Dean Medical Center Dean Health Plan
|
|
- Hannah Rodgers
- 5 years ago
- Views:
Transcription
1 Dean Medical Center Dean Health Plan
2 Improving LDL Screening Following an Acute Coronary Event
3 Project Team Jennifer Close-Goedjen, MS Dean Health Plan William Koller, Jr., MD Dean Health Plan, Dean Medical Center Albert Musa, MD Dean Medical Center Daniel Staddler, MD Dean Medical Center Penny Bogrand Dean Health Plan Jack Bowhan Dean Health System Leslie Gruendel Dean Health Plan Jill Hanson Dean Health Plan Mark Kaufman, MD Dean Health Plan Timothy Lechmaier, MD Dean Medical Center Francis Pagel Dean Health Plan
4 ABBREVIATED ORGANIZATION CHART DHS, Inc. Physician Shareholders SSM SSM Health Care Care Corporation Dean Health Systems, Inc. SSM Health Care of Wisconsin, Inc. Inc. Dean Physician St. St. Marys Practice Association Dean Health Plan Hospital Medical Medical Center Center Dean Medical Center Clinical Practice Committee St. Marys Dean Venture, Inc. Multiple other health care facilities
5 Lipid Testing after an Acute Coronary Event: The Importance Total cost of cardiovascular disease in US estimated to be $329.2 billion (American Heart Association, 2002) Increasing prevalence of cardiovascular disease in DHP population (DHP Population Analysis, 2004) Scientific evidence supporting importance of routine lipid testing and active lipid control in prevention of subsequent coronary events (e.g., Cannon, et al. 2004, Nissen, et al., 2004)
6 Lipid Testing after an Acute Coronary Event: The History 2000 HEDIS results in 25 th percentile Quality Improvement Medical Management Committee (QIMMC) identified as system-wide clinical opportunity for improvement 2002 Member intervention implemented as part of IHC-ATP project (Dr. Mark Kaufman) LDL screening reminder mailed to member LDL educational brochure included
7 Why remind members at 270 days post-event? LDL Testing Days Percent Tested Year LDL Testing days post-event LDL Testing days post-event
8 Aim Statement In the next 12 months, we will improve the day post-acute coronary event (i.e., AMI, PTCA, CABG) LDL screening rate by 10%.
9 Primary Customers Patients/Members Clinicians (PCPs and Cardiologists) Employers (Purchasers) NCQA
10 Project Process Flowchart Identify population Agree to clinical recommendation Develop baseline (post-pilot intervention) measure and goal Develop enhanced intervention retrospective prospective Use HEDIS criteria Identification at SMH by Cardiac Rehab. Staff 1st year: LDL test between 60 and 365 days post event HEDIS 2004 data: LDL test 83.03% LDL control 69.97% Barriers analysis; Cause and Effect Diagram Build patient registry; 12/31/99 and forward Develop data collection tool Subsequent years: annual LDL testing Goals (by 2005) LDL test: 90% LDL < 100: 75% Discuss potential interventions and change ideas Implement monthly registry update process Enter data into laptop LDL order prior to discharge Implement pilot intervention Select enhanced intervention Identify enhanced intervention population
11 Cause and Effect Diagram Information systems no central database lack of system EMR Patient unaware of need for LDL medication compliance no master member index medication cost Coordination of care multiple providers variable clinical follow-up primary care cardiology cardiac surgery physician extender HIPAA concerns no patient registry HEDIS LDL value is 130 revenue codes no follow-up protocol no performance data no clinical consensus no standard follow-up doesn t believe LDL needed who is in charge? financial system QI structure lack of dedicated staff Lack of follow-up LDL after AMI, PTCA, or CABG Follow-up LDL control not < 100 Data Physician System resources
12 Improvement Opportunity Actively engaging practitioner in improvement Practitioner letter Practitioner alert Copy of member materials Request assistance Why focus on practitioners? addressed member, data, and information systems causes Implemented member registry Implemented member intervention Resolved revenue code issues
