A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS
|
|
- Sherilyn Perkins
- 2 years ago
- Views:
Transcription
1 A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS The matrix below provides a comparison of all measures included in Medi-Cal P4P programs and the measures includes in DHCS s External Accountability Set and Auto- program. It is arranged in alphabetical order by the name of the managed care plan and includes all measures included in the plans primary care P4P programs. The measures are broken down by domain including access, clinical quality, encounter submission, patient experience, utilization and all other measures. Set & Net Joaquin Mateo ACCESS Children and Adolescents Access to PCPs X Cycle time Extended hours X X X X 4 Improvement in access as measured by CG-CAHPS Member reassignments Patient auto assignment PCP office visits per member per year Practice open to new members Third next available appointment Depression screen Annual monitoring for patients on persistent medications: ACE or ARB, Digoxin, Diuretics, Anticonvulsants Controlling high blood pressure Comprehensive chronic pain management Diabetes blood pressure control X X
2 Set & Net Joaquin Mateo Diabetes eye exam X X X X X X X X X X X 1 Diabetes HbA1c control Diabetes HbA1c testing X X X X X X X X X 8 X X X X X X X X X X X Diabetes LDL control Diabetes LDL testing X X X X X X 6 Diabetes nephropathy X X X X X X X X X X 9 Postpartum care X X X X X X X 6 Same day pregnancy testing and referrals Timeliness of prenatal care Overuse of imaging studies for low back pain Adolescent comprehensive well-care visits years Adolescent immunizations Adult preventive medicine evaluation X X X X X X X X 6 X X BMI percentile-adult BMI percentilepediatric Breast cancer screening Cervical cancer screening Childhood immunizations X X X X X X X X X X X 0 X X X X X X X X X X 8 Chlamydia screening Colorectal cancer screen
3 Set & Net Joaquin Mateo Counseling for nutrition 3-17 years Counseling for physical activity 3-17 years y weight for life form Smoking status & intervention Well child visit with PCP 3-6 years Well infant care 0-15 months X X X X X X X X X X X Women s Exam (Pap, pelvic, breast) Appropriate testing for children with pharyngitis Appropriate treatment for children with URI Asthma health assessment/action plan Avoidance of antibiotic treatment for adults with acute bronchitis X Use of appropriate medications for people with asthma PATIENT EXPERIENCE Appointment with specialist Implement survey (such as CAHPS) Implement training Meet PCMH criteria
4 Set & Net Joaquin Mateo PATIENT EXPERIENCE Rating of all healthcare Rating of PCP Staff satisfaction improvement strategies Team based care Timely patient visits Overall rating of health network Overall satisfaction with UM process RESOURCE USE All-cause readmissions following acute inpatient stays Ambulatory care sensitive admissions Avoidable emergency department visits Emergency department visits per 1,000 member years Generic prescription and formulary compliance rates Inpatient bed days per 1,000 member years Physician and outpatient expenses not covered by capitation Potentially preventable admissions X X X X X X 4 ENCOUNTER AREA Timeliness, completeness, acceptance rate of data submitted
5 Set & Net Joaquin Mateo ENCOUNTER AREA Data accuracy between encounter and medical record data Encounter data submission OTHER Call abandonment Provider continuity Show rate/no show rate Initial health assessment Meaningful use of health IT Medicare DualChoice Annual Visit Outreach to patients recently discharged from hospital PCMH recognition Peer led self management support groups POLST/advanced care planning form Utilization of CAIR TOTAL NUMBER OF MEASURES
11/2/2015 Domain: Care Coordination / Patient Safety
11/2/2015 Domain: Care Coordination / Patient Safety 2014 CT Commercial Medicaid Compared to 2012 all LOB Medicaid Quality Compass Benchmarks 2 3 4 5 6 7 8 9 10 Documentation of Current Medications in
A Detailed Data Set From the Year 2011
2012 HEDIS 2012 A Detailed Data Set From the Year 2011 Commercial Product We are pleased to present the AvMed HEDIS 2012 Report, a detailed data set designed to give employers and consumers an objective
