Quality: Finish Strong in Get Ready for October 28, 2016
|
|
- Merilyn Bates
- 5 years ago
- Views:
Transcription
1 Quality: Finish Strong in Get Ready for 2017 October 28, 2016
2 Agenda Stars: Medicare Advantage Quality Changes for 2017 Pay for Quality and PCMH Programs Important Announcements! 7
3 Stars: Medicare Advantage Quality
4 Topics Diabetes Incentive Program High Performer Program Dual Special Needs Metrics Medication Management Medication Reconciliation Post Discharge Medication Therapy Management Medication Review Blood Pressure Control 9
5 CMS Asks: How Good is Your Medicare Advantage Plan? CMS wants to: Inform beneficiaries as they choose a plan Encourage best evidence-based practices Improve/maintain health and well-being Payments for VALUE rather than volume 10
6 What Gets Scored? Preventive Screenings Breast Cancer Colorectal Cancer Chronic Disease Monitoring and Control Diabetes Hypertension Rheumatoid Arthritis Osteoporosis Medication Oversight Medication Adherence Medication Reconciliation Post Discharge Medication Therapy Management 11
7 Diabetes Incentive Program
8 Akamai Advantage Diabetes Incentive Program 741 members participating (out of 8,700 with diabetes) Potential to earn $100 in gift cards Services during 2016 HbA1c Testing PCP Visit for Diabetes Eye Exam Diabetes Education It s not too late to sign up! 13
9 High Performer Program
10 What is the program? You have patients who struggle with preventive services, so you were invited to participate We selected members who need the most assistance with gaps in care The program aligns bonus payments with the extra effort from your team 15
11 High Performer Program Update 527 Providers invited Packets mailed early September Initial gap for each member: $20 Additional gaps for each member: $5 Office incentives: gift cards 40 gaps = $100 Each additional 20 gaps = $50 more in gift cards 10 Offices with the most gaps closed = additional $100 Questions? Call
12 Dual Special Needs
13 DSNP: What Gets Measured? Members who are eligible for BOTH Medicare and Medicaid All standard Medicare Quality Metrics Preventive Screenings Diabetes/Chronic Disease Measures Medication Management Four DSNP specific measures Health Risk Assessment Care for Older Adults 18
14 Care for Older Adults: Dual Special Needs Once per calendar year Four-part assessment: Medication Review Functional Status Assessment Pain Assessment Advance Care Planning COA form available with coding and checklist assessments Complete the assessments Add completed form to your medical record File a claim 19
15 Medication Management
16 CMS Emphasis: Medication Oversight Medication Reconciliation Post Discharge All Akamai Advantage Members Medication Therapy Management (MTM) 3 Chronic Conditions 8 or more Medications Medication Review Dual Special Needs (DSNP) Enrollees Within 30 days of hospital discharge Refer to Pharmacy Vendor Once per calendar year 21
17 Medication Reconciliation Post Discharge Hospital Discharge 30-day window Medication Reconciliation Document on claim 22
18 The Quick Version of Documentation MRP: Medication Reconciliation Post-Discharge (Medicare) The percentage of discharges from 1/1-12/1 of the measurement year for members 18+ for whom medications were reconciled on or within 30 days of discharge. Documentation needed: Medication reconciliation completed by the prescribing practitioner, clinical pharmacist, or registered nurse on or within 30 days of discharge. Need documentation that it was completed and the date that it was done in the outpatient chart. Any of the following evidence meets criteria: Notation that, I have reviewed patient s discharge medications and reconciled against pre-admit medications -or- Notation that no medications were prescribed upon discharge Submit CPT II Code: 1111F 23
19 Medication Therapy Management Patient receives a free comprehensive medication review by a pharmacist Help for your most complex patients 3+ chronic diseases 8+ maintenance medications spend >$ /quarter on medications Refer patient to HMSA s vendor: Mirixa (866)
20 Cozeva Medication Tracking 25
21 Take Home Thoughts Diabetes Incentives High Performer Program (including office bonuses) Dual Care: COA forms Medication Measures Med Recon help from Pharmacare Med Management help from Mirixa Blood Pressure last chance for in-control values! 26
22 Akamai Advantage Review of Chronic Conditions (RCC) Deadline for RCC and supplemental reporting is December 31, Plan aiming for highest possible completion 74.5% Pay for Quality PCPs: Best strategy: work to achieve 4 to 5 stars (90%-95%) on RCC! Payment Transformation PCPs: Goal is 95% or higher for Maximum RCC rate as of 10/24/16 27
23 RCC Supplemental Reporting Most supplemental reporting for RCC requires upload of medical record into Cozeva. Deadline is December 31. Disconfirm Condition has improved; medical record required Disconfirm Condition has resolved; medical record required Disconfirm -- Insufficient evidence of this condition. Medical record is NOT required. Be sure to submit your complete attestation in the Cozeva comment box, or upload a document that contains the attestation. 28