13 Data Specifications Identify members with an acute coronary event HEDIS Technical Specifications for Cholesterol Management after an Acute Coronary Event Measure Administrative Medical Claims Member Identification Number Member Name ICD-9 Code (410.x1, 36.01, 36.02, 36.09, 36.1, 36.2) or DRG Code (105, 107, 109, 112, 121, 122, 516) Event date Determine if LDL Test received in days following event date HEDIS Technical Specifications for Cholesterol Management after an Acute Coronary Event Measure Administrative Medical Claims Member Identification Number Member Name CPT code (80061, 83715, 83716, 83721) Date of Service Identify assigned primary care practitioner for members without an LDL screening Imputation Algorithm Quarterly Imputation File Member identification Number PCP Code Primary Care Practitioner Name/Clinic Location
14 Data Sources Administrative Medical Claims Member Number (11 digits) Member Name (Last Name, First Name, Middle Initial) ICD-9 code or 410.x1, 36.01, 36.02, 36.09, 36.1, 36.2) DRG Code(105, 107, 109, 112, 121, 122, 516) Date of Acute Coronary Event (mm/dd/yyyy) CPT Code (80061, 83715, 83716, 83721) Date of LDL Screening (mm/dd/yyyy) Quarterly Imputation File (internally generated SAS database) PCP Code Primary Practitioner Code (xxxxx) Primary Care Site Code (xxx)
15 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% LDL Test Following an Acute Coronary Event ( Days) Member Letter Clinician Letter 11/00 12/00 01/01 02/01 03/01 04/01 05/01 06/01 07/01 08/01 09/01 10/01 11/01 12/01 01/02 02/02 03/02 04/02 05/02 06/02 07/02 08/02 09/02 10/02 11/02 12/02 01/03 02/03 03/03 04/03 05/03 06/03 07/03 08/03 09/03 10/03 11/03 12/03 Event Date Percent of Members
16 Next steps Evaluate effectiveness of practitioner intervention Collaborate with CPC task force to improve system-wide screening rates Implement automated reminders and lab orders through EMR Compare performance to local competitors using HEDIS 2005 data
SMARTCare Site Job Descriptions Site Physician Lead (Champion)
SMARTCare Site Job Descriptions Site Physician Lead (Champion) Educational Requirements: Local (Site) Physician Champion Cardiovascular Fellow of the American College of Cardiology The Local Physician
More informationThe Heart and Vascular Disease Management Program
Element A: Program Content The Heart and Vascular Disease Management Program GHC-SCW is committed to helping members, and their practitioners, manage chronic illness by providing tools and resources to
More informationCASE STUDY. An HIE-populated personal health record for cardiac revascularization patients
CASE STUDY An HIE-populated personal health record for cardiac revascularization patients PROGRAM NAME ONC Challenge Grant Consumer-Mediated Information Exchange PILOT SITE LOCATION Parkview Physicians
More informationA. DIABETES AND HEART/STROKE Data Detail
A. DIABETES AND HEART/STROKE Data Detail Under the category of Effective Care, MHMC currently reports practices who have achieved national recognition for any of the Bridges to Excellence (BTE) clinical
More informationMove the Needle on Difficult Quality Measures: How Health Plans Can Control High Blood Pressure
Move the Needle on Difficult Quality Measures: How Health Plans Can Control High Blood Pressure A Centauri Health Solutions Sm White Paper By melanie Richey 2016 by Centauri Health Solutions, Inc. All
More informationATTACHMENT 3b REVISED DATA COLLECTION TOOL #1. Million Hearts Hypertension Control Champion Application Form
ATTACHMENT 3b REVISED DATA COLLECTION TOOL #1 Million Hearts Hypertension Control Champion Application Form 0920-0976 Form Approved OMB No. 0920-0976 Exp. date 12/31/2019 Million Hearts Hypertension Control
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 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 informationBundled Payments to Align Providers and Increase Value to Patients
Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is
More informationSTEMI RECEIVING CENTER
Monterey County EMS System Policy Policy Number: 5150 Effective Date: 5/1/2012 Review Date: 12/31/2016 STEMI RECEIVING CENTER I. PURPOSE To define requirements for designation as a Monterey County STEMI
More informationCMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016
CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 Agenda Collaborative Learnings HF Correlation to AMI and CABG Bundled Payments CMS AMI & CABG Bundled Payment Programs
More informationdiabetes care and quality improvement in our practice
The Multidisciplinary Team: The key to successful planned diabetes care and quality improvement in our practice Robb Malone, PharmD UNC General Internal Medicine January 20, 2009 Objectives Review the
More informationMedicare Physician Group Practice Demonstration
Medicare Physician Group Practice Demonstration Disease Management Colloquium Philadelphia, Pennsylvania June 23, 2005 John Pilotte Senior Research Analyst Medicare Demonstrations Program Group Centers
More informationTransforming Care Delivery by Moving from Episodic to Coordinated Payment
Transforming Care Delivery by Moving from Episodic to Coordinated Payment Kenneth E. Berkovitz, M.D. System Medical Director Bob Hunter, M.B.A., M.A. System Administrative Director Robert A. Gerberry,
More informationCatholic Medical Partners
Improving Health Outcomes Patricia Podkulski, MS,RN October 13, 2011 Catholic Medical Partners 2 Independent Practice Association WNY: Erie/Niagara counties 900 physicians Four (4) Acute Care Hospitals
More informationDisclosures. Platforms for Performance: Clinical Dashboards to Improve Quality and Safety. Learning Objectives
Platforms for Performance: Clinical Dashboards to Improve Quality and Safety Disclosures The program chair and presenters for this continuing pharmacy education activity report no relevant financial relationships.
More informationData Quality Improvement Plan
Data Quality Improvement Plan Goal This interac ve document is for Clinical Health Informa on Technology Advisors (CHITAs) to work with a prac ce to ins tute sustainable quality improvement. The Data Quality
More informationPURPOSE: The purpose of this policy is to establish requirements for designation as a STEMI Receiving Center (SRC) in San Joaquin County.
PURPOSE: The purpose of this policy is to establish requirements for designation as a STEMI Receiving Center (SRC) in San Joaquin County. AUTHORITY: Health and Safety Code, Division 2.5, Sections 1797.67,
More informationNational Priorities for Improvement:
National Priorities for Improvement: Standardization of Performance Measures, Data Collection, and Analysis Dale W. Bratzler, DO, MPH Principal Clinical Coordinator Oklahoma Foundation Contracting for
More informationAsthma Disease Management Program
Asthma Disease Management Program A: Program Content GHC-SCW is committed to helping members, and their practitioners, manage chronic illness by providing tools and resources to empower members to self-manage
More informationCollaboration of the Hybrid AF Patient: Role of Advanced Practice Providers. Jennifer Walker, RN, MSN, ANP-BC UNC Center for Heart and Vascular Care
Collaboration of the Hybrid AF Patient: Role of Advanced Practice Providers Jennifer Walker, RN, MSN, ANP-BC UNC Center for Heart and Vascular Care Conclusions New paradigm has shifted towards team-based
More informationReducing Hospital Admissions Through the Use of IT. Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods
Reducing Hospital Admissions Through the Use of IT Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods Conflict of Interest Steven Milligan, MD Has no real or apparent conflicts
More informationPPC2: Patient Tracking and Registry Functions
PPC2: Patient Tracking and Registry Functions Element F: Use of System for Population Management At we use our EMR, clinical event manager, and the ad hoc reporting system (Business Objects) for a multi-pronged
More informationOctober 3, Dear Dr. Conway:
October 3, 2016 Patrick Conway Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-5519-P P.O. Box 8013 Baltimore, MD 21244-1850 Dear Dr. Conway: Thank you
More informationPCMH: Recognition to Impact
PCMH: Recognition to Impact 3.1.16 Prepared by: Shannon Nielson, MHA, PCMH CCE Prepared for: OACHC 2016 Annual Conference Centerprise, Inc Objectives Defining a Patient Centered Medical Home Translating
More informationRisk Adjustment Methods in Value-Based Reimbursement Strategies
