Instructions for Accessing the Secure Portal and the Verification Process

Instructions for Accessing the Secure Portal and the Verification Process Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 1

Contents Overview... 3 Step 1: Access to the secure portal for medical groups... 4 Step 2: Clinic roster report... 4 Step 3: Clinic roster application... 5 Step 4: Confidential draft Community Checkup report results... 6 Step 6: Patient verification instructions... 10 Step 7: Running the patient verification report(s)... 12 Step 8: Reporting a patient discrepancy... 14 Frequently Asked Questions... 16 Addendum A: Summary of reasonableness review process for medical groups... 17 Addendum B: specifications document... 18 Copyright,. All rights reserved. Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 2

Overview The Community Checkup reports on health care quality and value across, helping health care consumers take a more active role in their health care. It lays the foundation for our community to build on so we can work together to improve the safety, effectiveness and affordability of our state s health care. The Community Checkup compares medical groups and clinics on different measures of effective care, including care for chronic conditions such as diabetes, heart disease and depression. Scores are drawn from the s large multi-payer of claims data supplied by health plans and selfinsured purchasers. Scores for hospitals are drawn from national and state sources, specifically: the U.S. Department of Health and Human Services hospital compare reporting process and State Department of Health. Results for health plans are based on scores calculated using evalue TM, a tool developed and maintained by the National Business Coalition on Health (NBCH). Medical groups, clinics and data suppliers such as insurers and self-funded purchasers work with the Alliance to develop the Community Checkup. To ensure the quality, accuracy and integrity of the report, draft results are made available through a secure portal for each medical group to review. This document provides the instructions for accessing the Alliance s secure portal and the detailed data available for validation. Each medical group receives access to: Blinded medical group results. Private review of your own medical group s draft results at the group, clinic location or individual provider level. We ask that medical groups benchmark their draft results against internal sources for a reasonableness review. Please provide any feedback to the Alliance and we will work with Milliman (the Alliance data vendor) to resolve any identified data issues. Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 3

Step 1: Access to the secure portal for medical groups The Alliance s secure portal through OneHealthPort (OHP) allows medical groups to review draft results prior to release. Accessing the secure portal: 1 The Alliance s secure portal is accessed online at: https://psha.milliman.com/ohp/default.htm. 2 Use your OneHealthPort User ID* and password to log into the site. * If you need to create an account with OneHealthPort, you can register online at: http://www.onehealthport.com/register/index.php. If you have questions about whether your organization is already registered, who your organization OHP Administrator is or need login assistance, you can call OneHealthPort at 1-800-973-4797. Step 2: Clinic roster report The clinic roster report allows you to download and print your practitioner information for. internal review. Accessing the Clinic Roster Report 1 To view and download your report, click on the Reports link in the green menu bar within the website. 2 To view and download your report, click on the Clinic Roster Report link. 3 When the report opens, you can output your report by using the Select a format to choose your desired output format. 4 Then click on Export. Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 4

1 2 3 4 Step 3: Clinic roster application This tool is available in case you need to make any changes to your practitioner or clinic information. Accessing the Clinic roster application 1 Click on the Clinic roster application link in the green menu bar within the website. This will bring you to the Practitioner Roster page. 2 From the Practitioner Roster page you may add practitioners or edit information about a particular practitioner. a. To search for a practitioner: ou can search for a practitioner by entering your search information by the filter textbox, then select filter. b. To edit a practitioner s information: Find the practitioner you want to edit and then select Edit. When you are finished editing the information, make sure you hit Update to save your work. c. To add a practitioner: On the bottom, where it says Add, enter all information into each of the fields (don t forget to scroll to the right to make sure you enter all necessary information). When you have completed all of the information for the practitioner, click Add to save. d. To add/edit a clinic: Select Click here to add\edit clinic information in the upper right hand corner. This will take you to the Clinic Roster screen. Follow the directions outlined above for adding and editing. Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 5

