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You have been BCC’d to protect your privacy. Dear PHC Provider,
To make sure you and your colleagues receive important QIP notifications from us, we maintain a contact list that is frequently updated. To help us keep our contact list up to date, please notify us of any changes to your staff or contact information via email at [email protected].
Click on the links below to jump to specific content:
I. QIP
a) eReports Audit Reminder b) June 14: 2015-2016 Wrap-up Webinar – Sign up today! c) Important Due Dates d) New Measurement Set Approved
II. PHC Initiatives
e) June 1: SHARE Approach Workshop f) Due May 6: Advanced Access Collaborative – Apply now! g) Common Themes for Genetic Testing by Non-Geneticists h) HEDIS Update i) June 8: Additional Motivational Interviewing Training j) New QI web page—Offering and Honoring Choices
III. Other Training Opportunities
k) May 31: Advanced care planning training
a) eReports Audit As a reminder, all provider-submitted data to the QIP are subject to a PHC bi-annual audit. The purpose of the audit is to ensure accurate data submissions into eReports. Starting in May, we will begin our first audit process for the 2015-16 QIP. PHC randomly selects sites across all clinical measures to submit documentation for a small sample of members where information was entered into eReports. If your site is selected for this bi-annual audit, please expect to hear from us in the next month. At that time we will provide instructions on what information is required and how to submit it to the QIP team.
b) June 14: Wrap-Up Webinar With the 2015-2016 QIP year closing June 30, we invite you to participate in our Wrap-Up Webinar on Tuesday, June 14. If you have not had much time to work on the QIP or if you have any questions, please attend this webinar to learn about important information that will help you maximize your point earnings. After registering, you will receive a confirmation e-mail with information about joining and participating in the webinar. Date: Tuesday, June 14 Time: 12:00 p.m. to 1:00 p.m. Register: https://attendee.gotowebinar.com/register/5064523554881149699
c) Important Due Dates Please review the following tables for important due dates as the end of the 2015-16 measurement year is fast approaching.
Clinical Measures and Dates
Date Event Notes to Providers
June 30, 2016 End of Measurement Year
This is the last day that services provided to patients in your denominators will count toward your 2015-2016 clinical measure rates
July 1-10, 2016 eReports under maintenance- No provider access to eReports
We will be validating your final denominator lists (with Continuous Enrollment criterion applied)
July 11, 2016 eReports can be accessed by providers
Continuous Enrollment criterion applied (i.e. denominators will only include members who were assigned to your site for at least 11 out of 12 months of the measurement period) Denominators for some measures may drop; changes in performance rates are likely. Relative Improvement scores will be populated based on 2014-2015 performance.
July 11 – Aug 15, 2016
Grace period to upload data on services delivered between July 1, 2015 and June 30, 2016
If for any clinical measures you have a denominator less than 10, you can submit evidence of outreach efforts to non-compliant members conducted during the measurement year. Please include the evidence in an Excel file, with the member’s CIN, outreach date, and description of the outreach, and send it to [email protected] by August 15.
This is an opportunity to provide supplemental data to maximize your QIP point earnings.
July 31, 2016
Last day to submit exclusions from Diabetes Management/Cervical Cancer Screening denominators for review
Please email the exclusion template (attached) to the QIP inbox. We only accept exclusions for clinical reasons such as gestational diabetes, and your submissions for exclusions will be reviewed on a case-by-case basis. You will be notified of approved exclusions via email.