24 Disconfirm - Insufficient Evidence PCP may choose to allow office staff (e.g., Cozeva Delegates) to complete attestation and submit supplemental data for disconfirmation on the PCP s behalf Sample: I, [staff member name], report that Dr. Aloha Lee, attests that this patient does not have the diagnosis of chronic renal disease. Dr. Lee has reviewed the pertinent medical information and finds that the patient has had normal creatinine levels over the past two years. PCPs will be held accountable for all submissions by Cozeva Delegate users. 29
25 30
26 Changes for 2017 Pay for Quality and PCMH Programs October 28, 2016
27 2017: A Transition Year Staggered starts for Payment Transformation January 1, 2017 PCPs in identified Physician Organizations will move fully into Payment Transformation (global monthly payment + new measures), joining the 2016 pilot April 1, 2017 Some PCPs begin global monthly payment, but remain on Pay for Quality measures through 2017 July 1, 2017 Last group of PCPs begins global monthly payment, but remain on Pay for Quality measures through 2017 Expectation that most PCPs will move to Payment Transformation payment and metrics by
28 PCPs in Transition to Payment Transformation Payment Transformation (Pilot, April 2016) Payment Transformation (January 2017) Payment Transformation (April 2017) Payment Transformation (July 2017) 33
29 Important Announcements In 2017, global monthly payment will be made on or about the 15 th of the month, with patient attribution from one month earlier New! Engagement measure to build PCP s profile on Sharecare find-a-provider application New! Performance measure Well-Being 5 being replaced by Sharecare RealAge Assessment Report to Provider will give more information about processing of each claim; will make account reconciliation easier Cozeva view will be reset in January 2017 Coming! PO training sessions and webinars 34
30 Important Announcements Supplemental data (commercial, QUEST Integration and Akamai Advantage) for January 2017 class ONLY must be entered into Cozeva by Dec. 31, 2016 Cozeva Pay for Quality view will be locked down for transition to Payment Transformation-only view for January 2017 All other PCPs have regular deadlines for submitting supplemental data: Jan. 31, 2017 for commercial, QUEST Integration and Akamai Advantage measures Dec for Review of Chronic Conditions 35
31 Payment Transformation Transition PCPs starting in April or July will remain on Pay for Quality program (rolling 12 months, quarterly payment). Will use familiar Cozeva dashboard Will also have sneak peek of Payment Transformation Cozeva dashboard All PCPs will work on 2 Physician Organization quality measures on the Payment Transformation dashboard Starting Date January 2017 April 2017 July 2017 Cozeva View Only Payment Transformation view Pay for Quality and Payment Transformation views; Will be scored on Pay for Quality measures 36
32 Pay for Quality View of Cozeva 37
33 Payment Transformation View Colored chiclets and stars replaced by bars Red = below 50th percentile Yellow = Minimum (earning 40% ) Green = Target (earning 100%) 38
34 Quality Measures Changes for 2017 Being dropped for P4Q because of small denominators; already dropped for Payment Transformation Appropriate testing for children with pharyngitis Appropriate treatment for children with upper respiratory infection Avoidance of antibiotic treatment in adults with acute bronchitis 39
35 Quality Measures Changes for 2017 Being dropped as a scored PCP measure, will remain as a Physician Organization measure that depends on PCP s performance Controlling high blood pressure Physician Organization measure Children with Special Health Care Needs Screener 40
36 Reporting Blood Pressure Report both systolic AND diastolic values on claims CPT codes 3074F 3075F 3078F 3079F Description Most recent systolic BP less than 130 mm Hg Most recent systolic BP mm Hg Most recent diastolic BP less than 80 mm Hg Most recent diastolic BP mm Hg For patients age 60 to 85 with hypertension, BP is considered adequately controlled when BP is below 150/90 mm Hg. Report compliant blood pressure values using Cozeva supplemental data. For patients age 60 to 85 with diabetes, BP considered in control if the blood pressure is below 140/90 mm Hg. For patients with Medicare primary/hmsa secondary, report using supplemental data on Cozeva or submit secondary claim to HMSA 41
37 Reporting CSHCN Screener Measure Procedure Code ICD-10 Code CSHCN Screener (NEW: ages 3-17, done every 3 years) Screening done; positive finding for chronic or special health care needs: E/M CPT code + HA modifier + Z Screening done; negative finding: E/M CPT code + HA modifier HA HCPCS code modifier = Child/adolescent program Z Personal history of other specified conditions For screener tool: 42
38 PCMH for 2017 Monthly PCMH payments continue until PCP moves to Payment Transformation global payment in January, April or July At that time, PCMH payment is wrapped into monthly global payment Old PCMH requirements dropped. Regardless of global payment start date, all PCPs work on PCP Engagement measures PCMH level advancement discontinued in
