1. YOUR GAME PLAN: QUALITY IN 2017
Introduction Preview the main points: Proactive approach to quality measures; how to effectively work care gap reports from each MCO; and where to find this information. Understanding HEDIS measures; exactly what the MCOs look for and how to maximize each visit.
Presented by: mary Buckler, lauren mcguirk & lisa sanders

3. Objectives:
Participants will be able to identify HEDIS Quality Measures
Participants will be able to identify care gap reports from each MCO
Participants will be able to identify best practice approaches for standard of care
Review what participants can expect to know at end of session

4. HEDIS
The Healthcare Effectiveness Data and Information Set is one of the most widely used set of healthcare performance measures in the United States.
HEDIS originated in the 1980’s as a product of a group of forward-thinking employers and quality experts, and entrusted to NCQA in the 1990’s. NCQA has expanded the size and scope to include measures for physicians, PPO’s, and other organizations.
It includes 88 measures and 7 domains of care.
•Effectiveness of care
•Access/Availability of care
•Experience of care
•Utilization and Risk Adjusted Utilization
•Relative Resource Use
•Health Plan Descriptive Information
•Measures Collected Using EMR Systems
NCQA’s Committee on Performance Measurement, which includes representation from purchasers, consumers, health plans, health care providers and policy makers, oversees the evolution of the measurement set. Multiple Measurement Advisory Panels provide clinical and technical knowledge required to develop the measures. Additional HEDIS Expert Panels and the Technical Measurement Advisory Panel provide invaluable assistance by identifying methodological issues and providing feedback on new and existing measures. 4

5. Quality in 2017: HEDIS
HEDIS measures track the health plan and physicians’ ability to manage health outcomes.
HEDIS measures the ability to monitor care to improve quality while reducing healthcare costs.
Medicare and Medicaid are moving to aligning payments based on quality of care in 2018.

6. Meeting Quality Measures
But, How!!!!

7. Clear, Concise Documentation in the patient’s record
Code claims accurately and using chronic care diagnoses
Outreach Patient’s to remind of appointments and preventive care
Provide care within NCQA designated time frames

8. How to submit supplemental data
Wellcare
How to submit supplemental data

9. iHOP: Use Google Chrome as the browser.
One provider login for all providers.
Use “Search” rather than “Provider Lookup” when inputting provider information.
Use either the report date OR the collection date for lab values.
Documents must be in .jpg, .pdf or .tif file formats. Also, documents may not exceed the file size limit of 5MB.

10. Other Options: Flat File Submission (need IT support)
FTP Upload (HbA1c values only)
Medicare/Medicaid Attestation Forms (one at the end of the year only)

11. How to submit supplemental data
Aetna
How to submit supplemental data

12. 3 Options: All information is sent to the attention of Stacie Grant.
Secure
Fax:
Regular Mail: HEDIS/Stacie Grant
Aetna Better Health of Kentucky
9900 Corporate Campus Drive Ste. 1000
Louisville, KY 40223

13. How to submit supplemental data
Passport
How to submit supplemental data

14. 1 Option:
Send supplemental data to your QI Specialist via secure , fax, regular mail, FTP upload or on a thumb drive.
PHD will then send all information directly to Passport.

15. How to submit supplemental data
Anthem
How to submit supplemental data

16. 3 Options: Medicaid Medicare Advantage Commercial Availity
Fax:
Medicare Advantage
Send supplemental data to your QI Specialist via secure , fax, regular mail, FTP upload or on a thumb drive.
PHD will then send all information directly to Anthem.
Commercial
There is currently not an option to submit supplemental data for this line of business.
Utilize provided care opportunity reports and Availity to close gaps as them come up.

17. Supplemental Data Reminders:
Two identifying pieces of information:
Name
DOB
Clinic Name
Measure
1 measure at a time

18. QUALITY MEASURES:
Descriptions/tips for providers

19. Adult BMI Assessment (ABA):
Members age who had their body mass index (BMI) and weight documented during an outpatient visit either by a claim or as a medical record entry during the measurement year or year prior

20. TIPS FOR PROVIDERS:
Members age 20 and older require BMI value however members age 19 and younger require BMI percentile documented or plotted on age-growth chart

21. Breast Cancer Screening (BCS):
Women age who had a mammogram any time on or between Oct. 1st two years prior to the measurement year and Dec.31st of the measurement year.
Reasons Women Do Not Get Mammograms
1.Mammograms are for older women. While most all agree after age 50yo women should have yearly mammograms. American Cancer Society recommends a baseline mammogram done for all women ages 35 to 39yo and yearly after that. If any family history of cancer, any breast changes or other high risk factors then a woman should talk to their doctor about having a mammogram at a younger age.
2.Radiation from a mammogram can cause cancer. The amount of radiation you receive from a mammogram is really no big deal. Women concerned about radiation from yearly mammograms over multiple years is understandable, but the harm from the radiation exposure is extremely small, and risk decreases as a woman ages.
3.Fear of finding something. Most mammograms don’t find anything. Eight out of 10 breast lumps are not cancerous. Mammograms save lives. Make that appointment and go. Mammograms can detect breast cancer well before you or your doctor can notice, most times up to two years before

22. TIPS FOR PROVIDERS:
Educate members about early detection and encourage screening.
Schedule member for mammogram and provide written order if needed.
Document history of mastectomy in medical record.
Exclusion: Bilateral mastectomy or two unilateral mastectomies documented.

23. Cervical Cancer Screening (CCS):
Women age who were screened for cervical cancer using either following criteria:
Ages who had pap test every three years
Ages who had pap test/HPV co- testing every five years

24. TIPS FOR PROVIDERS:
Request results of screenings done by OB/GYN for medical home record.
New exclusions accepted if provider documents: “hysterectomy” and also that “member no longer needs pap testing” or “hysterectomy” along with “vaginal pap smear”.
Exclusions: Hysterectomy documented with no residual cervix (complete, total, radical), cervical agenesis or acquired absence of cervix

25. Tableau
What is included?
How do I Use it ?

28. Tableau :

30. : Reiterate the importance of consistently reviewing reports on the FTP site, actively working those reports and enforcing change when necessary.

31. Need some help or support? REACH OUT TO US!
Mary Buckler, Quality Improvement Specialist
Cell:
Melia Hall, Director of Quality Improvement
Cell:
Lauren McGuirk, Quality Improvement Specialist
Cell:
Lisa Sanders, Quality Improvement Specialist
Cell: