Best Practices in Adult Immunizations Collaborative Data Orientation Webinar. June 14, 2017

Transcription

1 Best Practices in Adult Immunizations Collaborative Data Orientation Webinar June 14, 2017

2 Welcome to Group 3 participating organizations! 2

3 Agenda Topic Speaker 1. Welcome Danielle Casanova, AMGA 2. Collaborative measures and Jill Powelson, AMGA specifications 3. More about the measures: Vaishali Joshi, AMGA Group 2 data illustrations 4. Where are my data? AMGA and Optum team And data FAQs 5. Process of submitting data Vaishali Joshi, AMGA 6. Data Q & A AMGA and Optum team 7. Upcoming events Erin Leaver- Schmidt, AMGA 3

4 Who are Groups 1, 2 and 3? Group 1 was comprised of 7 healthcare organizations; also referred to as the pilot Group 2 is a cohort of 20 organizations; began in January 2017 Group 3 is you! Another cohort of 20 healthcare organizations 4

5 Collaborative measures and specifications (excerpts from more detailed documents) 5

6 2.1. Measure List Measure 1: Pneumococcal immunization for adults age 65 years and older Measure 2: Pneumococcal immunization for adults age 19 64, who also have a high- risk condition (high- risk conditions are described in more detail below) Optional Measure 2a: Pneumococcal immunization for adults age 19 64, who also have an at- risk condition (at- risk conditions are described in more detail below) Pneumococcal immunization may consist of: Pneumococcal conjugate vaccine, 13 valent (PCV13) Pneumococcal polysaccharide vaccine, 23 valent (PPSV23) Non- defined pneumococcal vaccines i.e., those where documentation is not specific enough to identify as PCV13 or PPSV23 (these should be minimal) Measure 3 evaluates influenza immunization for adults age 18 and older each flu season. 6

7 2.2. Measurement and Reporting Group 3 7

8 3. Measurement Specifications 3.1. General Definitions (1 of 2 slides) PCP Definition: Health care organizations should use their own definition for classifying a PCP, but examples are: Internal Medicine, Family Medicine, Geriatrics/Gerontology, and OB/GYN. Eligible providers include: Doctor of Medicine (MD), Doctor of Osteopathy (DO), Physician Assistant (PA), Advanced Practice Registered Nurse (APRN, ARNP), and other advanced practice professionals (APPs). Outpatient Visit Definition: 1. The patient s records reflect some type of encounter from the list of encounter codes included in the value set document (tab = Encounter Codes), the visit occurs on or between the first and last date of each reporting period, AND 2. The patient has an assigned PCP at the time of report generation, to qualify for the denominator (the visit does not have to occur with the PCP). 8

9 3. Measurement Specifications 3.1. General Definitions (2 of 2) Figure 1: Age Ranges for each Measure CDC/ACIP recommendations for high- risk and at- risk pneumococcal immunization are not capped at age 65. However, for purposes of this collaborative All patients age 65+ should be reported in Measure 1, regardless of their risk of contracting pneumococcal disease. Patients reported in Measures 2 and 2a should be between the ages of 19-64, as well as have a high- risk or at- risk (respectively) diagnosis from a problem list or claim. Copyright 2016 AMGA Analytics LLC and OptumInsight Inc. All rights reserved. 9

10 3. Measurement Specifications 3.2. Data Sources Different sources of data about immunization are acceptable. Each health care organization s sources may vary. Patient self- report of vaccination: It is recommended to accept credible patient self- reports of influenza immunization, but documentation should be provided for pneumococcal immunization before it is recorded as received. Documentation of pneumococcal immunization is recommended in order to confirm which vaccine (PCV13 or PPSV23) was received. Main data elements you will need: Patient detail: Date of birth or age, whether patient is attributed to one of your Primary Care Providers Encounter detail: Date of service, procedure code, diagnosis code Problem list: Diagnosis code Evidence of immunization: Immunization module, registry, medical claim, pharmacy claim, medication module. Types of codes could include CPT, HCPCS, NDC, RxNorm, CVX, SNOMED. If you do not have all of these, just use what you have. 10

11 3. Measurement Specifications 3.3. Denominators (1 of 3 slides) Outpatient Visit/PCP Requirement: Patients must have a face- to- face outpatient visit (i.e., provider clinic visit, nurse visit or flu shot clinic visit) during the reporting period in order to qualify for the denominator of each reporting period. (tab = Encounter Codes) Each patient should have an assigned PCP within the HCO, but the qualifying visit does not need to have occurred with the PCP. Determining Age: Patient age should be determined as of the beginning of each Reporting Period. 11