39 Engagement to Encourage Active Participation These are foundational, relatively easy-to-achieve engagement steps Ensures providers are engaged in the systems to succeed in the new payment model Examples: Use of Cozeva Engage all attributed members annually through visit, call, , mail, text, online care Referring patients to ecosystem programs (e.g.,hmsa Care Model, HMSA health education workshops, Dr. Dean Ornish Program for Reversing Heart Disease, community programs ) New! Sharecare Engagement build provider profile and upload PCP s photo for find-a-provider application 44
40 Engagement to Encourage Active Participation Will be displayed on Cozeva for ALL PCPs in 2017 Payment Transformation Pilot will be scored in 2018 Payment Transformation January 2017 will be scored in 2018 Payment Transformation April and July 2017 will be scored in
41 Engagement: Details Measure Commercial Akamai Advantage QUEST Integration PCP/staff log into Cozeva at least once a month [pass = 100%] Check on well-being of all patients in panel [patient survey; pass = 75% of respondents report contact] Refer patients to health programs [Cozeva attestation; pass/fail] 5% 5% 4% 5% 5% 4% 5% 5% 4% New! Sharecare Engagement 5% 5% 4% Submit EPSDT forms [audit] 4% TOTAL 20% 20% 20% In Payment Transformation, each measure is all-or-nothing across all plans. Performing well adds up to 20 pct. points to the 80% base PMPM the following year. Doing poorly could result in loss of up to 20 pct. points. 46
42 PCMH Meets Payment Transformation To calculate global payment PMPMs for 2017, HMSA will use FFS data for your PCMH level (Level 1, 2 or 3) as of December 1, 2016 PCMH Level Level 1 Level 2 Level 3 Credited for PMPM $1 PMPM $3 PMPM $3.50 PMPM To advance to PCMH level 2 or 3, request and documentation needs to be submitted to HMSA by November 4 for review and approval in time for a Dec. 1 effective date to affect global payment for
43 PCP Affiliation with Physician Organization If you are joining or switching to a new Physician Organization, PO must notify HMSA by Dec.15 Be mindful of PO s Payment Transformation transition date (Jan, April, or July 2017). Affects your quality/performance measures January 2017 Payment Transformation performance measures April 2017 and July 2017 Remain on Pay for Quality measures through 2017 Switch to Payment Transformation measures in Jan
44 Adult Measures Cancer screenings Breast cancer Cervical cancer Colorectal cancer Diabetes measures HbA1c in control Eye exam Attention for nephropathy Blood pressure control Advance care planning 2017 Trigger Yes Yes Yes Includes 65+ Patient age 2 visits with diabetes as DX Patient age BMI assessment for adults Yes Any outpatient visit with PCP, specialists Review of Chronic Conditions for Akamai Advantage members Controlling Blood Pressure Yes Yes PO measure Patient age and DX 1 visit with hypertension as DX 49
45 Payment Transformation: Adult Measures Screening for depression and anxiety (age 18 and older) [Patient Health Questionnaire-4] Tobacco cessation and followup 2017 Trigger Yes Yes Outpatient visit with an eligible PCP type * Outpatient visit with an eligible PCP type * Influenza shots Yes Patient age New! Sharecare RealAge Assessment Yes Patient age Patient Experience (survey) N/A [Not a measure in 2017] * Eligible PCP type: Peds, FP, GP, IM, APRN, PA, naturopaths 50
46 Pediatric Measures 2017 Trigger Well-child visits in first 15 months Yes Patient age Well-child visits, 3 to 6 years Yes Patient age Childhood immunizations by age 2 Yes Patient age Immunizations for adolescents Yes Patient age Weight assessment and counseling for nutrition and physical activity Yes Outpatient visit with PCP or ob/gyn* * Eligible PCP type: Peds, FP, GP, IM, APRN, PA, naturopaths 51
47 Payment Transformation: Pediatric Measures Developmental screening in child s first 3 years (annually) 2017 Trigger Yes Patient age Adolescent well-care visit (ages 12 to 21) Yes Patient age Screening for symptoms of clinical depression and anxiety (ages 12 to 17) [Patient Health Questionnaire-2, -4, -9, -Adolescents] CSHCN Screener completion (ages 3 to 17, every 3 years) Yes Yes PO Measure Outpatient visit with an eligible PCP type * Patient age Patient Experience (survey) N/A [Not a measure in 2017] * Eligible PCP type: Peds, FP, GP, IM, APRN, PA, naturopaths 52
48 Sharecare RealAge Assessment New! Commercial members 18 and older who complete Sharecare RealAge assessment at least once during the measurement year. Gauges how fast you re aging based on lifestyle and medical history. Replaces Well-Being 5 More information to be provided. Explore at 53
49 Support for PCPs Your Physician Organization is your quality and transformation leader Call Cozeva at for questions or training about Cozeva display Call HMSA at on Oahu or 1 (877) , toll-free or psinquiries@hmsa.com: Need training/support from HMSA s Training Unit for you and your practice team 54
Payment Transformation: Essentials of Patient Attribution An Introduction for Internal Staff
Payment Transformation: Essentials of Patient Attribution An Introduction for Internal Staff May 6, 2016 Payment Transformation Will Address Key Goals In Pursuit of Māhie 2020 - Maximize Value to Members,
More informationPlease stand by. There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 10/28/2015 1
Please stand by There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 10/28/2015 1 Webinar Tips Today s webinar is a one-way audio broadcast through
