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Primary Care Meeting REVIEW OF BEST PRACTICE MODEL What is Best Practice? Do I have a choice to participate? If you are participating with HealthNow on January 1, 2017 you will be automatically enrolled in BestPractice reimbursement model. The only way to opt-out is to not participate with HealthNow ©2011 Proprietary and Confidential How your monthly reimbursement is determined: 4 5 6 ©2011 Proprietary and Confidential HEDIS/STAR Measures Cost/Utilization Metrics 8 PCP Efficiency *Cost outliers are trimmed to 2 standard deviations above and below the mean. ©2011 Proprietary and Confidential 10 Examples of Types of Services Included in BestPractice Capitated Service Codes Remaining Fee-For-Service Sick visits New patient evaluation(s) Office laboratory services i.e. urinalysis Preventive office services i.e. well child visits, routine annual physicals, annual well visits (Medicare patients) Electrocardiogram In-office procedures i.e. skin tag removal Immunizations ©2011 Proprietary and Confidential Timeline 2016 Apr 2017 May June July Aug Sept Oct Nov Dec Jan Info Seminars In-office meetings Final code set Benchmark quality measures Provider-specific reimbursement Go Live and First BestPractice Payment QUALITY MEASURES: HEDIS/STAR 2016 Star, HEDIS and other Quality Measures Measure Data Source CI Program/ HPHS Measure At Risk w/ Health Plans - Breast Cancer Screening HEDIS/ACO Yes Yes - Colorectal Cancer Screening HEDIS/ACO Yes Yes - Annual Flu Vaccine CAHPS Yes Yes - Adult BMI Assessment HEDIS/ACO Yes - Care for Older Adults – Medication Review HEDIS Yes - Care for Older Adults – Functional Status Assessment HEDIS - Care for Older Adults – Pain Assessment HEDIS - Osteoporosis Management in Women who had a Fracture HEDIS - Diabetes Care – Eye Exam HEDIS/ACO Yes Yes - Diabetes Care – Kidney Disease Monitoring HEDIS/ACO Yes Yes - Diabetes Care – Blood Sugar Controlled HEDIS/ACO Yes Yes - Controlling Blood Pressure HEDIS/ACO Yes Yes - Rheumatoid Arthritis Management HEDIS ©2011 Proprietary and Confidential Yes Yes 2016 Star, HEDIS and other Quality Measures Measure Data Source CI Program/ HPHS Measure At Risk w/ Health Plans Yes - Reducing the Risk of Falling (Falls Risk Screening & Management) HEDIS/ACO Yes - Beta Blocker Therapy for LVSD (18+) ACO Yes - CAD ACE or ARB Use (*CAD&DM or CAD&LVSD) (18+) ACO Yes - IVD Aspirin Use (18+) ACO Yes - Depression Screening (12+) ACO Yes - Medication Adherence for Diabetes Medications Prescription Drug Event (PDE) data; Medicare Enrollment Database Yes - Medication Adherence for Hypertension (RAS antagonists) Prescription Drug Event (PDE) data; Medicare Enrollment Database Yes - Medication Adherence for Cholesterol (Statins) Yes ©2011 Proprietary and Confidential Prescription Drug Event (PDE) data; Medicare Enrollment Database 2016 Star, HEDIS and other Quality Measures Measure Data Source CI Program/ HPHS Measure At Risk w/ Health Plans Yes Yes Yes Yes - Plan All-Cause Readmissions HEDIS - Getting Needed Care CAHPS - Getting Appointments and Care Quickly CAHPS - Customer Service CAHPS - Rating of Health Care Quality CAHPS - Rating of Health Plan CAHPS - Care Coordination CAHPS - Annual Wellness Visit/EAV or Vatica Use None - Palliative Care Program Expansion None Yes - CKD Care Management Program Expansion None Yes - Care Management Measures None ©2011 Proprietary and Confidential Yes Yes MCKESSON RISK MANAGER TOOL What is McKesson Risk Manager? What is McKesson Risk Manager? • It is on online analytical tool of HealthNow • Assists in identifying quality and cost drivers for their members • Provides both high level and patient level reports • Available through www.bcbswny.com provider portal ©2011 Proprietary and Confidential What kinds of quality and cost information is available? • • • • HEDIS/STAR Gaps in care Patient Risk Levels Rx Use Emergency Room Use ©2011 Proprietary and Confidential ©2011 Proprietary and Confidential ©2011 Proprietary and Confidential ©2011 Proprietary and Confidential Patient Gap Reports for the HEDIS measures are found under Quality then Patient Detail by SubMeasure ©2011 Proprietary and Confidential VATICA & ANNUAL WELLNESS VISITS What is Vatica? • Cloud based technology tool • Combines claim data with EMR data for the completion of the AWV • Assists with accurate diagnosis coding • Identifies gaps in care related to quality measures ©2011 Proprietary and Confidential Provider Home Page Claims History/Demographic Information Claims History Map to specific HCC diagnosis code Pre-Visit Worklist Pre-Visit Worklist Abnormal Diagnostic Images/Labs Map to specific HCC diagnosis code Preventive Tests and Therapies All Preventive Services are indicated Diagnosis Code Sheet Provider clicks “Accept” if agrees with diagnosis; reject if not Diagnosis Code Sheet Gap Closure How do Providers Benefit from using Vatica? • Additional clinical data about patients from health plan • Accurate diagnosis coding leads to accurate risk scores for patients • Decision support built into the tool assists with closing gaps in care • Prompts providers to address gaps in care which improves quality measures ©2011 Proprietary and Confidential Vatica Implementation Process QUALIFYING Do you have BlueCross BlueShield of Western New York Medicare Advantage patients? Patients with the following prefixes would be eligible: YJE or YJX INFORMATION AGREEMENTS Contact HealthNow to schedule a Vatica Webinar Sign user agreements with Vatica Health Iris Wilisbach or Megan Lombardi (MSA, BAA & SOW) Complete the IT Setup Form to define all users that need access to the Vatica tool Contact your provider representative or Contact your provider representative or Megan Lombardi for the agreements Megan Lombardi for the IT Setup Forms Iris Wilsbach, [email protected] Megan Lombardi, [email protected] ©2011 Proprietary and Confidential USER SET UP TRAINING Fax IT Setup Form to Megan (716-887-6725) to be scheduled for training The training is provided via webinar and in person Vatica Jump Start Program Pre-visit Support Vatica Health’s jump start clinicians can help enter pertinent information from your EMR into the tool, saving you time during the visit with your patients Post-visit Support Vatica Health’s jump start clinicians can help enter reportable data back into your EMR after the visit is completed. This will help your office stay in compliance with your quality standards. For more information please contact: Danielle VanDette, [email protected] Megan Lombardi, [email protected] ©2011 Proprietary and Confidential Phone Support Vatica Health’s jump start clinicians can make calls to patients with upcoming appointments to explain the importance of an AWV & encourage them to add this to their appt. Certain parts of the HRA are completed on the call as well to save time during the visit. Incentive Information Provider: $150 AWV fee schedule + $200 AWV Incentive Member: $20 Debit Card After AWV is completed MARK YOUR CALENDAR THE NEXT CATHOLIC MEDICAL PARTNERS PCP MEETING IS TUESDAY, SEPTEMBER 13, 2016 ©2011 Proprietary and Confidential