1. Using Data to Forge Rapid Quality Improvement Presentation by Precision Healthcare Delivery KPCA 2015 Spring Conference Presentation by Precision Healthcare Delivery KPCA 2015 Spring Conference

2. Our Focus  KPCA Incentive Programs for 2016  Reports available for use to achieve quick quality score increases  Additional steps to speed up the improvement process  Including the patient in the effort  Your contacts at Precision Healthcare Delivery  KPCA Incentive Programs for 2016  Reports available for use to achieve quick quality score increases  Additional steps to speed up the improvement process  Including the patient in the effort  Your contacts at Precision Healthcare Delivery

3. 2016 KPCA Value-Based Endeavors  KPCAlliance ACO  Aetna Better Health of KY (formally CoventryCares)  Anthem Commercial & MA EPHC Plans  Passport Health Plan  WellCare  KPCAlliance ACO  Aetna Better Health of KY (formally CoventryCares)  Anthem Commercial & MA EPHC Plans  Passport Health Plan  WellCare

4. 2016 KPCAlliance ACO - Measures  Fall Risk Screening  Current Med list in Chart  Adult BMI Screening and Follow Up  Tobacco Use Assessment  Depression Screening  Depression Remission at 12 Months  Colorectal Cancer Screening  Screening Mammography  High BP Screening and Follow Up  Diabetes Composite – HbA1c <9 and Eye Exam  Statin Therapy for the Prevention of Cardio Disease  CAD  HTN  IVD  CHF  Influenza Immunization  Pneumococcal Vaccination  Fall Risk Screening  Current Med list in Chart  Adult BMI Screening and Follow Up  Tobacco Use Assessment  Depression Screening  Depression Remission at 12 Months  Colorectal Cancer Screening  Screening Mammography  High BP Screening and Follow Up  Diabetes Composite – HbA1c <9 and Eye Exam  Statin Therapy for the Prevention of Cardio Disease  CAD  HTN  IVD  CHF  Influenza Immunization  Pneumococcal Vaccination

5. 2016 KPCA Aetna Better Health of KY Value-Based Contract - Measures  Ambulatory Care: ED Visits/1000 (AMBED)  HEDIS: Adolescent Well-Care Visits (AWC)  HEDIS: Breast Cancer Screening (BCS)  HEDIS: Cervical Cancer Screening (CCS)  HEDIS: Retinal Eye Exam for Members with Diabetes (CDC)  HEDIS: Chlamydia Screening (CHL)  HEDIS: Childhood Immunization Status – Combo 10 (CIS)  Plan All-Cause Readmission Rate (PCR)  HEDIS: Well-Child in the First 15 Months of Life (W15)  HEDIS: Weight Assessment and Counseling for Nutrition and Physical Activity and BMI Assessment for Children/Adolescents (WCC)  Ambulatory Care: ED Visits/1000 (AMBED)  HEDIS: Adolescent Well-Care Visits (AWC)  HEDIS: Breast Cancer Screening (BCS)  HEDIS: Cervical Cancer Screening (CCS)  HEDIS: Retinal Eye Exam for Members with Diabetes (CDC)  HEDIS: Chlamydia Screening (CHL)  HEDIS: Childhood Immunization Status – Combo 10 (CIS)  Plan All-Cause Readmission Rate (PCR)  HEDIS: Well-Child in the First 15 Months of Life (W15)  HEDIS: Weight Assessment and Counseling for Nutrition and Physical Activity and BMI Assessment for Children/Adolescents (WCC)