More informationPayment Transformation 2018 Measure Changes and Updates. April 4, 2018
Payment Transformation 2018 Measure Changes and Updates April 4, 2018 1. 2018 Performance Measures 2. 2018 Engagement Measures 3. Patient Attribution & Panel Management Cozeva 4. Coreo 1. Effectively Manage
More informationToday s Presenters. Paula Murray Educator, Provider Services. Lara Adelberger STARS Clinical Coordinator 5/12/2017 5
Today s Presenters Paula Murray Educator, Provider Services Lara Adelberger STARS Clinical Coordinator 5/12/2017 5 Risk Adjustment, Quality Measures, and Care of Older Adults April 27, 2017 Agenda Risk
More informationGateway to Practitioner Excellence GPE 2017 Medicaid & Medicare
Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare Recognizing and Rewarding Excellent Practices Improving the Health of Gateway Members PRACTICE ELIGIBILITY (see PCMH slide #27 for separate
More informationQUALITY IMPROVEMENT PROGRAM
QUALITY IMPROVEMENT PROGRAM EmblemHealth s mission is to create healthier futures for our customers and communities. We will do this by providing members with a broad range of benefits and conscientious
More informationPatient-Centered Medical Home
2017 Primary Care Federally Qualified Health Centers (FQHCs) January 2017 (released December 2016) HMSA Patient-Centered Medical Home Getting Started and Ongoing Management P R O G R A M G U I D E An Independent
More informationArkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual
Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2017 This document is a guide to the 2017 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas
More informationPassport Advantage Provider Manual Section 8.0 Quality Improvement
Passport Advantage Provider Manual Section 8.0 Quality Improvement Table of Contents 8.1 Quality Improvement Program 8.2 Clinical Practice Guidelines 8.3 Star s 8.4 Quality of Care Concerns 8.3 Practitioner
More informationPatient-Centered Medical Home
2015 QUEST Integration HMSA QUEST Integration Patient-Centered Medical Home Getting Started and Ongoing Management P R O G R A M G U I D E An Independent Licensee of the Blue Cross and Blue Shield Association
More information2015 Annual Convention
2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 8:00 am 9:30 am Location: Gaylord National Harbor Resort and Convention Center, National Harbor 10 Title: Activity Type: Speaker: Opportunities
More informationHEDIS Measures and the Family Physician Office. Pablo J Calzada DO, MPH, FAAFP, FACOFP
HEDIS Measures and the Family Physician Office Pablo J Calzada DO, MPH, FAAFP, FACOFP Disclaimer HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA and payers
More informationArkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual
Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2016 This document is a guide to the 2016 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas
More informationHouseCalls Objectives
Overview Agenda Overview Objectives Background Case studies Member Experience Primary Care Provider Experience Referrals and Follow-up Influence on Centers for Medicare & Medicaid Services (CMS) Star Ratings
More informationQuality Measurement Approaches of State Medicaid Accountable Care Organization Programs
TECHNICAL ASSISTANCE TOOL September 2014 Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs S tates interested in using an accountable care organization (ACO) model
More informationFast Facts 2018 Clinical Integration Performance Measures
IMPORTANT: LHP providers who do not achieve a minimum CI Score in 2018 will not be eligible for incentive distribution and will be placed on a monitoring plan for the 2019 performance year. For additional
More informationPatient-Centered Medical Home
2014 Primary Care HMSA Patient-Centered Medical Home Getting Started and Ongoing Management P R O G R A M G U I D E HMSA, an Independent Licensee of the Blue Cross and Blue Shield Association Progressing
More informationPatient Centered Medical Home 2011 Standards
PCMH Standard 6 1 Patient Centered Medical Home 2011 Standards 2 Today s Agenda PCMH 6 PCMH 6 PCMH 6 Elements A-B Elements C-E Elements F-G Standard 6 A MEASURE PERFORMANCE PCMH 6A Measure Performance
More informationBlue Advantage (PPO) SM 2018 Quality+Partnerships
Blue Advantage (PPO) SM 2018 Quality+Partnerships Your Partner in Quality Care BlueCross BlueShield of Tennessee is committed to ensuring our members have access to a network of high quality providers.
More informationand HEDIS Measures
1 SC Medicaid Managed Care Initiative and HEDIS Measures - 2009 Ana Lòpez De Fede, PhD Institute for Families in Society University of South Carolina Regina Young, RNC SC Department of Health and Human
More informationPCMH 2014 Recognition Checklist
1 PCMH1: Patient Centered Access 10.00 points Element A - Patient-Centered Appointment Access ~~ MUST PASS 4.50 points 1 Providing same-day appointments for routine and urgent care (Critical Factor) Policy
More informationAETNA BETTER HEALTH OF ILLINOIS Provider Newsletter June 2017, Vol. 7
AETNA BETTER HEALTH OF ILLINOIS Provider Newsletter June 2017, Vol. 7 www.aetnabetterhealth.com/illinois With questions or concerns, please contact Provider Services at 866-212-2851 Option 2 We heard you!
