Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual"

Transcription

1 Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2016 This document is a guide to the 2016 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas Blue Cross PCMH). This document does not guarantee clinic participation in the Arkansas Blue Cross PCMH program. This document is subject to change without notice.

2 ARKANSAS BLUE CROSS AND BLUE SHIELD PATIENT-CENTERED MEDICAL HOME (PCMH) 1. DEFINITIONS 2. ENROLLMENT AND ATTRIBUTION 2a Enrollment Eligibility 2b Clinic Enrollment and Clinic Withdrawal 2c Attribution of Members (Patient Panel) 3. CARE COORDINATION PAYMENTS 3a Care Coordination Payment Eligibility 3b Care Coordination Payment Amount 3c NCQA 4. SHARED SAVINGS 5. METRICS AND ACCOUNTABILITY FOR PAYMENT INCENTIVES 5a Practice Transformation Activities Tracked 5b Metrics Tracked 5c Accountability 5d Provider Reports 6. COMPREHENSIVE PRIMARY CARE (CPC) INITIATIVE CLINIC PARTICIPATION IN THE PCMH PROGRAM 7. CONTACT US 1 DEFINITIONS AHIN (Advanced Health Information Network) Attributed Members (Patient Panel) Care Coordination Care Coordination Payments AHIN is a web-based portal that provides the Arkansas provider community real-time access to the information needed to efficiently manage a practice. AHIN s functionality includes eligibility, claim information, remittance information, and access to the State PCMH, Episode Reporting and ABCBS PCMH programs. A patient panel is a list of patients assigned (or attributed) to a Primary Care team in a practice. The team is responsible for managing the overall care for the attributed patient panel. Examples of the types of care that the team will be responsible for overseeing include: preventive care, chronic disease management, follow-up from any ED or in-patient hospital visit as well as any acute care needs. Activities focused on population management and patient engagement that aim in helping the patient/member navigate the healthcare system and improve their overall health. These activities may be carried out by an individual or spread across the care team. Per member per month (pmpm) payments made to participating Primary Care Physician practices. The payment amount is based on the number of members 1

3 CPC (Comprehensive Primary Care) Fully Insured Interoperability Medical Neighborhood Medical Neighborhood Barriers Participating Clinic Patient Alignment Patient-Centered Medical Home (PCMH) Performance Period attributed through either member selection or the attribution processed outlined in the PCMH amendment. The Comprehensive Primary Care Initiative is a multipayer program which promotes collaboration between public and private health care payers to strengthen primary care. The goal is to improve overall patient health while lowering costs. An arrangement by which a licensed insurance company gives its employer-group customers financial protection against claim loss in exchange for a monthly premium. The term fully insured member is used throughout this document. The ability of the component parts of an application (e.g. multiple EHRs communicating, hospital systems communication with clinics, or TeleVox) to operate successfully together. Involves the PCMH serving as the core provider plus any supporting entities, including but not limited to: specialists, behavioral health, pharmacists, home health, community resources and services, and other associated services. Obstacles to the delivery of coordinated care that exist in areas of the health system external to PCMH. A physician clinic that is enrolled in the PCMH program, which must be one of the following: A. An individual primary care physician (Provider Type: Family Medicine, General Practice, Geriatrics, Internal Medicine, Pediatrics) B. A physician group of primary care providers who are affiliated, with a common group identification number C. A Rural Health Clinic D. An Area Health Education Center E. Federally Qualified Health Center (FQHC) The process of aligning our members with a Primary Care Provider based on recent claims data, member selection, and in some cases, geographic considerations. A Primary Care Provider will then manage the patients/members that have been assigned/attributed. Participating clinics may receive care coordination payments to support population health management activities for the attributed members. The term member refers to patients. A team-based care delivery model led by Primary Care Physicians (PCPs) who comprehensively manage patients health needs with an emphasis on health care quality and value. The period of time over which performance is aggregated and assessed. 2