Paper 10621-2016 Risk Adjustment Methods in Value-Based Reimbursement Strategies ABSTRACT Daryl Wansink, PhD, Conifer Health Solutions, Inc. With the move to value-based benefit and reimbursement models,
More informationComplex Patient Care Redesign: ThedaCare Innovation. Gregory Long, MD Chief Medical Officer
Complex Patient Care Redesign: ThedaCare Innovation Gregory Long, MD Chief Medical Officer ThedaCare Northeastern Wisconsin An Integrated Community Health System; >7000 employees Primary service area of
More informationUsing Data to Yield High Impact Business Intelligence Wednesday, July 25, 2012
Using Data to Yield High Impact Business Intelligence Wednesday, July 25, 2012 Brent J. Estes President and CEO, Rush Health About Rush Rush University Medical Center 673 Beds 36,000 admissions 391,700
More informationObjective Measurement
STEMI Designation Contract HOSPITAL SERVICES A. Current license to provide Basic Emergency Services in Contra Costa County Copy of License B. Cardiac Catheterization Laboratory services Copy of License.
More informationNext Generation Physician Compensation Design in a Schizophrenic Payer Environment
Next Generation Physician Compensation Design in a Schizophrenic Payer Environment Presented to: 2015 Spring Managed Care Forum Friday, April 24, 2015 Today s agenda Setting the Stage Why are we Here?
More informationCVD Prevention Takes a Team. Ed Havranek, MD Denver Health University of Colorado
CVD Prevention Takes a Team Ed Havranek, MD Denver Health University of Colorado CVD Prevention Potential Impact Modality # RCTs Outcome RR Aspirin 1 10 CV events 0.94 (0.88 0.99) BP control 2 68 All-cause
More informationCOMPASS Workflow & Core Elements
COMPASS Workflow & Core Elements Care of Mental, Physical, and Substance use Syndromes! The project described was supported by Grant Number 1C1CMS331048-01-00 from the Department of Health and Human Services,
More informationMedical Record Review Tool Standards with Definitions
WellCare Health Plans, Inc. WellCare of Georgia, Inc The WellCare Group of Companies Medical Record Review Tool Standards with Definitions Item # STANDARD DEFINITION SOURCE All Medical Records: 1 Patient
More informationSouthwest Cardiology Physician Preferences
Southwest Cardiology Physician Preferences Dr. Reddivari a. Pull in last office visit note. b. Add wild cards under HPI, ROS, EXAM, Cardiac History and Recommendations. c. If no old note is available,
More informationAssessment of Primary Care Resources and Supports for Chronic Disease Self management (PCRS) Quality Levels
To be filled in by your survey administrator: Site/ Location: Team: Focus of assessment or patient population under consideration (e.g., those with specific condition, those seen by certain patient care
More informationHIMSS Davies Enterprise Application --- COVER PAGE ---
HIMSS Davies Enterprise Application --- COVER PAGE --- Applicant Organization: Hawai i Pacific Health Organization s Address: 55 Merchant Street, 27 th Floor, Honolulu, Hawai i 96813 Submitter s Name:
More informationFY 2014 Inpatient Prospective Payment System Proposed Rule
FY 2014 Inpatient Prospective Payment System Proposed Rule Summary of Provisions Potentially Impacting EPs On April 26, 2013, the Centers for Medicare and Medicaid Services (CMS) released its Fiscal Year
More informationBundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience
Bundled Payments AMGA September 25, 2013 Who Are We AGENDA Our Business Challenge Episode Process Experience 1 Cleveland Clinic is transforming Fee for service Fee for value 3 Fast Facts 41,200 employees
More informationPart 2: PCMH 2014 Standards
Part 2: PCMH 2014 Standards Heather Russo, CCE PCMH Consultant September 15, 2015 Advancing Healthcare Improving Health For Practices Recognized at Level 2 or Level 3 under the 2011 Standards Your Guide
More informationN.E.W.T. Level Measurement:
N.E.W.T. Level Measurement: Voldemort or Dumbledore? Nathan Spell, MD, FACP Chief Quality Officer, Emory University Hospital Georgia Chapter Scientific Meeting American College of Physicians Savannah,
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 informationTargeted technology and data management solutions for observational studies