More informationMIPS Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017
CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network (SNE PTN) MIPS 2017- Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017 2 Review Determine
More informationGetting Ready for the Maryland Primary Care Program
Getting Ready for the Maryland Primary Care Program Presentation to Maryland Academy of Nutrition and Dietetics March 19, 2018 Maryland Department of Health All-Payer Model: Performance to Date Performance
More informationFederally Qualified Health Centers Rural Health Clinics. February Interim. Pay for. Quality
Federally Qualified Health Centers Rural Health Clinics February 2018 2018 Interim Pay for Quality P R O G R A M G U I D E Table of Contents Introduction to the 2018 Primary Care Pay-for-Quality Program....2
More informationUnited Medical ACO Participation Criteria
United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More informationQuality Improvement Program (QIP) Measurement Specifications
Quality Improvement Program (QIP) 2014 2015 Measurement Specifications Developed by: Marya Choudhry Contributors include: Robert Moore Jess Liu Jennifer Dionisio Carolyn Stewart Melanie Lam Jessica Thatcher
More information2012 QUEST Primary Care HMSA. Patient-Centered Medical Home. and. Pay-for-Quality. Getting Started and Ongoing Management
2012 QUEST Primary Care HMSA Patient-Centered Medical Home and Pay-for-Quality Getting Started and Ongoing Management P r o g r a m G u i d e Table of Contents Overview....2 Introduction....4 Basic Requirements,
More informationMeaningful Use Stage 1 Guide for 2013
Meaningful Use Stage 1 Guide for 2013 Aprima PRM 2011 December 20, 2013 2013 Aprima Medical Software. All rights reserved. Aprima is a registered trademark of Aprima Medical Software. All other trademarks
More informationMedicare Advantage Star Ratings
Medicare Advantage Star Ratings December 2017 The Star Rating System measures how well Medicare Advantage (MA) and its prescription drug plans perform for consumers. As an integrated health system, Presbyterian
More informationFalcon Quality Payment Program Checklist- 2017
Falcon Quality Payment Program Checklist- 2017 DISCLAIMER: This material is provided for informational purposes only and should not be relied upon as legal or compliance advice. If legal advice or other
More informationImportant RMHP Pharmacy Change for 2016
Fall 2015 Provider Edition Important RMHP Pharmacy Change for 2016 In an effort to control increasing medication costs, RMHP will begin using MedImpact s High Performance pharmacy network beginning January
More informationHEDIS 101 for Providers 2018
HEDIS 101 for Providers 2018 Improving Quality of Care HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Author: Commercial & GBD Communication HEDIS Team Document
More informationMedi-Cal Performance Measurement: Making the Leap to Value-Based Incentives. Dolores Yanagihara IHA Stakeholders Meeting October 3, 2018
Medi-Cal Performance Measurement: Making the Leap to Value-Based Incentives Dolores Yanagihara IHA Stakeholders Meeting October 3, 2018 Why Standardization? MEDI-CAL CROSS PRODUCT San Francisco Health
More informationImproving Primary Care Medication Patient Safety: System-level Medication Adherence Issues
Improving Primary Care Medication Patient Safety: System-level Medication Adherence Issues Marie Smith, PharmD Professor and Asst. Dean, Practice and Public Policy Partnerships Meg Mello Moniz, PharmD
More informationStage one: Meaningful Use Changes in 2014
Stage one: Meaningful Use Changes in 2014 Publication MO-06-06-HOSP GEN This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers
More informationClinical Webinar: Integrated Pharmacy
Clinical Webinar: Integrated Pharmacy Benjamin Gross, Pharm D, MBA, BCPS, BCACP, CDE, BC ADM, ASH CHC Associate Professor Director of Residency Programs Lipscomb University College of Pharmacy Objectives
More informationHEDIS TOOLKIT FOR PROVIDER OFFICES. A Guide to Understanding Medicaid Measure Compliance
HEDIS TOOLKIT FOR PROVIDER OFFICES A Guide to Understanding Medicaid Measure Compliance TABLE OF CONTENTS WHAT IS HEDIS 1?... 1 ANNUAL HEDIS TIMELINE... 2 HEDIS MEDICAL RECORD REQUEST PROCESS:... 2 TIPS
More informationACOs: California Style
ACOs: California Style ACO Congress John E. Jenrette, M.D. Chief Executive Officer Sharp Community Medical Group November 2, 2011 California Style California Style A CO California Style California Style
More informationTotal Cost of Care Technical Appendix April 2015
Total Cost of Care Technical Appendix April 2015 This technical appendix supplements the Spring 2015 adult and pediatric Clinic Comparison Reports released by the Oregon Health Care Quality Corporation
More informationAppendix 5. PCSP PCMH 2014 Crosswalk
Appendix 5 Crosswalk NCQA Patient-Centered Medical Home 2014 July 28, 2014 Appendix 5 Crosswalk 5-1 APPENDIX 5 Crosswalk The table compares NCQA s Patient-Centered Specialty Practice () standards with
More informationPCSP 2016 PCMH 2014 Crosswalk
- Crosswalk 1 Crosswalk The table compares NCQA s Patient-Centered Specialty Practice (PCSP) 2016 standards with NCQA s Patient-Centered Medical Home (PCMH) 2014 standards. The column on the right identifies
More informationQUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program:
QUALITY IMPROVEMENT Molina Healthcare maintains an active Quality Improvement (QI) Program. The QI program provides structure and key processes to carry out our ongoing commitment to improvement of care
More informationMeaningful Use Measures: Quick Reference Guide Stage 2 (2014 and Beyond)
Meaningful Use Measures: Quick Reference Guide Stage 2 (2014 and Beyond) Core Measures Required: All 17 objectives Objective: Requirement: Exclusions: Accomplish in Clinical 1. Computerized - Documenting
More informationBenchmark Data Sources
Medicare Shared Savings Program Quality Measure Benchmarks for the 2016 and 2017 Reporting Years Introduction This document describes methods for calculating the quality performance benchmarks for Accountable
More informationPatient-centered medical homes (PCMH): eligible providers.
