QUALITY HEALTH AND IMPROVEMENT COMMITTEE/ MEDICAL DIRECTORS MEETING July 28, 2016 Primary Care Coalition 4pm 6:00 pm

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1 Present: CCACC Dr. Yao-Yao Zhu Mansfield Kaseman Clinic- Dr. Neil Speigel; Pat Schaefer Mary s Center Caeaden Dempsey McCarrick Center Dorys Peraza Mercy Health Clinic- Dr. Lauren Cosgrove Mobile Med Dr. Audrey Corson; Kathy Luton, NP Montgomery County DHHS - Doreen Kelly The Peoples Community Wellness Center Dr. Carla Lambert Proyecto Salud Dr. Monica Howard PCC- Fareed Anjum; Rose Botchway; Barbara Eldridge; Jenna Hall; Mary Joseph; Dr. Tom Lewis; Nneka Madu; Jennifer Pauk; Rafael Ramirez; Barbara Raskin; Ben Turner Guests: From Montgomery County Adult Behavioral Health: Maria Caro; Randall Ingate; Anita Nnuchuku Not represented: Care for Your Health; CCI; Holy Cross; Muslim Community Center Topic Updates and Announcements Dispensing Clinic providers do not require dispensing permits (nonprofit; no charge) PCC working with Maryland Academy of Physician Assistants (MAPA). MAPA leading efforts next legislative session to obtain PA dispensing under COMAR. Clinic executives engaged; Agnes Saenz has contacted Senator Kagan s office. Vaccines PCC has identified favorable vaccine pricing and sources of free vaccines. Clinics may utilize their own funding to purchase, but County community pharmacy funds may only be used for seasonal flu and pneumococcal vaccines. Research and Specialty Care Whitman Walker (FQHC in DC) is seeking participants for Pre-exposure Prophylaxis, and has offered to provide continuing education or specialty resource for Trans, LGPT, HIV, other infectious disease specialty care. Has requested time on October QHIC agenda Project Access Increases in provider recruitment, rate negotiations and process improvements contributed to improved efficiency and effectiveness. 75% of referrals in FY 16 resulted in a completed consult (80% in the last quarter of the year) Project Access is focusing recruitment toward GI, general surgery, ophthalmology, urology and ambulatory surgery centers. Process improvement work revealed opportunities to streamline referrals that could cut time from referral to first Next Steps Updates and Announcements Vaccines See pricing and contacts provided as handouts. PCC continues to seek grant funding for cost of recommended adult vaccines. Research and Specialty Care Unanimous response; not a significant issue in Montgomery Cares population; no interest in presentation. Barbara will advise Whitman Walker. Project Access 2-3 clinics will be invited to pilot new referral process in the fall.

2 visit from 8-12 to 4 weeks. Clinics can help to expedite referrals by making sure that they have spoken with the patient and included in the referral: o Current phone number o Dates/times available for appointments o Agreement that patient wants the referral and will remain in the area to attend an appointment/complete episode of care (generally 8 weeks). Montgomery Cares 2.0 Cards Patients misunderstanding the purpose of the card; expecting coverage for hospitals, EDs, labs Montgomery County Adult Behavioral Health Program (ABH) Presentation by Randall Ingate, LCSW-C. ABH recently added a community health nurse to better promote collaboration with medical clinics; facilitate bidirectional referrals between ABH and primary care to provide recommended care and care coordination; reduce ED and hospital utilization. Introduced Maria Caro, RN as the community health nurse; will be co-located with Proyecto Salud. ABH includes 5 therapists (multiple languages) and treats patients with serious mental illness. Sliding fee scale ($5- $15 visits). ABH clients in need of primary and specialty care; particularly neurology and oncology services. Services generally not available for the approximately 100 undocumented ABH clients. Capacity 315 clients/year. Mammography Screening Progress Update QHIC previously requested regular updates on this topic at QHIC. Ben Turner presented data through March Mammography rates have increased; more clinics reaching HEDIS benchmarks. More established patients (3 or more visits) are screened at rates > HEDIS benchmarks. Small but persistent gaps in screening rates among non- Hispanic white, Asian Pacific Islanders, and Speakers of Chinese, Urdu and Bangala. Causes of low screening rates among Asian women include unfamiliarity/acceptance with screening if asymptomatic. Elderly population relies on family for transportation and support. Montgomery Cares 2.0 Cards Rose Botchway indicated that MC 2.0 team is aware of patient confusion around the card and working on improvements. Jennifer Pauk will coordinate obtaining a single point of contact in each clinic for ABH. Barbara Raskin will send information to ABH listing clinic locations, services, languages spoken. Clinics may make direct referrals to ABH: o Phone Randall at o Contact Access Team to discuss resources/options Subsequent to meeting, Randall confirmed with Cornerstone that they do not accept uninsured patients for care. Clinics encouraged to reinforce with providers the efficacy of their recommendations/referrals for screening mammography Diagnostic studies/additional diagnostic views should be referred by the clinic to WCCP or BCCP. Screening radiology providers are not routinely reimbursed for diagnostic studies. Mary Joseph confirmed that WCCP no longer requires state issued ID. BCCP (and Maryland Cancer Fund) require proof of Maryland residency. PCC to send rates by provider