4 Practice Transformation Primary Care Physician (PCP) PCMH Provider Portal Remediation Time Self-insured Plan Same-day appointment Shared Savings program The adoption, implementation and maintenance of approaches, activities, capabilities and tools that enable a participating clinic to serve as a PCMH. A physician providing primary care services whose sole or primary specialty is General Practice, Family Medicine, Internal Medicine, Pediatric Medicine, Geriatric Medicine. The provider portal will be used for the 2016 ABCBS and its family of companies PCMH enrollment process, submitting required reporting activities and/or metrics as well as receiving any information/reports shared by the plan. The provider portal is available on AHIN. The period during which participating clinics that fail to meet deadlines, targets or both on relevant activities tracked for practice transformation may continue to receive care coordination payments while improving performance. A health plan through which an employer or other group sponsor, rather than an insurance company, is financially responsible for paying plan expenses, including claims made by group plan members. Also known as a selffunded plan. Accommodating a patient s request to be seen by a clinician within 24 hours. A separate program to reward cost-efficient and quality care. A shared savings program will not be available for the 2016 program year. 2 ENROLLMENT AND ATTRIBUTION 2a. Enrollment Eligibility The Arkansas Blue Cross and Blue Shield PCMH Program eligibility requirements are: A. The practice must include primary care physicians (Family Medicine, General Practice, Geriatrics, Internal Medicine, or Pediatrics) enrolled in the following networks: Arkansas Blue Cross and Blue Shield (Preferred Provider Participant), Health Advantage and True Blue. AND B. The practice must complete the PCMH enrollment application located on the AHIN portal during the designated PCMH enrollment period. The enrollment period is announced annually on AHIN. AND C. The practice must return contract amendments signed by each primary care physician who provides primary care to patients at the PCMH clinic location. 2b. Clinic Enrollment and Clinic Withdrawal Enrollment in the PCMH program is voluntary. Enrollment is open to physicians providing primary care to patients. A clinic representative must complete the PCMH application available on the AHIN PCMH portal. True Blue, Health Advantage and Preferred Provider Participant contract amendments must be signed by the person in the clinic with administrative authority. 3

5 Each physician participant will only need to sign Exhibit B. Upon receipt of the signed amendment, the clinic and its eligible physicians will be enrolled in the PCMH program. Clinics are expected to re-enroll annually. A PCMH will remain in good standing until: A. The clinic or physician withdraws; B. The clinic or physician becomes ineligible, is suspended or terminated from network participation or the PCMH program; C. Arkansas Blue Cross and Blue Shield terminates the PCMH program A participating clinic must update the Primary Care department on changes to the list of physicians who practice at the clinic. To add or withdraw a physician from the PCMH program, send an to Include the name and NPI number for the physician in the . Withdrawing from the PCMH program will not impact clinic/physician participation in any other existing contract(s) or program with Arkansas Blue Cross and Blue Shield and its family of companies. Physician(s) may terminate the PCMH agreement and be removed from the PCMH program by providing 30 days prior written notice of termination to: Arkansas Blue Cross and Blue Shield Primary Care, 4S 601 S. Gaines Little Rock, AR Questions regarding the termination process should be directed to the Arkansas Blue Cross and Blue Shield Primary Care Department by calling or via 2c. Attribution of Patients (Patient Panel) Fully insured members will be assigned to a physician based on an attribution methodology that will include but not be limited to factors such as claims containing specific evaluation and management CPT codes ( ), assignment through recent dates of service, the total allowed amount of the paid claims and a member PCP selection process. If a member cannot be assigned based on paid claims or the member declines to select a PCP that member may be assigned to a participating clinic based on geographic proximity to the participating clinic. Members assigned to participating clinics but who have not established care at that clinic (no paid claims for E&M codes ) will not be included in the patient panel of attributed members until the participating clinic is paid for an eligible E&M service code ( ). For those members, care coordination payments will not be begin until the member has established care and the participating clinic has been paid for an eligible E&M service code ( ). Self-insured employers will independently choose to participate or not participate in the PCMH program. They will also choose the Care Coordination Payment amount for their members. 4