ACTION: Final DATE: 09/21/2018 3:40 PM 5160-1-71 Patient-centered medical homes (PCMH): eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model led by primary
More informationQuality Management Report 2018 Q1
Quality Management Report 2018 Q1 Care Wisconsin Participates in Many Quality Initiatives Across the State and Federal Levels These activities include: Centers for Medicare & Medicaid Services (CMS) Department
More informationPATIENT CENTERED. Medical Home. Attestation. Facility Compliance
2 0 1 7 Attestation PATIENT CENTERED Medical Home of Facility Compliance State of Wyoming, Department of Health, Division of Healthcare Financing Check the Patient Centered Medical Home (PCMH) Programs
More informationBuilding an Ambulatory System of Care: Using Population Health to Combat Secular Trends & Achieve the Triple Aim
Building an Ambulatory System of Care: Using Population Health to Combat Secular Trends & Achieve the Triple Aim Christopher T. Olivia, MD, President June 11, 2014, All Rights Reserved and CONTINUUM HEALTH
More informationALL NEW ALOHACARE WEBSITE
NEWS FOR PHYSICIANS AND PROVIDERS QUARTER 4 2017 NEW STREAMLINED PRIOR AUTHORIZATION PROCESS AlohaCare will implement a simplified and reduced list of services requiring Prior Authorization effective January
More informationTO BE RESCINDED Patient-centered medical homes (PCMH): eligible providers.
ACTION: Final DATE: 09/21/2018 3:40 PM TO BE RESCINDED 5160-1-71 Patient-centered medical homes (PCMH): eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model
More informationProvide an understanding of what comprises "meaningful use" of EHR technology
1 Provide background on federal electronic health record (EHR) incentives Overview of Health IT Incentives Medicare/Medicaid EHR incentives Provide an understanding of what comprises "meaningful use" of
More informationQuality Measurement and Reporting Kickoff
Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER
More informationAt the start of each HEDIS season, you will receive a fax from L.A. Care. Each fax request will stipulate what documents need to be faxed back.
Office Manager s Guide to HEDIS 2018 L.A. CARE MEDICAL RECORD REQUESTS At the start of each HEDIS season, you will receive a fax from L.A. Care. Each fax request will stipulate what documents need to be
More informationMeaningful Use Stages 1 & 2
Meaningful Use Stages 1 & 2 Making Sure You Get the Most Out of Your EHR Tracy McDonald Medicaid EHR Incentive Program Coordinator Agenda Meaningful Use Stages & Incentive Program Timing 2014 Changes to
More informationDevelopmental Screening Focus Study Results
Developmental Screening Focus Study Results February 28, 2018 Lisa Albers, MD, MC II Medical Quality Improvement Unit, Supervisor Managed Care Quality and Monitoring Division Objectives Review performance
More informationGoals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE
Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures
More informationALOHACARE CHANGE IN REFERRAL POLICY
NEWS FOR PHYSICIANS AND PROVIDERS QUARTER 3 2017 ALOHACARE CHANGE IN REFERRAL POLICY We are pleased to announce the elimination of Referral Notifications when you refer an AlohaCare member to other in-network
More informationQuality Management Report 2017 Q4
Quality Management Report 2017 Q4 Care Wisconsin Participates in Many Quality Initiatives Across the State and Federal Levels. These activities include: CMS DHS DHS & CMS HEDIS Member Satisfaction (CAHPS
More informationSeptember 2, Dear Administrator Tavenner:
September 2, 2014 Marilyn B. Tavenner, MHA, BSN, RN Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services P. O. Box 8013 Baltimore, MD 21244-8013 RE: Medicare
More informationAssistance. Improving. Consumer Health. Strategies for
Assistance Strategies for Improving Consumer Health A resource to help educate consumers about available preventive health incentives and eliminating barriers to receiving care www.bhpi.org www.healthsharesolutions.org
More informationAmbulatory Care Delivery Strategy: The Key to Successful Population Health Management
Ambulatory Care Delivery Strategy: The Key to Successful Population Health Management Christopher T. Olivia, MD, President Michael Renzi, DO, Chief Medical Officer March 18, 2014 2014, Continuum Health
More informationCoding Coach Coding Tips
An Independent Licensee of the Blue Cross and Blue Shield Association Coding Coach Coding Tips Medication Reconciliation Measure for Blue Advantage (November 2017) You can use Current Procedural Terminology
More informationAccountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services
Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative
More information2018 PROVIDER TOOLKIT
1100 Circle 75 Parkway Suite 1100 Atlanta, GA 30339 2018 PROVIDER TOOLKIT Understanding the Centers for Medicare and Medicaid (CMS) Stars Rating System What is CMS Quality Star Ratings program? CMS evaluates
More informationCommunicator. the JUST A THOUGHT. Ensuring HEDIS-Compliant Preventive Health Services. Provider Portal Features. Peer-to-Peer Review BY DR.
