Introduction to the Provider Care Management Solutions Web Interface

Introduction to the Provider Care Management Solutions Web Interface Release 0.2 Introduction to the Provider Care Management Solutions Web Interface Purpose Provider Care Management Solutions (PCMS) is a web-based application available to practices participating in the Enhanced Personal Health Care program. Through alerts, dashboards, and reports, PCMS gives practices the tools they need to manage their patients health and to thrive in a value-based payment environment. The application helps practices stratify their patient population based on risk and prevalence of chronic conditions, and it offers actionable clinical insights, including alerts to potential gaps in care and flagging patients at high risk for readmission. The deployment of the software capabilities will occur in phases with the pilot starting in December of 2013 and the final phase planned for delivery in 2014. The full scope will allow practices to both monitor and improve performance in the Enhanced Personal Health Care payment model, connecting the dots between the actionable activities and value-based financial incentives. This includes provider and member- level quality performance scores in an effort to improve quality of care, as well as reports that can help identify cost savings opportunities such as potentially avoidable ER visits and provider referrals. In short, PCMS offers tools and information that enable holistic care management, helping transition practices into a patient-centered care model focused on managing total cost and quality of care. This Quick Reference Guide introduces the new web interface, and guides the end user through each section of the web interface in order to pull All Patient (Attribution), Hot Spotter Chronic, Hot Spotter Readmission, Care Opportunity and Inpatient Authorization reports. We will cover how to filter the reports using several filter options. In addition to filters, we will identify icons, how to get more information by hovering or clicking, and basic navigation. This guide will help you easily navigate through the web application to obtain comprehensive clinical information. 1 of 24

Login Home Page Log in to Availity Navigate to POIT From the Report Search page select Launch Provider Care Management Solutions The landing page for the application is shown below and includes: Home Page view and Population Management view tabs Tickers o Patients o Readmission Hot Spotters o Chronic Hot Spotters o IP Authorizations o Care Opportunities Dashboard o Care Opportunity by Condition s Tickers Provider Dashboard 2 of 24

Home Page Field Description Provider Group The provider group the report is for Tickers Tickers allow the user to view key metrics on the Home page, including trends in their patient population. Clicking on the ticker displays patient information found in the Population Management view. Field Attribution Readmission Hot Spotters Chronic Hot Spotters IP Authorizations Description Shows the number of attributed patients, including a count of newly-attributed patients for the current month. Click on the Attribution ticker to display a list of all attributed patients. This report is updated monthly; however, inactive members fall off daily. Shows the number of Hot Spotter patients with readmissions, the count from the previous month displays and includes an arrow showing the trend. Click on the ticker to display a list of all Hot Spotter readmission patients. Updated daily. Shows the number of Hot Spotter patients with chronic conditions and the number of cases last month with an arrow showing the trend. Click on the Chronic Hot Spotter ticker to display all chronic Hot Spotter patients. Updated monthly. Shows the number of current inpatient authorizations and the number authorized on the previous day, with an arrow showing the trend. Click on the IP Authorization ticker to display a list of all patients with an inpatient authorization. Updated daily. 3 of 24

Care Opportunities Shows the current number of Care Opportunities and the number of Care Opportunities last month with an arrow showing the trend. Click on the Care Opportunities ticker to display the Care Opportunities list. Information is updated monthly and refreshed daily. Patients status may change on a daily basis. Once a past due care opportunity is resolved, it may take a few months to display, as the data is based on periodic claims data updates. Dashboards Dashboards highlight key information. They provide a quick view of what you will see in the Population Management view. For example, the practice may identify which conditions have the most Care Opportunities as a way to prioritize care coordination and planning. Field Dashboard Description Care Opportunities by Condition Shows which Care Opportunities are most prevalent by condition. Click on the Care Opportunity Dashboard to view the Care Opportunities screen. 4 of 24

Hover Over Dashboard Care Opportunities By Condition When you hover over any of the opportunities, additional information displays to indicate the number past due, those due in 30 and 60 days, and the Close Ratio (the number of completed measures divided by the total for the rolling 12 months) 5 of 24

Management: All Patients Click on the Population Management tab to see a list of all attributed patients. There are two views under Population Management: 1. All Patients 2. Care Opportunities. Below is a view of All Patients. Filter Patients Using Simple Provider teams can filter the patient list into four different filtered views, using the simple filter checkboxes at the top. See below. Hot Spotter Chronic Hot Spotter Readmission New Patient, or Inpatient Authorization. Most information displayed in Day 1 reports is available using these filters. 6 of 24

Management: All Patients When you filter the list, the system will show you what you have filtered. In the example below, the list is being filtered to display Hot Spotter Chronic and Inpatient Authorization, which appear on the green banner. When you filter the list, only patients who meet both criteria display. For example, above, only Hot Spotter Chronic patients who also had inpatient authorizations are displayed on this report. Anytime you choose a filter, it will display in the green banner to the upper -left side of the screen as shown above. 7 of 24