6 3 CARE COORDINATION PAYMENTS 3a. Care Coordination Payment Eligibility In addition to the enrollment eligibility requirements listed in Section 2a, participating clinics must meet the practice transformation activities and metrics identified in sections 5a and 5b to receive care coordination payments. 3b. Care Coordination Payment Amount Care Coordination payments are calculated per attributed member, per month and paid monthly. Care Coordination payments support practice transformation and care coordination services. In order to begin receiving care coordination payments for the first quarter of 2016, a clinic must submit a complete PCMH Provider Participation Agreement on or before December 15, Members assigned to participating clinics but who have not established care at that clinic (no previous paid claims for E&M codes ) will not be included in the care coordination payment until an eligible claim is submitted and paid. 3c. NCQA Practice(s) that hold NCQA PCMH recognition during the enrollment period 10/1/15-12/1/15 will receive an increased care management fee per member per month for their patients with a fullyinsured policy based on the level of recognition during the time of enrollment. If the practice(s) NCQA PCMH recognition expires prior to December 31, 2016 the PMPM payments will revert back to the base level the month following the expiration unless an updated recognition has been submitted to 4 SHARED SAVINGS 4a. Shared Savings A Shared Savings program will not be available for the 2016 program year. 5 METRICS AND ACCOUNTABILITY FOR PAYMENT INCENTIVES 5a. Practice Transformation Activities Tracked Using the PCMH Provider Portal, participating clinics must complete and document the activities as described in the table below by the deadline indicated in the table. The reference point for the deadlines is January 1, Month Activities Deadline A. Identify top 10% of Arkansas Blue Cross and Blue Shield high-priority members using: 1. Arkansas Blue Cross and Blue Shield and its family of companies patient panel data that ranks members by risk at beginning of performance period. March 31, UPDATE: Due date has been extended to April 30, 2016 (If such list is not submitted by this deadline, Arkansas Blue Cross and Blue Shield and its family of 5

7 OR 2. The clinic s patient-centered assessment to determine which members on this list are highpriority. Submit this list to the PCMH portal. companies will identify a default list of high-priority members for the clinic, based on risk scores). B. Report clinical quality measure data for calendar year 2015 for: Controlling High Blood Pressure, Diabetes: Hemoglobin A1c Poor Control, and Weight Assessment for Children and Adolescents (BMI). - Controlling High Blood Pressure: - Numerator: The number of patients in the denominator whose most recent BP is adequately controlled (<140/90) during the measurement year. - Denominator: Total number of patients age who had at least one outpatient encounter with a diagnosis of hypertension (HTN) during the first six months of the measurement year. - Diabetes: Hemoglobin A1c Poor Control - Numerator: Patients whose most recent HbA1c level is greater than 9.0% or is missing a result, or for whom an HbA1c test was not done during the measurement year. - Denominator: Patients years of age by the end of the measurement year who had a diagnosis of diabetes (type 1 or type 2) during the measurement year or the year prior to the measurement year. - Weight Assessment and Counseling for Children and Adolescents - Numerator: The percentage of patients in the denominator who had evidence of Body Mass Index (BMI) percentile documentation during the measurement year. - Denominator: Patients 3-17 years of age with at least one outpatient visit with a primary care physician (PCP) or OB GYN during the measurement year. March 31, Month Activities Deadline C. Assess operations of practice and opportunities for improvement. D. Develop strategies to implement practice transformation and care coordination. E. Identify and address medical neighborhood barriers to coordinated care at the clinic level (including Behavioral Health professionals and facilities). June 30, 2016 June 30, 2016 June 30, 2016 F. Make available 24/7 access to care. Provide telephone June 30,

