Pediatric and adlescent preventive care and HEDIS * * HEDIS is a registered trademark f the Natinal Cmmittee fr Quality Assurance (NCQA). UniCare Health Plan f West Virginia, Inc.
Healthcare Effectiveness Data and Infrmatin Set (HEDIS) Quality imprvement initiative 88 measures acrss seven dmains f care Measures perfrmance Cmpares apples-t-apples Natinally recgnized Natinal Cmmittee fr Quality Assurance (NCQA) Centers fr Medicare & Medicaid Services (CMS) HEDIS 2017 Cvers the 2016 measurement year UniCare Health Plan f West Virginia, Inc. 2
Adlescent well-child exam (AWC) This HEDIS measure evaluates adlescent members annually wh are: 12-21 years f age Had at least ne cmprehensive well-care visit with a PCP r an OB/GYN practitiner during the measurement year (2016). The PCP des nt have t be assigned t the member. Acceptable dcumentatin must cntain the prvider s signature, and includes: Early and Peridic Screening, Diagnstic and Treatment (EPSDT) frm (age specific) Electrnic nte that has health histry, mental and physical develpment, a physical exam, and health educatin/anticipatry guidance A handwritten nte prvided that all elements f the electrnic nte abve are present UniCare Health Plan f West Virginia, Inc. 3
Well-child 3-6 years (W34) At least ne well-child visit with a PCP during the measurement year (2016) The well-child visit must ccur with a PCP, but the PCP des nt have t be the practitiner assigned t the child Acceptable dcumentatin must cntain the prvider s signature, and includes: EPSDT frm (age specific) Electrnic nte that has health histry, mental and physical develpment, a physical exam, and health educatin/anticipatry guidance A handwritten nte prvided that all elements f the electrnic nte abve are present UniCare Health Plan f West Virginia, Inc. 4
Well-child exams the first 15 mnths f life (W15) The percentage f members wh turned 15 mnths ld during the measurement year and wh had the fllwing number f well-child visits with a PCP during their first 15 mnths f life Seven different rates are measured, frm zer visits in first 15 mnths up t six visits in first 15 mnths f life with the latter being the ideal scenari Acceptable dcumentatin must cntain the prvider s signature, and includes: EPSDT frm (age specific) Electrnic nte that has health histry, mental and physical develpment, a physical exam, and health educatin/anticipatry guidance A handwritten nte prvided that all elements f the electrnic nte abve are present UniCare Health Plan f West Virginia, Inc. 5
Key pints fr AWC, W34 and W15 If n well exam was cmpleted fr 2016, all ntes will be cllected fr the year t see if elements f well exam can be fund in the ntes Example: histry in ne nte, develpmental fund in anther, etc. Key phrases can cunt fr elements f well exam Example: the statement f well develped in a sick visit can cunt fr bth physical and mental develpment The generic statement educatin and cunseling can cunt fr anticipatry guidance/health educatin n AWC, W34 and W15 Fr AWC and W34: nly ne qualifying well exam is needed in 2016 Fr W15: all well visits need t be cmpleted befre 15 mnths f age When in dubt, send in all the ntes fr 2016 fr AWC and W34; fr W15, all ntes befre 15 mnths f age UniCare Health Plan f West Virginia, Inc. 6
Weight assessment cunseling fr nutritin and physical activity (WCC) The percentage f members 2-17 years f age wh had an utpatient visit with a PCP r OB/GYN and wh had evidence f Bdy Mass Index (BMI) percentile dcumentatin, cunseling fr nutritin and cunseling fr physical activity during the measurement year Dcumentatin fr nutritin cunseling must include a nte indicating the date and at least ne f the fllwing: Discussin f current nutritin behavirs (fr example, eating habits, dieting behavirs) Checklist indicating nutritin was addressed Cunseling r referral fr nutritin educatin Indicatin that member received educatinal materials n nutritin Anticipatry guidance fr nutritin UniCare Health Plan f West Virginia, Inc. 7
Weight assessment cunseling fr nutritin and physical activity (cnt.) Dcumentatin fr physical activity assessment fr WCC must include a nte indicating the date and at least ne f the fllwing: Discussin f current physical activity behavirs (fr example, exercise rutine, participatin in sprts activities, exam fr sprts participatin) Checklist indicating physical activity was addressed Cunseling r referral fr physical activity Indicatin that member received educatinal materials n physical activity Anticipatry guidance fr physical activity UniCare Health Plan f West Virginia, Inc. 8
Weight assessment cunseling fr nutritin and physical activity (cnt.) BMI percentile Dcumentatin must include a nte indicating the date n which the BMI percentile was dcumented and evidence f either f the fllwing: BMI percentile BMI percentile pltted n age-grwth chart UniCare Health Plan f West Virginia, Inc. 9
