proven steps to accelerate star and hedis performance 091714
TRANSCRIPT
Proven Steps to Accelerate Star and HEDIS Performance
AHIP Medicare Conference
September 28, 2014
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2014 Community Care Health Network, Inc. All Rights Reserved.
2
Today’s Agenda
» Key takeaways
» Speaker introductions
» Health plan reflections on improving Star measures
» New insights on leveraging in-home testing
» Ideas to use Star data to improve care
» Overcoming challenges
» Best practices
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
3
Provider collaboration is key
Data collection rules—the roleof physician scorecards
Incentives help but are not the only answer
Stars must be integral to the health plan operations, not a stand-alone project
Focus on the member as a whole patient,not the score
Key Takeaways
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
Update
Your Speakers
4 Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
Jeremy StoneVice President,
Account Management,Matrix Medical
Network
Deb DiCiccoDirector, Care Center
Matrix Medical Network
Doug FultonDirector, Medicare Stars
OrganizationHighmark
Mary VogtPresident, Home Access
Health
5
2
Matrix Medical Network Overview
Two product families Assessment Analytics
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
Founded in 2000
Experience withMedicare, Medicaidand SNPs
More than 600Nurse Practitioners
Acquired Ascender
Software in 2012
2
Home Access Health
» Recognized leader in at-home laboratory testing
» Services exclusive to laboratory testing using mailed-in specimens
7
Health Plan Reflections
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
Health plan reflections on improving Star measures
Doug FultonDirector, Medicare Stars
OrganizationHighmark
8
In-Home Testing
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
New insights on leveraging in-home testing
Mary VogtPresident, Home Access
Health
Home Access HealthThe Leader in At-home Laboratory Testing
September 28, 2014
Agenda
• Home Access - Introduction• NCQA – 2015 Technical Standards• At-Home Laboratory Services for HEDIS and
Star Improvement Programs• Case Studies• Questions
1
Home Access - Introduction
Recognized Leader in at-home Laboratory Testing• Product development • Specimen collection kit manufacturer• Serve all 50 states and Puerto Rico from our
central facility (Chicago)• Services exclusive to laboratory testing using
mailed-in specimens• Reference Lab Certifications of Accuracy
• CRMLN and NGSP • CAP-accredited laboratory
2
NCQA - 2015 Technical Specifications for Health Plans
“47. Member-Collected Samples and Biometric Values
Test results from member-collected samples may be used for FOBT, urinalysis testing and blood spots for HbA1c, LDL-C, glucose and total cholesterol. Member collected samples must be sent to the laboratory or provider’s office for analysis.
Other member-collected biometric values (i.e, blood pressure [BP], body mass index [BMI], height and weight) may not be used for HEDIS reporting.”
3
Services in Sync with NCQA
• Self-collected finger-stick blood - HIV-1 . Hepatitis
C . Total Cholesterol . HDL-cholesterol . Triglycerides .
Hemoglobin A1c . direct LDL-cholesterol . Blood Glucose . ALT Liver Enzyme
• Self-collected stool specimen – iFOBT (Colorectal Cancer)
• Self-collected urine specimen - Urine Albumin . Urine Albumin/Urine Creatinine Ratio
4
HEDIS . Star Improvement Programs
1. Engagement
2. Kit Distribution
3. Laboratory Testing
5. Results Distribution
• Patient• Patient’s PCP• Health Plan
4. Alert Notification and Specimen Management
6. Data and Reporting
5
Case Studies
Distribution through In Home AssessmentAdvantages
• Maximum utilization (blood and urine used during visit)• Stool specimen collection Kit left with Patient
• Reminder Calls – Encourage Use of iFOBT Kit• Laboratory results to IHA organization
• IHA organization manages Alert notification• IHA manages results distribution to Patient/PCP
• Add-on service to Risk Assessment services
6
Case Studies, continued
Direct Kit Distribution
7
Case Studies, continued
Member Opt-in – with or without incentive
8
18
Impact Care with Stars Information
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
Ideas to use Star data to improve care
Deb DiCiccoDirector, Care Center
Matrix Medical Network
19
Close Star gaps. Impact care.
Stars Data Provides Insights into Care Needs
Matrix Medical Network Proprietary Information: Do Not Distribute© 2014 Community Care Health Network, Inc. All Rights Reserved.
A1C Urine Protein FIT0%
10%20%30%40%50%60%70%80%90%
100%
Gaps closed and care impacted
Collected Alert Percentages
Update numbers
20
Members and Providers Respond to Alerts
Member
“After getting the FIT results,I contacted my doctor who referred meto a gastroenterologist to schedule a colonoscopy. My family has a history of colon cancer. My sister died from it just two years ago. I am very emotional and anxious about the results, but very thankful for being tested.”