12 3. Measurement Specifications 3.3. Denominators (2 of 3) Measure 1 Denominator: Patient is age 65 or older and meets the Outpatient Visit/PCP requirement. Measure 2 Denominator: Patient is age 19 64, meets the Outpatient Visit/PCP requirement, and has at least one high- risk diagnosis (value set name = High- risk) on an Outpatient Visit or Problem List prior to, or during the Reporting Period. Measure 2a (optional) Denominator: Patient is age 19 64, meets the Outpatient Visit/PCP requirement, and has at least one at- risk diagnosis (value set name = At- risk) on an Outpatient Visit or Problem List prior to, or during the Reporting Period. Measure 3 Denominator: Patient is age 18 or older and meets the Outpatient Visit/PCP requirement. 12

13 3.3. Denominators (3 of 3) refer to value sets Samples of Denominator value sets: Note: These tables are abbreviated. Refer to value set document for complete listings, including High- risk diagnoses, At- risk diagnoses, and Encounter Codes. 13

14 Example of Group 2 data: Receipt of ANY Pneumococcal Vaccine, by High- Risk or At- Risk Condition *CDC recommends that high- risk patients receive both PPSV23 and PCV13 and at- risk patients receive PPSV23 only. **Data for 6 Optum One organizations participating in Group 2 Note: If a patient has more than one of these conditions, he/she would appear multiple times in the counts. 14

15 3. Measurement Specifications 3.4. Numerators (1 of 5 slides) Measure 1 Age 65+ PV Numerator: Among the population included in the denominator, for each of the below numerators, please report a count of unique patients (not a count of immunizations/codes). The immunization are administered any time after the patient s 65 th birthday in order to count for this measure. The following four Numerator categories should be mutually exclusive; a patient should only fall into one of them: Numerator A: Evidence of only PPSV (value set name = PPSV) Numerator B: Evidence of only PCV (value set name = PCV) Numerator C: Evidence of only UNKNOWN pneumococcal vaccination. The immunization was for pneumococcal but was not able to be defined as PCV or PPSV (value set name = Pneumo- Unknown). Numerator D: Evidence of BOTH PPSV and PCV (value set name = PPSV and value set name = PCV) 15

16 3.4. Numerators (2 of 5) refer to value sets Sample portion of a Numerator value set: Note: This table is abbreviated here. Refer to value set document for complete listings of PPSV, PCV, Pneumo- Unknown, and Flu value sets. 16

17 3. Measurement Specifications 3.4. Numerators (3 of 5) Measure 2 High- risk PV Numerator: Among the population included in the denominator, for each of the below numerators, please report a count of unique patients (not a count of immunizations/codes). The immunization should be administered any time after the patient s 19 th birthday and before their 65 th birthday. These four Numerator categories should be mutually exclusive; a patient should only fall into one of them. Numerator A: Evidence of only PPSV (value set name = PPSV) Numerator B: Evidence of only PCV (value set name = PCV) Numerator C: Evidence of only UNKNOWN pneumococcal vaccination. The immunization was for pneumococcal but was not able to be defined as PCV or PPSV (value set name = Pneumo- Unknown). Numerator D: Evidence of BOTH PPSV and PCV (value set name = PPSV and value set name = PCV) Note: These Numerator names and descriptions are the same as for Measure 1. 17

18 3. Measurement Specifications 3.4. Numerators (4 of 5) Measure 2a (optional) At- risk PV Numerator: Among the population included in the denominator, for each of the below numerators, please report a count of unique patients (not a count of immunizations/codes). The immunization should be administered any time after the patient s 19 th birthday and before their 65 th birthday. These Numerator categories should be mutually exclusive; a patient should only fall into one of them. Numerator A: Evidence of PPSV (value set name = PPSV) Numerator B: Evidence of UNKNOWN pneumococcal vaccination. The immunization was for pneumococcal but was not able to be defined as PCV or PPSV (value set name = Pneumo- Unknown). Note: The at- risk population is not currently recommended to receive PCV. Therefore, Only PCV and BOTH PPSV and PCV are not numerator options for Measure 2a like they are for Measures 1 and 2. 18

19 3. Measurement Specifications 3.4. Numerators (5 of 5) Measure 3 Flu Numerator: Evidence of Influenza Immunization, anytime on or between the first and last date of the influenza season during which the reporting period falls (i.e., since July 1) (value set name = Flu). Note: The flu season is defined from July 1 to June 30 each year for this collaborative. The entire year is included to ensure that all vaccinations are captured. Each July 1, all patients vaccination status starts over as unvaccinated. 19

20 More about the measures: Group 2 data illustrations 20

21 Measure 1 Pneumococcal (Any) Immunization, age 65 Baseline Period 1/1/16 12/31/16 Note Optum Analytics provided data for 6 participating organizations Copyright 2016 AMGA Analytics LLC and OptumInsight Inc. All rights reserved. 21

22 Measure 1 Pneumococcal (Any) Immunization, age 65 Baseline Period 1/1/16 12/31/16 Note Optum Analytics provided data for 6 participating organizations Copyright 2016 AMGA Analytics LLC and OptumInsight Inc. All rights reserved. 22

