1. Obtaining & Reporting Quality: Preventive Measures Welcome The webinar will start at 1:00 pm ET. It is interactive, so please make sure that you have connected via phone with your audio pin. Call-in information is shown on your dashboard, right side of screen.

2. Agenda 1. Introductions 2. Housekeeping 3. Presentation 4. Q & A 5. Follow-up Final Webinar in Series: January 8 NAACOS’ Spring 2014 Conference will be on one of the following dates, check back for more details soon April 2-4 in Washington, DC or April 23-25 in Baltimore

3. Housekeeping 1.Panelists will present for approximately 40 minutes 2.Q&As will take the remainder of the hour Submit anonymous written questions using the Q/A tab (not chat) on dashboard 3.Webinar is being recorded Slides and recording will be available at www.NAACOS.com/webinars. www.NAACOS.com/webinars

4. Today’s Presenters Carrie Hagan, Coastal Carolina Health Care Carrie Hagan is the associate administrator for Coastal Carolina Health Care and the associate executive director for CCQC. Ms. Hagan’s responsibilities include support of the work of the organization’s CEO focusing on the establishment and optimization of day-to-day operations in the organization. She plays active leadership role with senior leadership and management team. Ms. Hagan is responsible for establishing a measure of performance, quality improvement, cost controls and efficient utilization of resources.

5. Today’s Presenters Sara Falkiewicz, ProHealth Solutions Sara Falkiewicz is the director of performance excellence for ProHealth Care (health system) and ProHealth Solutions (ACO). Her responsibilities include measurement and monitoring and performance improvement functions for both organizations. Their departments provide all regulatory-required, publicly- reported and payor-driven data for the two organizations including areas like Core Measures, PQRI/PQRS and Meaningful Use, for over 450 physicians and 100 leaders. Ms. Falkiewicz develops key organizational metric sets and serves in a leadership role to drive the development and management of key data assets and business intelligence.

6. Carrie Hagan, MBA, CPC, CPCO Coastal Carolina Quality Care, Inc.

7. Introduction and Background Carrie Hagan, MBA, CPC, CPCO, Six Sigma Green Belt Associate Executive Director Coastal Carolina Quality Care, Inc. Internal Medicine Family Practice Emergency Medicine Cardiology Hematology/Oncology Gastroenterology Neurology Pulmonary/CC 50+ Providers (60% PCP) 12 Clinic Locations Imaging Center Urgent Care Sleep Lab GI ASC Integrated Enterprise-wide EHRAll Providers are Meaningful Users of EHR Experience with Population Health Management and Reporting

8. ACO Background 100% Owned by Medical Practice Reporting Period Started April 1, 2012 11,000+ Attributed Beneficiaries Advanced Payment Model ACO Successfully reported 2012 ACO GPRO Measures

9. ACO Preventive Health Quality Measures 14. Influenza Immunization 15. Pneumococcal Vaccination for Patients 65 Years and Older 16. Body Mass Index Screening and Follow-up 17. Tobacco Use: Screening and Cessation Intervention 18. Screening for Clinical Depression and Follow-Up Plan 19. Colorectal Cancer Screening 20. Breast Cancer Screening 21. Screening for High Blood Pressure and Follow-Up Documented

10. Quality Points and Weighting By Domain DomainNumber of Individual Measures Total Measures for Scoring Purposes Total Possible Points Per Domain Domain Weight Patient/Caregiver Experience 71 measure with 6 survey module measures combined, plus 1 individual measure 425% Care Coordination/Patient Safety 66 measures, plus the electronic health records measure double-weighted (4 pts.) 1425% Preventive Health88 measures1625% At-Risk Population127 measures, including 5- component diabetes composite measure and 2- component coronary artery disease composite measure 1425% Total332348100%