Step 4: Confidential draft Community Checkup report results The Alliance provides medical groups with a private, internal review of draft Community Checkup results. Medical groups can download these reports for their internal review and use. We remind you that these results are confidential until the Community Checkup is published. The blinded medical group comparison shows performance results for each of the medical groups eligible for public reporting in the Community Checkup. To ensure that medical groups have a chance to review their results before results are made public, medical groups are all blinded. This report is organized by the performance measure so you can compare results across the blinded medical groups for each measure. Each medical group is assigned a secret identifier which is identified in the header of the report. Only individuals from your medical group have access to the secret ID. These results remain blinded until all results are final and the Community Checkup is published. Accessing the confidential draft Community Checkup report 1 Click on the Reports link in the green menu bar within the website. 2 Click on the Blinded Medical Group Comparison link 3 ou have the ability to select whether you want to see results for the populations covered by the following insurance types: Commercial Medicaid (includes Managed Medicaid and Medicaid Fee for Service) All payers (commercial and Medicaid combined) 1 2 3 Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 6

Step 4: Confidential Draft Community Checkup Report Results (continued) 4 To view your report: a. Click on the button View Report after selecting the insurance type. b. Once your report opens, you can output your report by using the Select a format to choose your desired output format. c. Click Export to download the report in the desired output format. 4b 4a 4c Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 7

Step 5: Private Results Review This is a confidential report that only includes results for your medical group(s). This report allows you to review measure results and is organize by measure. Accessing the Performance Results by Measure 1 To view and download your report, click on the Reports link in the green menu bar within the website. 2 Click on the Community Checkup Private Review link. 3 ou have the ability to select whether you want to see results for the populations covered by the following insurance types: Commercial Medicaid (includes Managed Medicaid and Medicaid Fee for Service) All payers (commercial and Medicaid combined) 4 ou have the option to view the results by: Medical Group summary results for your medical group Clinic only clinic summary results, at each of your clinic locations Provider detailed provider results for a selected provider. 5 If you selected Provider under Step 4, select the provider to run their individual results. 1 2 5 3 4 Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 8

Step 5: Private Results Review (continued) 5 To view your report: a. Click on the button View Report after selecting the insurance type. b. Once your report opens, you can output your report by using the Select a format to choose your desired output format. c. Click Export to download the report in the desired output format. 5b 5a 5c Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 9

Step 6: Patient verification instructions The patient verification tool allows you to review patient-level information of Community Checkup results for your specific medical group. Note: Avoidable emergency department report results are not included in the patient-level verification. The secure tool also provides you a way to report any discrepancies at the patient level regarding the data that is feeding the Community Checkup reports. Accessing the Patient Verification Tool: 1 The patient verification tool is accessed through the Alliance secure portal. The Alliance secure portal is accessed online at: https://psha.milliman.com/ohp/default.htm. Use your OneHealthPort User ID* and password to log into the site. If you need to create an account with OneHealthPort, you can register online at: http://www.onehealthport.com/register/index.php. If you have questions about whether your organization is already registered, who your organization OHP Administrator is, or need general assistance, you can call OneHealthPort at 1-800-973-4797. 2 Once logged on, select the Patient Verification link along the top green menu bar: 1 2 Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 10

Step 6: Patient Verification Instructions (continued) 3 A confidentiality statement screen will appear. Please read the statement and select I agree if you wish to continue. 3 Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 11

Step 7: Running the patient verification report(s) Patient Results - By Patient is a confidential report that only includes patient results for your medical group(s). This report allows you to review patient-level measure results, organized and searchable by patient. The report allows you to set parameters by which the report will be filtered. ou may select the desired clinic(s) or let the report default to all clinics. ou can also filter by either patient ID or patient last name. Patient Results - By Measure is a confidential report that only includes patient results for your medical group(s). This report allows you to review patient-level measure results, organized and searchable by measure. The report allows you to set parameters by which the report will be filtered. ou may select the desired clinic(s) or let the report default to all clinics. ou must select the desired measure (e.g. Diabetes Blood Sugar Test ). ou can also filter within the selected measure by either patient ID or patient last name. Accessing the Patient Verification Tool: 1 After accessing the patient verification tool and agreeing to the statement in the previous steps, you may choose from two different patient verification reports: Patient Results - By Patient and Patient Results - By Measure. 1 Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 12

Step 7: Running the patient verification report (continued) Accessing the patient verification tool: 2 Once you have selected which results you d like to verify, set your parameters in the appropriate fields and click View Report. 3 After the report is run, you can expand the patient information to obtain the attributed provider(s), clinic, measure and compliant status. 2 3 Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 13