Key pints fr weight assessment cunseling fr nutritin and physical activity Well exams have mst, if nt all, f the infrmatin we need Sprts physicals cunt tward the physical activity cmpnent BMI values can t be used, s if yu re using electrnic medical recrds it is easy t set it up t calculate BMI value and percentile autmatically If paper charting is used, send in BMI grwth chart with the name f the patient, the date f birth n the frm and the date f the recrded BMI, if pssible If n well exam was cmpleted, send in all 2016 ntes If paper charting is used and EPSDT screening frm was used fr well exam, send in all ntes fr 2016 with the EPSDT frm, as the frm desn t adequately address physical activity unless specific handwritten statements under activities are fund, such as plays sprts, rides bicycles regularly, etc. UniCare Health Plan f West Virginia, Inc. 10
Childhd Immunizatin Status The percentage f children 2 years f age wh had fur diphtheria, tetanus and acellular pertussis (DTaP); three pli (IPV); ne measles, mumps and rubella (MMR); tw H influenza type B (HiB); three hepatitis B (HepB); ne chicken px (VZV); fur pneumcccal cnjugate (PCV); tw hepatitis A (HepA); tw r three dse series rtavirus (RV); and tw influenza (flu) vaccines by their secnd birthday. Fr MMR, hepatitis B, VZV and hepatitis A, if they haven t had the immunizatin, any f the fllwing can be cunted: Evidence f the antigen r cmbinatin vaccine Dcumented histry f the illness A serpsitive test result fr each antigen UniCare Health Plan f West Virginia, Inc. 11
Key pints fr Childhd Immunizatin Status Examples f acceptable dcumentatin include: Sht recrd Nte stating immunizatin was given and the date alng with prvider signature Fr certain antigens, evidence f illness r serpsitive test All shts must ccur n r befre the child s secnd birthday Dcumentatin stated that sht given at birth r in hspital fr Hepatitis B is acceptable Immunizatin registry infrmatin is acceptable Statement that shts are up-t-date is nt acceptable UniCare Health Plan f West Virginia, Inc. 12
Lead screening fr children The percentage f children 2 years f age wh had ne r mre capillary r venus lead bld test fr lead pisning by their secnd birthday Dcumentatin in the medical recrd must include bth f the fllwing: A nte indicating the date the test was perfrmed The result r finding Results can be in the frm f a lab test result r nte by physician, as lng as the date and value are present in the nte UniCare Health Plan f West Virginia, Inc. 13
Adlescent immunizatins Children wh have turned 13 during the measurement year (2016) Have ne meningcccal cnjugate r meningcccal plysaccharide vaccine n r between the member s eleventh and thirteenth birthdays One tetanus, diphtheria txids and acellular pertussis vaccine (TDaP) r ne tetanus, diphtheria txids vaccine (Td) n r between the member s tenth and thirteenth birthdays UniCare Health Plan f West Virginia, Inc. 14
Dcumentatin needed fr adlescent immunizatins Immunizatin recrd Prvider-signed and dated nte stating that immunizatin was given Immunizatin registry infrmatin is acceptable Statement that shts are up-t-date is nt acceptable UniCare Health Plan f West Virginia, Inc. 15
Human Papillmavirus (HPV) This measure assesses the percentage f female adlescents wh turned 13 years ld during the measurement year and wh received the three-dse HPV vaccine series n r between their ninth and thirteenth birthdays Accrding t the Centers fr Disease Cntrl and Preventin, at least 50% f all sexually active peple will have genital HPV at sme pint during their lifetime Early vaccinatin is key in preventing the disease UniCare Health Plan f West Virginia, Inc. 16
Prmte an HPV/cancer-free generatin Empwer parents t eliminate cancer Increase vaccinatin rates Deliver the HPV vaccine at the same time as ther rutine vaccines Deliver a strng, bundled recmmendatin t parents Encurage parents questins and decisins Shift perceptin frm sexually transmitted infectin t cancer Is the HPV vaccine necessary and des the vaccine wrk? The HPV vaccine culd prevent mst f the 26,000 cases f cancers caused by HPV each year The vaccine has been shwn t prevent almst 100% f warts and precancers caused by the HPV types in the vaccine UniCare Health Plan f West Virginia, Inc. 17
Best practices Vaccinating at 11-12 years f age prvides the best prtectin pssible, prvides a better immune respnse in preteens and prevents mre disease when given at the recmmended age Vaccinate befre expsure HEDIS Requirements: HPV vaccine fr female adlescents: Lks at the percentage f female adlescents 13 years f age wh had three dses f the HPV vaccine n r between their ninth and thirteenth birthdays HPV vaccines administered prir t a member s 9th birthday cannt be cunted fr HEDIS UniCare Health Plan f West Virginia, Inc. 18
HPV immunizatin names Trade name Abbreviatin Manufacturer Cervarix 2vHPV GlaxSmithKline Gardasil 4vHPV Merck Gardasil 9 9vHPV Merck UniCare Health Plan f West Virginia, Inc. 19
References Natinal Assciatin f Cunty and City Health Officials (NACCHO) Natinal Cmmittee fr Quality Assurance (NCQA) HEDIS 2016 Healthcare Effectiveness Data and Infrmatin Set fr the 2015 measurement year Assciatin fr Cmmunity Affiliated Plans (ACAP) American Academy f Pediatrics (AAP) UniCare Health Plan f West Virginia, Inc. 20
Thank yu www.unicare.cm UniCare Health Plan f West Virginia, Inc. UWVPEC-0438-16 July 2016 UniCare Health Plan f West Virginia, Inc. 21