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Quality Management Program 2012 Overview Quality Improvement
HEDIS/CAHPS 101. August 13, 2012 Minnesota Measurement and Reporting Workgroup
HEDIS/CAHPS 101 Minnesota Measurement and Reporting Workgroup Objectives Provide introduction to NCQA Identify HEDIS/CAHPS basics Discuss various components related to HEDIS/CAHPS usage, including State
AETNA BETTER HEALTH OF MISSOURI
Aetna Better Health of Missouri 10 South Broadway, Suite 1200 St. Louis, MO 63102 800-566-6444 AETNA BETTER HEALTH OF MISSOURI HEDIS Quick Reference Billing Guide 2014 Diagnosis and/or procedure codes
Contra Cost Health Plan Quality Program Summary November, 2013
Contra Cost Health Plan Quality Program Summary November, 2013 Mission Statement: Contra Costa Health Plan, along with our community and county health care providers, is committed to ensure our diverse
MEASURING CARE QUALITY
MEASURING CARE QUALITY Region November 2015 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance
SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES
Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling
Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW
Clinical Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW NQF 0105 PQRS 9 NQF 0002 PQRS 66 Antidepressant Medication Management Appropriate Testing for Children with Pharyngitis (2-18 years)
ProviderReport. Message from the CEO. Provider Relations adds Provider Partnership team
ProviderReport Message from the CEO We recognize the important role our providers play in ensuring member access to high quality services. Our success is built on the philosophy that quality healthcare
TO: FROM: DATE: RE: Mid-Year Updates Note: NCQA Benchmarks & Thresholds 2014
TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Policy DATE: July 25, 2014 RE: 2014 Accreditation Benchmarks and Thresholds Mid-Year Update This document reports national benchmarks
Vermont ACO Shared Savings Program Quality Measures: Recommendations for Year 2 Measures from the VHCIP Quality and Performance Measures Work Group
Vermont ACO Shared Savings Program Quality Measures: Recommendations for Year 2 Measures from the VHCIP Quality and Performance Measures Work Group Presentation to VHCIP Steering Committee August 6, 2014
1. How are you using health IT enabled clinical quality measures for internal quality improvement efforts and patients care?
1. How are you using health IT enabled clinical quality measures for internal quality improvement efforts and patients care? Sharp Rees-Stealy medical group (SRSMG), a 400-physician multispecialty group
NCQA Health Insurance Plan Ratings Methodology March 2015
NCQA Health Insurance Plan Ratings Methodology March 205 REVISION CHART Date Published March 205 Description Final version (next update will be based on the 50% measure exclusion rule) TABLE OF CONTENTS
2010 QARR QUICK REFERENCE GUIDE Adults
2010 QARR QUICK REFERENCE GUIDE Adults ADULT MEASURES (19 through 64 years) GUIDELINE HEDIS COMPLIANT CPT/ICD9 CODES DOCUMENTATION TIPS Well Care Access to Ambulatory Care Ensure a preventive or other
Quality Improvement Program
Quality Improvement Program Section M-1 Additional information on the Quality Improvement Program (QIP) and activities is available on our website at www.molinahealthcare.com Upon request in writing, Molina
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents BMI Percentile (Total)
Appendix C: New Performance Measures DOM Performance Measures Relevant HEDIS Measure(s) HEDIS 2012 Benchmark 50 th Percentile The 50 th percentile benchmarks are an indicator that half of the health plans
AmeriHealth Caritas Northeast. Aetna Better Health. PA Performance. Measure. AmeriHealth Caritas Northeast. Aetna Better Health
Asthma Use of Appropriate Medications for People with Asthma, Ages 5 to 64 Medication Management for People with Asthma (75% compliance), Ages 5 to 64 Annual Number of Asthma Patients with One or More
Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions
Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions Scott Flinn MD Deborah Schutz RN JD Fritz Steen RN Arch Health Partners A medical foundation formed
Small Physician Groups Aim High
Small Physician Groups Aim High Arch Health Partners A medical foundation in San Diego formed by Palomar Health and PIMG, a 20 year old multispecialty medical group formerly known as Centre for Health