Step 8: Reporting a patient discrepancy Both the Patient Results - By Patient and Patient Results - By Measure reports allow you to report a patient discrepancy. Reporting a Patient Discrepancy 1 To report a discrepancy, you must first run one of the patient verification reports. Once run, expand the patient information. A red exclamation point to the far right of the report (!) will appear. 2 By clicking on the exclamation point (!), a new window will appear that provides areas to indicate the discrepancy reason, service date, procedure code, and comments related to the discrepancy. 1 2 Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 14

Step 8: Reporting a patient discrepancy (continued) 3 Select a discrepancy reason from the drop down list. 4 Depending on the reason selected, you may also need to provide date(s) and procedure code(s) related to the discrepancy. A comments field is also available to you if you would like to provide additional information. 5 Select the Submit button once the discrepancy fields have been completed. 3 4 5 Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 15

Frequently Asked Questions 1. We have a practitioner who works at more than one clinic location within our medical group. How do I reflect this? If you have a practitioner who works at more than one location, add a separate record for each location where the practitioner works. 2. What name(s) should I use to identify individual clinics? To ensure that clinic names appear correctly in the Community Checkup, make sure that: a. Patients can easily identify and look up your clinic. Use the name that appears on your clinic sign and communication materials and by which the clinic is commonly known. b. our medical group appears in the clinic name. For example, if your medical group is Northwest Family Medicine Centers and one clinic location is known as The Main Street Clinic, you would list this clinic in the roster as, Northwest Family Medicine Centers - The Main Street Clinic. 3. How can I find a specific practitioner or group of practitioners in the roster? ou can filter practitioner records by selecting specific criteria or combinations of criteria (e.g., name, clinic site, specialty, etc.). To do this, select the criteria using the drop down menus for any column(s). Then select the Filter button. For example, to review all of the practitioners at Main Street Clinic with the last name Jackson: select Main Street Clinic from the clinic drop down menu above the clinic field, then type in Jackson in the box under the last name column. Then press Filter. 4. How do I indicate that a provider is no longer with our medical group? There are a couple of ways to indicate that a provider is no longer part of your practice. ou must first select the Edit option for that provider record within the Clinic Roster Application. ou may then populate the Practice Begin Date and Practice End Date fields and click Update. This is the preferred method as you do not need to keep track of the reporting period for the Community Checkup. Alternatively, you may select Exclude from Reports and fill out the Reason If Excluded (e.g., practice start/end dates) and confirm who within your medical group is authorizing the exclusion. 5. We just hired a new practitioner this month. Should I add her to our roster? es, feel free to add this practitioner. ou should populate the Practice Begin Date and the computer programs that create the measures will include or exclude the provider as appropriate based on the date entered. 6. What provider specialties should I include in the roster? ou may include providers of any specialty in the roster. The computer programs that create the measures will use the specialty information as needed so it does not hurt to include all provider specialties. However, if you are trying to reduce your amount of data entry, you may exclude the following provider specialties: dentists, physical therapists, occupational therapists and surgical assistants. This is not an all-inclusive list as we do not want to list specialties that we may end up needing for future measures. Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 16

Addendum A: Summary of reasonableness review process for medical groups Goals of reasonableness review period 1. Communicate expectations to medical groups and clinics regarding the review process in order to build trust and credibility in the performance report. 2. Seek feedback from medical groups and clinics on their clinic roster information, report format and reasonableness of the draft results 3. Work collaboratively to make revisions if issues are identified. Operational/technical steps 1. Prior to the release of the draft results, the Alliance contacts all new and existing medical groups and clinics to prepare them to receive the reports. At the time that groups and clinics are contacted, the following materials are shared: Project overview: Describes the Community Checkup project and data processes. Reasonableness review: Instructs participants on how to access, review and provide feedback on the draft measure results. Attribution methods: Provides an explanation of how patients are attributed to clinicians. Frequently asked questions: Provides information and answers to questions about the report and related processes. 2. During July, the Alliance makes available draft results to each medical group through a secure online portal. Each medical group receives access to: 1) blinded medical group results and 2) confidential results for their medical group and clinic location and clinician-level results for those clinicians within their medical group and/or clinic location and 3) Review of readmission results (these are scored differently, and as such, are reported differently from other measures. Medical groups are asked to benchmark against internal sources for a reasonableness review. The Alliance and Milliman work with clinics to resolve any identified data issues. 3. From July to early August, medical groups review the draft results, identify issues and provide feedback to the Alliance. 4. During August, the Alliance reviews feedback and works with Milliman and the medical groups to resolve issues. 5. In August, the Alliance finalizes the results and releases an advance, detailed version of the Community Checkup report to the medical groups for final review at the beginning of September. Community Checkup report: www.wacommunitycheckup.org More about the Alliance: www.wahealthalliance.org 17

