Illinois Health Connect Quality Assurance Tools

Transcription

1 Illinois Health Connect Quality Assurance Tools Margaret Kirkegaard, MD, MPH Medical Director, Illinois Health Connect ICAAP Medical Home Collaborative

2 Disclosure for CME I am employed by Automated Health Systems, the administrator of Illinois Health Connect. I do not intend to discuss off label uses of FDA approved products.

3 Learning Objectives At the end of this session participants will be able to: Identify and access two Quality Tools available through IHC. Define one Claims History Report item that could be used to improve your practice. Describe one use for panel roster preventative services.

4 IHC Quality Tools Claims History Panel Rosters IHC Bonus Payment program Provider Profiles

5 Accessing IHC QA Tools QA tools can only be accessed through the HFS MEDI (Medical Electronic Data Interchange) system. Complete instructions for MEDI registration available on under Provider Information or by contacting IHC Provider Service Representative at Large groups can designate a MEDI administrator at each clinic site to assign username and password to appropriate clinical staff.

6 Illinois Health Connect Link

7 Illinois Health Connect Provider Portal

8 Illinois Health Connect Claims History

9 Report Screen Shot - Child

10 Claims History Report Contents Prescription Summary (2 years of data) Prescription Date Prescription Quantity Prescription Description Immunization Summary (currently 5 years of data, will expand to 7 years) Immunization Date Immunization Code Immunization Description Claim Summary (2 years of data) Service Date Claim Date Provider Name Diagnosis Code Procedure Code Claim Type

11 Illinois Health Connect Provider Portal

12 IHC Panel Roster

13 IHC Panel Rosters Available online to download in CSV (Excel format), can be sorted, can request a mailed paper copy Disease Management Eligibility Clients who meet definition of persistent asthma are noted Clients who have had 6 or more ED visits in past 12 months without an admission are indicated by frequent ED user

14 Panel Roster-Preventive Services Well-child visit, developmental screening, vision and lead screening, mammogram and pap currently reflect date of last paid claim, reflect due status based on HFS recommendations Last page of Panel Rosters defines the information provided for each patient Captures claims data from other providers

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16 Panel Roster in CSV Format sorted by due for mammogram

17 IHC Bonus Payment Program $2.8 million paid 2008, $3.2 million paid 2009 Measures selected by Quality Management Subcommittee Obj dev screening, immunizations, mammograms, HBA1C, asthma controller meds Benchmarks established by national norms Based on claims data No special reporting Claim is counted whether or not it was the current PCP or another provider who rendered the service during the measurement period

18 Bonus Data available on IHC Portal

19 Provider Profiles Sent semi-annually to all IHC PCPs Spring-fall cycle Core primary care measures selected by QM subcommittee

20 Provider Profile Clinical Measures Immunizations Developmental screening Diabetes Management Asthma management Well child care Adolescent well care Vision screening Breast cancer screening Cervical cancer screening Lead screening ages 1 and 2 yrs

21 Provider Profile Example

22 Take-Home Messages Refer eligible pts to Your Healthcare Plus at : for additional services Obtain a MEDI username and password so you can access the Claims History Review your Panel Rosters Sort by due for outreach Review the Provider Profiles to assess opportunities for clinical quality improvement Select a bonus measure for a QI project with a financial pay-off Take advantage of IHC QA Nurse and Provider Service Representatives