteoarthritis only leads to joint problems; it does not cause problems with the skin, internal organs or any other part of the body. Often there is a family history, and it appears that some people have cartilage that is more prone to wear-and-tear than others.

A recent panel with osteoarthritis experts from 12 countries found that 3 symptoms and 3 signs lead to the diagnosis of osteoarthritis with 99% accuracy. The 3 symptoms are: pain on use, short-lived morning stiffness, and limitations on how the joint functions such as stiffness. The 3 signs on exam are: crepitus (a grinding noised with bending of the joint), restricted movement, and bony enlargement. The most obvious place that bony enlargement can be seen is in the finger joints. When bony knobs form on the middle joint of the finger they are called Bouchard’s nodes and when they form on the end joints they are called Heberden’s nodes. You might want to think about whether or not these symptoms sound like ones you have and check in with your primary care physician.

Treatment for osteoarthritis has more to do with lifestyle than medical intervention. The Agency for Healthcare Quality and Research (www.ahrq.gov) recently published a guide, “Osteoarthritis of the Knee”, based on available scientific evidence.

There is a lot of good information in that guide about what helps. The top recommendations are to lose weight, keep moving with low impact exercises, and take mild pain relievers. You might also ask your physician about physical therapy. Strengthening the muscles that move the knee, particularly the large thigh muscle in front, the quadriceps, can lead to improved function and support of the knee.

The guide also discusses other treatments that usually do not reduce pain or improve knee movement for people with osteoarthritis: Glucosamine/ chondroitin supplements, joint lubricant shots (not the same as cortisone shots) and arthroscopic knee surgery to smooth out cartilage.

Ultimately knee osteoarthritis can lead to surgery for joint replacement but it is best to put that possibility off into the future by protecting your knees now.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

 

Primary Care is Cost Effective!

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A recent study by Johns Hopkins University found that traditional fee-for-service Medicare could save approximately $10 billion a year by avoiding unnecessary hospitalizations.

The study, commissioned by the Alliance of Community Health Plans (ACHP), compared the Medicare Retiree Advantage programs of community based health plans, including Capital Health Plan, against traditional Medicare.

In traditional Medicare, hospital readmissions account for $17 billion of the $102.6 billion spent in hospital payments each year. The results of the study show that Capital Health Plan outperformed traditional Medicare in hospital readmission rates, preventable ER visits, and preventable hospital admissions. With rates similar to that of CHP, traditional Medicare could save approximately $10 billion annually.

Chief Medical Officer Dr. Nancy Van Vessem explains how we are able to accomplish these low rates:

“At Capital Health Plan we believe that access to strong, consistent outpatient care by a physician who knows the patient is the best defense for avoiding unnecessary hospital admissions and emergency room visits.”

“That same relationship improves transitions of care between the inpatient and outpatient setting and contributes to CHP’s low rate of readmissions within 30 days. Our Care Coordination Department and the nurses in our staff model practice, contact at-risk members to ensure that follow-up appointments with their primary care physician are organized within a week of discharge from the hospital.”

The Johns Hopkins research further supports Capital Health Plan’s philosophy that focusing on coordinated care and preventative health maintenance will improve care and lower costs.

 

Hospital Readmission Rate Within 30 days Preventable ER Visits (per 100 member months) Preventable Hospital Visits (per 100 member months)
Capital Health Plan 7.68% 2.76 1.44
Medicare Fee-for-Service 18.6% 15.5 19.0

 

Dr. Nancy Represents CHP at NCQA Press Conference

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On October 22nd the National Committee for Quality Assurance (NCQA) held a news conference in Washington, DC to release “The State of Health Care Quality: 2009.” The report is produced annually to monitor performance trends over time, track variations in patterns of care and provide recommendations for future quality improvement. It also provides an exclusive look at how well the health system performed over the past year in key areas of care and service. Data is drawn from audited data conveyed to NCQA through its Health Care Effectiveness Data and Information Set (HEDIS®) -- the most widely used performance measurement tool in health care -- as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).

Dr. Nancy Van Vessem represented Capital Health Plan at the press conference, which focused on the achievements of a few notable health plans in the country. She highlighted Capital Health Plan’s achievements in Diabetes and Coronary Heart Disease Relative Resource Use (RRU) measures. NCQA will start publicly reporting HEDIS® RRU measures in 2010. These measures, unlike previous HEDIS® measures, assess the efficiency of care delivered by health plans for certain chronic diseases. In general, CHP members require less “rescue” such as inpatient admission and emergency room visits than members in other health plans.

Dr. Van Vessem emphasized that the long-term success of CHP is rooted in its high member satisfaction, high levels of trust, and low disenrollment. This means members with diabetes and coronary heart disease have been involved with local physicians and disease management programs over many years. They have fewer gaps in care attributed to a consistent approach to chronic disease and stable benefits.