Aug 15, 2016 Last day to upload data for the 2015-2016 QIP
Non-Clinical Measures and Dates
Due Date QIP Measure Submission Template QIP Points/Incentive
July 31, 2016 Patient Experience Part II
Patient Experience Template
5 points
Year-Round (Last day to submit: July 31, 2016)
Advance Care Planning (ACP)
ACP Attestation Template $100 per Qualifying Attestation
Patient-Centered Medical Home
Recognition
PCMH Recognition Template
One-Time Payment: Level 1: $2000, Level 2: $3000, Level 3: $3500
Peer-Led Self-Management Support
Group
Peer-Led Self-Management Support
Group Template
$1000 per Group; 10 groups max. per site and 20 groups
max. per entity
d) 2016-2017 Measurement Set Approved The Physician Advisory Committee approved the proposed measurement set for the 2016-2017 QIP Measurement Year. The QIP team would like to thank our participants for your continuous feedback on the measures throughout the year! We will be hosting an educational webinar to review these changes and go over the entire measurement set this summer. Information for the webinar will be provided in the next monthly newsletter. The finalized measurement set is attached and a summary of changes is below:
* Clinical Care: Removal of the Child BMI measure (Pediatric and Family Medicine sites) and addition of the Monitoring Patients on Persistent Medications measure (Family Medicine sites) — Performance on Child BMI has been consistently high, and unlike other QIP measures that assess outcomes, the documentation of Child BMI is a process measure. The points will be redistributed to existing measures for pediatric practices. Points for family medicine sites will be shifted to Monitoring Patients on Persistent Medications (MPM), the HEDIS rate and the QIP performance on which have been less than satisfactory.
* Unit of Service: Advanced Care Planning— The measure has been expanded to make all MediCal members over the age of 18 eligible for ACP discussions, advanced directives, and POLSTs. PCH will pay sites for submissions attesting to discussions alone, and/or in conjunction with advanced directives and POLSTs. Submitted discussions will receive $50 each (maximum of 100/site) and submitted advanced directives or POLSTs will each receive $100 (maximum of 100/site). Payments will now be made on an annual basis.
* Unit of Service: Health Information Exchange— A new measure rewarding participation in a local Health Information Exchange will be added for 2016-2017.
e) June 1: SHARE Approach Workshop Shared Decision Making: How to Incorporate it into Clinical Practice—The workshop is a one-day, accredited train-the-trainer program developed by the Agency for HealthCare Research and Quality (AHRQ) to help health care professionals work with patients to make the best health care decisions together. The workshop is based on a five-step approach to shared decision making referred to as the SHARE approach. Please refer to the attached flyer for more information and email questions to Lennie-Jane Utanes [email protected]
Date: June 1 (Wednesday) Time: 8:30 a.m. to 4:30 p.m. Location: PHC-Fairfield 4665 Business Center Dr., Fairfield, CA (Live Event) Register: http://meetings.afyainc.com/shareddecisionmaking/register-ca06012016/ Location: PHC-Eureka 1036 5th St., Eureka, CA (Video Broadcast of Fairfield Event) Register: http://meetings.afyainc.com/shareddecisionmaking/register-ca06012016eureka/ Location: PHC- Redding 3688 Avtech Parkway, Redding, CA (Video Broadcast of Fairfield Event) Register: http://meetings.afyainc.com/shareddecisionmaking/register-ca06012016redding/
f) Due May 6: Applications Accepted for Advance Access Collaborative In an effort to support our provider network in improving access, Partnership HealthPlan has partnered with Tantau & Associates to offer the Advanced Access Collaborative (AAC). The AAC is a FREE, 10 month program for groups who are serious about tackling the daunting issue of improving access to care.
The goal of the AAC is to establish and refine the empanelment process, optimize care teams, and improve access clinical outcomes and patient/provider/staff satisfaction. The AAC will achieve results by increasing opportunity for patients to seek and receive care from the provider of their choice at the time of their choosing. Applications (attached) are due May 6! Check out the PHC Advanced Access Collaborative - Program Overview. For more information, contact Barbara Selig: [email protected].
g) June 2: Common Themes for Genetic Testing by Non-Geneticists It seems like new genetic tests become available every day without enough guidance as to how and when they should be used for patients. This webinar is designed to provide an overview of several new genomic technologies as well as some guidance for approaching patients suspected to have or with a family history of a genetic condition. We will also discuss counseling about genetic tests and some tests that may be ordered inappropriately.
Date: June 2 (Thursday) Time: 12:00 p.m. to 1:30 p.m. Register: https://attendee.gotowebinar.com/register/7497851638023258882 Email questions to Lennie-Jane Utanes [email protected]
h) HEDIS Update PHC will be concluding our medical record collection for HEDIS 2016 on May 16th. In the meantime, you may receive a request for additional records. We appreciate your continued support and cooperation with our annual HEDIS project! HEDIS 2016 regional rates for calendar year 2015 will be released and posted to our webpage by July 31, 2016. Please take a moment to review our HEDIS page to identify your region and past performance: http://www.partnershiphp.org/Providers/Quality/Pages/HEDISLandingPage.aspx
i) June 8: Motivational Interviewing Training PHC is promoting Motivational Interviewing (MI) Skill Development training that will focus on helping clients to engage in change talk to promote behavioral change. Several health centers have offered basic MI training to their staff and found the techniques useful in many aspects of primary care. This training is designed for those staff who have completed a basic training and are ready to learn more advanced techniques.
Date: June 8 (Wednesday) Time: 9:00 a.m. to 4:30 p.m. Location: Partnership HealthPlan Regional Office, 495 Tesconi Circle, Santa Rosa, CA 95401 Register: https://advanced-mi-training.eventbrite.com Email questions to Sheila Hakel [email protected]
j) New Offering and Honoring Choices Webpage The QI department is happy to share a new page to our website specifically for our Offering and Honoring Choices program. The initiative encompasses advanced care planning and palliative care, as well as policy and public education activities to support them both. Please click here to check out the new site!
k) May 31: California End-of-Life Option Act (Advanced Care Planning Training by CCCC) The Coalition for Compassionate Care in California is offering training for providers about the key concepts of the new law. The workshop will also focus on conversation skills to discuss end-of-life planning with patients. This information may be helpful for many of your patients and for satisfying the ACP QIP measure. Find out more at: http://coalitionccc.org/training-events/end-of-life-option-act-conversation-training/
Date: May 31 (Tuesday) Time: 8:30 a.m. to 4:30 p.m. (includes 5 CEUs for nurses, social workers, and chaplains) Location: Nonprofit Innovation Center, Sacramento, CA Registration Cost: $159 – $249
The QIP Team Quality Improvement Department Partnership Healthplan of California 4665 Business Center Drive, Fairfield, Ca 94534 Fax (707) 863-4316 E-Mail: [email protected] Our Website: http://www.partnershiphp.org/Providers/Quality/Pages/default.aspx
REGISTER NOW http://meetings.afyainc.com/shareddecisionmaking/upcoming-workshop-venues/ For more information: Lennie-Jane Utanes | Health Services Coordinator | [email protected]
SAVE THE DATE
JUNE 1
June 1, 2016 | 8:30am to 4:30pm Partnership HealthPlan of California
4665 Business Center Drive | Fairfield, CA
94534 *Continental Breakfast and Lunch to be provided
The SHARE Approach Workshop is a one-day, accredited train-the-trainer
program developed by AHRQ to help health care professionals work with patients to make the best possible health care decisions together.
AHRQ’s SHARE Approach is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each option through meaningful dialogue about what matters most to the patient.
Step 1: Seek your patient’s participation.
Step 2: Help your patient explore and compare treatment options.
Step 3: Assess your patient’s values and preferences.
Step 4: Reach a decision with your patient.
Step 5: Evaluate your patient’s decision.
The training focuses on how to engage patients in their health care decision making and how to use patient-centered outcomes research (PCOR) information tools and resources (e.g., patient decision aids) to help patients understand their treatment options and to explore their own values and preferences.
Participating physicians, physician assistants, nurses, nurse practitioners, certified diabetes educators, certified health educators, and pharmacists will earn seven hours of continuing medical education credits/continuing education units (CME/CE).
The Agency for HealthCare Research and Quality (AHRQ) is the lead
Federal agency charged with improving the safety and quality of America’s health care system. AHRQ develops the knowledge, tools, and data needed to improve the health care system and help Americans, health care professionals, and policymakers make informed health decisions. AHRQ works with Department of Health and Human Services (HHS) agencies and other partners to make sure that the evidence is understood and used in an effort to achieve the goals of better care, smarter spending of health care dollars, and healthier people.
SHARE Approach Workshop
2016
This is the only SHARE program
to be offered in California, this year.
Enrollment is limited, sign up soon!
Shared Decision Making: How to Incorporate it into
Clinical Practice
Attachment 1.1) Finalized 2016-17 Measurement Set (A) Fixed Pool Per Member Per Month (PMPM) Measures Providers have the potential to earn a total of 100 points in four measurement areas: 1) Clinical Care; 2) Appropriate Use of Resources; 3) Access and Operations; and 4) Patient Experience. Clinical Care
Family Practice: 45 pts total 1. Child BMI (3-17 yrs) (5 pts) 2. Monitoring Patients on Persistent Medications (5 pts) 3. Well Child Visits (3-6 yrs) (5 pts) 4. Childhood Immunization (2 yrs): DTaP (5 pts) 5. Controlling High Blood Pressure (18-85 yrs) (5 pts) 6. Cervical Cancer Screening (21-64 yrs) (5 pts) 7. Colorectal Cancer Screening (51-75 yrs) (5 pts) 8. Diabetes Management (18 – 75 yrs) (5 pts each)
- HbA1C good control - Retinal eye exam - Nephropathy
Internal Medicine: 45 pts total 1. Monitoring for Patients on Persistent Medications (>18 yrs) (10 pts) 2. Controlling High Blood Pressure (18-85 yrs) (10 pts) 3. Cervical Cancer Screening (21-64 yrs) (5 pts) 4. Colorectal Cancer Screening (51-75 yrs) (5 pts) 5. Diabetes Management (18 – 75 yrs) (5 pts each)
- HbA1C good control - Retinal eye exam - Nephropathy
Pediatric Specialty: 65 pts total 1. Child BMI (3-17 yrs) (10 pts) 2. Nutrition Counseling (3-17 yrs) (10 pts) 3. Physical Activity Counseling (3-17 yrs) (10 pts) 4. Well Child Visits (3-6 yrs) (10 pts) 5. Childhood Immunization (2 yrs): DTaP (10 pts) 6. Childhood Immunization (2 yrs): MMR (10 pts) 7. Adolescent Immunization (13 yrs) (10 pts) 8. Asthma Care (5-18 yrs) (5 pts)
Partnership HealthPlan’s Advanced Access Collaborative
Program Description & Application
ADVANCED ACCESS COLLABORATIVE Page 1
PROGRAM OVERVIEW The Advanced Access Collaborative (AAC) is a FREE, 10-month program for groups who are serious about tackling the daunting issue of improving access to care. The goal of the AAC is to establish and refine the empanelment process, optimize care teams, and improve access clinical outcomes, and patient/provider/staff satisfaction. The AAC will achieve results by increasing opportunity for patients to seek and receive care from the provider of their choice at the time of their choosing. A team of expert faculty is assembled for the AAC. These experts include physicians who are currently practicing in Advanced Access settings and have made the transition from traditional systems to Advanced Access. Catherine Tantau, MPA, and president of Tantau & Associates is the head of our faculty. She is a former director of primary care for Kaiser Permanente, Roseville, California, and partnered with Dr. Mark Murray to develop the Advanced Access model. Ms. Tantau is a nationally recognized innovator in health care delivery with extensive experience assisting health care organizations in a wide variety of settings to dramatically improve access, continuity and reduce costly waits and delays. The AAC model offers:
• Support from PHC Quality Improvement staff • The opportunity to master evidence-based access improvement methods • Ongoing consultation, communication, and support from national experts and peers including hands-on
coaching for team members • Access to email list serves, conference calls, webinars and team reports for supplemental learning
EXPECTATIONS FOR CLINICAL TEAMS Each participating practice will select representatives to form a team (or teams). Team members should include: physician, project lead, nurse, medical assistant/technician, receptionist, and appointment scheduler. Throughout the AAC, clinical teams will work together to reduce delays for all appointment types and services, and to optimize care teams. Participating teams will test strategies to create a system that provides world-class service and access, forming a firm foundation for the patient-centered health home. The AAC clinical teams will learn how to:
• Effectively empanel patients with a PCP • Develop processes for the ongoing maintenance of panels • Optimize continuity between patients and their PCPs • Forecast appointment demand • Meet appointment demand on a daily basis • Eliminate delays for appointments • Offer patients an appointment with the provider of choice at a time that is convenient for the patient • Work down appointment backlogs • Optimize care teams
Representatives from each care team will be required to attend four (4), two-day Learning Sessions spread over ten months. Learning Sessions will provide methodology focused on high-leverage changes for improving empanelment, access, office flows, and patient care; and ensure that teams leave with a robust work plan for testing and implementing changes in their practices. Between Learning Sessions, teams will:
• Apply their learnings, test ideas, and implement strategies; • Maintain contact with each other and the collaborative faculty through e-mail, conference calls, monthly
reports, and site visits
Site Patient CIN Comments by provider
Site Patient CIN Diabetes exclusion comments Medical Chart information (lab values, etc.)
