PCMH webinar 2018 Enrollment and Update 20170825...– Count each ICN claim with attributed PCMH as one visit – Claims occurring on the same day do not count as multiple visits Quality

PCMH2018EnrollmentandUpdate

August25,2017

EnrollmentRequirementsAnneSantiferHealthCareInnovationsDepartmentofHumanServices

2018EnrollmentRequirements

• AphysicianpracticethatisenrolledinthePCMHprogram,whichmustbeoneofthefollowing:

A. IndividualPCPprovider(Type01or03)B. AphysiciangroupofPCPwhoareaffiliated,withacommongroup

identificationnumber(ProviderType02,04or81)C. ARuralHealthClinic(ProviderType29)D. AnAreaHealthEducationCenter(Providertype69)

2018EnrollmentRequirements

• ThepracticemustincludePCPsenrolledintheConnectCare PrimaryCareCaseManagement(PCCM)Program.AllPCPsmustbesection-4affiliatedwiththesitetheyareenrolling.

• Allsatellitelocationsmustbelistedonapplicationandwillbesubjecttovalidation.AllsatellitelocationsmusthavethesametaxIDastheprimarylocation.

NewRequirementsfor2018*

• Practicemusthaveatleast150beneficiariesatthetimeofenrollment(previously300)

• Musthaveintegratedacertifiedelectronichealthrecord(EHR)intopracticeworkflows

• Beingoodstandingorhavecorrectedpreviouslydeficienciesthatmayhavecausedremediation,withdrawalorsuspensionfromPCMHprogram

*Pendinglegislativeapproval

ApplicationProcessCourtneyTippleAPIIandAIPTSupervisorDXCTechnology

EnrollmentApplication

Re-enrollment

MustcompletetopsectionofSectionI

Mustsigneverypage

PoolingForm

ActivityRequirementsShelleyRuthQualityAssuranceManagerAFMC

2018PCMHActivitiesforPracticeSupport• PCMHsmustmeetall activitiesbythespecifieddeadlinestobeeligibleforpracticesupport

• 3-monthactivityby3/31/2018• 6-monthactivitiesby6/30/2018• 12-monthactivitiesby12/31/2018

• Ifactivitiesarenotmetbythespecifieddeadlines,PCMHsaregiventheopportunitytoremediateandcorrectperformance

• Attestationremediationis90days• Validationremediationis45days

• ActivitydetailsarelocatedontheHealthCarePaymentImprovementInitiativewebsite:

• http://www.paymentinitiative.org/pcmh-manual-and-additional-resources

2018PCMHActivitiesforpracticesupport

Activity DeadlineA. Identifytop10%ofhigh-prioritypatients(includingBHclients) 3month 3/31/18

B.Provide24/7accesstocare 6month6/30/18

C.Documentapproachtoexpandingaccesstosame-dayappointments 6month6/30/18

D.Capacitytoreceivedirecte-messagingfrompatients 6month6/30/18

E.EnrollmentintheArkansasPrescriptionMonitoringProgram(PMP) 6months6/30/18

F.Childhood/Adult VaccinationPracticeStrategy 12months12/31/18

G.JoinSHARE orparticipateinanetworkthatdelivershospitaldischargeinformationtopracticewithin48hours 12months12/31/18

H.Incorporate e-prescribingintopracticeworkflow 12months12/31/18

I.CarePlansforhigh-priority beneficiaries:createcareplans 12months12/31/18

J.Patient LiteracyAssessmentTool:Chooseanyhealthliteracytoolandadministerthescreeningtoatleast50beneficiaries(enrolledinthePCMHprogram)ortheircaregivers.

12months12/31/18

K. Abilitytoreceivepatientfeedback 12months12/31/18

L.CareInstructionforHPB:createandsharewiththepatientanafter-visitsummaryofthepatient’svisit. 12months12/31/18

M.MedicationManagement:DescribethepracticesEHR reconciliationprocess.DocumentupdatestoactivemedicationlistsintheEHRforthehigh-prioritybeneficiary.

