Using CareAnalyzer Reports to Manage HUSKY Health Members

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Shauna Blair
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1 Usig CareAalyzer Reports to Maage HUSKY Health Members A Departmet of Social Services PCMH Presetatio hosted by Commuity Health Network of CT, Ic.

2 Learig Objectives Use CareAalyzer reports to idetify: Members who may have gaps i care Members with high risk coditios for itervetio ad/or care maagemet Members for referral to Itesive Care Maagemet for care coordiatio support Cost of care for your attributed members vs. the overall populatio ad/or subsectio (settig) of the populatio 1

3 CareAalyzer Uses CareAalyzer ca be used to: Assist with proactive populatio maagemet through the use of aalytics Categorize HUSKY members by risk ad severity Examie the relatioship betwee morbidities/illesses ad healthcare service utilizatio Geerate member risk score based o claims diagostic history Provide member detail data Utilizatio ad illess profiles CareAalyzer uses the Johs Hopkis ACG (Adjusted Cliical Group) Logic 2

4 Populatio Maagemet Defie Populatio Stratify Risk What member segmet do you wat to evaluate? Who are your high risk members? Idetify Gaps Which members are missig care? Egage Patiets Track Outcomes How do you outreach to members i eed of care? Which treatmet plas are workig, which are ot? 3

5 CareAalyzer Data Source & Criteria Claims Admiistrative data oly Time Period Limitatios Rollig 12 moth period Data availability depedet o member choice to share their data 4

6 Aalyzig Your Data from CareAalyzer Use data/iformatio for plaig how to address gaps i care ad maage risk levels Risk Utilizatio Gaps Actio 1. Select measure/coditio 2. Aalyze 3. Stratify risk 4. Establish baselie 5. Set goals 6. Take actio 5

7 Select Project Gettig Started Home Page Expad HEDIS, ACG, ad Provider modules to view report meu tree Help for Glossary of Terms ad Report Overview & Uses If a report does ot ope, disable pop-up blockers 6

8 Tips for Usig Reports Use hyperliks for more iformatio Withi data results: Click to drill dow to lie item detail Withi report headigs: Click for report/headig explaatios CareAalyzer opes tabs to geerate reports Idividual report tabs may be closed DO NOT close the CareAalyzer tab itself or you will be locked out for about 30 miutes To exit CareAalyzer : Log Out o the HOME page 7

9 ACG (Risk) Module Idetify high risk members Target care maagemet itervetios Drill dow to detail Disease Prevalece Report Coditio prevalece summary with associated costs Classifies HUSKY members ito disease categories 8

10 ACG Report Tips Click OK whe pop-up appears to cofirm oly your data will be displayed Select PCP_TIN withi Group Type drop dow meu Reports default to All Report will auto-populate Reports take a few secods to populate Refresh ot required at this poit 9

(Expaded Diagosis Clusters) hyperliks withi report 2.

11 ACG Report - Disease Prevalece 1. Select coditio type Use MEDC (Major Expaded Diagosis Clusters) filter or EDC (Expaded Diagosis Clusters) hyperliks withi report 2. Click Refresh to populate report 3. Drill ito data detail High Risk Members Report Example: Asthma with status asthmaticus (acute, severe asthma attack) 10

12 High Risk Members Report Asthma High Risk Member report has multiple filters Click Show Filterig Criteria for optios Click Member ID hyperliks to drill dow to Member Cliical Profile report Sample Member 11

13 High Risk Members Report Filterig Criteria Filter settigs ca be saved as custom filters Filter for members by EDC (Expaded Diagosis Clusters) Groups diagosis codes ito coditio categories 12

Utilizatio Chroic Coditio Cout 15 ER Services 2 Uique MDs 9 Igrediet Cout 24 CHF Member

14 Member Cliical Profile Report - Asthma WHITE/CAUCASIAN NON-HISPANIC ENGLISH Defiitios: NP = Not Preset NR = Not Reported TRT = Member meets treatmet criteria for coditio Member Risk & Utilizatio Chroic Coditio Cout 15 ER Services 2 Uique MDs 9 Igrediet Cout 24 CHF Member Coditio Markers Hypertesio Persistet Asthma Member evet i May Drill to Pharmacy Adherece Report 13

15 Pharmacy Adherece Report - Asthma TRT i Preset colum idicates member meets criteria for treatmet for associated coditio Drill dow to Pharmacy Spas Detail Report from TRT hyperlik 14

16 Pharmacy Spas Detail Report Not accessible from the meu tree Use to determie ay gaps betwee prescriptio refills 15

17 Provider Module Use to target members to improve quality outcomes Drill dow behavior i Provider Module Provider Effectiveess Report drills dow to Provider Detail Report PCP Cost of Care Assessmet Report drills dow to PCP Profile Report PCP Profile Report drills dow to PCP Member List Report 16

18 Provider Module Report Tips Provider Module reports compare practice to peer groups Provider Effectiveess ad PCP Cost of Care Assessmet Reports Click Ope Report Provider Detail, PCP Profile ad PCP Member List Reports Eter Practice TIN i Provider ID field Click Ope Report Module 17

19 Provider Effectiveess Report Looks at rates across a umber of quality measures Drill ito Provider (Measure) Detail reports Example: Two asthma reports AMR & MMA Peer Group ca be filtered to Settig type; choose Group Value 18

