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1 Please Stand By There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation. 4/20/2016 1

2 Webinar Tips This is a one-way audio broadcast through the participants computer speakers or phone devices. For best results, use computer audio or dial in from a landline. The toll-free number and access code were provided in the notice. Please send questions using the Chat tool. Use the drop down at the top of your screen Select Chat. Chat box appears on the right side of your screen. Questions will be addressed at the end of the webinar. 4/20/2016 2

3 To ask a question or make a comment: 1. Click on the Chat icon at the top 2. Send to: HOST 3. Type your message in the Chat space here. 4/20/2016 3

4 Upcoming HMSA Provider Trainings 5/18/16 New Provider Orientation 5/19/16 QUEST Integration - Par Providers 4/20/2016 4

5 HMSA s Pay-for-Quality Programs Updates and Highlights April 21, 2016

6 Today s Presenters Wayne Shishido Trainer, Provider Services Lara Adelberger STARS Clinical Coordinator 4/20/2016 6

7 Agenda Introduction BMI Reporting, Weight Assessment and Nutrition and Physical Activity Counseling for Children/Adolescents Review of Chronic Conditions Chronic vs. Suspect conditions Q & A Well-Being 5 Surveys Akamai Advantage diabetes member incentives Medication Management for Akamai Advantage members PCMH Practice Assessment and Transformation Plan Q & A 4/20/2016 7

8 Introduction Today s Audience P4Q/PCMH PCPs Have joined a PO Specialty is eligible for P4Q Receiving PCMH monies for population management Payment Transformation (PT) Pilot PCPs Contracted w/po with signed HMSA Payment Transformation Pilot Agreement 4/20/2016 8

9 Introduction Scope of the presentation Measures common to Pay for Quality and Payment Transformation Performance PCMH Practice Assessment and Transformation Plan Does not apply to Practice Transformation Pilot PCPs Note: PT Pilot PCPs Please refer questions on the pilot program to your respective PO. 4/20/2016 9

10 - BMI Reporting - Weight Assessment and Nutrition and Physical Activity Counseling X For P4Q/PCMH and PT Pilot PCPs

11 BMI Reporting Age 3-17 Age Age BMI Percentile + Nutrition Counseling + Physical Activity Counseling BMI Percentile BMI Value 11

12 Weight Assessment and Nutrition and Physical Activity Counseling Commercial & QUEST Integration members Single measure on Cozeva Numerator Credit Requires: BMI Percentile, and Nutrition Counseling, and Physical Activity Counseling Denominator: Members 3 17 years who had an outpatient visit during the measurement period Reported with a well-child visit or an office visit 12

13 Reporting Pediatric Weight/Counseling BMI percentile codes for patients 3 to 20 years old Code Description Z68.51 BMI pediatric, less than 5th percentile for age Z68.52 BMI pediatric, 5th percentile to less than 85th percentile for age Z68.53 BMI pediatric, 85th percentile to less than 95th percentile for age Z68.54 BMI pediatric, greater than or equal to 95th percentile for age Counseling codes for patients 3 to 17 years old Code Description Nutrition Counseling Z71.3 Dietary counseling and surveillance Physical Activity Counseling Z71.89 Other specified counseling 13

14 Counseling for Nutrition Medical record documentation note indicating date and one of the following: Current Nutrition Behaviors Discussion (e.g., eating habits, dieting behaviors) Checklist Indicating Nutrition Addressed Counseling/Referral for Nutrition Education Member Received Nutrition Educational Materials During Face-to-Face Visit Anticipatory Nutrition Guidance Weight/obesity counseling 14

15 Counseling for Physical Activity Medical record documentation note indicating date and one of the following: Current Physical Activity Behaviors Discussion (e.g., exercise routine, participation in sports activities) Checklist Addressing Physical Activity Physical Activity Counseling/Referral Member Received Physical Activity Educational Materials During Face-to-Face Visit Anticipatory Physical Activity Guidance Weight/Obesity Counseling 15

16 Cozeva Supplemental Reporting Pediatric weight assessment Date, Height, Weight, & BMI Percentile Upload Age-Growth Chart with Percentile Plotted Pediatric Counseling for Nutrition/Physical Activity Date & Medical Record Documentation drop down menu options (e.g., discussion, checklist, counseling, educational materials, anticipatory guidance, weight counseling, etc.) Adult BMI Report Date, Height, Weight and BMI value Upload Medical Record Showing BMI value 16