12months12/31/18

N. 10-dayfollow-upafteranacuteinpatienthospitalstay 12months12/31/18

QualityMetricsWilliamGolden,MD,MACPMedicalDirector,ArkansasMedicaid

Metric 1PCP Visits: Percentageofapractice’shighprioritybeneficiarieswhohavebeenseenbyanyPCPwithintheirPCMHatleasttwiceinthepast12months

▪ Denominator includes beneficiaries designated high priority by practices according to Section 241.000 of the PCMH Provider Manual and attributed to the PCMH for at least 6 months– Excludes hospice beneficiaries

▪ Numerator includes the number of those high priority beneficiaries with 2 visit types with their attributed PCMH:– Count each ICN claim with attributed PCMH as one visit– Claims occurring on the same day do not count as multiple visits

QualityMetrics TrackedforSharedSavingsIncentivePaymentsforthe2018PerformancePeriod

Metric 2Infant Wellness: Percentageofbeneficiarieswhoturned15monthsoldduringtheperformanceperiodwhoreceiveatleastfivewellnessvisitsintheirfirst15months(0–15months)

▪ Denominatorincludesnumberofbeneficiarieswhoturned15monthsoldduringthemeasurementyear– Excludes hospice beneficiaries

▪ Numerator includes number of beneficiaries who had 5 or more wellness visits during “first 15 months of life” (0–15 months)▪ For specifications, please see website for HEDIS 2017 measurements

Metric 3Child Wellness: Percentageofbeneficiaries3-6yearsofagewhohadoneormorewell-childvisitsduringthemeasurementyear

▪ Denominator includes number of beneficiaries 3–6 years old on the anchor (last) date of the measurement year– Excludes hospice beneficiaries

▪ Numerator includes number of beneficiaries who had one or more wellness visits during the measurement year▪ For specifications, please see website for HEDIS 2017 measurements

Metric 4Adolescent Wellness: Percentageofbeneficiaries12-20yearsofagewhohadoneormorewell-carevisitsduringthemeasurementyear

▪ Denominator includes number of beneficiaries 12–20 years old on the anchor (last) date of the measurement year– Excludes hospice beneficiaries

▪ Numerator includes number of beneficiaries who had one or more wellness visits during the measurement year▪ For specifications, please see website for HEDIS 2017 measurements

▪ Denominator includes number of beneficiaries 5 to 64 years of age with a diagnosis of persistent asthma– Exclude any beneficiary who had at least one encounter (any setting) with a code to identify the following: Emphysema, COPD,

Obstructive Chronic Bronchitis, Chronic Respiratory Conditions Due to Fumes/Vapors, Cystic Fibrosis, Acute Respiratory Failure

– Exclude any beneficiary who had no asthma controller medications dispensed during the performance period▪ Numerator includes number of beneficiaries who achieved a PDC of at least 50% for their asthma controller medication during the

measurement year▪ For specifications, please see website for HEDIS 2017 measurements

Metric 5Asthma: Percentageofbeneficiaries5-64yearsofageduringthemeasurementyearwhowereidentifiedashavingpersistentasthmaandweredispensedanasthmacontrollermedicationforatleast50%oftheirtreatmentperiod

Metric 6ADHD: Percentageofbeneficiaries6-12yearsofagewithanambulatoryprescriptiondispensedforADHDmedicationthatwasprescribedbytheirPCMH,whohadafollow-upvisitwithin30daysbyanypractitionerwithprescribingauthority

▪ Denominator includes a modified HEDIS metric to determine the percent of patients between 6–12 years of age with a first ambulatory prescription dispensed for ADHD medication that was prescribed by their attributed PCMH. The intake period is modified from the HEDIS metric to be the first 11 months of the performance period– Excludememberswhohadaninpatientencounterduringthe30daysaftertheIPSDandhospice beneficiaries

▪ Numerator includes those ADHD patients who had one follow-up visit (per the HEDIS 2017 definition please see website for HEDIS 2017 measurements) with any practitioner with prescribing authority during the 30 days following initiation of the prescription.

▪ Any provider with one of the following individual provider types: 01, 03, 08, 17, 58, 79, 22withproviderspecialtyX4,99withproviderspecialtyN2,95withproviderspecialtyNUorNV(Specialties must be active on the date of the follow-up visit)

Metric 7URI: Percentageofbeneficiary,age1yearandolder,eventswithadiagnosisofnon-specifiedURIthathadantibiotictreatmentduringthemeasurementperiod

▪ Denominatorincludesalleventsforattributedbeneficiaries,whoare1yearofageandolder,onthedetail“from”dateofservicewithaprimaryorsecondarydiagnosis*ofnon-specifiedURIincombinationwithaCPTorHCPCScode*– EventsaredeterminedbythebeneficiariesthathadaclaimwheretheperformingproviderwasanyPCPwithintheirattributed

PCMHoverthemeasurementperiod.MeasurementperiodforMetric7isdefinedasthestartoftheperformanceperioduntil20dayspriortotheendoftheperformanceperiod.