23 Measure 2 Pneumococcal (Any) Immunization for adults ages with High- Risk Conditions Baseline Period 1/1/16 12/31/16 Note Optum Analytics provided data for 6 participating organizations Copyright 2016 AMGA Analytics LLC and OptumInsight Inc. All rights reserved. 23

24 Measure 2 Pneumococcal (Any) Immunization for adults ages with High- Risk Conditions Baseline Period 1/1/16 12/31/16 Note Optum Analytics provided data for 6 participating organizations Copyright 2016 AMGA Analytics LLC and OptumInsight Inc. All rights reserved. 24

25 Measure 2A (Optional) Pneumococcal Immunization for adults ages with At- Risk Conditions Baseline Period 1/1/16 12/31/16 Note Optum Analytics provided data for 6 participating organizations Copyright 2016 AMGA Analytics LLC and OptumInsight Inc. All rights reserved. 25

26 Measure 3 Influenza Immunization, age 18 Baseline Period 7/1/15 6/30/16 Note Optum Analytics provided data for 6 participating organizations Copyright 2016 AMGA Analytics LLC and OptumInsight Inc. All rights reserved. 26

27 Groups 2 & 3 Plan for Comparison Group A matched comparison group will be created Comprised of Optum One users who are not in the Adult Immunization collaborative but who have similar characteristics, i.e. payer mix, baseline immuniz. rates, minority patient proportion, annual wellness visits, geography, type of organization, etc. This will result in a propensity score matching. Purpose is to identify immunization trends outside of this collaborative Data from the comparison group will be contrasted with data from Optum One users participating in the collaborative, to better identify improvements associated with participation in the learning collaborative (resulting in a difference in differences analysis) Propensity Score Matching Difference in Differences Analysis 27

28 Where are my data? And data FAQs 28

29 Locating immunization data Variety of sources used to find Immunization data in EHRs and claims: Immunization Tables Health Maintenance Tables CPT/G Codes ICD- 9 & - 10 Codes Also state immunization registries (IIS), which are required to include adults not just for children anymore Consider how you will identify these data in your EHR, claims, or population health software. Or external sources that you will use (state IIS, pharmacies, employers). 29

30 A few data related FAQs We have patients who just turned 65 and have had their PCV, but it is not yet time for their PPSV which is due one year later. How do we report these patients? Answer: Report these patients in Measure 1, Numerator B, evidence of only PCV. If patients decline to be vaccinated, should they be removed from the measure denominators? Answer: No, they should be included in the denominator if they meet the criteria. There are no exclusions or exceptions for the immunization measures in this collaborative. You asked for unique counts of patients for the measures. Are the unique counts per month or per reporting period? Answer: Per reporting period See more data FAQs at 30

31 Process of submitting data 31

32 Data submission Two data submission methods are available. 1. Edit and excel template to 2. Use the collaborative data collection portal to enter or upload the data directly into a reporting webpage Data submissions can be made using or the web portal interchangeably throughout the duration of the collaborative The portal will be ready on 07/01/2017. Stay tuned for additional details. Note: More about Optum One users on upcoming slides. 32

33 Data submission All team members listed in the MOUs have been registered. You must be registered into our database in order to submit data. If not, your submission will not be accepted. Contact Sunny Temesgen at if you are unsure of your status. To restate or revise any prior submission for any reporting period, simply edit the relevant entries in the template and resend the entire file via or login into the portal to make the selected corrections. The template and the portal are designed to accommodate cumulative data submission, so users should retain prior reporting period data in the file as each new period data is available. 33

34 Data submission & benchmarking For users of Optum One, Optum will be in touch regarding details about data submission Reporting periods and reporting deadlines are included in the measure specifications First report - Baseline data - is due September 29, 2017 Quarterly data webinars will illustrate progress toward the goals and provide benchmarking against your peers 34

35 Adult Immunization Collaborative web page Data resources on the web page: Measure specifications Narrative specs* Value sets* Reporting template Data related FAQs Insert brochure pic Visit our website, *These documents have also been e- mailed to your organization. 35

36 Data Q & A AMGA: Jill Powelson jpowelson@amga.org Vaishali Joshi vjoshi@amga.org Optum Analytics: Catherine Mullins catherine.mullins@optum.com Ashton Kennedy ashton.kennedy@optum.com Obtain more information at: 36

37 Upcoming events Group 2 Monthly Webinar on Marketing: July 11, 2017, 2:00-3:30 pm (ET) Repeat of Data orientation webinar: August 3, 2017, 2:00-3:30 pm (ET) Orientation webinar: August 10, 2017, 2:00-3:30 pm (ET) First data due: September 29, 2017 Save the date: in- person meeting October 16-18, 2017 in San Diego, CA 37