“At Capital Health Plan we encourage every member to have a primary care physician. Our goal is to help the physicians manage the chronic disease of their patients,” said Dr. Van Vessem. One of the newest enhancements is that primary care physician offices can access its patients’ information related to gaps in care for a variety of quality measures via CHPConnect. This collaboration between Capital Health Plan, physicians and members has led to continued success measured by consistently excellent results on quality and member satisfaction scores. Now, that success has continued with notable performance on relative resource use measurements.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

 

CHP Champions Program Celebrates Year 4

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In the fall of 2004 the Leon County School District completed the first-ever study of body mass indexes (BMI) in grades K, 1 and 3-8. The results showed 36.2% of the children were either overweight (18.9%) or at-risk for overweight (17.4%).

Capital Health Plan recognized that the future health of our community depends on the lifestyle choices offered to our children today. In partnership with Leon County Schools, Titus Sports Academy, the Chamber of Commerce’s World Class Schools and Capital Health Plan, the CHP Champions program was launched.

Four years later, CHP Champions is in every elementary school and middle school in Leon, Gadsden, Jefferson and Wakulla County. Participation has increased from 1,151 children in its first year to over 8,800 participates last school year. Working with the FSU Medical School to implement a K-2nd grade program in 12 elementary schools, CHP Champions has a target goal this school year of 12,600 participants.

The focus of the program is to provide students with developmental physical activity by incorporating the basic level of sports performance training principles. Initially offered as an after-school program, it is now offered before school and during the day in a large portion of schools. CHP Champions is currently working to incorporate program lessons into the standard physical education curriculum.

A key element of this initiative is a well-designed set of evaluations. Each student is given a pre-test and post-test each semester to track their progress. The test gathers data including BMI, hip-to-waist ratio, and performance in a number of physical fitness activities.

An independent analysis conducted by the University of Massachusetts at Amherst found significant correlation in students’ participation in the CHP CHAMPIONS program and their overall improvement in health and fitness. An indication of this correlation is the downward shift of CHP Champions pre-BMI compared to CHP Champions post-BMI. The study looked at data collected from the 2006/2007 school year including weight, BMI, and improvement in the following performance tests: 40 Yard Dash, Pro Agility, Broad Jump, and 300 Yard Shuttle Run.

 

Weight Status Category CHP CHAMPIONS Pre BMI* CHP CHAMPIONS Post BMI*
Healthy Weight 53 % 57 %
Overweight 33 % 25 %

*Includes 242 participants with at least 40% participation Rate who were enrolled in both Fall 2006 and Spring 200.

If you would like more information on the CHP Champions Program please email info@mychampions.com or visit the website at www.mychampions.com.

 

 

We’ve Got Your Wellness Covered

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Capital Health Plan’s Medicare Advantage (HMO) plans offer wellness benefits that go above and beyond what you’d expect from Original Medicare. We know that preventive services are important to you as Capital Health Plan members, and your wellness is a top priority to us too. That is why we are proud to offer an extensive list of preventive services—some of which are no cost to you.

Although Original Medicare covers one physical when you first become eligible for Medicare, Capital Health Plan Medicare Advantage plans provide you with coverage for one physical exam
year.

According to the Centers for Disease Control and Prevention, “Much of the illness, disability, and death associated with chronic disease is avoidable through known prevention measures. Key measures include practicing a healthy lifestyle (e.g., regular physical activity, healthy eating, and avoiding tobacco use) and the use of early detection practices (e.g., screening for breast, cervical, and colorectal cancers, diabetes and its complications, and depression).” Capital Health Plan is pleased to offer our members colorectal screening exams, mammograms (annual screening), prostate cancer screening exams, and bone mass measurements.

Capital Health Plan also offers health and wellness education benefits including written health education materials, nutritional training, a 24-hour nursing hotline, and a health club membership/fitness class reimbursement up to $150 per year. At Capital Health Plan, we strive to provide you with the tools necessary to Live Well!

Sources: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion. May 29, 2009. Healthy Aging for Older Adults. Retrieved from http://www.cdc.gov/aging.

 

 

Emmaline J. Scarborough

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When I retired I did not think I could afford a Capital Health Plan (CHP) Medicare Advantage plan. I had seen other Medicare plans with lower or no monthly premiums. I decided to try one of these other plans. Soon after making the switch, I needed to be transported by ambulance from my doctor’s office to the hospital. This ambulance ride cost me $890 out of my own pocket. Then I found out that my heart doctor didn’t take this Medicare plan, even though I had been told I could go to any doctor. I had to wait almost a year until the next election period to rejoin CHP. Emmaline says with joy, “I switched back to CHP and I’ll never leave CHP again!”

 

 

Capital Health Plan Ranked Among The Nation’s Top 5 Commercial and Medicare Health Plans By U.S.News & World Report

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CHP among “America’s Best Health Insurance Plans 2009-10,” top health plan in Florida

TALLAHASSEE, Fl. - Capital Health Plan (CHP) has once again received national acknowledgement. CHP is ranked 5th in the nation for both Commercial and Medicare health plans. In the 2009-10 America’s Best Health Insurance Plans rankings published by U.S.News & World Report and the National Committee for Quality Assurance (NCQA), CHP is also the top-ranked plan in Florida. This is the highest combined ranking CHP has ever achieved.