11. Quality Scoring Sliding Scale ACO Performance LevelQuality Points (all measures except EHR) EHR Measure Quality Points 90 + percentile FFS/MA or 90+percent 2 points4 points 80 + percentile FFS/MA or 80+percent 1.85 points3.7 points 70 + percentile FFS/MA or 70+percent 1.7 points3.4 points 60 + percentile FFS/MA or 60+percent 1.55 points3.1 points 50 + percentile FFS/MA or 50+percent 1.4 points2.8 points 40 + percentile FFS/MA or 40+percent 1.25 points2.5 points 30 + percentile FFS/MA or 30+percent 1.10 points2.2 points <30 percentile FFS/MA or <30 percent No points

12. Challenges of ACO GPRO Reporting Competing Priorities Dynamic Metrics Patient Empanelment Capabilities

13. Best Practices- What is the best way to eat an Elephant?

14. Doing What is Best for Their Patients Financial Incentives Competitive Spirit Sentinel Effect What Motivates Physicians?

15. While not Required, it is Extremely Important Implement Integrated Full Feature EHR Problems, Medications, Allergies, Labs, History, Etc. Need Discrete Data Populated Need to Determine Who is Accountable Attribute Patients to Provider Medicare QIO Measure Up Pressure Down Begin Reporting Quality Measures What gets Measured get s Improved Report Measures Monthly Utilize Medicare Wellness Visit and Transition Care Management Payments to Fund Team Expansion Utilize Team Approach It will Never be Complete Don’t wait until Everything is Done Operational Changes and Preparations

16. Develop Strategy and Structure for Reporting Quality Measures Develop Purpose Get Physician Leaders Involved Establish Clear Measurable Objectives Create Appropriate Incentives Make Objectives Easy to Accomplish Provide Doctors with Resources Have Staff do as Much as Possible Educate Everyone on Staff Celebrate Small Successes and Praise Champions

17. Develop Strategy and Structure for Reporting Quality Measures Elaborate systems and HIE are not required Utilize team approach-Leverage IT, clinical Staff and coders Use CMS provided Excel templates Structured data in EHR helps Some clinical data will need to be abstracted from unstructured notes Claims data is very useful to determine where preventive services are being performed to request reports and “backfill” data in to the EHR or paper record Be ready to start data collection January 13 th, 2014 when CMS will provide your GPRO patient list Decide ahead of time whether you will be using XML upload or manually entry into GPRO WI tool 17

18. EHR and Reporting Tools Allscripts Enterprise E H R Allscripts Clinical Quality Actionable at Point-of-care (For all contracts and populations) Saves provider and staff time searching thru chart Easy to use and train EHR serves as the main data repository for the data Can integrate with multiple EMRs

19. Allscripts CQS Patient Dashboard

20. CCQC Mammography Screening

21. CCQC CRC Screening

22. CCQC Pneumococcal Vaccination

23. CCQC Influenza Vaccination

24. Best Practices Provide clinical and system resources Communication Train and educate everyone in the medical group on Quality Measures; key to success Provide hands on training to help staff input, review and coordinate measure reporting Promote Annual Wellness Visits for ACO patients Develop and Present monthly “scorecards” to create healthy competition among providers and staff Share best practices and lessons learned across clinical locations Decide ahead of time whether you are focusing on completion rates or measure performance- Oversampling Counts! Module Completion rates are calculated by successfully completing data on at least 411 patients Measure performance is calculated on data completed for all patients- Oversampling may increase measure rates 2013 GPRO is Pay for Reporting

25. Contact Information Carrie Hagan chagan@cchealthcare.com

26. Measurement and Improvement of Preventive Health Within an ACO Sara Falkiewicz

27. Background 475 Physicians, 121 Allied Health in ACO – PCPs 31 percent (33% independent) – Specialists 69 percent (83% independent) – Independent 66 percent – Employed 34 percent – Allied Health Members 121 Represent approximately 20 specialties – No Behavioral Health, Anesthesiology 50%/50% between Health System, IPA

28. Background Health System – 19 primary care and specialty clinics – 2 hospitals One medium size teaching hospital One small community hospital – Joint Ventures Ambulatory Surgery Center Rehabilitation Hospital of Wisconsin – Continuum Home Health, Hospice, Senior Center