– Excludesbeneficiariesthathaveatleasttwoofthesamecomorbiditycodes365dayspriortotheeventenddateasidentifiedfromthelistofco-morbiditiesICD-9orICD-10codes*andhospice beneficiaries

▪ Numeratorincludesthosebeneficiaryeventsthatweredispensedaprescriptionforanantibiotic,atleastoneAHFScode*,withintwentydaysfromtheinitialevent’sstartdate

*Pleaseseethe“PCMHProgramPolicyAddendum”forlistofcodes

Metric 8HbA1c: PercentageofdiabetesbeneficiarieswhocompleteannualHbA1C,between18-75yearsofage

▪ Denominator includes number of beneficiaries 18 to 75 years old identifiedasbeingdiabeticthrougheitherclaimorpharmacydata.– Excludes gestational and steroid-induced diabetes denominator and hospice beneficiaries

▪ Numerator includes number of beneficiaries 18 to 75 years old identified as diabetic who completed a HbA1c test during the measurement period

▪ For specifications, please see website for HEDIS 2017 measurement

Metric 9Diabetics on Statin: Percentageofdiabeticbeneficiariesbetween40-75yearsofagewhoareonstatinmedication

▪ Denominatorincludesnumberofbeneficiaries40–75yearsidentifiedasbeingdiabeticthrougheitherclaimorpharmacydata.– Excludes gestational and steroid-induced diabetes denominator and hospice beneficiaries

▪ NumeratorcountsthenumberofbeneficiariesthatalsohadatleastoneoftheHIC3codes*toidentifystatindrugs


Metric 10Xanax: Percentageofbeneficiariesage18yearsandolderwhowereprescribedchronicAlprazolam(Xanax)duringthemeasurementperiod

▪ Denominatorincludesbeneficiaries18yearsandolderforwhomprescriptionswerewrittenduringthemeasurementperiod– Pharmacydetail-levelclaim– Excludes hospice beneficiaries

▪ Numerator includes the number of beneficiaries that had four unique distinct dispensing events (a unique dispensing event is defined as pharmacy claim with minimum drug quantity ≥ 15mg on a different first date of service as another dispensing event) of drug with an ‘Alprazolam’ description under the HIC3 code* during the measurement period

Metric 11ODA: Percentageofbeneficiariesatleast18yearsofageasofthebeginningofthemeasurementperiodwithdiabetesmellituswho hadatleasttwoprescriptionsforasingleoraldiabetesagentoratleasttwoprescriptionsformultipleagentswithinadiabetesdrugclassandwhohaveaProportionofDaysCovered(PDC)ofatleast0.8foratleastonediabetesdrugclassduringthemeasurementperiod(12consecutivemonths)

▪ Denominatorincludesnumberofbeneficiariesatleast18yearsofageasofthebeginningofthemeasurementperiodwithdiabetesmellitus(HEDIS2017specificationsusedtoidentifydiabetics)andatleasttwoprescriptionsforasingleoraldiabetesagentoratleasttwoprescriptionsformultipleagentswithinadiabetesdrugclassduringthemeasurementperiod(12consecutivemonths)– Excludes gestational and steroid-induced diabetes denominator and hospice beneficiaries

▪ Numeratorincludesnumberofbeneficiarieswithdiabetesmellituswithatleasttwoprescriptionsfororaldiabetesagents*, inanydiabetesdrugclass,withaPDCofatleast0.8foratleastonediabetesdrugclass

▪ For specifications, please see website for NQF specifications:http://www.qualityforum.org/QPS/QPSTool.aspx and measure search on “ODA”


Metric 12Eye Exams: Percentageofdiabeticbeneficiaries18-75yearsofagewhohadaneyeexam(retinal)performed

▪ Denominator includes number of beneficiaries 18 to 75 years old identifiedasbeingdiabeticthrougheitherclaimorpharmacydata.– Excludes gestational and steroid-induced diabetes denominator and hospice beneficiaries

▪ Numerator includes number of beneficiaries 18 to 75 years old identified as diabetic who had an eye exam (retinal) performed▪ For specifications, please see website for HEDIS 2017 measurements