“We are very pleased with this recognition which reflects a lot of outstanding work by our staff and this medical community. This also would not be possible without great support year after year from our members and area employers,” said John Hogan, CEO of Capital Health Plan. “This type of feedback is great news for Tallahassee and only furthers CHP’s dedication to delivering high quality, affordable health care and service to our community.”

As part of its commitment to excellence, CHP continues to focus on three primary strategic initiatives:

  • Improving the health of the population
  • Enhancing the patient experience of care (including quality, access, and reliability)
  • Controlling trends in the per capita cost of care

John Hogan reflects, “We have a lot to accomplish in all three areas as does our nation, but Tallahassee definitely stands out in these efforts.”

NCQA’s Quality Compass database also reported high ratings for Capital Health Plan. The scores of commercial health plans are voluntarily reported NCQA using data from HEDIS® and CAHPS® measures in categories related to access to care, overall satisfaction, prevention and treatment. These scores reflect the results of consumer surveys and success in preventing and treating illness compared to other plans.

Commercial Ratings:

  • CHP members rated their satisfaction with their personal doctor (rating of 9 or 10) as the highest in the state.
  • CHP members once again scored the Plan the highest in the state and the South Atlantic Region when asked “how satisfied are you with your health plan?”
  • CHP scored the very highest in the nation for Spirometry Testing for COPD.

Medicare Ratings:

  • CHP scored the very highest in the nation for Diabetic eye exams.
  • CHP scored the very highest in the nation for Colorectal cancer screenings for the 5th year in a row.
  • CHP scored the very highest in the nation for Spirometry Testing for COPD.

The 2009-10 “America’s Best Health Insurance Plans” rankings are published online at www.usnews.com/healthplans, and will be featured in the December 2009 issue of U.S. News, which will be on newsstands Tuesday, December 1.

“America’s Best Health Insurance Plans” is a trademark of U.S. News & World Report. HEDIS® stands for Healthcare Effectiveness Data and Information Set and is a registered trademark of the National Committee for Quality Assurance (NCQA).

The source for data contained in this publication is Quality Compass® 2009 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2009 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

 

 

Live Healthy for the Holidays

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What a wonderful time of year! The weather begins to cool down; we begin to think about the holidays; maybe we anticipate vacation from work and school. And ugh…the time of year when many people get sick! You have probably heard a few good tips for keeping your defenses against flu and other germs, but you may not have thought of one of your best defenses. Something you probably do at least three times a day. Yes - what you eat!

 

Most of us realize that our diet impacts our long term health. But we may not know how it impacts our ability to fight off germs. The more healthy nutrients you take in the better your immune system can fight germs and keep you from getting sick. Remember, that drinking plenty of water and exercising regularly also helps keep the body’s resistance up. So go for a walk, take your water bottle along, and come home to cook a healthy recipe! (See recipe for Turkey Cranberry Soup for an idea of what to make.)

Live Healthy: Recipe

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Turkey Cranberry Soup

Ingredients:

2 teaspoons canola oil
1 medium onion, chopped
1 large carrot, cut into bite-size pieces
1 rib celery, cut into thin slices
1 parsnip, peeled and cut into bite-size pieces (optional)
1 medium sweet potato or yam, peeled and cut in half, then into bite-size pieces
1 bay leaf
1 teaspoon dried thyme
2 cups non-fat, reduced-sodium turkey or chicken stock, divided
1 sweet, juicy apple, peeled, cored and cut into bite-size pieces
1 cup frozen (and defrosted) cranberries or canned whole cranberries, rinsed and drained
3 cups diced cooked turkey
Salt and freshly ground black pepper, to taste*

  • In a deep pan or skillet, heat the oil over MEDIUM-HIGH heat.
  • Sauté the onion until it softens, about 4 minutes.
  • Add the carrot, celery, parsnip (if using) and sweet potato.
  • Lower heat to MEDIUM and, stirring frequently, sauté until the vegetables become lightly browned.
  • Add the bay leaf, thyme and 1 cup of stock.
  • Lower heat to a simmer and cook until the vegetables are almost tender, about 10 minutes or less.
  • Stir in the apple and cranberries, if using the frozen kind.
  • If the mixture seems dry, add enough additional stock to cook the fruit.
  • Gently simmer until the apple has softened and the cranberries are tender, about 5 minutes.
  • If using canned cranberries, add them after the apple has softened, along with the turkey.
  • Heat through for a few more minutes, until the turkey is hot.
  • Season to taste with salt and pepper.
  • Serve as is or over cooked brown rice or whole-grain pasta, if desired.

Credit: Recipe courtesy American Institute for Cancer Research. This recipe meets Produce for Better Health Foundation (PBH) and Center for Disease Control and Prevention (CDC) nutrition standards that maintain fruits and vegetables as healthy foods.

Nutritional Information per Serving

Calories: 207 Carbohydrates: 18g
Total Fat: 5.2g Cholesterol: 53mg
Total Fat: 5.2g Dietary Fiber: 4g
% of Calories from Fat: 23% Sodium: 231mg
Protein: 22g