Payment Transformation 2018 Measure Changes and Updates. June 27, 2018

Transcription

1 Payment Transformation 2018 Measure Changes and Updates June 27, 2018

2 A G E N D A Performance Measures 2. News & Updates Engagement Measures 4. Patient Attribution & Panel Management Cozeva 5. Coreo: Effectively Manage Your Panel in Coreo 6. Toolkit and Resources 2

3 Performance Measures 3

4 New Measures in Tobacco Screening and Cessation Counseling 2. Screening for Symptoms of Depression and Anxiety 3. Influenza Vaccine 4. Adolescent Well Care 5. Developmental Screening in the First Three Years 6. Sharecare RealAge Assessment 4

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6 Payment Transformation Updates 2017 final performance is available on Cozeva 2018 Q1 advance payment will be available at the end of June 6

7 Medicare STARs Measures 7

8 Medicare STARs Measures 8

9 Medicare STARs Measures The following Medicare STARs measures are available as of June 1, 2018, in Coreo. This measure set includes: Osteoporosis management in women who had a fracture (OMW). Medication adherence for diabetes medication. Medication adherence for hypertension (RAS antagonists). Medication adherence for cholesterol (statins). 9

10 Diabetes Incentive Office visit with diabetes as the primary diagnosis = $25 HbA1c testing = $25 Dilated retinal eye exam = $25 Maximum Reward potential = $75 per member *Only services received during 2018 apply **Akamai Advantage members only Customer Relations: O ahu Neighbor Islands 10

11 Member Updates Changes need to be made through the employer group for demographics corrections (e.g. dob, name misspellings, gender) Direct patients to contact their Human Resources Dept. 11

12 Sharecare RealAge The percentage of members 18 years of age and older who completed the RealAge assessment at least once during the measurement period. Re-Instated for 2018 Minimum threshold 5% Target threshold 10% 12

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15 Sharecare RealAge Assessment Has not yet taken the RealAge Assessment Already completed the RealAge Assessment 15

16 Sharecare: HMSA Account Not Linked iphone: Unlock Exclusive Content Android: Unlock Exclusive Benefits 16

17 Sharecare Sharecare is available on the following operating systems and devices: All ios devices running ios10 and higner The following Android devices running 4.1 Jellybean and higher that also have Google Service: Samsung GS2, GS4, GS5, GS6 NEXUS 4, 5, 6 HTC One M8 and other HTC models Motorola MotoG The following web browsers: Chrome Mozilla Firefox Safari 17

18 Sharecare Materials 18

19 Review of Chronic Conditions Measurement period will be January 1 September 30, 2018 Supplemental data accepted through October 31,

20 PCP Performance Measures PATIENT EXCLUSION Applies to members living in long-term care facilities Patient institutionalized a least 6 months during the measurement year with supporting documentation Request for Reconsideration R4R required each year Exclusion requests accepted beginning Q

21 Engagement Measures 21

22 PCP Engagement Measures ENGAGEMENT MEASURE COMMERCIAL 2018 MEASURE WEIGHT AKAMAI ADVANTAGE QUEST INTEGRATION Access to and Use of Cozeva 6% 6% 5% Panel Management 7% 7% 5% Engagement with Ecosystem 7% 7% 5% EPSDT Completion Rate 5% TOTAL 20% 20% 20% **Sharecare Engagement REMOVED for

23 Engagement with Ecosystem HMSA Care Model Diabetes Education Programs- e.g. InControl Diabetes Center, Diabetes 101, Queens' Diabetes Education HMSA and Healthways health education workshops - e.g., Diabetes 101, Hypertension Explained, Family Fitness, Stress Bucket HMSA and Healthways health coaching - e.g., chronic disease management, depression, substance abuse, smoking Dr. Dean Ornish Program for Reversing Heart Disease Healthways Financial Well-Being Powered by Dave Ramsey Healthways SilverSneakers Fitness QuitNet - tobacco cessation program Aloha Kidney - kidney disease education program QCIPN Care Coordination Hospice- e.g. Islands Hospice, Hospice Hawaii Other (e.g. community-based programs or other resources to assist patients in reaching their health and well-being goals) 23