2016 HEDIS /QRS/QARR/EES Physician Documentation Guidelines and Administrative Codes
2016 HEDIS /QRS/QARR/EES Physician Documentation Guidelines and Administrative Codes This document contains a description of HEDIS and other quality of care measures and includes suggestions and/or recommendations
Methodology Overview July 2013
July 2013 ii REVISION CHART Date Published May July Description Final version Final with updated measure list iii TABLE OF CONTENTS Revision Chart... iii Table of Contents... iv 1 Summary... 5 Rankings
Methodology Overview February 2014
February 2014 REVISION CHART Date Published February Description Initial Version ii TABLE OF CONTENTS Revision Chart... ii Table of Contents... iii 1 Summary... 1 Rankings contact information... 1 2 How
Ohio Health Homes Learning Community Meeting. Overview of Health Homes Measures
Ohio Health Homes Learning Community Meeting Overview of Health Homes Measures Tuesday, March 5, 2013 Presenter: Amber Saldivar, MHSM Associate Director, Informatics Analysis Health Services Advisory Group,
Radiology Business Management Association Technology Task Force. Sample Request for Proposal
Technology Task Force Sample Request for Proposal This document has been created by the RBMA s Technology Task Force as a guideline for use by RBMA members working with potential suppliers of Electronic
Texas Medicaid Managed Care and Children s Health Insurance Program
Texas Medicaid Managed Care and Children s Health Insurance Program External Quality Review Organization Summary of Activities and Trends in Healthcare Quality Contract Year 2013 Measurement Period: September
HEDIS 2010 Summary Table of Measures, Product Lines and Changes Applicable to:
HEDIS 2010 Summary Table of Measures, Product Lines and Changes Adult BMI Assessment Added CPT codes 99341 99345, 99347 99350 to Table ABA-A. Added ICD-9-CM Diagnosis codes 678, 679 to Table ABA-C. Weight
HEDIS Code Quick Reference Guide Preventive/Ambulatory Services
HEDIS Code Quick Reference Guide Preventive/Ambulatory Services Child/Adolescent Care Well-Child Visits in the First 15 Months of Life [Commercial, Medicaid] Well-Child Visits in the Third, Fourth, Fifth
2013 ACO Quality Measures
ACO 1-7 Patient Satisfaction Survey Consumer Assessment of HealthCare Providers Survey (CAHPS) 1. Getting Timely Care, Appointments, Information 2. How well Your Providers Communicate 3. Patient Rating
Patient Centered Medical Home
Patient Centered Medical Home 2013 2014 Program Overview Florida Blue is a trade name of Blue Cross and Blue Shield of Florida Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.
SUMMARY TABLE OF MEASURE CHANGES
SUMMARY TABLE OF MEASURE CHANGES Measure Name Effectiveness of Preventive Care Adult BMI Assessment Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Childhood
HEDIS, STAR Performance Metrics. Sheila Linehan, RN,MPH, CPHQ Director of QM, Horizon BCBSNJ July 16, 2014
HEDIS, STAR Performance Metrics Sheila Linehan, RN,MPH, CPHQ Director of QM, Horizon BCBSNJ July 16, 2014 Goals Discuss what HEDIS and Star Metrics are Discuss their impact on Health Plans Discuss their
CREATING A POPULATION HEALTH PLAN FOR VIRGINIA
CREATING A POPULATION HEALTH PLAN FOR VIRGINIA Life Expectancy 1900, 2013 1900 50.6 years old 2013 78.8 years old 0 20 40 60 80 100 Age (Years) Source: http://ucatlas.ucsc.edu/health.php Year - 2000 Source:
Molina Healthcare of Ohio Ohio Medicaid s Quality Strategy. March 18, 2015 Presented by: Martin Portillo, MD FACP VP Medical Affairs and CMO
Molina Healthcare of Ohio Ohio Medicaid s Quality Strategy March 18, 2015 Presented by: Martin Portillo, MD FACP VP Medical Affairs and CMO The Molina Story Three Decades of Delivering Access to Quality
Making the Grade! A Closer Look at Health Plan Performance
Primary Care Update August 2011 Making the Grade! A Closer Look at Health Plan Performance HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized measures designed to track
Oregon Standards for Certified Community Behavioral Health Clinics (CCBHCs)
Oregon Standards for Certified Community Behavioral Health Clinics (CCBHCs) Senate Bill 832 directed the Oregon Health Authority (OHA) to develop standards for achieving integration of behavioral health