Targeted technology and data management solutions for observational studies August 18th 2016 Zia Haque Arshad Mohammed Copyright 2016 Quintiles Your Presenters Zia Haque Senior Director of Data Management,
More informationAccelerating the Impact of Performance Measures: Role of Core Measures
Accelerating the Impact of Performance Measures: Role of Core Measures Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair
More informationManaging Congestive Heart Failure as a Business September 13, 2010 Session M30 Society for Healthcare Strategy and Market Development annual meeting
Managing Congestive Heart Failure as a Business September 13, 2010 Session M30 Society for Healthcare Strategy and Market Development annual meeting Chris Kane SVP, Strategic Business Development WellStar
More informationImplementing AHA Quality Improvement Programs: Get With the Guidelines
Implementing AHA Quality Improvement Programs: Get With the Guidelines Sidney C. Smith, Jr. MD FAHA, FACC, FESC Professor of Medicine/Cardiology University of North Carolina Past President, American Heart
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 informationAETNA BETTER HEALTH OF VIRGINIA Provider Newsletter
AETNA BETTER HEALTH OF VIRGINIA Provider Newsletter Winter 2016 Table of Contents 2017 HEDIS Tips...1 Member Rights and Responsibilities..2 Interpreter and Translation Services..2 Practice Guidelines...3
More informationQuality Measures for HMO s: Understanding HEDIS
Quality Measures for HMO s: Understanding HEDIS DANE COUNTY IMMUNIZATION COALITION MEMBERSHIP MEETING November 29, 2011 Elaine Rosenblatt MSN, FNP-BC Director, Quality and Care Management UW Medical Foundation/
More informationSIMPLE SOLUTIONS. BIG IMPACT.
SIMPLE SOLUTIONS. BIG IMPACT. SIMPLE SOLUTIONS. BIG IMPACT. QUALITY IMPROVEMENT FOR INSTITUTIONS combines the American College of Cardiology s (ACC) proven quality improvement service solutions and its
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 informationAirStrip ONE Cardiology
AirStrip ONE Cardiology A Synchronized View of the Vital Patient Data Needed to Improve Care Heart disease is the leading cause of death in the U.S. The associated costs exceed $100 billion annually. AirStrip
More informationBackground Paper For the Cardiology Audit and Registration Data Standards (CARDS) Conference during Ireland s Presidency of the European Union
Background Paper For the Cardiology Audit and Registration Data Standards (CARDS) Conference during Ireland s Presidency of the European Union Executive Summary The Minister for Health and Children aims
More informationThe Role of Analytics in the Development of a Successful Readmissions Program
The Role of Analytics in the Development of a Successful Readmissions Program Pierre Yong, MD, MPH Director, Quality Measurement & Value-Based Incentives Group Centers for Medicare & Medicaid Services
More informationResuscitation Centers of Excellence: Designation Process Rev January 2010
Resuscitation Centers of Excellence: Designation Process Rev January 2010 The Path to Improved Outcomes from Sudden Cardiac Arrest in the Austin/Travis County Area The concept of regionalized and specialized
More informationOutpatient Hospital Facilities
Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology
More informationWe do all of IT to help you do all of Healthcare
We do all of IT to help you do all of Healthcare Euroscore Telemedicine Risk Factor Risk Calculator Patient Portal ICD 10 National Registry Mobile App Critical Care Management CPOE Lifeline E-Clinic Cardiac,
More informationBuilding & Strengthening Patient Centered Medical Homes in the Safety Net
Blue Shield of California Foundation County Coverage Expansion Planning Workshop #2 Building & Strengthening Patient Centered Medical Homes in the Safety Net July 8, 2011 Presented by: Kathryn Phillips,
More informationRetrospective Bundles
Bundled Payment for Care Improvement (BPCI) Overview Shawn Matheson MBA, LNHA, FACHCA Market Manager Idaho Health Care Association Annual Convention Boise, ID July 13, 2017 Retrospective Bundles Surgeon
More informationMOC Part IV: Your Guide to Making it Happen.