WINTER 2016 MHS NEWSLETTER FOR PHYSICIANS Ensuring HEDIS-Compliant Preventive Health Services Here are a few best practice strategies for raising HEDIS and EPSDT onsite review scores, as demonstrated by
More informationRussell B Leftwich, MD
Russell B Leftwich, MD Chief Medical Informatics Officer Office of ehealth Initiatives, State of Tennessee 1 Eligible providers and hospitals can receive incentives for meaningful use of certified EHR
More informationCalifornia Pay for Performance: A Case Study with First Year Results. Tom Williams Integrated Healthcare Association (IHA) March 17, 2005
California Pay for Performance: A Case Study with First Year Results Tom Williams Integrated Healthcare Association (IHA) March 17, 2005 Agenda National Perspective California Program Overview Data Collection
More informationTips for PCMH Application Submission
Tips for PCMH Application Submission Remain calm. The certification process is not as complicated as it looks. You will probably find you are already doing many of the required processes, and these are
More informationMeaningful Use and PCC EHR
Meaningful Use and PCC EHR (tim@pcc.com) Users Conference 2016 Agenda MU basics and eligibility How to participate in MU Meeting MU measures in PCC EHR Understanding CQM reporting in PCC EHR Takeaways
More informationTELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL
TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL NOVEMBER 2017 CSHCN PROVIDER PROCEDURES MANUAL NOVEMBER 2017 TELECOMMUNICATION SERVICES Table of Contents 38.1 Enrollment......................................................................
More informationPCC Resources For PCMH. Tim Proctor Users Conference 2017
PCC Resources For PCMH Tim Proctor (tim@pcc.com) Users Conference 2017 Agenda Current state of PCMH and what s coming Exploration of how PCC functionality applies to new 2017 PCMH factors PCC Resources
More informationYour health comes first
Your health comes first Here are the many ways we re working to ensure the quality of your care At Amerigroup, our focus is on you. We want to help you get and stay healthy. That s why we have many programs
More informationExhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)
Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,
More informationVersion 11.5 Patient-Centered Medical Home (PCMH) 2014 Reference Guide for Sevocity Users
Version 11.5 Reference Guide for Sevocity Users Table of Contents Product Support Services... 3 Introduction to PCMH 2014... 4 PCMH 2014 Scoring... 5 PCMH 2014 Meaningful Use Alignment... 7 PCMH 2014 Summary
More informationPRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management
PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management Mission: To improve the health of the people of Connecticut through safe and effective medication
More information04/03/2015. Quality Matters: How to Succeed with PQRS in A Short History of PQRS. Participate Or Else..
Quality Matters: How to Succeed with PQRS in 2015 Jeanne Chamberlin, MA, FACMPE Director, MSOC Health A Short History of PQRS 2007: 3 measures on 80% 2% Bonus 2012: 3 measures on 50% / 80% 0.5% Bonus Performance
More informationWellness Guide for LCRA Retirees
2016 Wellness Guide for LCRA Retirees Contents 2 How the EmPOWER program works 3 How to register 3 Text message reminders 4 Member health assessment 4 Biometric screening 5 Earning points and saving money
More informationPatient-centered medical homes (PCMH): Eligible providers.
ACTION: Final DATE: 09/20/2016 8:11 AM 5160-1-71 Patient-centered medical homes (PCMH): Eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model led by primary
More informationDISEASE MANAGEMENT PROGRAMS. Procedural Manual. CMPCN Policy #5710
DISEASE MANAGEMENT PROGRAMS Procedural Manual CMPCN Policy #5710 Effective Date: 01/01/2012 Revision Date(s) 11/18/2012; 10/01/13 ; 01/07/14 Approval Date(s) 12/18/2012 ; 10/23/13, 05/27,14 Annotated to
More informationFlorida Medicaid: Performance Measures (HEDIS)
Florida Medicaid: Performance Measures (HEDIS) Justin M. Senior Florida Medicaid Director Agency for Health Care Administration Senate Health Policy October 20, 2015 Statewide Medicaid Managed Care (SMMC)
More informationProviderReport. Managing complex care. Supporting member health.