24 EPSDT Completion Rate - Form completion Patient Information Screen date (no future dates) Date of birth Member s full name Medicaid/QUEST ID number EPSDT periodic screening age Services Provide all information for required periodic screenings (e.g., measurements, immunizations, etc.) Provider Information Print provider s name completing the screening Provider sign s the form NPI number is correct 24

25 EPSDT Completion Rate Filing Claims PCPs submit EPSDT form 8015 (or Form 8016 for catch up visits). Paper claim - staple EPSDT form to the claim. Electronic claim - mail EPSDT form separately to: HMSA QUEST Integration P.O. Box 3520 Honolulu, HI Special notes: The mailed form must be received by HMSA by the time the electronic claim processes. Originals and resubmissions are due within three (3) months of completion of screening. 25

26 Verifying PCP Information on HHIN HMO, QUEST Integration, and Medicare Advantage ALOHA, KIMBERLY ALOHA PHYSICIANS GRP 1/1/2018 Medical Verify the name displayed under Primary Care Provider Name. If the provider s name is not displayed on HHIN: 1. Ensure patients are informed and agree that they want you as their PCP. 2. Explain your role as their PCP and the significance of the Patient Attestation Form. 3. Member signs the Patient Attestation Form. 4. Provider s office faxes the form to HMSA. Please allow 10 business days to process your request. Note: If you or your office do not have access to HHIN, please contact HHIN at (808) on Oahu or 1 (800) , ext toll-free Neighbor Islands 26 26

27 Patient Attribution Dual Members HMO, QUEST Integration and Medicare Advantage members 1. When a member has dual membership with an HMO, QUEST, and/or Medicare Advantage plan, it is important to verify that the provider s name is displayed on HHIN. 2. The attributed provider is aligned with PCP assignments in HMSA s enrollment databases, which are also displayed on HHIN. PCP information is updated to reflect the provider s name. (e.g., dual PPO and HMO attribution will be aligned with the PCP displayed on HHIN for HMO) The PCP name displayed on HHIN match. (e.g., dual HMO and QUEST)

28 Panel Management Module: Overview Panel management consists of 3 sub-modules: All patients registry Transfer registry Attribution activity log

29 Panel Management: All Patients Registry The All Patients Registry displays all actively attributed patients 29

30 Panel Management: Transfer Registry and Attribution Activity Log The Transfer Registry allows users to view pending additions and removals, as well as recently completed transfers. The Attribution Activity Log is a historical log of all attribution movement over time.

31 Tasking: Requests for Reconsideration (R4R) Easily submit R4R Requests for Reconsideration data 1. Prepare supplemental documentation file (PDF) 2. Click the silhouette icon 3. Record required data 4. Supply a statement of justification 5. Click the paperclip icon to upload supporting data 6. Click the Submit button

32 Toolkit and Resources 32

33 Provider Toolkit Understanding your PMPM band Patient attribution Patient Satisfaction survey samples Screening tools Performance measure codes and claims filing guidance Report to Provider samples and sample provider reports and cover letters Total Cost of Care overview Brochures for patients explaining Payment Transformation 33

34 Provider Resources hmsa.com 34

35 Provider Resources hmsa.com 35

36 Provider Resources - Contacts Your Physician Organization is your transformation leader Call Cozeva at for questions or training about Cozeva display Call HMSA at on Oahu or 1 (877) , toll-free or psinquiries@hmsa.com: Questions about global payment amount Questions about engagement or performance measures Need training/support from HMSA s Training Unit for you and your practice team 36

37 Provider Resources - HHIN Payment Transformation Program Guide To request HHIN access, call on Oahu or 1 (800) , ext toll-free Neighbor Islands 37

38 QUESTIONS? 38