Transcript May 18, 2016 Primary Care Best Practice Presentation

Primary Care Meeting
REVIEW OF BEST PRACTICE MODEL
What is Best Practice?
Do I have a choice to participate?
If you are participating with HealthNow
on January 1, 2017 you will be
automatically enrolled in BestPractice
reimbursement model.
The only way to opt-out is to not
participate with HealthNow
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How your monthly
reimbursement is determined:
4
5
6
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HEDIS/STAR Measures
Cost/Utilization Metrics
8
PCP Efficiency
*Cost outliers are trimmed to 2 standard deviations above and below the mean.
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10
Examples of Types of Services
Included in BestPractice
Capitated Service Codes
Remaining Fee-For-Service
Sick visits
New patient evaluation(s)
Office laboratory services i.e.
urinalysis
Preventive office services i.e. well child
visits, routine annual physicals,
annual well visits (Medicare
patients)
Electrocardiogram
In-office procedures i.e. skin tag
removal
Immunizations
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Timeline
2016
Apr
2017
May June July
Aug Sept Oct Nov
Dec
Jan
Info Seminars
In-office meetings
Final
code
set
Benchmark
quality
measures
Provider-specific
reimbursement
Go Live and
First
BestPractice
Payment
QUALITY MEASURES:
HEDIS/STAR
2016 Star, HEDIS and other Quality Measures
Measure
Data Source
CI Program/
HPHS Measure
At Risk w/ Health
Plans
-
Breast Cancer Screening
HEDIS/ACO
Yes
Yes
-
Colorectal Cancer Screening
HEDIS/ACO
Yes
Yes
-
Annual Flu Vaccine
CAHPS
Yes
Yes
-
Adult BMI Assessment
HEDIS/ACO
Yes
-
Care for Older Adults – Medication Review
HEDIS
Yes
-
Care for Older Adults – Functional Status Assessment
HEDIS
-
Care for Older Adults – Pain Assessment
HEDIS
-
Osteoporosis Management in Women who had a Fracture HEDIS
-
Diabetes Care – Eye Exam
HEDIS/ACO
Yes
Yes
-
Diabetes Care – Kidney Disease Monitoring
HEDIS/ACO
Yes
Yes
-
Diabetes Care – Blood Sugar Controlled
HEDIS/ACO
Yes
Yes
-
Controlling Blood Pressure
HEDIS/ACO
Yes
Yes
-
Rheumatoid Arthritis Management
HEDIS
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Yes
Yes
2016 Star, HEDIS and other Quality Measures
Measure
Data Source
CI Program/ HPHS
Measure
At Risk w/ Health Plans
Yes
-
Reducing the Risk of Falling (Falls Risk Screening &
Management)
HEDIS/ACO
Yes
-
Beta Blocker Therapy for LVSD (18+)
ACO
Yes
-
CAD ACE or ARB Use (*CAD&DM or CAD&LVSD) (18+)
ACO
Yes
-
IVD Aspirin Use (18+)
ACO
Yes
-
Depression Screening (12+)
ACO
Yes
-
Medication Adherence for Diabetes Medications
Prescription Drug Event (PDE)
data; Medicare Enrollment
Database
Yes
-
Medication Adherence for Hypertension (RAS antagonists) Prescription Drug Event (PDE)
data; Medicare Enrollment
Database
Yes
-
Medication Adherence for Cholesterol (Statins)
Yes
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Prescription Drug Event (PDE)
data; Medicare Enrollment
Database
2016 Star, HEDIS and other Quality Measures
Measure
Data Source
CI Program/ HPHS
Measure
At Risk w/ Health Plans
Yes
Yes
Yes
Yes
-
Plan All-Cause Readmissions
HEDIS
-
Getting Needed Care
CAHPS
-
Getting Appointments and Care Quickly
CAHPS
-
Customer Service
CAHPS
-
Rating of Health Care Quality
CAHPS
-
Rating of Health Plan
CAHPS
-
Care Coordination
CAHPS
-
Annual Wellness Visit/EAV or Vatica Use
None
-
Palliative Care Program Expansion
None
Yes
-
CKD Care Management Program Expansion
None
Yes
-
Care Management Measures
None
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Yes
Yes
MCKESSON RISK MANAGER TOOL
What is McKesson Risk Manager?
What is McKesson Risk Manager?
• It is on online analytical tool of
HealthNow
• Assists in identifying quality and
cost drivers for their members
• Provides both high level and patient
level reports
• Available through
www.bcbswny.com provider portal
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What kinds of quality and cost
information is available?
•
•
•
•
HEDIS/STAR Gaps in care
Patient Risk Levels
Rx Use
Emergency Room Use
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Patient Gap Reports for the HEDIS measures are found
under Quality
then Patient Detail by SubMeasure
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VATICA &
ANNUAL WELLNESS VISITS
What is Vatica?
• Cloud based technology tool
• Combines claim data with EMR data for the completion of the AWV
• Assists with accurate diagnosis coding
• Identifies gaps in care related to quality measures
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Provider Home Page
Claims History/Demographic Information
Claims History
Map to specific HCC
diagnosis code
Pre-Visit Worklist
Pre-Visit Worklist
Abnormal Diagnostic
Images/Labs
Map to specific HCC
diagnosis code
Preventive Tests and Therapies
All Preventive Services are
indicated
Diagnosis Code Sheet
Provider clicks “Accept” if agrees with
diagnosis; reject if not
Diagnosis Code Sheet
Gap
Closure
How do Providers Benefit from using Vatica?
• Additional clinical data about patients from health plan
• Accurate diagnosis coding leads to accurate risk scores for patients
• Decision support built into the tool assists with closing gaps in care
• Prompts providers to address gaps in care which improves quality
measures
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Vatica Implementation Process
QUALIFYING
Do you have
BlueCross BlueShield
of Western New York
Medicare Advantage
patients?
Patients with the
following prefixes
would be eligible:
YJE or YJX
INFORMATION
AGREEMENTS
Contact HealthNow to
schedule a Vatica
Webinar
Sign user agreements
with Vatica Health
Iris Wilisbach
or
Megan Lombardi
(MSA, BAA & SOW)
Complete the IT Setup
Form to define all
users that need access
to the Vatica tool
Contact your provider
representative or
Contact your provider
representative or
Megan Lombardi for
the agreements
Megan Lombardi for
the IT Setup Forms
Iris Wilsbach, [email protected]
Megan Lombardi, [email protected]
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USER SET UP
TRAINING
Fax IT Setup Form to
Megan
(716-887-6725)
to be scheduled for
training
The training is
provided via webinar
and in person
Vatica Jump Start Program
Pre-visit
Support
Vatica Health’s jump
start clinicians can help
enter pertinent
information from your
EMR into the tool,
saving you time during
the visit with your
patients
Post-visit
Support
Vatica Health’s jump
start clinicians can help
enter reportable data
back into your EMR
after the visit is
completed. This will help
your office stay in
compliance with your
quality standards.
For more information please contact:
Danielle VanDette, [email protected]
Megan Lombardi, [email protected]
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Phone
Support
Vatica Health’s jump
start clinicians can make
calls to patients with
upcoming appointments
to explain the
importance of an AWV &
encourage them to add
this to their appt.
Certain parts of the HRA
are completed on the call
as well to save time
during the visit.
Incentive
Information
Provider:
$150 AWV fee schedule
+
$200 AWV Incentive
Member:
$20 Debit Card After
AWV is completed
MARK YOUR CALENDAR
THE NEXT CATHOLIC MEDICAL PARTNERS
PCP MEETING IS
TUESDAY, SEPTEMBER 13, 2016
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