MOC Part IV: Your Guide to Making it Happen. Joseph P. Drozda, Jr., MD, F.A.C.C. Mercy, MO Paul D. Varosy, MD, F.A.C.C., FAHA, FHRS University of Colorado Denver School of Medicine, CO Disclosures Course
More informationRequirements Document for the Blue Quality Physician Program sm Criteria Effective 08/03/2015
All practices must reapply to the BQPP every 18 months Criteria Definition Validation Source(s) 7 Practice Elements 3 Provider Elements Practice level points: 1. PCMH/PPC/PCSP Recognition *Mandatory 2.
More informationCare Management Policies
POLICY: Category: Care Management Policies Care Management 2.1 Patient Tracking and Registry Functions Effective Date: Est. 12/1/2010 Revised Date: Purpose: To ensure management and monitoring of patient
More informationQuality Based Impacts to Medicare Inpatient Payments
Quality Based Impacts to Medicare Inpatient Payments Overview New Developments in Quality Based Reimbursement Recap of programs Hospital acquired conditions Readmission reduction program Value based purchasing
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 informationVisit to download this and other modules and to access dozens of helpful tools and resources.
This is the third module of Coach Medical Home a six-module curriculum designed for practice facilitators who are coaching primary care practices around patient-centered medical home (PCMH) transformation.
More informationFlorida Blue Clinical Documentation Improvement Program (CDI)
Florida Blue Clinical Documentation Improvement Program (CDI) Why Are CDI Programs Important? Clinical documentation is at the core of every patient encounter. In order to be meaningful, it must be accurate,
More information2017 Quality Rewards Program
2017 Quality Rewards Program Overview High-level Program Description and Guidelines What Is Changing in 2017 Bonus Payments Description Payment Timing 2 Doc #: PCA-1-005014-02032017_03092017 Updated 06262017
More informationReducing Readmissions for Myocardial Infarctions with Early Access to Clinic: An Innovative Approach
Reducing Readmissions for Myocardial Infarctions with Early Access to Clinic: An Innovative Approach Kathryn Ward, MSN, PHCNS-BC, DNPc 2016 Ninth Annual DNP Conference, Baltimore, MD October 5-7, 2016
More informationPGY-1 Pharmacy Practice
Lutheran Health Network PGY-1 Pharmacy Practice Residency Program LHN Pharmacy Residency Program Mission Statement The mission of the LHN Pharmacy Residency Program is to empower pharmacy residents to
More informationHealthcare Effectiveness Data and Information Set (HEDIS)
Healthcare Effectiveness Data and Information Set (HEDIS) IlliniCare Health is a proud holder of NCQA accreditation as a managed behavioral health organization (MBHO) and prioritizes best in class performance
More informationInnovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination
Innovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination November 15, 2017 RRHA Healthcare Innovations Conference Agenda Arnot Health Overview
More informationCountry report Bosnia and Herzegovina December 2015
Country report Bosnia and Herzegovina December 2015 Report by: Prof. Mirza Dilic, MD, PhD, FESC, FACC National CVD Prevention Coordinator of the Federation of Bosnia and Herzegovina Prof. Dusko Vulic,
More informationOutpatient Quality Reporting Program
OQR 2016 Specifications Manual Update Questions & Answers Moderator: Pam Harris, BSN Speakers: Nina Rose, MA Samantha Berns, MSPH Bob Dickerson, HSHSA, RRT Angela Merrill, PhD Colleen McKiernan, MSPH,