Partnership HealthPlan’s Advanced Access Collaborative
Program Description & Application
ADVANCED ACCESS COLLABORATIVE Page 2
WHO SHOULD APPLY? Clinics that have access improvement as one of the top 3 strategic priorities for the organization and a strong commitment to the Gold Standard for access, which is to: “Offer an appointment today for any problem (urgent or routine) with the PCP or teammate in the absence of the PCP.” Special consideration will be given to clinics that serve a large number of PHC members and have documented access challenges (i.e. long appointment wait times, high no-show rate, high appointment backlog, etc.). Clinics should also demonstrate a willingness to engage fully in the AAC model, including:
• Participation in an on-site assessment interview, to determine the current state of access with the clinical team
• Completion of collaborative pre-work measurements to prepare for the first In-Person Learning Session
• Attendance at all four in-person Learning Sessions (2 days each);
• Attendance at monthly webinars; • Adoption of measurable goals for access;
• A commitment to test a variety of strategies in their practice to reach those goals;
• The use of rapid cycle tests of change; • The use and monitoring of defined measures
related to the teams’ aims; • Sharing information with other AAC teams,
including the details of changes tested and data; • Real work, hard work, fun work; and • Presentation of experiences and results.
COLLABORATIVE SCHEDULE
Date Topic Duration Location
June-July, 2016 On Site Practice Assessment 1 day In Person, at clinic site June, 23 2016 Kick-Off 60 minutes Webinar July 13, 2016 Pre-Work 60 minutes Webinar August 24, 2016 Check-In 60 minutes Webinar September 27-28, 2016 Learning Session 2 days In-Person, location TBD October 20, 2016 Check-In 60 minutes Webinar November 17, 2016 Check-In 60 minutes Webinar December 6-7, 2016 Learning Session 2 days In-Person, location TBD January 19, 2017 Check-In 60 minutes Webinar February 7-8, 2017 Learning Session 2 days In-Person, location TBD March 16, 2017 Check-In 60 minutes Webinar April 4-5, 2017 Learning Session 2 days In-Person, location TBD
*Dates are subject to change based on participant/instructor need
APPLICATION PROCESS Applications will be available on the PHC website from Friday April 8, 2016 until May 6, 2016. Each practice may submit one application; multi-site practices may submit one application per site. A team of PHC leaders and staff will review applications and conduct team interviews May 10-19, 2016. Up to 15 teams will be selected to participate and selected sites will be informed by May 30, 2016.
Application Milestones Date Application release date April 8, 2016 Application due date May 6, 2016 Clinic Team interviews w/ PHC & Catherine Tantau May 10-19, 2016 Team selection and announcement Late May 2016
Partnership HealthPlan’s Advanced Access Collaborative
Program Description & Application
ADVANCED ACCESS COLLABORATIVE Page 3
APPLICATION I. Health Center Information
Health Center/Practice Name: Address: City:
State: Zip:
Phone:
Fax:
II. Advanced Access Team Lead
Name:
Title:
Phone:
Email address:
III. Advanced Access Team Members
Name Title
Phone Number Email
Name: Title
Phone Number Email
Name Title
Phone Number Email
Name: Title
Phone Number Email
Name: Title
Phone Number Email
Name Title
Phone Number Email
*Please submit additional names on a separate sheet
Partnership HealthPlan’s Advanced Access Collaborative
Program Description & Application
ADVANCED ACCESS COLLABORATIVE Page 4
IV. Application Questions
1. Please describe your data collection activities. a) Complete the table below:
Measure How often are you
collecting this data? Who is responsible for collecting, analyzing and sharing this data?