Addendum B: specifications document Technical Specifications Community Checkup Measures July About the technical specifications The Community Checkup relies on three categories of data to produce results: The maintains a robust that includes health care claims and encounter data from 20 data suppliers and reflects care provided to approximately 3.9 million people living in. Results for many measures in the Community Checkup are calculated at the medical group, clinic, hospital, county, ACH and state levels using this. Results for other measures in the Community Checkup are provided by partner organizations who have agreed to provide de-identified and aggregated results for public reporting. These partners include the State Hospital Association, the State Department of Health, the State Department of Social and Health Services, the State Health Care Authority, the Foundation for Health Care Quality, the National Committee on Quality Assurance and several health plans. Results for these measures have been provided at the hospital, health plan, county and state levels. Patient experience results (primary care) are from a survey on patient experience administered by the Center for the Study of Services (CSS) on behalf of the. Patient experience results (hospital) are from CMS Hospital Compare and are updated quarterly. The specifications provide information about the source, reporting period, and measure logic for all results included in the Community Checkup. Additional measures with data sources other than those presented below are described within the technical specification. Measures sourced from the Database The medical group and clinic measures used in the Community Checkup report are primarily based on the Healthcare Effectiveness Data and Information Set (HEDIS ) specifications developed by the National Committee for Quality Assurance (NCQA). HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare health care quality. All other non-hedis measures are noted accordingly. The results for many of the measures that the Alliance produces are reported at the clinic level. In order to report at this level, the Alliance must assign or attribute the care of a patient to an individual clinician. This document includes the methodology used for the attribution process. The results in the report are based on administrative claims data with a measurement year of July 1, 2014 through June 30,. This differs from the typical HEDIS measurement year which runs on a calendar cycle (January 1 through December 31). To obtain detailed specifications regarding HEDIS measures, including eligibility definitions, age ranges, procedure codes, diagnosis codes, specified dates of service, exclusions, continuous eligibility requirements, etc. please reference HEDIS Volume 2: Technical Specifications for Health Plans, NCQA, Copyright 2014. With the exception of two new measures: Managing Medications for People with Asthma and Statin Therapy for Patients with Cardiovascular Disease, measures produced from the Alliance are adapted and utilized from the HEDIS Volume 2: Technical Specifications with permission from the National Committee for Quality Assurance (NCQA). The two new measures are adapted and utilized from the HEDIS Volume 2: Technical Specifications with permission from the National Committee for Quality Assurance (NCQA). To purchase copies of of these publications, contact NCQA Customer Support at 888-275-7585 or www.ncqa.org/publications Health Plan results The primary source for health plan results is Quality Compass and is used with the permission of the National Committee for Quality Assurance ( NCQA ). Any analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation, or conclusion. Measures sourced from the State Department of Health Measures relying on Behavioral Risk Factor Surveillance System: Data Source: State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System, supported in part by Centers for Disease Control and Prevention, Cooperative Agreement U58/SO000047-02, - 03. The State Immunization Information System is a lifetime registry that tracks immunization records for people of all ages in State (denominators are based on birth certificate entries). It is a secure, Web-based tool for healthcare providers and schools administered by the Department of Health DOH. Results are based upon immunizations that occurred between January 1 December 31, 2014. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 18 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward Access to Care Measures: Adult access to primary care - ages 20-44 - ages 45-64 - ages 65+ Child and adolescent access to primary care - ages 12-19 years - ages 7-11 years - ages 2-6 years - ages 12-24 months Asthma & COPD measures: For commercially insured: adults who had a preventive care visit in the past three years. For Medicaid insured: adults with a preventive care visit in the past year. Report each of the three age ranges separately. The number of children ages 12 months to six years with a primary care physician (PCP) visit in the past year, or the number of children ages seven to 19 years with a PCP visit in the past two years. Report each of the four age ranges separately. Eligible adults are defined as: Adults age 20 and older as of the last date in the Eligible children are defined as: Children ages 12 months to 19 years as of the last date in the Compass for health plan results Compass for health plan results Managing medications for people with asthma The number of patients ages 5 to 64 identified as having persistent asthma who were dispensed appropriate medications and remained on them for at least 50% of the period between the initial prescription during the measurement year through the end of the Eligible People with Asthma are defined as: Patients ages 5 to 64 during the measurement year who were identified as having persistent asthma because of at least four asthma medication dispensing events*, at least one emergency department visit with asthma as the primary diagnosis, at least one acute patient discharge with asthma as the principal diagnosis, or at least four outpatient asthma visits and dispensed at least two asthma medications. Exclusions: Exclude from the eligible population all members diagnosed with emphysema, COPD, cystic fibrosis, chronic bronchitis or acute respiratory failure at any time in the patient s history up through the last day of the