University Health Plans, Inc. (UHP) would like to make you aware of some important information. UHP is currently going through a process to become officially “accredited” by the National Committee for Quality Assurance (NCQA). NCQA requires UHP to send certain information to its providers. This letter addresses how we operate our business and includes a short synopsis of our Quality Improvement (QI) programs. In the future, you will see and hear more about UHP and NCQA in letters we send you, items posted on our website or in the provider newsletter.

Quality Improvement

UHP has a Quality Improvement Program (QIP) that looks at the quality of healthcare and personal service our members receive. Our QIP makes sure that for every member, all care settings and services are part of our quality improvement activities.

The QIP lets UHP track improvement activities and issues over time. Each year, UHP develops a QI Work Plan for the coming year. The Work Plan includes QI activities, reporting and studies from all areas of UHP (clinical and service), and also includes timelines for getting the quality improvement plan done and reported to the QI Committee and the UHP Board. If you have any questions or are interested in participating on UHP QI committees, please contact the UHP QI Department at 1-732-476-1077.

UHP has teamed with other Medicaid managed care organizations in New Jersey to promote lead poisoning prevention awareness. UHP has specific guidelines for lead screening and testing that follows the New Jersey Department of Health recommendations. All children ages 9 months and up to six years of age should be tested for lead.

UHP also focuses on ensuring that all children and adolescents get their immunizations, and monitor well-child visits and Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) exams as well.

Adolescent Immunization HEDIS rates are as follows:

HEDIS Measure	Rate 2006	Rate 2007	State Performance Benchmark
Effectiveness of Care
Adolescent Immunization
MMR	37.96%	45.01%	80%
HEP B	38.20%	49.39%	80%
VZV	24.82%	27.98%	80%
Combo 1 (MMR and Hep B)	N/A	N/A	N/A
Combo 2 (MMR,Hep B and VZV)	21.90%	21.90%	80%

HEDIS rates for Childhood Immunizations are as follows:

HEDIS Measure	Rate 2006	Rate 2007	State Performance Benchmark
Effectiveness of Care
Childhood Immunization
DTaP/DT	49.15%	54.26%	80%
OPV/IPV	57.66%	62.77%	80%
MMR	75.43%	80.05%	80%
HIB	65.94%	71.53%	80%
HEP B	54.26%	68.61%	80%
VZV	62.29%	77.62%	80%
Pneumococcal Conjugate	21.41%	43.31%	80%
Combo 1 (DPT, OPV/IPV, MMR, HIB, Hep B)	N/A	N/A	N/A
Combo 2 (DPT, OPV/IPV, MMR, HIB, Hep B, VZV)	31.87%	45.26%	80%
Combo 3 (DPT, OPV/IPV, MMR, HIB, Hep B, VZV, pneumococcal conjugate)	N/A	33.09%	80%

In review, UHP found that some of the results did not meet the intended goal. UHP will continue to outreach to members and providers hoping to increase the scores next year for Childhood and Adolescent Immunizations. UHP will also continue to reach out to members and providers to review the need for preventive healthcare. Providers may visit our website at www.uhpnet.com to obtain preventive healthcare guidelines including lead screening and immunizations recommendations and EPSDT requirements.

UHP Access and After Hours Standards

UHP’s annual PCP Access Audit was conducted in September and December 2006.  The audit sample consisted of 98 PCPs representing 2895 members. Of the 98 PCPs, 33 were Pediatricians who do not treat adult members, 36 were Internists who do not treat members less than 16 years of age, and the remaining 29 were Family Practice (FP) or General Practice (GP) treating both children and adults.

Analysis:

1)   100% of PCPs audited met the plan general standards for access.

2)   One PCP office was found to be in non compliance with Plan standards for after-hours   service.  The areas were:

• No recorded message directing the caller to a servicing or on call provider

Within three (3) days of the audit, UHP’s Provider Relations Department informed each of the two non-compliant offices of these discrepancies. Corrections were made to the after-hours messages and verified by the Plan.

This entry is filed under News.