1. Disclosures
Successful completion of this continuing education activity includes the following:
Signing into the conference and providing your address
Attending the entire CE activity
Completing the evaluation
You will receive an ed 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.

2. 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.

3. 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

4. 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.

5. Questions?
If you have any questions about this CE activity, contact Margaret Stahl at or (206)

6. 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)

7. Healthcare Effectiveness Data and Information SetSR
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

8. 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

9. 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)

10. 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.

11. 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: Z (< 8 days old), Z (8-28 days), Z (routine health with abnormal findings), Z (>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%

12. 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

13. Video: PDSA In Everyday LifeSR
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

14. 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

15. References