Disclosures Successful completion of this continuing education activity includes the following: Signing into the conference and providing your email address Attending the entire CE activity Completing the evaluation You will receive an emailed copy of your certificate This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Institute for Medical Quality/California Medical Association (IMQ/CMA) through the joint providership of Cardea and the Washington Chapter of the American Academy of Pediatrics. Cardea is accredited by the IMQ/CMA to provide continuing medical education for physicians. Cardea designates this live activity for a maximum of 5.5 AMA PRA Category 1 Credits™. Physicians should claim credit commensurate with the extent of their participation in the activity.

Disclosures Faculty: Stephen Reville, MD, FAAP CME Committee: David Couch; Kathleen Clanon, MD; Johanna Rosenthal, MPH; Pat Blackburn, MPH; Richard Fischer, MD; Sharon Adler, MD. Richard Fischer, MD is a member of an Organon speaker’s bureau. Dr. Fischer does not participate in planning in which he has a conflict of interest, and he ensures that any content or speakers he suggests will be free of commercial bias. None of the other planners and presenters of this CE activity have disclosed any conflict of interest including no relevant financial relationships with any commercial companies pertaining to this CE activity. There is no commercial support for this presentation.

Disclosures This conference was supported by: Amerigroup, Coordinated Care, Mary Bridge Children’s Hospital, Molina Healthcare, Seattle Children’s, Swedish Pediatrics, and United Healthcare Community Plan

Disclosures Following completion of this session, learners should be able to: Describe standards measured by the Healthcare Effectiveness Data and Information Set (HEDIS). Discuss how a pediatric practice would design and implement process improvements to meet HEDIS standards.

Questions? If you have any questions about this CE activity, contact Margaret Stahl at seattle@cardeaservices.org or (206) 447-9538

Process Improvement Methods Move the Needle on HEDIS Metrics Stephen Reville, MD, FAAP (Physician Executive – Mary Bridge Children’s Hospital and Health Network) Samantha Hughes, CMA (Supervisor of Ambulatory Operations – Mary Bridge Pediatrics in Auburn)

Healthcare Effectiveness Data and Information Set SR The Healthcare Effectiveness Data and Information Set (HEDIS) one of the most widely used sets of health care performance measure in the United States. originated in the late 1980s as the product of a group of forward-thinking employers and quality experts Initial intent (and most common use) is to create terms for apples to apples comparison of the performance of Health Insurance plans entrusted to NCQA in the early 1990s. The National Committee on Quality Assurance measurement development process has expanded the size and scope of HEDIS to include measures for physicians, PPOs and other organizations.1

SR Borrowed slide from Jared, Masters program in Pop. Health Management Identify area for improvement Can the population be identified Can you identify those at risk of falling out Make the knowledge actionable Enlist the patient (or parent) in the plan Follow up/follow through Set up next steps to achieve outcome

Prioritization SR Ambulatory Effectiveness Index QI and Resource Utilization goals Embedded into the compensation plan for providers and clinic and system leadership Based upon: HEDIS Healthier Washington HCA Value Based Purchasing goal ACO Value Based Contracts Emerging Best Practices (AAP Recommendations)

Utilization Measure Well Child Visits in the First 15 Months of Life Assesses children who turned 15 months old during the measurement year and had from no well-child visits to six well-child visits with a primary care physician during their first 15 months of life. SH This measure looks at the adequacy of well-child care for infants. It measures the percentage of children who had between one and six or more well-child visits by the time they turned 15 months of age.2 The American Academy of Pediatrics (AAP) (2000) recommends seven well-child visits in the first year of life: the first during the newborn period, and then at around 1, 2, 4, 6, 9, and 12 months of age.

The Starting Line: 68% Our Targets: Meets Expectations = 72.4% Medicaid Commercial Aggregate Payor Mix 56% 44% 75th percentile 68% 87% 90th percentile 74% 90% SH Well Child Care Visits 0-15 Months* current=73.4% (rolling 12 months) 2017 Meets: 72.4% (2016 payer adjusted 75th%ile), Exceeds 75.4% (2016 halfway to 90th%ile, payer adjusted) Commercial (2017) 75th=87%, 90th=90% Medicaid (2016) 75th=68%, 90th=74% MCC target=66% 2017 payer mix in pediatric clinics (aggregate) 56% Medicaid 44% Commercial A registry will be structured to manage no shows, non-scheduled and visit-deficient infants and families. This will be managed at the clinic level (supervisor and front desk). Data comparing each provider’s rates will be provided to each clinic (anonymous or non-anonymous by preference). Please use codes: Z00.110 (< 8 days old), Z00.111 (8-28 days), Z00.121 (routine health with abnormal findings), Z00.129 (>28 days). The provider(exceeds)/clinic (meets) goal will be to increase from a current Mary Bridge (MB) performance of 68% to 72.4% and the clinic management exceeds goal will be 75.4% of children receiving all 6 visits. Our Targets: Meets Expectations = 72.4% Exceeds Expectations = 75.4%

Model for Improvement SH Mary Bridge uses the PDSA/PDCA cycle as the framework to guide improvement work. What are we trying to accomplish? 3 How will we know that a change is an improvement? 3 What change can we make that will results in improvement? 3

Video: PDSA In Everyday Life SR Mary Bridge uses the PDSA/PDCA cycle as the framework to guide improvement work. What are we trying to accomplish? 3 How will we know that a change is an improvement? 3 What change can we make that will results in improvement? 3

Workflow adjustments (scheduling standardization and provider coding) Cycle 5 Cycle 4 SH Cycle 1 (02/2017) Identified population EHR logic to screen for those at risk for fallouts. Tested and retested sample logic. Cycle 2 (03/2017) Trial implementation with Supervisor and Front Office Lead, real patients Cycle 3 (04/2017) Workflow adjustments (scheduling standardization and provider coding) Cycle 4 (05/2017) Full implementation with Front Office Team Cycle 5 (10/2017) Weekly task assignment among receptionists to ensure registry work is maintained Cycle 3 Cycle 2 Cycle 1

References http://www.ncqa.org/hedis-quality-measurement/hedis-measures https://www.qualitymeasures.ahrq.gov/summaries/summary/49819?search=Eating%20abilities%20 http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx