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SHP Manual

SHP Provider Manual
7.2 Quality Assurance Performance Improvement (QAPI) | 7.4 How Licensed Home Health Agencies are Evaluated

7.3 Licensed Home Care Service Agency Quality Reports   

Healthfirst evaluates the quality of Licensed Home Care Services Agencies using their Overall Quality Rating (OQR), a numerical score on a scale of 1.0 to 5.0 that summarizes the provider’s weighted average performance on select quality and satisfaction measures.  The measures are informed by NYS MLTC Quality Incentive Measures and CMS Stars measures which are updated on a yearly basis. A list of the quality measures used for OQR calculation(s) is provided via the HQIP for LHCSAs Program Guide supplied to all participating providers.
 
The Healthfirst Quality Incentive Program for Licensed Home Care Services Agencies (HQIP for LHCSAs) program helps Healthfirst gauge the quality and experience of care provided to our members.  Healthfirst MLTC membership is used to determine eligibility for the HQIP for LHCSAs. The HQIP for LHCSAs program is open to LHCSAs that serve at least 150 Senior Health Partners (SHP) members. Eligibility for this program is at the sole discretion of Healthfirst. LHCSAs that meet the requirements for participation in the HQIP for LHCSAs program receive monthly reports summarizing their performance on the measures included in the program.  A sample of the domains LHCSA’s are evaluated on is outlined below:
 
  • Quality: MLTC Quality Incentive Measures identified by NYSDOH and calculated from the Uniform Assessment System for New York (UAS-NY).
  • Satisfaction: Select measures obtained from the Healthfirst Member Satisfaction Survey, which is a proxy for the IPRO survey utilized by NYSDOH and substantiated grievances filed by Healthfirst members.
  • Efficiency: (Potentially Avoidable Hospitalizations) A PAH is an inpatient hospitalization that might have been avoided if proper outpatient care was received in a timely fashion. The hospitalization is identified as potentially avoidable if the primary diagnosis is any one of the following conditions: heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection.
  • Medication Adherence:  Measures designed by CMS to assess the adherence to medications prescribed for chronic conditions.

Healthfirst reserves the right to suspend or rescind provider eligibility for HQIP for LHCSAs for any reason, including agency attendance to program trainings and performance meetings.  Quality ratings will be used internally to evaluate performance across the network. Healthfirst will set a minimum threshold on an annual basis and a notification will be sent to providers falling below that threshold. LHCSAs whose performance is consistently below minimum thresholds may be subject to certain actions including, but not limited to, suspension from the Healthfirst Quality Incentive Program and network.