User’s Guide: CPC Ohio / HEDIS Gap Report...coordination and payment transformation. As part of the CPC Ohio member organizations, you are a co-owner of the process and have a voice

User’s Guide: CPC Ohio / HEDIS Gap Report

Updated: 06/2019

Contents

Acknowledgments and Disclaimers………………………………………………………………………….………………3

National Committee for Quality Assurance (NCQA): Healthcare Effectiveness Data and Information Set (HEDIS) -

Copyright Notice and Disclaimer……………………………………………………………………………….……………..3

Overview………………………………………………………………………………………………………………………………….3

Basic Navigation in Tableau

Accessing Data on the Server….…………………………………………………………………………………...………….4-5

Worksheets………………………………………………………………………………………………………………………………5

Dashboards…………………………………………………………………………………………………………………….…….….5

HEDIS Introduction Background……………………………………………………………………………………………………………………….…………………..6 Measures to be Included / Available Filters…..………………………………………………………………..………...………….6

Notes………………………………………………………………………………………………………………….…………………………………6 Measure Definitions………………………………..………………………………………………………………..…………………………..7-8

Dashboards

Table of Contents…………………………………………………………………………………………………………..…………9

Payor Worklist…………………………..…………………………………………………………………………………….……....10

Practice Worklist………………………….………………………………………………………………………………….….…...11

PCP Worklist…………………………………………………………………………………………………………….………...…….12

Patient Worklist……………………………………………………………………………………………….….……………..…….13

Resource Center………………………………………………………………………………………………..……………..………14

The Health Collaborative presents this material in good faith, believing it to be accurate and useful for

persons working within CPC Ohio member organizations. However, any use of this material is entirely

at the risk of the user, and The Health Collaborative cannot accept any responsibility for any problems

caused by errors in the material or any ill effects they may cause.

THIS USER’S GUIDE DOCUMENT CONTAINS NO PROTECTED HEALTH INFORMATION (PHI).

The measure results in the CPC Ohio / HEDIS Gap Report Tool that this document is intended to accompany contains

PHI. Providers, facilities, and payers are required to review all information in the Data Tool reports to ensure that no

misrouted PHI is included. Misrouted PHI includes information about patients that the receiving provider or facility is

not treating or that a payer is not insuring. Providers, facilities, and payers are required to safeguard the PHI for as long

as it is retained and destroy any misrouted PHI as soon as possible. We request that a provider, facility, or payer that

receives the PHI of an individual who is NOT (1) its patient or (2) its health insurance beneficiary notify the Health

Collaborative by email correspondence to [email protected] OR by calling 1-513-618-3634. Copying,

sharing, or any further use or disclosure of misrouted PHI may constitute a violation of federal law. Medical information

in this document or the Claims Data Tool is provided as an information resource only and is not to be used or relied

upon for any specific diagnostic or treatment purposes.

Reference to any specific commercial product, process, or service, or the use of any trade, firm or corporation name is for

the information and convenience of the CPC Ohio membership, and does not constitute endorsement, recommendation,

or favoring by The Health Collaborative.

National Committee for Quality Assurance (NCQA): Healthcare Effectiveness Data and Information Set (HEDIS) - Copyright Notice and Disclaimer

The HEDIS® measures and specifications were developed by and are owned by the NCQA. The HEDIS measures and

specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no

representations, warranties, or endorsement about the quality of any organization or clinician that uses or reports

performance measures or any data or rates calculated using the HEDIS measures and specifications and NCQA has no

liability to anyone who relies on such measures or specifications. NCQA materials may not be modified by anyone other

than NCQA. Anyone desiring to use or reproduce the materials without modification for an internal non-commercial

purpose may do so without obtaining any approval from NCQA. All other uses, including a commercial use and/or

external reproduction, discretion and publication must be approved by NCAQ and are subject to a license at the

discretion of NCQA. ©2018 NCQA all rights reserved.

Overview

The Health Collaborative’s goal for the CPC Ohio / HEDIS Gap Report is to build a regional culture of team-based care coordination and payment transformation. As part of the CPC Ohio member organizations, you are a co-owner of the process and have a voice in the how the service is provided with influence over decisions about how valued is defined, patients are attributed, and how data is measured, and measure gaps addressed. As your payments from the health insurance plans becomes increasingly aligned with value, a seat at this table becomes more important. The CPC Ohio / HEDIS Gap Report Tool is the window to view performance, track progress, and inform process improvement decisions.