Early Results of a Marketwide ACO Initiative: The Alternative Quality Contract (AQC)
Early Results of a Marketwide ACO Initiative: The Alternative Quality Contract (AQC) Dana Gelb Safran, Sc.D. Senior Vice President Performance Measurement and Improvement 13 July 2011 Twin Goals of Improving
ACO Shared Savings Program: Adolescent Health Measures
ACO Shared Savings Program: Adolescent Health Measures December 20, 2013 Alicia Cooper, MPH, PhD Dept. of VT Health Access Vermont Health Care Innovation Project 3/24/2014 1 Overview Beginning in 2014,
Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology
Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology The chart below lists the measures (and specialty exclusions) that eligible providers must demonstrate
SUMMARY TABLE OF MEASURE CHANGES
Summary Table of Measure 1 SUMMARY TABLE OF MEASURE CHANGES Guidelines for Physician Measurement Effectiveness of Preventive Care Guidelines for Physician Effectiveness of Care Adult BMI Assessment Weight
THE PATIENT-CENTERED MEDICAL HOME INITIATIVE IN NEW YORK STATE MEDICAID
THE PATIENT-CENTERED MEDICAL HOME INITIATIVE IN NEW YORK STATE MEDICAID Report to the Legislature April 2013 EXECUTIVE SUMMARY The American College of Physicians (ACP), the American Academy of Family Physicians
Stage 1 Meaningful Use for Specialists. NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene
Stage 1 Meaningful Use for Specialists NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene 1 Today s Agenda Meaningful Use Overview Meaningful Use Measures Resources Primary
Total Health Quality Indicators For Providers 2015
Total Health Quality Indicators For Providers 2015 Adult- Preventive Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 BMI Assessment BMI Recording 18-74 yrs Yearly G8417, G8418, G8420
ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION)
ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION) Hello and welcome. Thank you for taking part in this presentation entitled "Essentia Health as an ACO or Accountable Care Organization -- What
SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES
Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling
8/14/2012 California Dual Demonstration DRAFT Quality Metrics
Stakeholder feedback is requested on the following: 1) metrics 69 through 94; and 2) withhold measures for years 1, 2, and 3. Steward/ 1 Antidepressant medication management Percentage of members 18 years
Quality Oversight in the Health Care Marketplace, Spring 2010 Tufts Health Care Institute
Quality Oversight in the Health Care Marketplace, Spring 2010 Tufts Health Care Institute Session 16: C.1. Performance Reports National Reports Some reports present information on a category of providers
QUALITY MANAGEMENT PROGRAM 2015 EVALUATION
QUALITY MANAGEMENT PROGRAM 2015 EVALUATION Tim Gutshall, MD Vice President & Chief Medical Officer Wellmark Blue Cross and Blue Shield Table of Contents Purpose... 2 Scope of Work... 2 Objectives... 2
Performance Results for Health Insurance Plans
WASHINGTON STATE COMMON MEASURE SET FOR HEALTH CARE QUALITY AND COST Performance Results for Health Insurance Plans DECEMBER 2015 Table of Contents Introduction... 3 About the Results... 4 How to Read
2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide
2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide HEDIS Measure: Test/Care Needed for Compliance Adult BMI Assessment Individuals ages 18-74 Documentation of BMI and
Accountable Care Organization
Accountable Care Organization April 13, 2011 The Indianapolis Association of Health Underwriters Drivers of Payment Reform Increased attention to regional variation in costs and quality Payment for care
2016 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set
2016 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set *Measures collected with medical record review. Red= new/addition to measures Blue= Medicare only Prevention and Screening Measure
Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year
Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2015 benchmarks for ACO-9 and ACO-10 quality
Meaningful Use 2014 Changes
Meaningful Use 2014 Changes Lisa Sagwitz HIT Workflow & Implementation Coordinator September 4, 2014 1 PA Reach Who are we? Designated by ONC as the PA East and PA West Regional Extension Center We have
SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES
Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling
NCQA Health Plan Accreditation. Creating Value by Improving Health Care Quality
NCQA Health Plan Accreditation Creating Value by Improving Health Care Quality NCQA Health Plan Accreditation Creating Value by Improving Health Care Quality Purchasers, consumers and health plans pay
Psychiatrists and Reporting on Meaningful Use Stage 1. August 6, 2012
Psychiatrists and Reporting on Meaningful Use Stage 1 August 6, 2012 Quick Overview Functional Measures Providers (tracked by NPI) must report on 15 core objectives and associated measures and 5 objectives
Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis
Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly
Primary Care in the U.S. Measuring and Improving Primary Care in the United States ISQua Indicators Summit 2012. CMS Measures. Primary Care Measures
Primary Care in the U.S. Measuring and Improving Primary Care in the United States ISQua Indicators Summit 2012 Cliff Fullerton, MD, MS VP Chronic Disease Baylor Health Care System Number of PCPs in the
Finding Common Ground: Vermont s Blueprint for Health and ACO Shared Savings Programs
Finding Common Ground: Vermont s Blueprint for Health and ACO Shared Savings Programs Presentation to: Rhode Island Care Transformation Collaborative February 27, 2015 Pat Jones, Health Care Project Director,
2011 Comprehensive Performance Report Commercial HMO, POS, and PPO Health Benefit Plans in Maryland
2011 Comprehensive Performance Report Commercial HMO, POS, and PPO Health Benefit Plans in Maryland Maryland Health Care Commission Marilyn Moon, PhD Chair Garret A. Falcone, NHA Vice Chair Reverend Robert
Henry J. Austin Health Center Kemi Alli, M.D. Chief Medical Officer kemi.alli@henryjaustin.org May 8, 2013
Henry J. Austin Health Center Kemi Alli, M.D. Chief Medical Officer kemi.alli@henryjaustin.org May 8, 2013 Henry J. Austin Health Center Presentation Outline 1. Henry J. Austin Health Center s Background
MedStar Family Choice Benefits Summary District of Columbia- Healthy Families WHAT YOU GET WHO CAN GET THIS BENEFIT BENEFIT
Primary Care Services Specialist Services Laboratory & X-ray Services Hospital Services Pharmacy Services (prescription drugs) Emergency Services Preventive, acute, and chronic health care Services generally
If you have a question about whether MedStar Family Choice covers certain health care, call MedStar Family Choice Member Services at 888-404-3549.
Your Health Benefits Health services covered by MedStar Family Choice The list below shows the healthcare services and benefits for all MedStar Family Choice members. For some benefits, you have to be
Key Performance Measures for School-Based Health Centers
Key Performance Measures for School-Based Health Centers As health care reform continues to take shape and additional provisions of the Affordable Care Act are implemented, there is an increasing demand
Shoot For The Stars. Medicare Advantage Plans. Quality Scores Drive Participation 1
Shoot For The Stars Medicare Advantage Plans Quality Scores Drive Participation 1 Stars Rating System CMS rates Medicare Advantage Plans (HMO, PPO, and PFFS) on a 1 to 5 Star scale. Star ratings can be
Medicare 2013 QI Program Evaluation
#1 Priority Measures Diabetes Medication Adherence D 3 69% 71% High Risk Meds in the Elderly D 3 8% 3% Sleep medications were added to the measure after the 2013 formulary was accepted. A number of high
Meaningful Use Stage 2: Important Implications for Pediatrics
Meaningful Use Stage 2: Important Implications for Pediatrics Glossary of Acronyms MU CQM EHR CEHRT EPs CAHs e-rx CPOE emar ONC CMS HHS Meaningful Use Clinical quality measure Electronic health record
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Medicare Quality Management Program Overview Quality Improvement (QI) Overview At Coventry, we
Quality Improvement & Utilization Management Program Evaluation
Quality Improvement & Utilization Management Program Evaluation 2012 Table of Contents 1. Introduction... 4 1.1. Executive Summary... 4 1.2. Quality Leadership... 6 2. Improving Member Health... 7 2.1.