29. Background ProHealth Solutions – Formed January 1, 2011 – MSSP Program July 1, 2012 – 15,000+ Attributed Beneficiaries

30. Preventive Metrics Influenza Pneumococcal BMI and Blood Pressure Screening/Follow Up Tobacco Screening/Intervention Colorectal and Breast Cancer Depression Screening

31. Strategy and Structure to Report Strong history of clinical reporting – Health System Medical Group Voluntarily submitting electronically gathered patient level data to state collaborative (WCHQ) since 2006 – Currently at 32 measures Immunization, tobacco, cancer screening – Independent Physician Association Measuring at a physician level since late 90’s in a manual fashion – As of 2012 had been running almost 200 metrics Immunization, tobacco, cancer screening

32. PHS Information Technology Timeline Secure electronic capabilities for each member practice Secure comprehensive electronic capture of clinical and administrative data Epic EMR, Patient Registries, Data Warehouse Electronically connect members for population management and organization performance 32

33. Obtaining Data Started With: – Multiple EMR’s – 20+ Individual Billing Systems End With: – One monster warehouse – 83% of providers on Epic – Balance on other EMR or SharePoint

34. How to Report: Technical

35. How to Report: Literal Studied each measure specification Identified impacted clinical workflows, and if discrete data was available (or not) Prioritized EMR documentation build projects based on metric needs Validation and test process for each metric Engage physicians in reporting manually if needed

36. Reporting Challenges Immunizations – Capturing out-of-clinic administrations – WIR – Wisconsin Immunization Registry BMI and Blood Pressure Screening/Follow Up – Doing the screening, couldn’t discretely capture the follow up – SmartText in Epic

37. Reporting Challenges Colorectal and Breast Cancer Screening – Capturing out-of-ACO procedures – Accurate documentation of exclusions Mastectomies, Colostomies Depression Screening – Had to identify a single tool – Rolling out in primary care, adding to rooming process

38. Reporting Challenges Physician assignment – Specialty versus primary care: “actionable” – Movement of physicians in and out of ACO Resources and Organizational “Breadth” – Preparation for ICD-10 – Meaningful Use quality measures – Increase in commercial payor metrics – Pressure from specialists for metrics more applicable to their practice

39. Strategy and Structure to Improve Develop a shared vision – Education Measure definitions Documentation requirements Supporting clinical evidence

40. Strategy and Structure to Improve Mobilize – During visit activity Utilize medical record decision support – Due date calendar – Easy-to-access orders Scheduling of testing outlined in care plan and next steps for patient – Outside of visit activity Searching charts for old or incorrectly documented testing Telephone, letter, and patient portal outreach communication

41. Strategy and Structure to Improve Monitor – Monthly data provided to leaders and clinicians Overall rate, numerator and denominator Patient-level detail on patients missing care or documentation

42. Monitoring Tool: Visual Reports

43. Thank You For Your Time!

44. Questions?  Submit anonymous written questions using the Q/A tab (not chat) on dashboard  If you did not have a chance to ask a question today or have new questions, please send to info@naacos.com. info@naacos.com

45. Speaker Emails Carrie Hagan, Coastal Carolina Health Care Email: chagan@cchealthcare.com Sara Falkiewicz, ProHealth Solutions Email: sara.falkiewicz@phci.org

46. Upcoming The final webinar in this series is Wednesday, January 8 at 1:00pm ET. The title for the next webinar is: Obtaining & Reporting Quality, At-Risk Measures. The speakers are Jeff Farber and Jill Kalman, Mount Sinai Medical Center. Slides and recording of today’s webinar will be posted on our website, www.NAACOS.com/webinar by tomorrow.www.NAACOS.com/webinar Watch our website for information about the 2014 Spring Conference and our next webinar series coming soon!

47. Thank You! Thank you for attending today’s webinar! Consider joining NAACOS The ACO and Business Partner applications can be found at www.NAACOS.comwww.NAACOS.com