Access / Availability of Care
Call Abandonment
The Call Abandonment measure determines the rate of calls to the health plan call center (during operating hours) that were abandoned (i.e., the caller decided to hang up) before being answered by a live person. For this measure a lower number is better.
Call Answer Timeliness
The Call Answer Timeliness measure addresses the performance of health plan call centers, calculating the percentages of calls answered by a live voice within 15 and 30 seconds.
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
The 2007 National Survey on Drug Use and Health (NSDUH), estimated that 22.3 million persons (9.0 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year. Of these, 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.7 million were dependent on or abused illicit drugs but not alcohol, and 15.5 million were dependent on or abused alcohol but not illicit drugs.
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2006 National Survey on Drug Use & Health indicated that more than a fourth of the persons under the legal age for drinking actually drank in the past month; that is, there were 10.8 million current underage drinkers. Younger female underage drinkers were more likely than older ones to have had their most recent drink in a car or other vehicle. For example, female underage drinkers aged 16 were eight times more likely to have had their last drank in a car than those aged 20 (12.8% vs. 1.6%).
According to AHRQ’s National Quality Measures Clearing House, “there are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. Treatment of medical problems caused by substance abuse places a huge burden on the health care system.”
The initiation of alcohol and other drug (AOD) dependence treatment measure looks at the percentage of adolescent and adult members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter, or partial hospitalization within 14 days of diagnosis. Three rates are reported: ages 13 -17, ages 18+, and total.
The engagement of alcohol and other drug (AOD) treatment measure looks at the percentage of adolescent and adult members who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit. Three rates are reported: ages 13 -17, ages 18+, and total.
Prenatal and Postpartum Care
Each year, there are over 4 million births in the United States. Getting early and regular prenatal care is one of the best ways to promote a healthy pregnancy and healthy babies. Prenatal care includes education and counseling about how to handle the different aspects of pregnancy, such as nutrition and physical activity plus a chance to talk to your health care provider about any questions or concerns you have related to pregnancy or birth. Regular prenatal visits can also help mothers and their physicians or midwives identify potential problems and possible complications early in the pregnancy when they can be prevented or more successfully treated.
Likewise, it is very important for a new mother to have a postpartum visit with her health care provider within three to eight weeks after delivery. Since the period immediately following birth is a time of many physical and emotional adjustments, practitioners can be helpful in recognizing and discussing problems, even when a woman feels fine.
These measures reflect the care women received in measurement year and year prior during pregnancy and following the birth of their babies. The Timeliness of Prenatal Care measure reports the percentage of women who received a prenatal care visit in the first trimester or within 42 days after enrolling in their health plan if already pregnant. The Postpartum Care measure shows the percentage of women who received a postpartum visit on or between 21 and 56 days after delivery. Health plans promote pregnancy wellness by distributing educational materials in newsletters and maternity programs and by encouraging their network physicians and midwives to provide appropriate and timely pregnancy care.
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