Vermont ACO Shared Savings Program: Recommendations for Year 2 Quality Measures
Vermont ACO Shared Savings Program: Recommendations for Year 2 Quality Measures Green Mountain Care Board October 9, 2014 10/9/2014 1 ACOs & SSPs Accountable Care Organizations (ACOs) are composed of and
Implications for I/T/U
Outpatient CMS Quality Measurement Programs Implications for I/T/U CAPT Michael Toedt, MD, FAAFP Acting Chief Medical Information Officer Office of Information Technology, Indian Health Service NIHB 2015
Primary Care Quality Care Indicators - Accuro EMR Prevention
Quality Indicators Primary Care Quality Care Indicators - Accuro EMR Prevention Data needs to be entered as indicated in order to auto populate the worksheet Date of colon cancer screening Exemption from
Colorado Medicaid HEDIS 2014 Results STATEWIDE AGGREGATE REPORT
Colorado Medicaid HEDIS 2014 Results STATEWIDE AGGREGATE REPORT December 2014 This report was produced by Health Services Advisory Group, Inc. for the Colorado Department of Health Care Policy and Financing.
Provider Manual. Section 18.0 - Case Management and Disease Management
Section 18.0 - Case Management and Disease Management 18.1.1 Introduction 18.2.1 Scope 18.3.1 Objectives 18.4.1 Procedures Case Management 18.4.1-A. Referrals 18.4.1-B. Case Management Mercy Maricopa Acute
Coding Seminar: Tips to Improve HEDIS Measures. Charlotte Kohler, CPA, CVA, CPAM, CPC, CHBC
Coding Seminar: Tips to Improve HEDIS Measures Charlotte Kohler, CPA, CVA, CPAM, CPC, CHBC Disclaimer HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA) This presentation
Focus on Obesity and on Medicare Plan Improvement
Focus on Obesity and on Medicare Plan Improvement The State of Health Care Quality 2012 Focus on Obesity and on Medicare Plan Improvement The State of Health Care Quality 2012 2 n at i o n a l c o m m
Reliability and predictable costs for individuals and families
INDIVIDUAL & FAMILY PLANS HEALTH NET HMO PLANS Reliability and predictable costs for individuals and families If you re looking for a health plan that s simple to use and easy to understand, you ve found
CQMs. Clinical Quality Measures 101
CQMs Clinical Quality Measures 101 BASICS AND GOALS In the past 10 years, clinical quality measures (CQMs) have become an integral component in the Centers for Medicare & Medicaid Services (CMS) drive
MEASURE C01: Breast Cancer Screening. MEASURE C02: Colorectal Cancer Screening. MEASURE C07: Adult BMI Assessment
HEDIS: THESE ARE THE S WE CAN HAVE THE GREATEST IMPACT ON! Healthcare Effectiveness Data and Information Set. Measures health plan performance on health care and service. HEDIS data are collected through
Commercial Business Medical Cost Target Measurement Period Handbook- For Enhanced Personal Health Care Measurement Period beginning: 01/01/16
Commercial Business Medical Cost Target Measurement Period Handbook- For Enhanced Personal Health Care Measurement Period beginning: 01/01/16 CBMCT Version 010116 V1 Introduction: Welcome to your Commercial
Population Health: Sharing A Parkland Perspective
Population Health: Sharing A Parkland Perspective Sue Pickens, MEd, PCMH CCE Sobha Fuller, DNP, RN-BC, NEA-BC, PCMH CCE Who is Parkland? Dallas County Hospital District d/b/a Parkland Health & Hospital
Clinical Quality Measures (CQMs) What are CQMs?
Clinical Quality Measures (CQMs) What are CQMs? What are CQMs? Clinical quality measures, or CQMs, are tools that help eligible providers (EPs) measure and track the quality of health care services provided
Health Plan Quality Metrics Work Group. Final Recommendations Report. May 2014
Health Plan Quality Metrics Work Group Final Recommendations Report May 2014 Health Plan Quality Metrics Work Group Members Lori Coyner Director of Accountability and Quality Oregon Health Authority Dr.