6. 2016 KPCA Anthem Commercial & MA EPHC Value-Based Contract - Measures  Medication Adherence: Cholesterol (Statins)  Medication Adherence: Diabetes  Medication Adherence: Hypertension  Medication Adherence: High Risk Medication  HEDIS: Controlling High Blood Pressure [CBP16]  HEDIS: DM HbA1c Control (< 9) [CDC16]  HEDIS: DM Eye Exam [CDC16]  HEDIS: DM Proteinuria (Kidney Disease Monitoring) [CDC16]  HEDIS: DM Statin Use [CDC16]  HEDIS: Osteoporosis Mgmt Fx [OMW16]  HEDIS: Rheumatoid Arthritis Management (DMARDs) [ART16]  HEDIS: Colorectal Cancer Screening [COL16]  HEDIS: Breast Cancer Screening [BCS16]  HEDIS: Adult BMI Assessment [ABA16]  Medication Adherence: Cholesterol (Statins)  Medication Adherence: Diabetes  Medication Adherence: Hypertension  Medication Adherence: High Risk Medication  HEDIS: Controlling High Blood Pressure [CBP16]  HEDIS: DM HbA1c Control (< 9) [CDC16]  HEDIS: DM Eye Exam [CDC16]  HEDIS: DM Proteinuria (Kidney Disease Monitoring) [CDC16]  HEDIS: DM Statin Use [CDC16]  HEDIS: Osteoporosis Mgmt Fx [OMW16]  HEDIS: Rheumatoid Arthritis Management (DMARDs) [ART16]  HEDIS: Colorectal Cancer Screening [COL16]  HEDIS: Breast Cancer Screening [BCS16]  HEDIS: Adult BMI Assessment [ABA16]

7. 2016 KPCA Passport Health Plan Value-Based Contract - Measures  EPSDT Assessment: Age-appropriate EPSDT Assessment  EPSDT Assessment: Med record documentation validates the completeness of required elements of billed assessment  Coordination of Care: 10% reduction in ED svcs/1000  Coordination of Care: Outpt follow up after ACSC ED and Admissions/Re- admission within 30 days of discharge  Coordination of Care: New enrollees have a baseline wellness visit within 120 days of enrollment  HEDIS: Adolescent Well-Care Visits  HEDIS: Adult BMI Assessment  HEDIS: Childhood Immunization Status (Combo 2)  HEDIS: Chlamydia Screening in Women (Total)  HEDIS: HbA1c Control < 9 for Members with Diabetes  HEDIS: HbA1c Testing for Members with Diabetes  HEDIS: Monitoring for Nephropathy for Members with Diabetes  HEDIS: Well-Child Visits 3-6 Years Old  EPSDT Assessment: Age-appropriate EPSDT Assessment  EPSDT Assessment: Med record documentation validates the completeness of required elements of billed assessment  Coordination of Care: 10% reduction in ED svcs/1000  Coordination of Care: Outpt follow up after ACSC ED and Admissions/Re- admission within 30 days of discharge  Coordination of Care: New enrollees have a baseline wellness visit within 120 days of enrollment  HEDIS: Adolescent Well-Care Visits  HEDIS: Adult BMI Assessment  HEDIS: Childhood Immunization Status (Combo 2)  HEDIS: Chlamydia Screening in Women (Total)  HEDIS: HbA1c Control < 9 for Members with Diabetes  HEDIS: HbA1c Testing for Members with Diabetes  HEDIS: Monitoring for Nephropathy for Members with Diabetes  HEDIS: Well-Child Visits 3-6 Years Old

8. 2016 KPCA WellCare Value-Based Contract - Measures  HEDIS: Adolescent Well- Care Visits  HEDIS: Adult BMI Assessment  HEDIS: HbA1c Testing for Members with Diabetes  HEDIS: HbA1c Control <9 for Members with Diabetes  HEDIS: Monitoring for Nephropathy for Members with Diabetes  HEDIS: Chlamydia Screening in Women  HEDIS: Childhood Immunization Status – Combo 2  HEDIS: Well-Child Visits 3- 6 Years Old  HEDIS: Adolescent Well- Care Visits  HEDIS: Adult BMI Assessment  HEDIS: HbA1c Testing for Members with Diabetes  HEDIS: HbA1c Control <9 for Members with Diabetes  HEDIS: Monitoring for Nephropathy for Members with Diabetes  HEDIS: Chlamydia Screening in Women  HEDIS: Childhood Immunization Status – Combo 2  HEDIS: Well-Child Visits 3- 6 Years Old

9. Reports for Speedy Score Increases  WHICH reports provide the quickest measure score increases if worked?  Precision’s QI Dashboard Report  Anthem Care Opportunity Report  WHERE can the FTP site be accessed?  Accessible via Internet (Explorer recommended)  ftp://192.149.84.20:13421/ ftp://192.149.84.20:13421/  WHICH reports provide the quickest measure score increases if worked?  Precision’s QI Dashboard Report  Anthem Care Opportunity Report  WHERE can the FTP site be accessed?  Accessible via Internet (Explorer recommended)  ftp://192.149.84.20:13421/ ftp://192.149.84.20:13421/

