BlueCross BlueShield of Western New York. Make every visit a preventive visit March 13, 2012

Transcription

1 BlueCross BlueShield of Western New York Make every visit a preventive visit March 13, 2012

2 Welcome

3 Opening Remarks We will cover: Evidence based clinical guidelines about an effective well visit Administration and documentation of immunizations Lead Screening Coding P4P

4 Dr. Gale Burstein

5 Children are our future!

6 Regionally all plans are scoring poorly Let s talk about some Regional statistics The graphs will show the BCBSWNY Medicaid specific statistics and the NYS Medicaid averages Statistics for these issues are similar to both Medicaid and Commercial plans Lets take a look at the data in the next few slides in the context of thinking about changes that could be made to improve care

7 Regionally 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Childhood Immunizations (2 yrs of age - Combo 3) 80% 69%

8 Regionally 100% Lead Testing - 3 Year Trend 90% 80% NYS Avg. 89% 70% 60% 50% 40% 30% 20% 10% 0% 84% 84% 80%

9 Regionally 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Well Child Visits, First 15 months of Life (5+ visits) - 3 Year Trend 81% 84% 85% NYS Avg. 83%

10 Regionally 100% Well Child Visits, 3-6 years - 3 Year Trend 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 78% 78% 78%

11 Regionally 100% Adolescent Child Visits - 3 Year Trend 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 54% 55% 55%

12 Barriers Systems Providers Patients

13 Dr. Colleen Mattimore

14 Best Practice

15 Components of a well visit Health and developmental history Physical exam Immunizations Lead screening children under 2 yrs Health Education / Anticipatory Guidance

16 Preparing for a comprehensive well visit Accurate appointment time frame Reminder systems to decrease no shows Optimization of EMR systems Parent preparation for the well visit both the parent and the doctor/office Relationship building with child/parent

17 Suggestions for combining a well and sick visit Know the components that make up a well visit Determine how much can be covered in one visit how likely is the patient to return for another visit? Know what immunizations can be given when a child presents sick Importance of documentation as it relates to a sick and/or well visit

18 Barriers Missed opportunities Parental concerns Appointment scheduling Transportation

19 Sandy Diagostino, RN

20 Immunizations and more Overview of child and adolescent immunizations changes in the 2013 schedule Importance of following the schedule Importance of entering in NYSIIS immunizations and lead screening VFC program and how to order

21 2013 updates There is a copy of immunization schedule in your packet Let s review some pertinent updates in this schedule

22 NYSIIS - New York State Immunization Information System Documentation Documentation Documentation

23 VFC Vaccines for Children The Vaccine for Children (VFC) Program In your packet there is a reminder on how to order Any questions related to ordering this VFC vaccine? Don t forget to bill for the administration of the VFC vaccine

24 Kathryn Glasser, CPC

25 Coding: best practices Choosing codes Coding resources online Coding documents in handout packet After the seminar

26 The Chicken or the Egg Sick (E&M) vs. Well (Preventive) Provide the services Document what was provided Code what was documented

27 Coding Resources Provider > Login > Payment and Operations Clinical Editing > Clinical Edit Search - represents the relationship(s) between CPT codes and the supporting clinical rationale for their bundled or unbundled states Code Resources > Code and Comment - provides detailed coverage information for a specific CPT code

28 Clinical Edit Search Request

29 Clinical Edit Result

30 Code and Comment Sample 1

31 Code and Comment Sample 2

32 Code and Comment Key Sample

33 Practice Specific Questions Contact the Provider Relations Department to speak with your representative. BCBSWNY Providers

34 BlueCross BlueShield is here to help you! Reminders via phone and mail are made regarding immunizations Pediatric Disease Management nurses available

35 BlueCross BlueShield is here to help you! P4P what s new in 2013 Implementation of new analytics tool Pinpoint gaps in care Revise methodology Generate reports

36 BlueCross BlueShield is here to help you! P4P measures Childhood Immunizations Lead Screening Use of Appropriate Medication for People with Asthma Appropriate Treatment for children with URI Appropriate Testing for children with Pharyngitis Chlamydia Screening

37 Questions

38 Thank You! A division of HealthNow New York, Inc. An independent licensee of the BlueCross BlueShield Association. BlueCross, BlueShield and the Cross and Shield symbols are registered trademarks of the BlueCross BlueShield Association.