Management: All Patients Icons New The icons you see below are situated to the right of the attributed patient to represent reports they are on. When you filter the data, all patients on the list will display the same icon but may also display additional icons. New attributed patients. When you hover over this icon it will display the attribution date and reason. Hot Spotter Chronic Hot Spotter Chronic Flame with a raised C.. When you hover over this icon it will display the risk drivers associated with the patient s conditions. Hot Spotter Readmission Hot Spotter Readmissions Flame with a raised R. When you hover over this icon it will display associated risk drivers. Inpatient Authorization Inpatient Authorization. Hover over the red cross icon to get more information, including the inpatient facility, length of stay, admission date, admitting diagnosis, and readmission risk. 8 of 24

Management: All Patients Report Date Export Report The Report Date displays in the upper right of the Population Management view. On the upper right side of the screen near the date, there is a button to export your report to Excel. More on this later. Patient Search You can search for patients using the Search field found on the upper right side of the screen. Patient Information Input the patient name and click on the Spyglass to search. The patient s record will display. The patient lists contain the following information about the member. First and last name F or M for female or male Age Icons indicating lists on which the patient appears Attributed provider Health Organization of the provider Prospective risk score (including an up or down arrow to indicate change when equal to or greater than 10% from the last month), The number and type of Care Opportunities, conditions and visits associated with the patient See the screen shot below. 9 of 24

Management: All Patients Patient Detail To see more patient detail, click on the + sign to the left of the patient name and it will provide more detailed information on the patient including member ID, line of business, product and patient phone number. Hover Over Care Opportunities Information Icon Care Opportunities Hover over the information icon to the right of the patient s Care Opportunities, Conditions and Visits columns for more information. By hovering over the icon next to the number of Care Opportunities, you will see the condition, the last service date (when available) and the clinical due date for open Care Opportunities. See below. Care Opportunities are color-coded based on whether the opportunity is past due (red), due in 30 days (orange) or due in 60 days (yellow). Open Care Opportunities are discussed when we turn to the Care Opportunities view. 10 of 24

Management: All Patients Hover Over Conditions Information Icon Hover over the information icon to the right of the conditions field to see the patient s conditions or past medical history of conditions. See below A list of conditions displays for the patient. 11 of 24

All Patients Hover Over Visits Information Icon Hover over the information icon to the right of the Visits field to see that patient s visit history during the 12-month period based on the count from current approved claims, including outpatient and inpatient services. You will receive information on five basic visit categories: 1. Outpatient 2. Professional (PR) 3. Urgent Care 4. Emergency Room 5. Inpatient See below. The Advanced can be used to filter the patient list for any of these types of visits. Professional visits may also be filtered by more detailed type, which we will describe next. 12 of 24

Management Advanced Advanced Expand or collapse filter list on right In addition to the simple filters on the top of the page that let you filter on Hot Spotter Chronic, Hot Spotter Readmission, New Patient, and Inpatient Authorization, there are additional Advanced on the right side of the page. These filters let you further refine your searches. Now, let s see how to find and use them. Expand or Collapse Advanced Filter List on Right In order to expand the filters pane, click on at the top of the vertical bar to the right. To collapse the filters, click on the same icon or the small arrow at the bottom of the vertical filters bar. Click to Expand Click to Collapse 13 of 24

Management: Advanced Advanced Condition The Advanced let you filter by: 1. Conditions 2. Risk Drivers 3. Visit Types 4. Care Opportunities 5. Organizations To filter your report, click the down arrow to the far right of each filter to expand the filtering options for each category. You may select a condition such as Asthma in addition to the simple Hot Spotter Chronic filter to see how many asthma patients are on the Hot Spotter report. First select the Hot Spotter Simple Filter at the top of the Population Management screen. For Advanced, you can either type the entry into the Search field or select the down arrow key to right of the type of filter you want to expand so you can choose from the list. When you have selected your filters, click on the Update button at the bottom of the advanced filters section. To remove some of the filters use the green navigation bar to go back one level and de-select the unwanted filters. To de-select all filters, select the Reset button to remove all filters selected both from the simple filters on top as well as the advanced filters to the right side. 14 of 24

Management Advanced Risk Driver To search for risk driver filters, type the risk driver into the Search field or expand the filter list under the Risk Drivers header using the arrow to the far right of the category to expand the list. Select the filter(s). Select Update to include the criteria in the search, or Reset to remove all the filters. 15 of 24

Management Advanced Visits To search using Visit Types filters, click on the downward arrow to the far right of the visits filter to expand the list of available visit filters. Visits can be filtered into five main categories: 1. Outpatient 2. Professional Services 3. Urgent Care 4. Emergency Room 5. Inpatient You can drill down to more specific types of Professional visits as well. Perhaps you want to filter using the PR-attributed provider Visits filter. This filter will generate patients who have had visits to their attributed provider. Select the filter you want to use and click on Update or Reset to remove the filters. 16 of 24

Management Advanced Care Opportunity Users can search for care opportunity filters by typing the risk driver into the Search field or expand the filter list using the arrow to the far right side of the category. You may select a whole category such as Diabetes which includes all the diabetic related measures, or filter by more specific measures shown underneath. Select Update to search or Reset to remove the filters. 17 of 24

Management Advanced Organization You may filter by organization by typing the organization name into the Search field or expand the filter list using the arrow to the far right side of the category. You may select a Provider Group or filter down to more specific provider detail under the category. Select Update to search or Reset to remove the filters. 18 of 24

Management: Export Reports Export Reports You may export a report by clicking on the Export button. Select which fields to include in the report. Some fields are pre-selected but you can de-select fields as necessary. For the pilot we will be exporting to Excel (not PDF) so the PDF button won t display until a future release in 2014. See below. 19 of 24

Management: Care Opportunities Care Opportunities We have been discussing the All Patients view. Now we turn to Care Opportunities, which is the second view under Population Management. Select Care Opportunities at the top of the page. See below. The Care Opportunities view provides more detailed information to help practices manage their whole patient population The screen shows conditions (and the measures associated within those conditions). Measures are color-coded red for past due, orange for measures due in 30 days, and yellow for measures due in 60 days. The graph displays where the most Care Opportunities are. If the provider group does not have any Care Opportunities for a measure, the bar won t display. 20 of 24

Management: Care Opportunities More Information Click on a condition on the graphic display (as shown above) to get more information on specific measures. For example, if you click on Diabetes, you will pull up the Care Opportunities associated with that category, as shown below. Hover over Care Opportunity To see more information on the Care Opportunity, hover over the condition. The system will show the close ratio (which is the number of completed measures divided by the total for the rolling 12 months) and how many patients are past due, due in 30 days, 60 days and the total. See below Click on a Condition The patient list that displays under the condition includes only members with that condition. See below. In this view the patient list includes much the same information as All Patients view, but also includes color coding for the next clinical due date for all upcoming opportunities. 21 of 24

Care Opportunities Continued Expand the Patient Row To see all patients Care Opportunities, expand the row by clicking on the + icon to the left of the patient s name (see below) to reveal the view shown below. You may have selected Care Opportunities for Diabetes, but when you expand the patient record, it shows all Care Opportunities (not just opportunities for Diabetes) and the next clinical due date. Filter by Patient or Provider The Patient List or Provider List options can be found in the upper left corner of the patient list view. The default is Patient list but you can also choose the Provider radio button. It displays the providers who have patients with Care Opportunities. You can use this field to identify which physician has the most past due opportunities. Click on the icon to the right of the Total column to produce a list of all patients for that provider. Care Opportunities Continued Filter by Status In the Care Opportunity view, the advanced filters on the right side can be used to filter on care opportunity Status (past due, due in 30 days, due in 60 days, complete). Click on the Status filter and make a selection. Click on Update. Care opportunity types cannot be displayed across conditions. Please select care opportunity types within a single condition. 22 of 24

Selected status will remain color coded and all other statuses will turn to grey on the graphic display. Show Status Detail When Greyed Out To clear selected advanced filters, click on Reset. Note: Care Opportunities that are complete do not show up on the graph by default and display on the graph as greyed out. By default, the status of all other Care Opportunities show on the graph unless you filter them out. Then the filtered category will appear in grey. To view completed Care Opportunities or those not previously selected, double-click on the greyed out status bar in the legend to see details. Use the boxes the steps to co The completed Care Opportunities will display on the graph and display in the patient list. 23 of 24

Care Opportunities Continued Status Detail continued The patient list will display with the Next Clinical Due Date showing in red (when any opportunities are Past Due). See below. Patient Detail Click on the + to the left of the patient name in the patient list to see detail about completed Care Opportunities. All Care Opportunities will display, not just the completed opportunities. The Anthem National Accounts business unit serves members of: Anthem Blue Cross Life and Health Insurance Company and Blue Cross of California using the trade name Anthem Blue Cross in California; using the trade name of Anthem Blue Cross and Blue Shield for the following companies in: Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Connecticut: Anthem Health Plans, Inc.; Georgia: Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.; Indiana: Anthem Insurance Companies, Inc.; Kentucky: Anthem Health Plans of Kentucky, Inc.; Maine: Anthem Health Plans of Maine, Inc.; Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits; Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada.; New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. ; Ohio: Community Insurance Company; Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123.; Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. In 28 eastern and southeastern counties in New York, Empire Blue Cross Blue Shield, the trade name of Empire HealthChoice Assurance, Inc., underwrites and/or administers the PPO, EPO, POS and indemnity policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 24 of 24