10. Accessing the FTP Site Log In Prompt

11. Accessing the FTP Site  Home page

12. Accessing the FTP Site Reminder: You can view your folder in this format for easier navigating.

13. Precision’s QI Dashboard Report  WHERE the QI Dashboard reports are found:

14. Precision’s QI Dashboard Report  WHAT is the QI Dashboard Report?  Two tabs that make up the QI Dashboard Report:  At a glance information on where your HEDIS scores rank for both Wellcare and Aetna Better Health of KY.  A list of patients with Care Gaps that can be used to create and initiate processes to close those gaps and improve your HEDIS scoring.  Written instructions called “User Instructions- QI Dashboard Report.docx” can also be found for this report in the FTP site Reference Folder  WHAT is the QI Dashboard Report?  Two tabs that make up the QI Dashboard Report:  At a glance information on where your HEDIS scores rank for both Wellcare and Aetna Better Health of KY.  A list of patients with Care Gaps that can be used to create and initiate processes to close those gaps and improve your HEDIS scoring.  Written instructions called “User Instructions- QI Dashboard Report.docx” can also be found for this report in the FTP site Reference Folder

15. Precision’s QI Dashboard Report - Sample  HEDIS Tab

16. Precision’s QI Dashboard Report - Sample  Care Gaps Tab

17. Anthem Care Opportunity Report  WHERE the Anthem Care Opportunity reports are found:

18. Anthem Care Opportunity Report  WHAT is the Anthem Care Opportunity Report?  Report pulled from Anthem’s Availity system for your clinic, formatted and saved in the “Other” folder on the Precision FTP site monthly.  Provides your Care Opportunities based on measures  Due in 30 days  Due in 60 days  Due in the calendar year, and  Past due  This list of patients can be used to create and initiate processes to close those gaps and improve your HEDIS scoring.  WHAT is the Anthem Care Opportunity Report?  Report pulled from Anthem’s Availity system for your clinic, formatted and saved in the “Other” folder on the Precision FTP site monthly.  Provides your Care Opportunities based on measures  Due in 30 days  Due in 60 days  Due in the calendar year, and  Past due  This list of patients can be used to create and initiate processes to close those gaps and improve your HEDIS scoring.

19. Anthem Care Opportunity Report

20. Taking Action on These Reports  Allow yourself to see beyond the obstacles. Work only what is relevant and actionable each month.  Utilize the health plans’ options for submitting supplemental data for measures you know you have met.  FLAG charts for what is missing on measures you see have not been met and ALERT your providers to be on the lookout for these flags.  Allow yourself to see beyond the obstacles. Work only what is relevant and actionable each month.  Utilize the health plans’ options for submitting supplemental data for measures you know you have met.  FLAG charts for what is missing on measures you see have not been met and ALERT your providers to be on the lookout for these flags.

21. Getting Ahead of the Gaps  Developing and implementing specific QI processes into, or in addition to, your current workflow can get you ahead of the gaps.  Let’s review a few examples….  Developing and implementing specific QI processes into, or in addition to, your current workflow can get you ahead of the gaps.  Let’s review a few examples….

22. Getting Ahead of the Gaps Adult BMI Assessment (ABA)  Suggested QI Processes:  Make BMI assessment part of every vital sign assessment at every visit.  Spot check to make sure required documentation is being captured at every visit.  If on an EMR, make sure your EMR template automatically calculates a BMI for each encounter.  If not on an EMR, find a mobile device app to calculate or go to: http://www.cdc.gov/healthyweight/ assessing/bmi/ http://www.cdc.gov/healthyweight/ assessing/bmi/  Make BMI charts visible wherever vital sign assessments are preformed  Consider giving patients customized cards with BMI noted to follow during visits if out of range.  Suggested QI Processes:  Make BMI assessment part of every vital sign assessment at every visit.  Spot check to make sure required documentation is being captured at every visit.  If on an EMR, make sure your EMR template automatically calculates a BMI for each encounter.  If not on an EMR, find a mobile device app to calculate or go to: http://www.cdc.gov/healthyweight/ assessing/bmi/ http://www.cdc.gov/healthyweight/ assessing/bmi/  Make BMI charts visible wherever vital sign assessments are preformed  Consider giving patients customized cards with BMI noted to follow during visits if out of range. Meeting the measure: Patients age 18 – 74 who had an outpatient visit with a BMI during the measurement year or the year prior to the measurement year Required documentation: BMI [date and value] and Weight [date and value] NOTE : A height, weight & BMI PERCENTILE must be recorded for pts younger than 21 years old