Introduction

This User’s Guide has been created by The Health Collaborative for the CPC Ohio / HEDIS Gap Report project. The following content will assist you to begin using the CPC Ohio / HEDIS Gap Report Tool and allows your practice to access data and analytics based on the claims submitted by the participating payers in the CPC Ohio project.

For the CPC Ohio initiative, reports are generated for participating entities at both the primary care organization (containing practice- and provider-specific data) level, the payer level, as well as patient level.

Accessing your data on the Server

System Requirements: To access the HEDIS Gap Report through the secure web portal you must have access to the

internet and a supported web browser. The supported web browsers are Chrome on Windows, Mac, and Android

4.4 or later; Microsoft Edge & Internet Explorer 11 on Windows; Mozilla Firefox & Firefox ESR on Windows and Mac;

and Apple Safari on Mac and iOS 8.x or later. (All Technical Specifications. (n.d.))

Step 1: Logging in to the Claims Data Co-Op Tool

1. Navigate to the following website using the link below or by typing the following

into your supported web browser.

https://reporting.healthcollab.org/#/signin

2. Use your personal login ID and password to access the data tool

Step 2: Opening the Data Tool

Once you have logged in using your personal username and password combination you will

be taken to the home screen for the Claims Data Tool.

You may access the report by clicking on the title of the project.

Step 3. Accessing the Reports

Your organization’s view of the Claims Data Tool will be visible. By hovering the mouse over the report and clicking

the “View” button you will arrive at a page with multiple dashboards built to help you navigate different views of

your claims data.

https://reporting.healthcollab.org/#/signin/

Basic Navigation in Tableau

Once you have accessed the Data Tool through the web portal you can begin navigating the reports.

The Aggregate Data views are divided into multiple dashboards and worksheets that are listed as tiles. You can see

each dashboard by clicking the image or the title below the image.

In most views, on the right side of the window are filters that will allow you to interact with the data. Choose one or

more filters to change the values in the table or graph.

To export the data on each dashboard, you can choose “Download” in the upper right corner of the dashboard

window. You may then choose to copy or export

the data as data, an image, or crosstab to Excel.

To make the screen larger for optimal viewing you may click the “Full Screen” button in the the upper right of the

dashboard window. To exit the “Full Screen” view Press the “Esc” button on your computer’s keyboard.

To move from one dashboard or worksheet to a different dashboard or worksheet you can click the blue filename hyperlink near the top of the Tableau window. This action will return you to the view with all the available

dashboards.

Worksheets

Tableau uses a workbook and sheet file structure, much like Microsoft Excel. The worksheets contain a single table

or graphic representation of the data. Multiple worksheets are combined in a Dashboard view to illustrate

relationships in the data and streamline the viewing options.

Dashboards

A dashboard is a collection of several worksheets and supporting information shown in a single place, so you can

compare and monitor a variety of data simultaneously. Like worksheets, dashboards are shown as tabs at the

bottom of the workbook.

HEDIS Background

HEDIS Measures and Technical Resources

Over 190 million people are enrolled in plans that report HEDIS results. That makes HEDIS one of health care’s most

widely used Gap closure performance improvement tools. HEDIS includes measures for physicians, PPOs and other

organizations. Visitors to this page often check HEDIS FAQs, or ask a question through MyNCQA.

Measures to be Included

1) BCS: Mammograms

2) CCS: Cervical Cancer Screenings

3) PQI09: Live Births <2500gms

4) AWC: Adolescent Well-Care

5) W15: Well Child Visits in 1st 15mth

6) W34: Well Child Visits within 2-6yrs

7) CDC1: HbA1c Testing

8) CDC2: Eye Exam performed

Filters (available on all dashboards)

1) Measure Result (legend): Colors codes Open (Orange) and Closed (Blue) result(s) 2) Measure Result (filter): Allows user to dropdown-click Open / Closed result(s) 3) Measure: Allows user to dropdown-click specific measure(s) 4) Payor Plan: Allows user to dropdown-click specific Payor(s) 5) PCP Parent Organization: Allows user to dropdown-click specific Parent Organization(s) 6) CPCid: Allows user to dropdown-click specific CPCid(s) 7) Practice Name: Allows user to dropdown-click specific practice(s) 8) PCP Last Name: Allows user to dropdown-click specific PCP(s) 9) Member Last Name: Allows user to dropdown-click specific member(s) 10) Gender: Allows user to dropdown-click specific gender (s) 11) Age Group: Allows user to dropdown-click specific age group(s) 12) Year of Next Exp Svc Date: Allows user to choose the population with that expected service year 13) “Home” Button: Takes user to “Table of Contents” when clicked

Notes

❖ THC does not engage in HEDIS Measure Reporting. THC has omitted the “Eligible Months Covered” criteria. THC did not

calculate a patient’s eligibility based on months covered within a measurement year.