Medicaid ACO Pediatric Quality Measures and Innovative Payment Models
Medicaid ACO Pediatric Quality Measures and Innovative Payment Models Select States Summer, 2015 Introduction Since the Medicaid program was implemented 50 years ago, it has undergone several evolutions
Improving Quality of Care for Medicare Patients: Accountable Care Organizations
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October
NY Medicaid EHR Incentive Program. Eligible Professionals Meaningful Use Stage 2 (MU2) Webinar www.emedny.org/meipass
Eligible Professionals Meaningful Use Stage 2 (MU2) Webinar www.emedny.org/meipass May 2015 2 Meaningful Use Stage 2 Overview of EHR Introduction to Meaningful Use Meaningful Use Stage 2 Objectives Clinical
Trends in Part C & D Star Rating Measure Cut Points
Trends in Part C & D Star Rating Measure Cut Points Updated 11/18/2014 Document Change Log Previous Version Description of Change Revision Date - Initial release of the 2015 Trends in Part C & D Star Rating
Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year
Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2014 benchmarks for ACO-9 and ACO-10 quality
Provider Newsletter March 2011
Provider Newsletter March 2011 2010 Practitioner Satisfaction Survey Results Molina Healthcare of California conducts an annual Satisfaction Survey with Primary Care Practitioners in Riverside, San Bernardino,
OUR ACO QUALITY RESULTS 2012 AND 2013
OUR ACO QUALITY RESULTS 2012 AND 2013 2012-2013 Patient and Caregiver Experience Source 2012 2013 ACO - 1 CAHPS: Getting Timely Care, Appointments and Information Survey 81.98 84.47 ACO - 2 CAHPS: How
Stage 2 June 13, 2014
Stage 2 June 13, 2014 1 General Overview of Idaho Medicaid s EHR Incentive Program Stage 2 Meaningful Use (MU) Overview 2014 Reporting Helpful Resources 2 3 Medicaid can pay certain providers an incentive
During Office Hours & After Office
During Office Hours & After Office Hours Emergency Care (Emergent) 1 Urgent Care Non-Urgent Sick Visit Routine Primary Care Preventive Care/Routine Physical Exam Emergency care is medical care given for
Population Health Solutions for Employers MEDIA RESOURCES
Population Health Solutions for Employers MEDIA RESOURCES ABOUT MISSIONPOINT MissionPoint s mission is to make healthcare more affordable, accessible and improve the quality of care for our members. MissionPoint
2012 Physician Quality Reporting System:
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Official CMS Information for Medicare Fee-For-Service Providers 2012 Physician Quality : Medicare Electronic Health Record
COVERAGE SCHEDULE. The following symbols are used to identify Maximum Benefit Levels, Limitations, and Exclusions:
Exhibit D-3 HMO 1000 Coverage Schedule ROCKY MOUNTAIN HEALTH PLANS GOOD HEALTH HMO $1000 DEDUCTIBLE / 75 PLAN EVIDENCE OF COVERAGE LARGE GROUP Underwritten by Rocky Mountain Health Maintenance Organization,
Applying Lessons from Two Years of a Commercial ACO to a Medicare Shared Savings Program
Applying Lessons from Two Years of a Commercial ACO to a Medicare Shared Savings Program Lee B. Sacks, MD, CEO Mark Shields MD, MBA, FACP, Senior Medical Director AMGA 2013 Annual Conference Orlando, FL
HMO Performance Report
NJ FamilyCare / Medicaid HMO Performance Report A Report on Utilization, Quality, and Member Satisfaction Delivered Under the New Jersey Medicaid and CHIP Managed Care Program 2011 Prepared by the Department
InteGreat EHR Meaningful Use 2 Features and Reports Jenni Walters, Sr. Business Analyst, McKesson Beth Crews, Business Analyst, McKesson
InteGreat EHR Meaningful Use 2 Features and Reports Jenni Walters, Sr. Business Analyst, McKesson Beth Crews, Business Analyst, McKesson Stage 2 Overview On September 4, 2012, CMS published final rule
We're Ready for MU2...Are You?
Meaningful Use Are you considering purchasing an Electronic Health Record (EHR) or moving from your current vendor? Is your goal to attain Meaningful Use status in order to receive EHR incentive dollars?