More informationAmerican College of Cardiology Patient Navigator Program Focus MI National PROGRAM REQUIREMENTS
American College of Cardiology Patient Navigator Program Focus MI National 1. Participant Responsibilities PROGRAM REQUIREMENTS 1.1. Program Management 1.1.1. Upon opting-in to the Patient Navigator Program
More informationBCBSM Pay-for-Performance Measure Technical Document (Version 2.0)
BCBSM Pay-for-Performance Measure Technical Document (Version 2.0) Developed by Michigan Value Collaborative July 2017 ACKNOWLEDGEMENTS P4P Measure Methodology Report 2 July 2017 TABLE OF CONTENTS LIST
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 informationACC State Chapters Best Practice Guide. Working with States on Clinical Data Requests
ACC State Chapters Best Practice Guide Working with States on Clinical Data Requests Prepared by: Science, Education and Quality Division As of: 3/16/2016 Contents 1. Introduction... 1 2. NCDR Registries
More informationHeart Failure Clinic a Multidisciplinary approach. Amy Benson, PA-C, MSPAS Presbyterian Heart Group Albuquerque, NM
Heart Failure Clinic a Multidisciplinary approach Amy Benson, PA-C, MSPAS Presbyterian Heart Group Albuquerque, NM Disclosure I have no actual or potential conflict of interest in relation to this program/presentation.
More informationBCBSTX Bridges to Excellence Cardiac Care Program Guide
BCBSTX Bridges to Excellence Cardiac Care Program Guide Blue Cross and Blue Shield of Texas (BCBSTX) is pleased to offer an innovative program that recognizes Texas physicians who deliver excellent care
More informationCultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director
Cultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director AMGA Pre-conference Workshop 1 April 14, 2011 Washington, D.C. Disclosure Nothing in Today
More informationKeenan Pharmacy Care Management (KPCM)
Keenan Pharmacy Care Management (KPCM) This program is an exclusive to KPS clients as an additional layer of pharmacy benefit management by engaging physicians and members directly to ensure that the best
More information2) The percentage of discharges for which the patient received follow-up within 7 days after
Quality ID #391 (NQF 0576): Follow-Up After Hospitalization for Mental Illness (FUH) National Quality Strategy Domain: Communication and Care Coordination 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY
More informationPragmatic Trial Designs Capturing Endpoints and Integrating Data from Non-Linked Sources
Pragmatic Trial Designs Capturing Endpoints and Integrating Data from Non-Linked Sources Matthew T. Roe, MD, MHS Duke Clinical Research Institute Conflict of Interest Statement Matthew T. Roe, MD, MHS
More informationAn overview of Wisconsin Medicaid quality
Focus On... Quality Improvement An overview of Wisconsin Medicaid quality Marcia K. Hladilek, MPH; Marilyn J. Howe, MSN, RN; Richard M. Carr, MD, MS Introduction Almost 100 years have passed since E. A.
More informationPresbyterian Healthcare Services Care Management
Presbyterian Healthcare Services Care Management Kathy M. Garcia RN, BSN Director of Nursing, Primary Care Service Line November 2012 Future Healthcare Challenges Increasing number of patients Decreasing
More informationPatient Centered Medical Home. History of PCMH concept. What does a PCMH look like? 10/1/2013. What is a Patient Centered Medical Home (PCMH)?