Measure Definitions1

1) BCS: Breast Cancer Screening a. Criteria

Assesses women 50–74 years of age who had at least one mammogram to screen for breast cancer in the past two years.

b. Purpose Aside from some forms of skin cancer, breast cancer is the most common cancer among American women, regardless of race or ethnicity. Screening can improve outcomes: Early detection reduces the risk of dying from breast cancer and can lead to a greater range of treatment options and lower health care costs.

2) CCS: Cervical Cancer Screening a. Criteria

Assesses women 21–64 years of age who were screened for cervical cancer using either of the following criteria: Women age 21–64 who had cervical cytology performed every 3 years. Women age 30–64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years.

b. Purpose Cervical cancer is a disease in which cells in the cervix grow out of control. Cervical cancer used to be one of the most common causes of cancer death for American women; effective screening has reduced the mortality rate by more than 50 percent over the last 30 years.1 Cervical cancer is preventable in most cases because effective screening tests exist. If detected early, cervical cancer is highly treatable.

3) CDC1 and CDC2: HbA1c Testing and Eye Exam Performed a. Criteria

Assesses adults 18–75 years of age with diabetes (type 1 and type 2) who had each of the following: Hemoglobin A1c (HbA1c) testing. HbA1c poor control (>9.0%). HbA1c control (<8.0%). HbA1c control (<7.0%) for a selected population. Eye exam (retinal) performed. Medical attention for nephropathy. BP control (<140/90 mm Hg). Additional exclusion criteria are required for this indicator, which will result in a different eligible population from all other indicators. This indicator is only reported for the commercial and Medicaid product lines.

Measure Definitions1

b. Purpose Diabetes is a complex group of diseases marked by high blood glucose (blood sugar) due to the body’s inability to make or use insulin. Left unmanaged, diabetes can lead to serious complications, including heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations and premature death.

Proper diabetes management is essential to control blood glucose, reduce risks for complications and prolong life. With support from health care providers, patients can manage their diabetes with self-care, taking medications as instructed, eating a healthy diet, being physically active and quitting smoking.

4) AWC, W15, W34: Adolescent Well-Care, Well Child 1st 15mths, Well Child 2-6yr a. Criteria

Well-Child Visits in the First 15 Months of Life: Assesses children who turned 15 months old during the measurement year and had 0–6 well-child visits with a primary care physician during their first 15 months of life. Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life: Assess children 3-6 years of age who received one or more well-child visits with a primary care practitioner during the measurement year. Adolescent Well-Care Visits: Assesses adolescents and young adults 12-21 years of age who had at least one comprehensive well-care visit with a primary care practitioner or an OB/GYN practitioner during the measurement year.

b. Purpose Assessing physical, emotional and social development is important at every stage of life, particularly with children and adolescents. Behaviors established during childhood or adolescence, such as eating habits and physical activity, often extend into adulthood. Well-care visits provide an opportunity for providers to influence health and development. They are a critical opportunity for screening and counseling

5) PQ109: The percentage of births with birthweight <2,500 grams a. Criteria

The number of babies born weighing <2,500 grams at birth in the population.

b. Purpose

Low birthweight is a major cause of infant mortality and increases an infant's chances for dying in Datainfancy. Preterm delivery underlies most low birthweight births. Lifestyle behaviors - such as cigarette smoking, insufficient weight gain or nutritional intake during pregnancy and use of other drugs - are known risk factors. Socioeconomic disadvantage is also closely related to low birthweight.

Dashboard: Table of Contents

Purpose: Homepage providing guidance to other dashboards.

Dashboard Links:

1) Payor Worklist

2) Practice Worklist

3) PCP Worklist

4) Patient Worklist

Functionality:

1) Click on a button (arrow pointing right) to be automatically directed to that Dashboard.

2) Click on the “The Health Collaborative” banner to be directed to said homepage.

3) Click on the “NCQA” link to be directed to said homepage.

Dashboard: Payor Worklist

Purpose: Provides multiple levels of review performance in Gap Measure coverage.

1) Plan Count: snapshot of both Open and Closed HEDIS Measures at a Payor level based on year of when a required

service is scheduled to be completed by.

2) Payor Impact: aggregates the total counts for each measure.

Functionality:

1) Hover over the Major Payor count for a snapshot of population information: HEDIS Measure, Major Payor, Measure

Result (Open / Closed), click for link to NCQA Homepage for HEDIS Info, as well as the “Resource Center.”

