Issue: 7HEDISNews

Harry HEDIS Shout-Outs

Agency Population Health Administrators (PHAs) presented at the Cenpatico-IC PHA Bi-Annual Mini Conference on February 3, 2016. The PHAs selected HEDIS outcome measures for their projects.

• SEABHS targeted HEDIS measure Follow-Up After Hospital Discharge in 7&30 Days. SEABHS will ensure member contact on a daily basis for the first 7 days after discharge for follow-up.• La Frontera’s goal is to achieve outreach to 100% of integrated care members with diabetes.• CODAC’s Pharmacy & Therapeutics process will result in increased support to prevent crises and reduce hospitalizations and readmissions by 20%.• Assurance Health and Wellness will utilize a registry to centralize all diabetic patient information and track compliance with their disease management protocol. Patients identified through the registry are referred to the diabetes self -management program to obtain an HbA1C, a foot exam or to improve their HbA1c level.• ACTS has an outcome goal to increase to 90% the number of members diagnosed with SMI and diabetes who obtain an HbA1C test. Members with elevated HbA1c levels will be provided with diabetic education.

Reminder and info!

Our favorite time of the year is here, Consumer Survey (Mental Health Statistics Improvement Program-MHSIP) time! The survey aims to capture member satisfaction on their behavioral health services. AHCCCS/DBHS selects a random sample of members and Cenpatico-IC distributes the lists and surveys to the ICCAs.

Two consumer surveys will be administered; one for adults and one for the parents/guardians of children receiving behavioral health services. The survey will be available for members in two languages: English and Spanish. The survey will be administered in April and training will begin in March.

Designated ICCA staff involved in administering the survey will be required to attend the training. Promotional activity and education regarding the survey has already begun. The survey will be advertised in Peer and Family Advisory Councils, Cultural Affairs Committees and other events aimed at reaching ICCA staff, members and families. Cenpatico-IC will introduce MHSIP Parties, peer support assistance, and an ICCA Toolkit to improve the survey experience. More information to come and the primary Cenpatico-IC contact for ICCAs is Tina Griffith (tgriffith@cenpatico.com).

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Who’s Harry?

Born from the mists of success, and integrated into the core of our measures; Harry forges forward in an undying quest to bring HEDIS knowledge to Cenpatico’s provider network.

• HEDIS News• Chlamydia Screening• EPSDT• FAQs• Harry’s Health Highlights

In This Issue

Cenpatico Integrated Care (Cenpatico IC) services are funded through a contract with the Arizona Department of Health Services and AHCCCS.

Chlamydia

Screening

Chlamydia Screening

Definition: Women age 21-24 who have had a Chlamydia screening in the Measurement Year.

Measurement Year: 10/1/15-9/30/16 (Medicaid Contract Year)

Numerator: # of women age 21-24 who have had a Chlamydia screeningDenominator: # of women age 21-24

Rate: By dividing the Numerator (# of women age 21-24 who have had a Chlamydia screening) by the Denominator (# of women age 21-24) = RATE. The Rate is the percent performance indicator for Cenpatico.

Hints:1. Track and monitor women age 21-24 for chlamydia screenings. While this measure focuses on age 21-24, annual testing for sexually active women is recommended to start at age 15. 2. Add a trigger question to intake and/or history forms: “Have you been tested for an STD in the past 12 months?”3. Provide information regarding Chlamydia testing and treatment, including follow up.4. Chlamydia can be asymptomatic. Testing of partners is encouraged.5. Repeat infection is common and can occur during or after treatment for chlamydia. Re-testing is recommended about three months after treatment completion.

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MPS: 63% Goal: 70%

What is EPSDT?

Chronic diseases are often preventable and manageable through early detection. Early Periodic Screening Diagnostic Treatment (EPSDT) addresses problems early and intervenes as soon as possible. The EPSDT benefit provides comprehensive and preventive health care services for members under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that this population receives appropriate preventive dental, mental health, developmental and specialty services (Medicaid.gov).

• Early: Assessing and identifying problems for members age 18 to 21 already enrolled with AHCCCS or as soon after the member’s eligibility for AHCCCS services has been established.• Periodic: Intervals established by AHCCCS Periodicity Schedules for screening to assure that a condition, illness, or injury is not incipient or present.• Screening: Regularly scheduled examinations and evaluations of the general physical and behavioral health, growth, development, and nutritional status of members age 18 to 21 and the identification of those in need of more definitive evaluation. For the purpose of the AHCCCS EPSDT program, screening and diagnosis are not synonymous.• Diagnostic: Determination of the nature or cause of a condition, illness, or injury through the combined use of health history, physical, developmental and psychological examination, laboratory tests, and X-rays, when appropriate.• Treatment: Provision of mandatory or optional services (described in Federal Law 42 USC 1396d), when necessary to correct or ameliorate defects, physical and mental illnesses and conditions detected by screening or diagnostic procedures.