“When I was contacted by the nurse about my test results, I scheduled an appointment for further testing and evaluation for possible colonoscopy.I have a history of colon cancer with eight inch colon resection.”
Provider
“After receiving a positive FIT, a member scheduled an appointment with a gastroenterologist, and then refused a colonoscopy. The gastroenterologist asked the Care Center RN to call the member.We spoke with the member and his daughter and the daughter called confirming that an appointment was scheduled.”
“Member’s PCP contacted the Care Center after a member’s positive FIT results were faxed to his office and asked the Care Center to contact the member to schedule an appointment for a colonoscopy. The Care Center RN called the member, who agreed and scheduled the appointment for further testing.”
21
Step 1: Interpret the GuidelinesFrom the Joint Commission National Patient Safety Goals Eight Recommendations for Policies for Communicating Abnormal Test Results…Policies…
1. Should be introduced with clear definitions of key terms
2. Should clearly outline provider responsibilities
3. Should specify procedures for fail0safe communication of abnormal test results
4. Must define verbal and/or electronic reporting procedures for both critical and significantly abnormal laboratory, imaging and other test values
5. Should specify “critical tests” and acceptable length of time between their ordering and reporting
6. Should define timelines between the availability of test results and patient notification, and institutions should specify preferred mechanism for patient notification
7. Must be of “real world” value and written with feedback from key stakeholders
8. Should establish responsibilities for monitoring and evaluating communication procedures
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
22
Step 2: Work Alerts Into Your Workflow
Matrix Medical Network Proprietary Information: Do Not Distribute© 2014 Community Care Health Network, Inc. All Rights Reserved.
Labs mailedLabs received and processed
Results returned,
evaluated and coded
Results Shared
A1c and FIT High-risk alert: Call/Certified mail to member
Call/Fax/Mail to PCP
A1c and MAU Regular alert: Priority mail to member
Call/Fax/Mail PCP
Non-alert: Regular mail to member & PCP
Care from PCP and health
plan’s care management
programs
Samples collected
23
Results Distributed to all Parties
Matrix clinically reviews all results prior to distribution
Matrix Medical Network Proprietary Information: Do Not Distribute© 2014 Community Care Health Network, Inc. All Rights Reserved.
Receives lab reportvia regular mail
Receives lab report via regular mail Daily results, including
alert values, posted toFTP facilitating Care Management follow-up
Dashboard provided monthly with key metrics
All CAT II codes sentvia established EDIClaims process
Receives lab reportvia priority mail
Call from Matrix Care Center to confirm receipt of results and encourage member follow-up
Fax / Mail member lab report
Receives lab reportvia certified mail
Call from Matrix Care Center to confirm receipt & encouragePCP follow-up
Call from Matrix Care Center to confirm receipt of results and encourage member follow-up
Fax / Mail member lab results
ProviderMember
Non-Alert
Alert
High-Risk Alert
Health Plan
24
Step 3: Monitor and Adjust
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
Timeframe appropriate?
Engagement level
appropriate?
Follow up clear?
Data complete?
???
???
Any others?
SolutionsSituation
In-Home Health Assessment
In-Home Screening
Case Study—Close Gaps and Impact Care
Health plans targeting 400k MA members in 2014 to capture data on 4 key measures to close HEDIS
gaps. Matrix used exclusive NP network to administer In-Home Health Assessments and In-
Home Screening simultaneously to maximize HEIDS gap closure.
Care ImpactResults
By collecting samples in the home, where the member was more comfortable, the health plans:
Member contactedby PCP’s nurse after
receiving fax with positive results from Care Center RN. The PCP scheduled member
with gastroenterologist.
Improvedcollection rates
Impacted carewith alert identifications
69%—A1C tests 3%—Uncontrolled sugar
66%—Urine protein tests 24%—Kidney disease risk
35%—FIT 10%—Colon cancer risk
Update with new numbers
26
Prepare for a higher volume
Plan for multiple methods to reach PCPs
Don’t mail until PCP alert completed
Define realistic timeframes for follow up
Build checks to ensure data integrity
Best Practices
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
1
2
3
4
5
27
Key Success Factor: Trust
Members are more open with NPs
Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
xxx xxx
Member Engagement
Kim to find data…
28 Matrix Medical Network Proprietary Internal Information: Do Not Distribute© 2011 Community Care Health Network, Inc. All Rights Reserved.
Ted KyiAscender Software
Kim RosengrenMatrix Medical Network
update