What is a Patient Centered Medical Home (PCMH)? Patient Centered Medical Home Jeremy Thomas, PharmD, CDE UAMS Department of Pharmacy "an approach to providing comprehensive primary care that facilitates
More informationPSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence
PSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence Rachel Brunt, RN, BSN, MBA-HCA, CIC, CPHQ, Director Quality Jessie Hanks, BS, RHIA, Director HIM Lafayette General
More informationIdentifying and Defining Improvement Measures
Identifying and Defining Improvement Measures M1 December 8, 2014 Following the CAUTI Case P2 1. Baselines, Gaps, Aims, Outcomes Where are we now, and what are we trying to accomplish? 2. Building a Theory
More information2017 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members
2017 Congestive Heart Failure Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Congestive Heart Failure Program Evaluation Program Title: Congestive Heart
More informationSTEMI SYSTEM RECEIVING CENTER STANDARDS AND DESIGNATION
POLICY NO: FAC - 9 DATE ISSUED: 11/2016 DATE TO BE REVIEWED: 11/2019 STEMI SYSTEM RECEIVING CENTER STANDARDS AND DESIGNATION Purpose: To define the criteria for designation as a STEMI Receiving Center
More informationMember Satisfaction: Moving the Needle
Member Satisfaction: Moving the Needle Webinar for IPAs and Providers January 4, 2017 Accreditation of Medi-Cal and L.A. Care Covered. L.A. Care QI Webinar 1 Agenda Topic Introduction CG-CAHPS Recommended
More informationCan Improvement Cause Harm: Ethical Issues in QI. William Nelson, PhD Greg Ogrinc, MD, MS Daisy Goodman, CNM. DNP, MPH
Session Code A4, B4 The presenters have nothing to disclose Can Improvement Cause Harm: Ethical Issues in QI William Nelson, PhD Greg Ogrinc, MD, MS Daisy Goodman, CNM. DNP, MPH December 6, 2016 #IHIFORUM
More informationRescueNet Dispatch, epcr, Care Exchange. HL7 v2. Ellkay LK EMR-Archive Smart on FHIR SAML Ellkay to Epic
Use Case Title: Heart Attack Overview: Morgan is 40 years old and is experiencing chest pains. A 911 call is placed. Emergency Medical Services arrives and Morgan is evaluated. The decision comes down
More informationCode Sepsis: Wake Forest Baptist Medical Center Experience
Code Sepsis: Wake Forest Baptist Medical Center Experience James R. Beardsley, PharmD, BCPS Manager, Graduate and Post-Graduate Education Department of Pharmacy Wake Forest Baptist Health Assistant Professor
More informationQuality ID #348: HRS-3 Implantable Cardioverter-Defibrillator (ICD) Complications Rate National Quality Strategy Domain: Patient Safety
Quality ID #348: HRS-3 Implantable Cardioverter-Defibrillator (ICD) Complications Rate National Quality Strategy Domain: Patient Safety 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE:
More informationPresenter Disclosure Information
The following program is co-provided by the American Heart Association and Health Care Excel, the Medicare Quality Improvement Organization for Kentucky. 3/1/2013 2010, American Heart Association 1 1 2
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 Efforts San Diego s Experience
Quality Improvement Efforts San Diego s Experience LIHP 2 nd Evaluation Convening Meeting May 9, 2013 Peter I. Shih, M.P.H. Administrator, Health Care Policy County of San Diego County of San Diego Population
More informationINTEGRATED DATA ANALYTICS AND CARE WORKFLOW OPTIMIZATION
INTEGRATED DATA ANALYTICS AND CARE WORKFLOW OPTIMIZATION CASE STUDY October 2016 1 AGENDA 1 2 3 INTRODUCTIONS Speaker and System 4 Q+A VALUE OF INTEGRATED DATA Why effective ACOs require EHR, Claims, and
More informationBlueprint Integrated Pilot Programs
Blueprint Integrated Pilot Programs Improving Access Improving Quality Improving Efficiency National Conference of State Legislatures December 10, 2008 Craig Jones MD Craig.jones@state.vt.us Health Care
More information