Patient EngagementPrimary Care Webinar for DY4

AgendaHousekeepingDSRIP TimelineDY3 and DY4 Targets and PerformanceAuditsChanges to Reporting TemplatesEngagement Criteria Refresher Trainingo3ai Model 1: Integration of Behavioral Health into Primary Careo3bi: Cardiovascular Disease ManagementWatchDox Refresher TrainingQ&A

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HousekeepingPlease DO NOT place your phone on “HOLD”Please keep your phone lines mutedWe have planned time for questionsAt any time feel free to submit questions using the chat feature and we will be sure to answer your questions

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DSRIP Calendar

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DY4April 1, 2018–

March 30, 2019

Next MPA Period:MY5

July 1, 2018–June 30, 2019

Demonstration Year (DY)

Measurement Year (MY)

DY3 and DY4 Targets and Performance

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DY3 Patient Engagement PerformanceProject DY3 Target (80%) DY3 Actual

2biii ED Care Triage 5,400 5,7492bvii INTERACT 460 4,3492bviii Hospital/Home Care Collaboration 720 1,4022di Patient Activation Measures 47,200 15,7833ai Behavioral Health Integration 13,620 52,9703aii Crisis Stabilization 8,721 15,7433bi Cardiovascular Disease Management 19,680 21,3943fi Maternal & Child Health 600 812TOTAL 96,401 118,202

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DY4 Targets

Project DY4 Target(80%)

3ai Behavioral Health Integration 13,6203bi Cardiovascular Disease Management 19,680TOTAL 33,300

7For these two projects, the DY4 target is the same as the DY3 target.

Audits

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Past AuditsNovember 2017: DY3Q2 sample requesto 60 patients for 3ai Model 1 onlyMarch 2018: Patient engagement audit and IA onsite visito 398 patients across all 8 projectsResults:o Partners were incredibly responsive in providing satisfactory substantiating

documentation on a tight deadline—THANK YOU!oWe did encounter several errors (approximately 4%)

• Reporting issues (bad data)• Misunderstandings of “actively engaged” criteria• Process issues (inability to retrieve patient records)

o To avoid these issues in DY4, we are conducting a series of re-education webinars for all partners

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We Will Be Audited AgainWe expect to be audited in late 2018 or early 2019 (for DY3), and a year after that (for DY4)When the state asks Millennium for substantiation, we will in turn ask you to provide itoTypical substantiation = screenshots of patients’ EMR recordsEnsure documentation is available should an audit take placeoConsider the delay—save records for at least a yearMillennium may also conduct its own audits at any time to monitor data quality and effectiveness of re-education

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ErrorsConsider doing your own audits internallyYou may discover a patient who was reported as engaged when they were not actually engagedIf you discover an error, please notify Millennium immediatelyo If we have not yet reported your data to NYS, we will work with you to

correct the erroroDo not simply upload a new file—we will have to manually delete

the erroneous data from the old fileo If your data was already submitted to NYS and the error is substantial,

we will notify NYS to mitigate issues in case of future audit• The state does not provide any mechanism for a PPS to correct a report or delete

patients erroneously reported

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Changes to Reporting Templates

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New Reporting Templates for DY4Projects 3ai Model 1 (Integration of Behavioral Health into Primary Care)3bi (Cardiovascular Disease Management)

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New blank templates are in WatchDox:Patient Engagement > DY4 Templates

Updated timeframes and instructionsAdded clarification about reporting engaged patientsRemoved columns for provider name and NPI—not needed

Changes to Templates

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Example: project 3bi

Do not alter the templateFiles must be in Excel format(not .csv)

Use the Template Correctly

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This is where the latest templates are stored

Engagement Criteria Refresher TrainingPrimary Care:3ai Model 1: Integration of Behavioral Health into Primary Care3bi: Cardiovascular Disease Management

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Valid Patient IDsThe state allows two types of patient IDs:

CIN: 8-digit alphanumeric Medicaid patient IDo 2 alpha, 5 numeric, 1 alphao Example: AB12345C

—OR—Managed Care Organization (MCO) ID: Member ID number from patient's insurer/payer/MCOo May be in various formatso Examples:

• WNH771234567• DAU12345C00• 74212345600• YJP8812345701

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Invalid Patient IDsWe omit any patient with the following suspicious/invalid IDs:oBlank (no ID)o4 characters or shorter (e.g., “+”)oAll alphabetical characters (e.g., “TEST”)oObviously invalid (e.g., “12345”)If your report includes a “TOTAL” or other extraneous rows, please remove them (otherwise your report will be rejected)

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Please: Filter these out before submitting your file.