Metric 13Medication Therapy: Percentageofbeneficiaries18yearsofageandolderwhoreceivedatleast180treatmentdaysofambulatorymedicationtherapyforaselecttherapeuticagent(angiotensinconvertingenzyme(ACE)inhibitorsorangiotensinreceptorblockers(ARB)ordiuretics)duringthemeasurementyearandatleastonetherapeuticmonitoringeventforthetherapeuticagentinthemeasurementyear

Metric 14Controlling BP (eCQM): Percentageofpatients18-85yearsofagewhohadadiagnosisofhypertensionandwhosebloodpressurewasadequatelycontrolled(<140/90mmHg)duringthemeasurementperiod(Allpayersource)

▪ Denominatorincludesnumberofpatients18to85yearsofagewhohadadiagnosisofessentialhypertensionwithinthefirstsixmonthsofthemeasurementperiodoranytimepriortothemeasurementperiod(Allpayersource)

▪ Numeratorincludesnumberofpatientswhosebloodpressureatthemostrecentvisitisadequatelycontrolled(systolicbloodpressure<140mmHganddiastolicbloodpressure<90mmHg)duringthemeasurementperiod(Allpayersource)

▪ Forspecifications,pleaseseewebsiteforCMS165v6MeaningfulUsemeasurements:https://ecqi.healthit.gov/ep

▪ Denominator includes number of beneficiaries 18 years of age and older who received at least 180 treatment days of ACE inhibitors or ARBs or diuretics, during the measurement year– Excludes hospice beneficiaries

▪ Numerator includes number of beneficiaries 18 years of age and older with at least one serum potassium and a serum creatinine therapeutic monitoring test in the measurement year

▪ For specifications, please see website for HEDIS 2017 measurements▪ Metric 13 will not include the annual monitoring for beneficiaries on digoxin

Metric15HbA1cPoorControl(eCQM): Percentageofpatients18-75yearsofagewithdiabeteswhohadhemoglobinA1c>9.0%duringthemeasurementperiod(Allpayersource)

▪ Denominatorincludesnumberofpatients18-75yearsofagewithdiabeteswithavisitduringthemeasurementperiod (Allpayersource)

▪ NumeratorincludesnumberofpatientswhosemostrecentHbA1clevel(performedduringthemeasurementperiod)is>9.0%(Allpayersource)


Metric16BMI(eCQM): Percentageofpatients3-17yearsofagewhohadanoutpatientvisitwithaPrimaryCarePhysician(PCP)orObstetrician/Gynecologist(OB/GYN)andwhohadevidenceofheight,weight,andbodymassindex(BMI)percentiledocumentationduringthemeasurementperiod(Allpayersource)

▪ Denominatorincludesnumberofpatients3-17yearsofagewithatleastoneoutpatientvisitwithaPCPoranOB/GYNduringthemeasurementperiod(Allpayersource)

▪ Numeratorincludesnumberofpatientswhohadaheight,weight,andBMIpercentilerecorded▪ duringthemeasurementperiod(Allpayersource)▪ Forspecifications,pleaseseewebsiteforCMS155v6MeaningfulUsemeasurements:

https://ecqi.healthit.gov/ep

Metric17TobaccoUse(eCQM): Percentageofpatientsaged18yearsandolderwhowerescreenedfortobaccouseoneormoretimeswithin24monthsANDwhoreceivedcessationcounselinginterventionifidentifiedasatobaccouserduringthemeasurementperiod(Allpayersource)

▪ Denominatorincludesnumberofpatientsaged18yearsandolderseenforatleasttwovisitsoratleastonepreventivevisit duringthemeasurementperiod(Allpayersource)

▪ Numeratorincludesnumberofpatientswhowerescreenedfortobaccouseatleastoncewithin24monthsANDwhoreceivedtobaccocessationinterventionifidentifiedasatobaccouser(Allpayersource)


Contacts

• ArkansasFoundationforMedicalCare(AFMC)• ProviderRelationsContactinformation:

• https://afmc.org/health-care-professionals/arkansas-medicaid-providers/policy-and-education/

• EmailforPCMHquestions:[email protected]• 501-212-8686

• DXCTechnology– APIIhelpdesk• [email protected]• 501-301-8311 or866-322-4946

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Documents

PCMH webinar 2018 Enrollment and Update 20170825...– Count each ICN claim with attributed PCMH as one visit – Claims occurring on the same day do not count as multiple visits Quality