20 Provider Detail Reports - Asthma Asthma measures iclude members 5-64 years of age durig the reportig period with persistet asthma Asthma Medicatio Ratio (AMR) Members with a ratio of 50% or greater durig the reportig period for cotroller medicatios to total asthma medicatio (cotroller medicatios to total asthma medicatio >50%) Medicatio Maagemet for People with Asthma (MMA) Members who were dispesed appropriate medicatios ad remaied o medicatios durig treatmet period Two rates reported: 50% = remaied o a asthma cotroller for at least 50% of their treatmet period 75% = remaied o a asthma cotroller for at least 75% of their treatmet period 19

Provider Detail Report - Asthma Medicatio Ratio Met Criteria filter defaults to All Date 1 Most recet date prescriptio filled for umerator data (AMR umerator = members who met 50% rate for cotroller

21 Provider Detail Report - Asthma Medicatio Ratio Met Criteria filter defaults to All Date 1 Most recet date prescriptio filled for umerator data (AMR umerator = members who met 50% rate for cotroller medicatios) Date 2 first date of service from qualifyig claims for deomiator data (AMR deomiator = members ages 5-64 with persistet asthma) Member 1 xx/xx/xxxx Data de-idetified Member Cout = 91 Results iclude all members meetig measure criteria 20

Provider Detail Report - Asthma Medicatio Ratio Set filter for Met Criteria to No; Refresh Report Use to idetify members diagosed with Persistet Asthma with a ratio of cotroller to

22 Provider Detail Report - Asthma Medicatio Ratio Set filter for Met Criteria to No; Refresh Report Use to idetify members diagosed with Persistet Asthma with a ratio of cotroller to total asthma medicatios less tha 50% Member Cout = 39 Results restricted to members with coditio ad did ot meet measure umerator criteria (cotroller use greater tha 50% for AMR) 21

Provider Detail MMA 50% & 75% Two rates based o cotroller use for defied

umerator data (MMA umerator = legth of time member o medicatio, 50/75% of

deomiator data (MMA deomiator = members ages 5-64 with persistet asthma)

23 Provider Detail MMA 50% & 75% Two rates based o cotroller use for defied percet of treatmet period Date 1 Most recet date prescriptio filled for umerator data (MMA umerator = legth of time member o medicatio, 50/75% of treatmet period) Date 2 first date of service from qualifyig claims for deomiator data (MMA deomiator = members ages 5-64 with persistet asthma) Member 1 Member 2 Member 3 Member 4 Member Cout = 91 Results iclude all members meetig measure criteria 22

Provider Detail MMA 50% & 75% Set filter for Met Criteria to No; Refresh

meet asthma medicatio use for 50/75% of the treatmet period Member 1

Member 10 Member Cout = 48 Results restricted to members with coditio ad

24 Provider Detail MMA 50% & 75% Set filter for Met Criteria to No; Refresh Report Use to idetify members diagosed with Persistet Asthma ad did ot meet asthma medicatio use for 50/75% of the treatmet period Member 1 Member 2 Member 3 Member 4 Member 5 Member 6 Member 7 Member 8 Member 9 Member 10 Member Cout = 48 Results restricted to members with coditio ad did ot meet measure umerator criteria (cotroller use of 50/75% or more for treatmet) 23

25 Additioal Provider Reports PCP Cost of Care Assessmet Report summarizes total actual cost vs. expected cost of care PCP Profile Report provides risk-adjusted compariso of total cost of care for attributed members Remider: Filter o Peer Group; select Settig Group Value = All or settig type for user practice FQHC, Glide Path No-FQHC, PCMH No- FQHC, or Practice with o PCMH Recogitio Drill dow to detail 24

Resource Utilizatio Bad Groupigs by health risk

26 PCP Profile Report/Provider Group Profile Profiles PCP practices compared to peer settig RUB = Resource Utilizatio Bad Groupigs by health risk level Compare risk adjusted expected costs to actual costs 25

27 Usig Data to Support Care Coordiatio Goals Data aalysis process Idetify member risks by coditio or utilizatio Stratify by treatmet eeds Idetify gaps i care Determie efficiecies for risk maagemet Use the same process withi CareAalyzer for data aalysis for ay selected coditio or utilizatio criteria Care coordiatio ad itervetios Use idetified gaps i care to defie care coordiatio eeds ad specific itervetios Care coordiatio services available to HUSKY members through referral to Itesive Care Maagemet (ICM) To refer members to ICM: Call , extesio 2025 Fax a completed ICM Referral Form to ; dowload from Select For Providers, Provider Bulletis & Forms the ICM Referral Form 26

28 Pritig, Exportig ad Savig Reports Use Export ad Prit icos at the top of ay report Export & Save a Report Click Export ico Select desired file type Select pages to export Click Export Save file 27

29 Key Cotacts for Support CHNCT Medical ASO geeral support CareAalyzer support Provider Egagemet Services Telephoe Fax Itesive Care Maagemet (ICM) Referrals Telephoe , x2024 Fax Provider Portal URL HUSKY Health Provider Portal Techical Assistace HUSKY Health Provider Portal prompt 3 WebSupport@chct.org CareAalyzer Registratio ad Traiig NetworkMaagemet@chct.org CareAalyzer Help Desk CareAalyzerHelpDesk@chct.org 28

30 Questios? 29

Person-Centered Care Coordination. December 8, 2016

Person-Centered Care Coordination. December 8, 2016 Perso-Cetered Care Coordiatio December 8, 2016 Preseters Departmet of Social Services (DSS) Perso-Cetered Medical Home (PCMH) Program Lead Erica Garcia-Youg, MPH Commuity Health Network of Coecticut, Ic.