EPSDT

HARRY’S DENTAL CORNER Did you know the average person makes 25,000 quarts of saliva (spit) in their lifetime? That is enough saliva to fill 2 swimming pools!For dental providers, the state of Arizona mandates providers use the AHCCCS Dental Periodicity Schedule during periodic screenings for this population, see (Chapter 400, Policy 430 AHCCCS Medical Policy Manual) for more information. Oral Examinations are recommended twice per year.

DENTAL PERIODICITY SCHEDULE Clinical oral examination including but not limited to the following:

Note: As in all medical care, dental care must be based on the individual needs of the patient and the professional judgment of the oral health provider.

• Assess oral growth and development• Caries-risk Assessment• Assessment for need for fluoride supplementation• Anticipatory Guidance/Counseling• Oral hygiene counseling• Dietary counseling• Injury prevention counseling

• Counseling for nonnutritive habits• Substance abuse counseling• Counseling for intraoral/perioral piercing• Assessment for pit and fissure sealants• Radiographic Assessment• Prophylaxis and topical fluoride

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EPSDT / Well Visit services include:

• Comprehensive health and developmental history • Nutritional assessments and interventions • Laboratory testing• Behavioral health screening and services provided by a PCP, including Attention Deficit Hyperactivity Disorder (ADHD), depression and anxiety • Comprehensive unclothed physical examination• Immunizations according to age and health history• Human papillomavirus (HPV) vaccine for female and male EPSDT members• Health education, counseling, and chronic disease self-management• Oral health screening, intended to identify oral pathology, including tooth decay and/or oral lesions• Tuberculin (TB) skin testing as appropriate to age and risk• Eye examinations and prescriptive lenses• Physical activity• Elevated BMI indicative of obesity• Tobacco/substance use, abuse, and/or dependency• Interpersonal and domestic violence screening• Sexually transmitted diseases• Human immunodeficiency virus (HIV)• Reproductive history, sexual practices and family planning counseling• In addition to the EPSDT benefits, adolescent women also qualify for preventative Well Women Services • Clinical breast exam• Pelvic exam (as necessary, according to current recommendations and best standards of practice)

AHCCCS EPSDT Tracking Form Submission

Intake and Coordination of Care Agencies (ICCAs) and Primary Care Physicians (PCPs) are responsible for submitting EPSDT forms for all Integrated Care members age 18 to 21. These forms should be submitted by fax to Cenpatico Integrated Care Attn: Utilization Manager-Physical Health, Medical Management at: 1-866-601-0111. For questions please contact the EPSDT/Maternal Health Coordinator, Kate Wescott at: 1-866-495-6738. Information gathered from the EPSDT form is reported on a quarterly basis to AHCCCS/DBHS.

EPSDT Outreach

Outreach is required during the contract year to ensure that members are receiving the designated EPSDT and dental services. The expectation is for ICCAs to engage eligible members for required EPSDT and dental services. For questions contact the EPSDT/Maternal Health Coordinator (Kate Wescott) at kwescott@cenpatico.com or the Oral Health Coordinator (Sue Fox) at sufox@cenpatico.com.

The Coordinators will track and monitor EPSDT and dental services. They will also send semi-annual reminders to members for EPSDT and dental services. In addition, agencies will be notified of EPSDT members in need of appointments. Participation in services will be reported to AHCCCS/DBHS quarterly.

EPSDT

Early Periodic Screening, Diagnostic and Treatment (EPSDT) Participation

Definition: EPSDT provides comprehensive and preventive health care services for Integrated Care members under the age of 21 during the Measurement Year.

Measurement Year: 10/1/15-9/30/16 (Medicaid Contract Year)

Numerator: # of members under the age of 21 receiving at least one initial or periodic screenDenominator: # of members under the age of 21

Rate: By dividing the numerator (# of members under the age of 21 receiving at least one initial or periodic screen) by the denominator (# of members under the age of 21) = Rate. The Rate is the percent performance indicator for Cenpatico.

Hints:1. Track and monitor EPSDT eligible members to ensure services are provided annually, the original form Is filed in the EHR, and a copy is forwarded to Cenpatico Integrated Care’s EPSDT/Maternal Health Coordinator.2. The EPSDT visit and screening form can be completed by an OB/GYN or a PCP.3. Focused efforts to engage members in this age group are necessary. Consider age specific peer groups, educational or social functions to successfully engage this population.