17 Review of Chronic Conditions Akamai Advantage X For P4Q/PCMH and PT Pilot PCPs

18 Review of Chronic Conditions ALWAYS code diagnoses to highest degree of specificity Use Cozeva to Identify Chronic Conditions Not Yet Addressed in 2016 Document Conditions Addressed During Visit in Patient s Medical Record MEAT (Monitor, Evaluate, Assess/Address, Treat) Include the diagnosis on your visit claim 18

19 Review of Chronic Conditions The deadline is September 30, 2016 Visits must be completed Supplemental reporting (disconfirming a diagnosis) must be completed Confirming a Diagnosis Can Only Be Done By Claim PCPs not expected to include Suspect Conditions on a claim unless PCP agrees the patient has the condition, and documents it in the patient s medical record 19

20 What is a Suspect Condition? Conditions that may not have been coded in the past or may not have been coded specifically 20

21 What is a Suspect Condition? Cozeva Coding Specificity (CCS) tool uses the following to identify Suspect Conditions: Prescriptions Indicative of Certain Acute Conditions Abnormal Lab Results/Frequency of Certain Lab Tests Frequency of Specialists Visits Hospital Stays and/or ER Visits Potential Progression of Certain Chronic Conditions Provider Coding Habits Evident in Practice Patterns 21

22 Identifying Suspect vs. Chronic Conditions Chronic Conditions are identified with Past Coded/ Submitted SUSPECT condition CHRONIC condition Provider name Provider name Provider name Provider name Provider name Provider name 22

23 Supplemental Reporting in Cozeva Review of Chronic Conditions Disconfirm Condition has improved; upload medical record Disconfirm Condition has resolved; upload medical record 23

24 Supplemental Reporting in Cozeva Review of Chronic Conditions Disconfirm -- Insufficient evidence of this condition. Do not upload medical records. PCP must submit an Attestation: They reviewed clinical information (such as medical record notes, consult reports, lab reports or imaging over the past two years) and finds: Insufficient Evidence to support the diagnosis, OR Clinical Information to the contrary of the diagnosis Attestation must be specific to patient and condition, and provide clinical rationale to the extent possible 24

25 Supplemental Reporting in Cozeva Review of Chronic Conditions Disconfirm -- Insufficient evidence of this condition After selecting Disconfirm Insufficient evidence of the condition from the drop down menu, the attestation must be entered in this area of Cozeva: 25

26 Supplemental Reporting in Cozeva: Review of Chronic Conditions Sample Attestation for Disconfirm - Insufficient Evidence of Condition: I, Dr. Aloha Lee, do hereby attest that this patient does not have the diagnosis of chronic renal disease. The patient has had normal creatinine levels seen over the past two years. Based on this history and my physical examination, this patient does not have the diagnosis of chronic renal disease. 26

27 Well-Being 5 survey X For P4Q/PCMH and PT Pilot PCPs

28 Well-Being 5 survey What is it? Survey provides an indepth evaluation of a patient s well-being Survey is taken Annually Patient receives a customized plan to focus on areas with potential for improvement 28

29 Important Well-Being 5 survey P4Q PCPs: Measure is Display Only (not scored) in 2016 PT Pilot PCPs: Measure is scored in

30 Well-Being 5 survey Commercial members 18 and older Although P4Q PCPs are not scored on this measure in 2016, they should encourage patients to complete this survey annually HMSA members-survey url 30

31 Well-Being 5 survey HMSA non-members: hmsa.com Scroll down to See where you are Click Take the survey 31

32 Well-Being 5 survey Cozeva Display P4Q PCPs Well-Being 5 gaps are displayed at the patient level. Not displayed in Registries tab that displays all quality measures. PT Pilot PCPs Well-Being 5 measure is displayed in the Registries tab, along with other performance measures. Gaps are displayed at the patient level. 32

33 QUESTIONS?

34 Akamai Advantage Diabetes Incentive Program X For P4Q/PCMH and PT Pilot PCPs

35 2015 Results: Diabetes Education $50 incentive for Certified Diabetes Education 261 Akamai Advantage members earned incentive 202 (77%) completed CDE for the first time