measurement year. NCQA HEDIS Compass for health plan results (NCQA HEDIS ) *A member identified as having persistent asthma because of at least four asthma medication events, where leukotriene modifiers were the sole HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 19 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward asthma medication dispensed in that year, must also have at least one diagnosis of asthma in the same year as the leukotriene modifier. Spirometry testing to assess and diagnose COPD Hospitalization for COPD or asthma Diabetes Measures: per 100,000 enrollees The number of patients ages 40 and older with a new diagnosis of COPD (Chronic Obstructive Pulmonary Disease) or newly active COPD who had appropriate spirometry testing to confirm diagnosis. This testing should occur in the two years before the diagnosis of COPD or up to 180 days after the diagnosis. Hospital admissions with a principal diagnosis of chronic obstructive pulmonary disease (COPD) or asthma for people ages 40 years and older; this measure is reported as a rate per 100,000 population and excludes obstetric admissions and transfers from other institutions. Adults with COPD are defined as: Patients 40 years of age and older with a new diagnosis of COPD or newly active COPD during the Exclusions: Members who had an outpatient, ED or acute inpatient visit with a COPD diagnosis during the two years prior to the episode date. Eligible population is described as: Enrollees 40 and over during the Compass for health plan results ) AHRQ Poor control of blood sugar (HbA1c) for people with diabetes Blood sugar (HbA1c) testing for people with diabetes NCQA benchmarks - lower rate is The number of patients ages 18 to 75 with diabetes (type 1 and type 2) who had an HbA1c test with a result >9.0% or does not have a test result during the The number of patients ages 18 to 75 diagnosed with diabetes (type 1 and type 2) whose blood sugar was tested using an HbA1c test by a doctor or other health care provider at least once in the one-year measurement period. Patients with Diabetes are defined as: Patients ages 18 to 75 as of the last day of the measurement year: a. who were dispensed insulin or a hypoglycemic/antihyperglycemic on an ambulatory basis during the measurement year or year prior; or, b. who had two face-toface encounters with different dates of service in an outpatient, observation, emergency department or non-acute inpatient setting with a diagnosis of diabetes on different dates during the measurement year or year prior; or, c. with one face-to-face Jan. - Dec. Compass Not generated from Alliance due to need for clinical data Compass for health plan results HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 20 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward Blood pressure control for people with diabetes Eye exam for people with diabetes NCQA benchmarks - higher rate is The number of patients ages 18 to 75 with diabetes (type 1 and type 2) who had a blood pressure reading taken during an outpatient visit or a nonacute inpatient encounter during the The number of patients ages 18 to 75 diagnosed with diabetes (type 1 and type 2) who had an eye exam at least once in a twoyear period or, if there is evidence of eye disease, during the measurement period. Specifically, the eye exam is a retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist). encounter in an acute inpatient setting with a diagnosis of diabetes during the measurement year or year prior. Exclusions: Patients with gestational diabetes, steroid-induced diabetes, or polycystic ovaries who did not have any face-toface encounters with a diagnosis of diabetes. For gestational and steroidinduced diabetes, the diagnosis can occur during the measurement year or the year prior to the For patients with polycystic ovaries, the diagnosis can come at any point in the patient s history. All diagnoses must have occurred by the last day of the Jan. - Dec. Compass Not generated from Alliance due to need for clinical data Compass for health plan results Kidney disease screening for people with diabetes Generic Prescriptions Measures: A negative retinal eye exam result is not necessary to count towards the numerator for exams occurring in the year prior to the measurement year due to the lack of clinical data available. Evidence that a retinal eye screening occurred without result data in either the measurement year or year prior to the measurement year will suffice for meeting the numerator requirement. The number of patients ages 18 to 75 with diabetes (type 1 and type 2) who had a kidney screening test or were treated for kidney disease (nephropathy) or who have already been diagnosed with kidney disease, at least once during the one-year measurement period. Evidence of nephropathy includes a nephrologist visit, a positive urine macroalbumin test as documented by claims, or treatment with ACE inhibitor/arb therapy. Compass for health plan results HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 21 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward Antacid medication generic prescriptions Antidepressant medication generic prescriptions ADHD medication generic prescriptions Cholesterollowering medication generic prescriptions High-blood pressure medication generic prescriptions Health Screenings Measures: Adolescent wellcare visits The number of prescriptions for antacids to reduce chronic stomach or gastric acid (proton pump inhibitors or PPIs) that were filled with a generic PPI anytime during the oneyear measurement period. The number of prescriptions for antidepressant drugs (all second generation antidepressants) that were filled with a generic antidepressant anytime during the one-year measurement period. The number of prescriptions for certain ADHD drugs that were filled with a generic drug rather than a brand name drug anytime during the oneyear measurement period. The number of all prescriptions for cholesterol-lowering drugs (statins) that were filled with a generic drug rather than a brand-name drug anytime during the oneyear period. The number of prescriptions for antihypertensive drugs (ACE inhibitor or ARB) that were filled with a generic antihypertensive anytime during the one-year measurement period. Members with at least one comprehensive well-care visit with a PCP or OB/GN practitioner during the Prescribing event is defined by: A prescription for at least