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MPS: 68% Goal: 80%

Harry

SEZ

Harry SEZ (Frequently Asked Questions)Please send your questions about HEDIS to Tony DeQuinzio, our HEDIS contact. Call (866-495-6738 x84452) or email Tony (ADeQuinzio@Cenpatico.com) with your question and we’ll post it and his answer under the next edition of “HARRY’S HEDIS HINTS” in the Harry SEZ… section. We look forward to responding to your questions in the newsletter!

Q. My Agency leadership has questions about why our HEDIS scores are low on some performance measures. Where can I find information about the Cenpatico HEDIS scoring methodology?A. Harry HEDIS Hints Newsletter #4 FAQs state that the DBHS GSA Integrated Care Performance Measures specifications may not match exactly to the CMS Core Measures and NCQA Measure Technical Specifications. The DBHS methodology used by C-IC to develop ICCA scores is described in the ADHS/DBHS Bureau of Quality & Integration Specifications Manual (BQI), Fiscal Year 2015 (last updated April 2015); Section B12. GSA Integrated Care Performance Measures pages 1-5 and Attachment B3c: GSA Behavioral Health Performance Measures: Data Assumptions. Modifications to the measurement specifications that were made in April 2015 are listed on pages 11-13 of the BQI located at http://www.azdhs.gov/bhs/documents/bqi-specifications/bqi-specifications-manual.pdf.

Q. We received the first HEDIS non-compliant lists from Cenpatico. What strategies do you recommend for using these lists to improve our HEDIS scores?A. We recommend that ICCAs: •Check the accuracy of the non-compliant lists against the member’s medical record. A copy of the provider records for services provided by a specialty provider or PCP should be stored in the electronic health record (EHR). •Consider flagging the EHR or create a registry of members with conditions that qualify for HEDIS measures, e.g., diabetes or asthma, for easy clinical team identification and action. •Look for clusters of non-compliant members based on location, doctor, or by service array. Evaluate the clusters for gaps in services or barriers to care. Develop strategies to address non-compliance. •Make every member visit a preventive visit. When scheduling the member appointment check the EHR for unmet HEDIS requirements and provide preventive services at the same visit.

Q. Are ICCAs not acting as Health Homes responsible for HEDIS Integrated Care Performance Measures? A. Only ICCAs acting as Health Homes are held accountable for Integrated Care performance measures. ICCAs that are not Health Homes are not accountable for Integrated Care measures. If an ICCA is acting as a specialty agency, they are not responsible for meeting Integrated Care measures.

Q. If a T19 SMI Adult has children served at a non-Health Home ICCA and wants to receive services from the agency as well, can that happen?A. Yes. ICCAs that are not Health Homes may serve adult members with SMI but must coordinate the member’s physical and behavioral health care.

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Harry’s Health HighlightsIn this issue of Harry’s HEDIS Hints we covered the Chlamydia Screening measure. As stated, one of the trigger questions for this measure is, ‘Have you been tested for STDs in the past 12 months?’ This testing should include HIV/AIDS testing.

The CDC supports national events like HIV/AIDS Awareness Days in order to raise awareness about HIV/AIDS among specific populations and provide information about HIV prevention, testing, and treatment. The federal web page AIDS.gov provides information and resources to help individuals and organizations plan events and activities around these observance days. http://www.cdc.gov/hiv/library/awareness/index.html

Get tested and encourage others to get tested, too.

Find the nearest testing center at GetTested.cdc.gov or text your ZIP code to “KNOW IT” (566948). Home HIV tests are also available. The GetTested.cdc.gov site lists MHC, El Rio and COPE specifically as testing sites!Use the HIV Testing Sites & Care Services Locator to find testing services, housing providers, health centers and other service providers.

Getting tested is also an important part of prenatal care to prevent mother to child transmission of HIV/AIDS. Did you know that perinatal transmission accounts for 91% of all AIDS cases among children in the United States? Antiretroviral therapy during pregnancy can reduce the transmission rate to 2% or less. One Test. Two Lives. http://www.cdc.gov/actagainstaids/campaigns/ottl/

Cenpatico Integrated Care has committed to assisting in extending the life span of our SMI population by eleven years in seven years. HIV/AIDS testing is an integral part of this endeavor.

National HIV Testing Day - June 27

Each year on June 27 we observe National HIV Testing Day. On this day, we unite with partners, health departments, and other organizations to raise awareness about the importance of HIV testing and early diagnosis of HIV. Help encourage HIV testing on National HIV Testing Day and every day to ensure people get tested for HIV, know their status, and get linked to care and treatment services.

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