36 2015 Results: Dilated Retinal Eye Exam $25 incentive for completing an eye exam 376 Akamai Advantage members earned the incentive 138 exams completed due to the incentive

37 2016 Coordinated Diabetes Incentives PCP Visit - $10 HbA1c Test - $10 (2 per year) Eye Exam - $20 Education - $50

38 Coordinated Diabetes Care Incentives 500 Akamai Advantage members signed up as of 4/13 Updated reports of eligible members mailed to provider offices mid-june First awards mailed to members early July Office flyers available!

39 Incentive Highlights Open to all Akamai Advantage members with diabetes Members must opt into program Awards based on services during 2016 only HMSA will track awards and send directly to members Encourage your patients to enroll Refer your patients for Diabetes Education

40 Akamai Advantage Medication Management X For P4Q/PCMH and PT Pilot PCPs

41 Medication Therapy Management Patient receives a free comprehensive medication review by a pharmacist Help for your most complex patients 3+ chronic diseases 8+ maintenance medications spend >$ /quarter on medications Refer patient to HMSA s vendor: Mirixa (866) /20/

42 PCMH Requirements Practice Assessment Transformation Plan X For P4Q/PCMH PCPs ONLY

43 PCMH Guide Available at MHProgramGuide.pdf

44 New PCMH Requirements for 2016 All PCMH PCPs must complete 6.1 Practice Assessment and 6.2 Transformation Plan PCP Effective date Deadline for submission to HMSA If deadline not met January 1, 2016 or earlier June 30, 2016 PCP reverts to PCMH Level 1 (no monthly population management fees) PO does not receive PCMH fees for that PCP

45 New PCMH Requirements for 2016 All PCMH PCPs must complete 6.1 Practice Assessment and 6.2 Transformation Plan PCP Effective date Deadline for submission to HMSA If deadline not met After January 1, 2016 By the end of the quarter in which they joined Not considered in a PCMH Not eligible for Pay-for-Quality programs

46 6.1 Practice Readiness Assessment Survey must be completed in Survey Monkey Suggested workflow: 1. Access a PDF version of the survey at practice-readiness-assessment-template.pdf 2. Read the directions carefully 3. Complete the fillable fields in the PDF and save it to your computer. We recommend that the PDF be completed first, because Survey Monkey has a time limit for completion. 4. Go to the Survey Monkey url: surveymonkey.com/r/pcmh61

47 6.1 Practice Readiness Assessment 5. Suggested workflow (cont.) 5. The logon password is contained in the Directions section of the PDF 6. Complete the assessment in Survey Monkey, cutting and pasting your responses from the PDF 7. Upon completion, print the Survey Monkey confirmation of completion for your records. Tip: Watch for the option to print your confirmation it appears for only briefly!

48 6.1 - Practice Readiness Assessment The fine print Each PCP in a group practice must submit an individual assessment. Group assessments are not accepted. If you have multiple locations, use the HMSA ID number for your primary location Survey Monkey will accept one login per IP address. A second physician cannot use the same computer to complete the survey.

49 6.1 - Practice Readiness Assessment The fine print (continued) If the practice has multiple physicians and the office computers are networked and share an external IP address, only one physician can complete PCMH 6.1 from the office.

50 6.2 Transformation Plan Open and complete the Transformation Plan template: transformation-plan-tmeplate.pdf Each PCP must submit a plan to their PO that reflects their own practice (group plans will not be accepted). PCPs can collaborate with their physician organization to complete the transformation plan Do not include Patient-identifying information; answer questions completely and thoroughly

51 6.2 Transformation Plan 1. PCP s Plan to PO PO Reviews Plan PO s the Plan to HMSA by the Deadline

52 Resources Pay for Quality, PCMH Guides Program details viders/ Cozeva Cozeva training, login assistance, technical assistance Cozeva ticket or HMSA Training Unit Pay for Quality measures, PCMH requirements, in office training requests on Oahu or 1 (877) , tollfree or psinquiries@hmsa.co m PT Pilot PCPs may direct questions on the pilot to their PO 4/20/

53 QUESTIONS?

54 MAHALO!