a 30-day supply of PPIs, both brand-name and generic, during the 12- month See Appendix D for details. Prescribing event is defined by: A prescription for at least a 30-day supply of second and third generation antidepressants, both brand-name and generic, during the 12-month See Appendix D for details. Prescribing event is defined by: A prescription for at least a 30-day supply of ADHD drugs, both brand-name and generic, during the 12-month See Appendix D for details. Prescribing event is defined by: A prescription for at least a 30-day supply of statins, both brandname and generic, during the 12-month See Appendix D for details. Prescribing event is defined by: A prescription for at least a 30-day supply of ACE inhibitors or ARBs, both brand-name and generic, during the 12- month See Appendix D for details. Eligible adolescents are described as: Continuously enrolled members age 12 to 21 by the end of the Alliance Pharmacy CIT/Generics Task Force Alliance Pharmacy CIT/Generics Task Force Alliance Pharmacy Generics Task Force Alliance Pharmacy CIT/Generics Task Force Alliance Pharmacy Generics Task Force Well-child visits (ages 3-6 years) The number of children ages three to six who had one or more well-child visits with a primary care provider during the Eligible children are defined as: Children ages three to six as of the last date in the measurement year. Compass for health plan results Compass for health plan HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 22 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward results Breast cancer screening Cervical cancer screening Chlamydia screening The number of women ages 50 to74 who had at least one mammogram screening for breast cancer on or between the first day of the year two years prior and the last day of the Exclusion (optional): Bilateral mastectomy any time during a member s history or more than one gap in enrollment during measurement period. The number of women ages 21 to 64 who had a Pap test in the past three years (begins at age 24 to allow three year look back), or women 30 to 64 who had a Pap test and HPV test every five years. Exclusion (optional): Members who have had a hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix at any time during their history, through the end of the The number of women ages 16 to 24 who were identified as sexually active and who had at least one test for chlamydia during the Exclusion (optional): Members who had a pregnancy test during the measurement year followed within 7 days by either a prescription for isotretinoin or an x-ray. Eligible women are described as: Women ages 50 to 74 by the end of the Eligible women are described as: Women ages 21 to 64 by the end of the Eligible women are described as: Women ages 16 to 24 by the end of the Compass for health plan results Compass for health plan results Compass for health plan results HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 23 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward Colon cancer screening The number of adults 50 to 75 years of age who had appropriate screening for colorectal cancer with any of the following tests: annual fecal occult blood test; flexible sigmoidoscopy every five years; or colonoscopy every ten years. Exclusion (optional): Members who had a total colectomy or who were diagnosed with colorectal cancer at any time in their history, through the end of the Eligible adults are described as: Adults ages 50 to 75 by the end of the Compass for health plan results Heart Disease Measure: Statin therapy for patients with cardiovascular disease The number of males 21-75 year and females 40-75 years by the end of the measurement year with atherosclerotic cardiovascular disease (ASCVD), who received a statin during the Eligible adults are described as: Males 21-75 year and females 40-75 years by the end of the measurement year with atherosclerotic cardiovascular disease (ASCVD), identified by: inpatient stay with an MI or CABG, or visits in any setting with a PCI or other revascularization procedure. Compass for health plan results Medication Safety Measures: Exclusions: pregnancy, IVF, Cirrhosis, ESRD, clomiphene prescription or myalgia, myositism myopathy or rhabdomyolysis. Taking cholesterollowering medications as directed This measure focuses on patient adherence to prescribed cholesterol medications by considering the number of days the patient had access to at least one drug in the statin medication class based on the prescription fill date and the days of supply. The proportion of days covered (PDC) rate must be at least 80 percent to meet the numerator. Adults with coronary artery disease are defined as: Adults age 18 or older with at least two filled prescriptions for statin medications during the Pharmacy Quality Alliance (PQA) HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 24 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward Taking diabetes medications as directed This measure focuses on patient adherence to prescribed diabetes medications by considering the number of days the patient had access to at least one drug in the diabetes medications class based on the prescription fill date and the days of supply. The proportion of days covered (PDC) rate must be at least 80 percent to meet the numerator. Eligible adults are described as: Adults age 18 or older with at least two filled prescriptions for diabetes medications during the measurement year. PQA Taking hypertension medications as directed Medication safety: monitoring patients on highblood pressure medications Behavioral Health Measures: Exclusions: Members with one or more prescriptions for insulin during the measurement period. This measure focuses on patient adherence to prescribed hypertension (high blood pressure) medications by considering the number of days the patient had access to at least one drug in the RAS Antagonist medications class based on the prescription fill date and the days of supply. The proportion of days covered (PDC) rate must be at least 80 percent to meet the numerator. The number of patients 18 years and older who received at least 180 treatment days of ACE inhibitors or ARBs (drugs to help lower blood pressure) during the measurement year and who had at least one monitoring event (serum potassium and serum creatinine) in the Eligible adults are described as: Adults 18 or older with at least two filled prescriptions for hypertension