23. Getting Ahead of the Gaps Childhood Immunization Status (CIS)  Suggested QI Processes:  Review each child’s immunization record before every visit and administer needed vaccines.  Consider using the state’s immunization registry.  Have your PROVIDERS educate on and recommend immunizations to parents.  Address common misconceptions about vaccinations.  Create a system to remind parents when immunizations are due.  Refer to the recommended Immunization Schedule and help parents understand that the requirements for school and childcare entry are not the same as the CDC indicated schedule.  Suggested QI Processes:  Review each child’s immunization record before every visit and administer needed vaccines.  Consider using the state’s immunization registry.  Have your PROVIDERS educate on and recommend immunizations to parents.  Address common misconceptions about vaccinations.  Create a system to remind parents when immunizations are due.  Refer to the recommended Immunization Schedule and help parents understand that the requirements for school and childcare entry are not the same as the CDC indicated schedule. Meeting the measure: Children 2 years of age who had the following vaccines on or before their 2 nd birthday: 4 DTaP 3 IPV 1 MMR 3 HiB 3 Hep B 1 VZV 4 PCV 1 Hep A 2 or 3 RV 2 Flu

24. Getting Ahead of the Gaps Adolescent Well-Care Visit (AWC)  Suggested QI Processes:  Make the very most of every office visit, including sick visits, and consider performing a well-care visit.  Make sports/day care exams into well-care visits by performing the required services and billing the appropriate codes.  Use standardized templates in paper charts and in EMRs that allow checkboxes for standard counseling activities.  During well-care exams, encourage parents on other important measures like taking their child to the dentist and receiving appropriate immunizations.  Suggested QI Processes:  Make the very most of every office visit, including sick visits, and consider performing a well-care visit.  Make sports/day care exams into well-care visits by performing the required services and billing the appropriate codes.  Use standardized templates in paper charts and in EMRs that allow checkboxes for standard counseling activities.  During well-care exams, encourage parents on other important measures like taking their child to the dentist and receiving appropriate immunizations. Meeting the measure: Patients age 12 – 21 who had one comprehensive well- care visit with a PCP or OB/GYN during the measurement year Well-Care Visit must include: ~A health and developmental history (physical & mental) ~A physical exam ~Health education/anticipatory guidance

25. Getting Ahead of the Gaps Chlamydia Screening in Women (CHL)  Suggested QI Processes:  Perform chlamydia screening every year on every 16 to 24 year-old female who takes birth control or who has a pregnancy test (use any visit opportunity).  Perform chlamydia screening as a standard lab on every 16 to 24 year- old female(use well-care and well women exams for this purpose).  Make sure your providers know to speak with your adolescent female patients without their parents as part of their exams.  Offer to your patients to use urine tests for chlamydia screenings.  Place chlamydia swab next to Pap test or pregnancy detection materials.  Suggested QI Processes:  Perform chlamydia screening every year on every 16 to 24 year-old female who takes birth control or who has a pregnancy test (use any visit opportunity).  Perform chlamydia screening as a standard lab on every 16 to 24 year- old female(use well-care and well women exams for this purpose).  Make sure your providers know to speak with your adolescent female patients without their parents as part of their exams.  Offer to your patients to use urine tests for chlamydia screenings.  Place chlamydia swab next to Pap test or pregnancy detection materials. Meeting the measure: Women aged 16 to 24 who were identified as sexually active and who had at least one chlamydia test during the measurement year. Women are identified as sexually active through the following types of claims: ~Pregnancy test ~Birth control Rx

26. Make the Patient Part of the Plan  Patient Outreach  Channels  Timing  Persuasive Language  Patient Education  Tools  Interactive play  Make it fun  Patient Accountability  Consider a Campaign  Don’t be afraid  Patient Outreach  Channels  Timing  Persuasive Language  Patient Education  Tools  Interactive play  Make it fun  Patient Accountability  Consider a Campaign  Don’t be afraid

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28. Questions?