ProviderReport Supporting member health Managing complex care Do you have patients whose conditions need complex, coordinated care they may not be able to facilitate on their own? A care manager may be
More informationChapter 7. Unit 2: Quality Performance Measures
Chapter 7 Unit 2: Quality Performance Measures In This Unit Topic See Page Unit 2: QualityBLUE Physician Pay-for-Performance Program Clinical Quality 2 Acute Pharyngitis Testing 10 Adolescent Well Care
More informationPatient Centered Medical Home: Transforming Primary Care in Massachusetts
Patient Centered Medical Home: Transforming Primary Care in Massachusetts Judith Steinberg, MD, MPH Deputy Chief Medical Officer Commonwealth Medicine UMass Medical School Agenda Overview of Patient Centered
More informationAdvancing Primary Care Delivery
Advancing Primary Care Delivery Tenth National Pay for Performance Summit March 3, 2015 Simeon Schwartz, MD CEO, WESTMED Medical Group, P.C. WESTMED Medical Group Established 1996 by 16 physicians 300
More informationPossible Denominator Codes Applicable to OMS * Le Fort Fractures 21346, 21347, 21348, 21422, 21423, 21432, 21433, 21435, 21436
Individual PQRS s Eligible OMS #20: #22: Perioperative Care: Timing of Antibiotic Prophylaxis Ordering Physician. Percentage of surgical patients aged 18 years and older undergoing procedures with the
More informationConnecticut Department of Public Health and Community Pharmacists Medication Management Services
Connecticut Department of Public Health and Community Pharmacists Medication Management Services MODERATOR: Marie Smith, PharmD Palmer Professor and Assistant Dean, Practice and Public Policy Partnerships,
More informationEnhancing Outcomes with Quality Improvement (QI) October 29, 2015
Enhancing Outcomes with Quality Improvement (QI) October 29, 2015 Learning Objectives! Introduce Quality Improvement (QI)! Explain Clinical Performance Person-Centered Medical Home (PCMH) Measures! Implement
More informationBehavioral Pediatric Screening
SM www.bluechoicescmedicaid.com Volume 3, Issue 5 June 2015 Behavioral Pediatric Screening Clinical recommendations, as well as behavioral pediatric screening best practices, indicate that you should administer
More informationTennessee Health Care Innovation Initiative
March 8, 2016 1 Tennessee Health Care Innovation Initiative It s my hope that we can provide quality health care for more Tennesseans while transforming the relationship among health care users, providers
More informationAlaska Medicaid Program
Alaska Medicaid Program ALASKA ELECTRONIC HEALTH RECORDS Incentive Program Updated January 2018 Provider Manual 1 Background... 4 2 How Do I use this manual?... 6 3 How do I get help?... 7 4 Eligible provider
More informationAnnual Reporting Requirements for PCMH Recognition Overview & Table Reporting Period: 4/3/ /31/2018
Annual Reporting s for PCMH Recognition Overview & Table Reporting Period: 4/3/2017 12/31/2018 Redesign Goals NCQA redesigned its PCMH Recognition program in April 2017 for practices to maintain an ongoing
More informationA Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation
A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation Daniel J. Marino, President/CEO, Health Directions Asad Zaman, MD June 19, 2013 Session Objectives Establish
More informationMedical Assistance Program Oversight Council. January 10, 2014
Medical Assistance Program Oversight Council January 10, 2014 Presentation Outline Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Evolution of the Concept of Patient-Centered Medical Home A New Model of HealthCare Delivery PCMH
More informationMAKING PROGRESS, SEEING RESULTS
MAKING PROGRESS, SEEING RESULTS VALUE-BASED CARE REPORT HUMANA.COM/VALUEBASEDCARE Y0040_GCHK4DYEN 1117 Accepted 2 Americans are sick and getting sicker, with millions of us living with chronic conditions
More informationTransforming to Value: One Way Forward
Transforming to Value: One Way Forward Intermountain Healthcare s Value-Based Reimbursement and Change Management Strategy Mark Briesacher, MD Senior Administrative Medical Director Intermountain Medical
More informationPatient-Centered Specialty Practice (PCSP) Recognition Program
Patient-Centered Specialty Practice (PCSP) Recognition Program Standards Workshop Part 2 2013 All materials 2013, National Committee for Quality Assurance Agenda Part 1 Content of PCSP Standards and Guidelines
More informationBest Practices. SNP Alliance. October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees
SNP Alliance Best Practices October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees Commonwealth Care Alliance is a Massachusetts-based non-profit,
More information