medications during the measurement year. Eligible adults are described as: Adults 18 years and older who received ACE inhibitors or ARBs and had at least one monitoring event during the Compass for health plan results Staying on antidepressant medication (12 weeks) The number of patients age 18 and older newly diagnosed with depression, who were prescribed (as determined by prescription fills) an antidepressant medication, and remained on an antidepressant for at least 12 weeks (i.e., effective acute treatment phase). Patients with Depression are defined as: Patients age 18 and older as of the last day of the fourth month of the measurement year diagnosed with a new episode of major depression during the measurement year and prescribed antidepressant medication. Compass for health plan results HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 25 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward Staying on antidepressant medication (6 months) Hospital readmissions within 30 days (psychiatric conditions) Follow-up after hospitalization for mental illness within 7 days Follow-up after hospitalization for mental illness within 30 days Adult mental health status - lower is NCQA benchmarks - higher rate is - lower rate is The number of patients age 18 and older newly diagnosed with depression, who were prescribed (as determined by prescription fills) an antidepressant medication, and continued taking an antidepressant for at least 6 months (i.e., effective continuation phase). Medicaid enrollees, ages 18 to 64, who had an acute readmission for a psychiatric diagnosis within 30 days of initial psychiatric acute admission during the An outpatient visit, intensive outpatient visit, or partial hospitalization with a mental health practitioner within seven days of discharge (includes: outpatient visits, intensive outpatient visits, or partial hospitalizations that occur on the date of discharge). An outpatient visit, intensive outpatient visit, or partial hospitalization with a mental health practitioner within 30 days of discharge (includes: outpatient visits, intensive outpatient visits, or partial hospitalizations that occur on the date of discharge). Survey respondents who reported having poor mental health for 14 or more days in the past 30 days during the measurement period. Exclusions: Patients who had a claim/encounter for any diagnosis of major depression or prior episodes of depression during the 120 days prior to the episode start date. Exclude patients who did not fill a prescription for an antidepressant medication 30 days prior to the prescription start date through 14 days after the episode start date. Exclude patients who filled a prescription for an antidepressant medication 90 days prior to the episode start date. Medicaid enrollees, ages 18 to 64, with an acute inpatient psychiatric admission during the measurement year and were continuously enrolled from one year prior to index admission through the month after index admission. The number of all discharges (for Medicaid population age six or older as of discharge date) from an acute inpatient setting with a principal diagnosis of mental illness in the first 11 months of the The number of all discharges (for Medicaid population age six or older as of discharge date) from an acute inpatient setting with a principal diagnosis of mental illness in the first 11 months of the Respondents to the Behavioral Risk Factor Surveillance System telephone survey who were at least 18 years of age by the end of the measurement period, living in State and answered the question: "Now thinking Jan. - Dec. Jan. - Dec. Jan. - Dec. Jan. 2013 - Dec. 2014 Compass for health plan results State Department of Social and Health Services (DSHS)/HCA (Medicaid Only) DSHS Compass Not generated from Alliance due to need for data not included in data submissions Compass Not generated from Alliance due to need for data not included in data submissions DOH/BRFSS BRFSS HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 26 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" Mental health services for children Mental health services for adults Children, ages 6 17 years old with a mental health service need who received at least one qualifying service during the measurement year, including: - Mental health service modality - Visit with a qualifying specialist - Qualifying mental health procedure - Primary care service with qualified provider specialty and mental health-related diagnosis. Adults, ages 18 64 years old with a mental health service need who received at least one qualifying service during the measurement year, including: - Mental health service modality - Visit with a qualifying specialist - Qualifying mental health procedure - Primary care service with qualified provider specialty and mental health-related diagnosis. Childrens, ages 6 17 years old by the end of the measurement period meet the mental health service need, including: receipt of a mental health service or diagnosis, or psychotropic medication within the measurement year or the year prior. Adults, ages 18 64 years old by the end of the measurement period meet the mental health service need, including: receipt of a mental health service or diagnosis, or psychotropic medication within the measurement year or the year prior. Jan. - Dec. Jan. - Dec. Health Plans and State Department of Social and Health Services (DSHS) DSHS Health Plans and State Department of Social and Health Services (DSHS) DSHS Substance use disorder services for children (Medicaid insured) Children, ages 6 17 years old with a substance use disorder service need who received substance use disorder services during the measurement period. Children, ages 6 17 years old with a substance use disorder service need within the measurement year or the year prior. Jan. - Dec. State Department of Social and Health Services (DSHS)/HCA (Medicaid Only) Substance use disorder services for adults (Medicaid insured) Adults, ages 18 and older with a substance use disorder service need who received substance use disorder services during the measurement period. Adultas, ages 18 and older with a substance use disorder service need. Jan. - Dec. DSHS State Department of Social and Health Services (DSHS)/HCA (Medicaid Only) DSHS Potentially Avoidable Care Measures: HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 27 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.