2) Hover over Plan Count for a snapshot of population information: Measure, Measure Result, snapshot of the attributed

population displayed as the Major Payor Count).

3) Hover over Measure Result Count for a snapshot of population information mimicking that of the Plan Count snapshot.

4) Hovering over any of these parameters will highlight all other graphs / charts. This provides, at a glance, an overall view

of Payor and Plan performance for HEDIS Measures.

5) Clicking on a specific measure will give you the option of linking to the HEDIS Measure Homepage and the Resource

Center Dashboard.


pg. 11 Guide to accessing and using the CPC Ohio / HEDIS Gap Report Data Co-Op Tool using Tableau® Software

Dashboard: Practice Worklist

Purpose: Provides multiple levels of review performance in Gap Measure coverage.

1) Practice Count: Provides a snapshot of practice level Gap Measure performance.

a. Indicates overall Open / Closed for a practice.

b. Provides an aggregate of the attributed population’s Open / Closed counts.

2) Practice Impact: Provides a snapshot of practice level Gap Measure Performance.

a. Breaks down the eligible population to individual Open / Closed results.

b. % given is a % of the total eligible practice population to that Practice.

Functionality:

1) Hover over the Practice count for a snapshot of population information: HEDIS Measure, Measure Result (Open /

Closed), and abbreviated patient list.

a. Click on count for a link to NCQA Homepage for HEDIS Info and Link to Resource Center.


3) Clicking any of these parameters will highlight all other graphs / charts.

a. This provides an overall view of Practice performance for HEDIS Measure Gap performance.


Center Dashboard.



Dashboard: PCP Worklist

Purpose: Provides different ways to review performance in Gap Measure coverage.

1) PCP Count: Provides a snapshot of PCP level Gap Measure performance.

a. Indicates overall Open / Closed for a practice.

b. Provides a total of the entire attributed eligible population Open / Closed counts.

2) PCP Impact: Provides a snapshot of PCP level Gap Measure performance.

a. Breaks down the eligible population to individual Open / Closed results.

b. % given is a % of the total eligible practice population to that PCP.

Functionality:

1) Hover over the PCP count for a snapshot of population information: HEDIS Measure, Major Payor, Measure Result (Open

/ Closed), and abbreviated patient list.

a. Click on count for a link to NCQA Homepage for HEDIS Info and Link to Resource Center.


3) Clicking any of these parameters will highlight all other graphs / charts.

a. This provides an overall view of PCP performance for HEDIS Measure Gap performance.


Center Dashboard.

1) PI 2) “Home” Butto



Dashboard: Patient Worklist

Purpose: Provides and actionable list of attributed patients.

1) Patient Worklist: Lists all attributed patients and Gap closure status for each HEDIS Measure.

a. If no “Open / Closed” for a measure, patient not reported eligible for said measure.

2) Patient Count: Provides a snapshot of overall measure “Open / Closed” performance.

a. Clicking on either outcome provides snapshot of Measure Result, Member Count, Link to NCQA HEDIS

Homepage, and link to Resource Center.

Functionality:

1) Clicking on either Open or Closed in the Patient Worklist displays a snapshot of demographics

a. Member Demographics

i. Displays contact information for patient

b. Measure Demographics

i. Displays most recent Measure Gap performance information such as Most Recent Date of Service

c. Service Demographics

i. If measure Closed (service provided), will display all associated service information

d. Payor Demographics

i. Major Payor

ii. Payor Plan

e. PCP Demographics

i. PCP of Record

ii. PCP First Name

iii. PCP Last Name



Dashboard: Resource Center (Currently in Development)

Purpose: Allows for actionable access to an attributed population for Care Management. (Will be able to provide

directions to local resources via email / direct to a patient’s phone.)

Functionality:

1) Last Known Patient Address:

a. This will include all pertinent info for the last known patient address:

i. Member ID

ii. Patient first name

iii. Address

iv. City

v. State

b. Clicking on the “Last Known Patient Address” allows you to map the address on the Satellite Maps and Highlights

that specific address on the plot map.

2) Plot Map: Gives a geographical reference of the Last Known Patient Address for an entire attributed patient population.

3) Satellite Map: Illustrates the Last Known Patient Address in relations to local commerce and resources

4) Measure Count: Provides a snapshot of total population performance for a given Measure and Measure Result

Documents

User’s Guide: CPC Ohio / HEDIS Gap Report...coordination and payment transformation. As part of the CPC Ohio member organizations, you are a co-owner of the process and have a voice