3 QUALITY HEALTH AND IMPROVEMENT COMMITTEE/ Improvement is the result of 2 factors: o More referrals to mammography o Effective structure of referrals resulting in high completion rates and few no-shows. Opportunity to improve timeliness for f/u of BI-RADS 0 Clinics find it helpful to indicate screening and additional views on referral, but understand that additional diagnostic tests are referred to WCCP (women 40 years) or BCCP (women <40). Concerns about timeliness of WCCP, WCCP requirement for state-issued ID, and personnel issues at WAH and Shady Grove radiology. Pharmacy and Medicine Access Jenna Hall previously sent out to QHIC requesting responses to formulary changes. 5 clinics have responded. Final decision by QHIC is deferred pending additional clinic input. Clinical Metrics: Chronic care and screening measures are based on HEDIS definitions. Currently no behavioral health measures are endorsed, but they are under review by NCQA and other national organizations. Jennifer Pauk anticipates that nationally endorsed measures will be similar to those the QHIC adopted last year. Once nationally endorsed measures are released, we will review our measures for possible modifications. FY 17 Montgomery Cares proposed measure definitions presented. o No changes to chronic care or screening measures. o Clarified which behavioral health measures include active patient definition o Restricted follow up and symptom reduction measures to MCBHP sites only, as measures of program effectiveness. That data is not readily available from other clinic sites. o Mobile Med objects to the exclusion of certain behavioral health CPT codes, since these may be used by Mobile Med in conjunction with primary Nneka, Ben and Mary are available to meet with individual clinics. Nneka and Ben will provide mammography screening rates by individual provider (these have been/are available any time upon request to Fareed Anjum) Clinics that have not yet responded agreed to reply to Jenna within 2 weeks. Jenna will then propose formulary changes for approval; Medical Directors agreed to a one week turnaround for approval after receipt. Jenna will confirm with Pharmedix the turnaround time to provide newly added medications. Clinical Metrics: PCC to evaluate use and impact of behavioral health codes with Mobile Med. Will then set up a meeting to include review of documentation if indicated.

4 o QUALITY HEALTH AND IMPROVEMENT COMMITTEE/ care visits. These codes only affect Mobile Med. Mobile Med also notes that these results are much lower than their own calculations indicate. PCC conducted previous analysis and found differences in definitions. Q2 CY 2016 results distributed. o Congratulations to CCI, Mercy, Mansfield Kaseman and Proyecto for exceeding goal that 90% of active patients received depression screening in the past year. o Significant improvements in diabetic retinal eye exams as a result of Project Access and individual clinics work with Columbia Lighthouse for the Blind. Montgomery Cares ecw Clinical Users Group CRISP Updates Every clinic needs to complete 3 items before CRISP integration can be completed. Only a few clinics have done so to date o Sign participation agreements o Insert language into Notice of Privacy Practices o Make patient opt-out forms available. Once completed, ehx tab should provide all CRISP history within the tab. ecw Mandatory Update o PCC must physically update ecw for each client in each clinic, requiring access to individual computers o Each update takes about 15 minutes/computer; PCC can update 3-4 computers at a time o IPad and remote access users do not need the update. ecw User Concerns Clinics voiced concerns about serious issues with ecw including one in which orders placed by a user defaults to the primary provider, resulting in legal liability. Concerns about requests and trouble shooting that have not been addressed by PCC/eCW Re-iterated requests for Smart Form that MA can complete; populate structured data fields (eg. screening). Due to expense of smart forms, PCC will need consensus among clinics before creating smart form (individual forms for each clinic is cost prohibitive) Interest in Pre-Appointment Huddle Report Meeting Schedule Clinical Users Group Fareed will re-circulate instructions for CRISP. ecw has requested that updates be completed in the next 2 weeks. PCC IT team to talk with Kathy Luton for additional understanding of workflow/legal concerns with ecw PCC team to establish tracking system to resolve/close issues raised by clinics and to establish regular clinical users group (not limited to Medical Directors/QHIC). o Suggested monthly meetings initially Next Meeting

5 Last Thursday of the month; 4-6pm at PCC 2017 Meeting schedule: o January 26 o April 27 o July 27 o October 26 Thursday, October 27 at PCC; 4-6pm