Measure Name Score Methodology Numerator: Definition for Compliance of Measure Denominator: Definition of Eligible Population and Exclusions Measurement Period Data Source Measure Steward Hospital readmissions within 30 days (commercially insured) Scores are determined by ranking results based on observed versus expected rate, accounting for sample size - lower observed to expected ratio is For patients 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. Eligible adults are described as: Adults ages 18 to 64 as of the Index Discharge Date for commercial populations. This measure includes only commercially insured individuals. Compass for health plan results Hospital readmissions within 30 days (Medicare insured) This measure is displayed on WHA's website with the observed rate, the score, and the denominator. For more information, see the Hospital Readmissions and Outpatient Care report (http://waco mmunityche ckup.org/me dia/default/ Documents/ hospital_rea dmissions_re sults.pdf) Observed to expected ratio national average For patients 18 years of age and older, the number of inpatient stays during the measurement year that were followed by a readmission for any reason (with the exception of a certain planned readmissions) within 30 days. Risk adjustment is applied to all cases to derive a riskadjusted readmission rate. Eligible adults are described as: Adults 18 years and older discharged from the hospital. Current CMS results publicly report results for Medicare FFS 65 years and older. FROM CMS: The target population for this measure is patients aged 18 years and older discharged from the hospital with a complete claims history for the 12 months prior to admission. The measure is currently publicly reported by CMS for those 65 years and older who are Medicare FFS beneficiaries admitted to non-federal hospitals. Hospital Compare Centers for Medicare & Medicaid Services (CMS) HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 28 ** HEDIS Volume 2: Technical Specifications, NCQA, Copyright 2014. *** HEDIS Volume 2: Technical Specifications, NCQA, Copyright.