How often are you sharing this data with the entire practice?
3NA
Panel Size
Continuity Rate (if available)
No-Show Rate
Visit Cycle Time
2. Describe any challenges you’ve encountered related to data collection, analysis or sharing
3. Please submit the following data along with your application:
3NA, Panel Size, Continuity Rate (if available), No-Show Rate, Visit Cycle Time
4. What are you hoping to gain from participating in the Advanced Access Collaborative?
5. Are you currently or have you ever participated in a Coleman, Bodenheimer and/or PHC ADVANCE Collaborative(s)?
a) if so, please describe the current state of implementation
6. Is improving access to care among one of the top 3 strategic initiatives of your health center? Please explain why or why not?
Partnership HealthPlan’s Advanced Access Collaborative
Program Description & Application
ADVANCED ACCESS COLLABORATIVE Page 5
V. Project Commitments
By signing below, you indicate you understand and agree to the commitments required to participate in the Advanced Access Collaborative • Our current Advanced Access Team (as specified in Sections II and III) will participate in the Kickoff Webinar, On-Site Assessment
Interview (at the clinics site) monthly check-in webinars & In-Person Learning Sessions • We will provide PHC with timely monthly data, including but not limited to:
• 3NA, Panel Size, Continuity Rate, No-Show Rate, Visit Cycle Time • Other deliverables, as identified in the Memorandum of Understanding (provided upon selection)
• We agree to allow PHC to share data with all Advanced Access Collaborative participants each month. • We will commit adequate resources to collect and report data. • We will commit adequate resources to refining, spreading and continuously improving our primary care access improvement
model. • We are willing to share data and feedback with PHC to inform future QI initiatives.
Executive Sponsor
Name: Date
Signature:
Team Lead
Name: Title:
Signature: Date:
Team Members
Name: Signature:
Name: Signature:
Name: Signature:
Name: Signature:
Name: Signature:
Name: Signature:
Submit Questions, Data, and Completed Application to:
Barbara Selig Senior Project Manager, Performance Improvement
E-mail at [email protected] Phone (707) 420-7826
Applications are due May 6, 2016 by 5:00 pm. Applications will not be complete without the following components:
• Completed paper application (pages 5 - 7) • An electronic copy of the most up-to-date data
Appropriate Use of Resources
Family Practice & Internal Medicine: 30 pts total 1. Admissions/1000* (7.5 pts) 2. Readmission Rate* (7.5 pts) 3. Pharmacy Utilization (10 pts) 4. Opioid Safety (5 pts) *Follow-up post discharge can be the back-up measure for either Admissions/1000 or Readmission Rate, but not both. Pediatric Practice: 10 pts total 1. Pharmacy Utilization
Access and Operations
All Sites: 15 pts total, 5 pts each 1. Avoidable ED Visits 2. Practice ‘open’ to PHC members 3. PCP Office Visits
Patient Experience
All Sites: 10 pts total CAHPS Survey for sites that meet member volume criteria, or Survey/Training Option for other sites (B) Unit of Service Measures Providers receive payment for each unit of service they provide.
Unit of Service
All Sites: 1. Advance Care Planning attestations: $100 per attestation (modified) 2. Access/Extended Office Hours: Equivalent payment of 10% cap 3. PCMH Certification: Level 1 ($2000) Level 2 ($3000) Level 3 ($3500) 4. Peer-led self-management support groups: $1000 per group (max. 10 groups per site) 5. Utilization of California Immunization Registry: pay for performance and improvement 6. Buprenorphine Qualified Providers: $500 per credentialed prescriber (max. 5 per site) 7. SBIRT: $5 per screening 8. Health Information Exchange