Duplicate PatientsFor projects 3ai and 3bi, a patient can be engaged only once per DSRIP year—duplicate patients are not allowedCheck your file: remove all duplicate patient IDs before uploadingFrom quarter to quarter, please include new data onlyo In other words, remove any patients you reported in previous quarters

in the same DSRIP year—these are duplicates and will be omittedPatients can be engaged under multiple projects within the year

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3ai Model 1: Behavioral Health IntegrationEngagement criteria:oPatients receiving appropriate preventive care screenings that include

mental health/substance abuseAny industry-standard behavioral health or substance abuse screening is acceptable (e.g., PHQ-2/9, SBIRT, PSC-17, etc.)The screening must be documented in the patient’s health recordIf a patient is considered ineligible to be screened for some reason, they should not be reported

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3bi: Cardiovascular Disease Management Currently for non-pediatric practices only (possible future opportunity)Engagement criteria:o Patients receiving services from participating providers with documented self-

management goals in medical record (diet, exercise, medication management, nutrition, etc.)

o Core components require documentation of patient-driven self-management goals in the medical record which are reviewed at every appointment

We struggled to meet our DY3 target; DY4 target is the sameAudit results showed wide variation in how partners document self-management goalsEngagement criteria were interpreted differently by different partners

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3bi: Frequently Asked QuestionsQuestion Answer

What CVD diagnosis codes are required?

None. There is no diagnosis requirement for this project. Patients may or may not have CVD.

What type of self-management goals are allowed?

Any type. Examples:• Patient wants to quit smoking; commits to call NYS QuitLine• Diabetic patient has a goal to improve A1C; commits to better diet• Depressed patient commits to reach out to support system when needed• Pediatric asthma patient has a goal to improve use of inhaler• A patient commits to eat healthier, lose weight, or exercise more• Patient has a goal to follow safe sex practices

How is the goal documented in the EMR?

The goal must be clearly shown in the patient’s record, so that an auditor can find it.

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Self-Management Goals:Required Under PCMH

NYS PCMH Standards and Guidelines: Care Management and Support (CM)PCMH-recognized practices should already meet this requirement

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Example Screenshots:Where are the goals?

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Patient 1 Patient 2 (Allscripts)

Example Screenshots:Where are the goals?, cont.

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Patient 3 (eClinicalWorks) Patient 4 (eClinicalWorks)

Example Screenshots:These might be goals . . .

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Patient 5 (eCW) Patient 6 (Allscripts)

Example Screenshots:Aha! Goals!!

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Patient 7 (Allscripts) Patient 8 (Allscripts Enterprise)

Example Screenshots:Aha! Goals!! cont.

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Patient 9 (Medent) Patient 10 (Medent)

EMR Demonstrations/TipsAllscripts ProeClinicalWorks

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EMR UsersAllscripts Professional:oChautauqua CenteroECMC clinicsoElmwood HealthoNeighborhoodoResource CenterAllscripts Enterprise:oOlean Medical

GroupoUB Family Medicine

Cerner:oChild and Family

ServicesoKaleida clinicseClinicalWorks:oCHCBo FoothillsoNFMMC clinicsoSummit PediatricsoTLC clinicsoUPC

Medent:oEvergreen HealthoGBUACOo Jericho RoadoMain Buffalo

PediatricsoNorthtown MedicaloOmega Family

Medicine

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WatchDox Refresher Training

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WatchDox BasicsLink: http://ecmc.watchdox.comIf someone at your organization needs WatchDox access, just let us know!oEmail reporting@millenniumcc.org and include the person’s email

addresso If someone leaves your organization, let us know so we can deactivate

their accountBlank templates are in your “DY4 Templates” folderOld files have been moved to “DY2_Archive” and “DY3_Archive”“Processed” and “Rejected” folders are now hidden

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Upload Patient Engagement Files to the Correct Location in WatchDox

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Make sure you’re in the correct folder!

Navigate to your Patient Engagement folder

Upload Patient Engagement Files to the Correct Location in WatchDox, cont.

What happens if I’m in the wrong folder?oYour file will not be detected by our system—it only searches for files in

Patient EngagementoYour patients will not be counted and you will not get credit for

reportingHow do I know I’m in the right place?o If you are in the Patient Engagement folder, you will see this at the top

of WatchDox:

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To Upload a File

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1. Click on the Upload button, then navigate to the file you want to upload

2. Click “Next” 3. Click “Done”

Double-Check the Location of Your Files

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Correct!Files are saved at the top level of Patient Engagement

(not in a subfolder)

Processing FilesMillennium developed a program that checks patient engagement files every hourThis system will either process or reject each file receivedYou should receive notifications within a few hours of uploading your file

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New file in correct folder

File is valid

WatchDox user receives an email stating that their file has been

processed

File is renamed and moved

New file in correct folder

File is invalidWrong format (does not match template), not

in Excel, invalid dates

WatchDox user receives an email stating that their file cannot be

used and explaining why

File is moved

New file is uploaded into another folder:

File not found

If you’re not receiving notifications, check your Spam or Junk folder!

www.millenniumcc.orgFind Millennium on social media:

Questions?For questions about patient engagement or WatchDox, contact Liz Thelen:(716) 898-1960ethelen@millenniumcc.org