8 access to a live voice (e.g., an employee of the primary care physician or an answering service) or to an answering machine that immediately pages an on-call medical professional 24 hours per day, 7 days per week. The on-call professional must: 1. Provide information and instructions for treating emergency and non-emergency conditions, 2. Make appropriate referrals for non-emergency services and 3. Provide information regarding accessing other services and handling medical problems during hours the PCP s office is closed. 4. PCPs must make the after-hours telephone number known by all patients; posting the afterhours number on all public entries to each site; and including the after-hours phone number on answering machine greetings. 5. When employing an answering machine with recorded instructions for after-hours callers, PCPs should regularly check to ensure that the machine functions correctly and that the instructions are up to date. G. Document approach to expanding access to same-day appointments. Answer the questions listed for Activity G on the PCMH portal. June 30, Month Activities Deadline H. Childhood/Adult Vaccination Practice Strategy. Answer the questions listed for Activity H on the PCMH portal. I. Establish processes that result in contact with patients who have not received preventive care. Complete the questions listed for Activity I on the PCMH portal. J. Patients ability to receive timely care, appointments and information from specialists, including Behavioral Health (BH) specialists. K. Incorporate e-prescribing into clinic workflows. Answer the questions listed for Activity K on the PCMH portal. L. Integrate EHR into practice workflows. Answer the questions listed for Activity L on the PCMH portal. M. A minimum of 80% of high-priority members (identified in Activity A) whose care plan as contained in the medical record includes: 1. Documentation of a patient s current problems; 2. Plan of care integrating contributions from health care team (including behavioral health professionals) and from the member; December 31, 2016 December 31, 2016 December 31, 2016 December 31, 2016 December 31, 2016 December 31,

9 3. Instructions for follow-up and 4. Assessment of progress to date. The care plan must be updated at least twice a year. 13 Month Activities Deadline N. Report clinical quality measure data for calendar year 2015 for: Controlling High Blood Pressure, Diabetes: Hemoglobin A1c Poor Control, and Weight Assessment for Children and Adolescents (BMI). - Controlling High Blood Pressure: - Numerator: The number of patients in the denominator whose most recent BP is adequately controlled (<140/90) during the measurement year. - Denominator: Total number of patients age who had at least one outpatient encounter with a diagnosis of hypertension (HTN) during the first six months of the measurement year. - Diabetes: Hemoglobin A1c Poor Control - Numerator: Patients whose most recent HbA1c level is greater than 9.0% or is missing a result, or for whom an HbA1c test was not done during the measurement year. - Denominator: Patients years of age by the end of the measurement year who had a diagnosis of diabetes (type 1 or type 2) during the measurement year or the year prior to the measurement year. - Weight Assessment and Counseling for Children and Adolescents - Numerator: The percentage of patients in the denominator who had evidence of Body Mass Index (BMI) percentile documentation during the measurement year. - Denominator: Patients 3-17 years of age with at least one outpatient visit with a primary care physician (PCP) or OB GYN during the measurement year. January 31, 2017 Arkansas Blue Cross and Blue Shield and its family of companies may add, remove, or adjust these practice transformation activities or deadlines, including additions beyond 12 months, based on new research, empirical evidence or experience from initial metrics. Arkansas Blue Cross and Blue Shield and its family of companies will publish such extension, addition, removal or adjustment on AHIN and in the PCMH Provider manual. 5b. Metrics Tracked Arkansas Blue Cross and Blue Shield and its family of companies assesses participating clinics on the following metrics tracked starting on the first day of the first calendar year in which the participating clinic is enrolled in the PCMH program and continuing through the full calendar year. 8

10 Quality Metrics 1. Percentage of patients who turned 15 months old during the performance period and who received at least four wellness visits in their first 15 months. 2. Percentage of patients 3-6 years of age who had one or more well-child visits during the measurement year. 3. Percentage of patients years of age who had one or more well-care visits during the measurement year. 4. Percentage of patients 6-12 years of age with an ambulatory prescription dispensed for ADHD medication that was prescribed by their PCMH, who had a follow-up visit within 30 days by any practitioner with prescribing authority. 5. Percentage of patients prescribed appropriate asthma medications. 6. Percentage of CHF patients age 18 years and over on beta blockers. 7. Percentage of children who received appropriate treatment for Upper Respiratory Infection (URI). 8. Percentage of diabetic patients who complete annual HbA1C between years of age. 9. Percentage of patients with Diabetes and CAD that are currently taking a statin. 10. Percentage of a clinic s high-priority patients seen by a member of the PCP s care management team at least twice in the past 12 months. 11. Percentage of members who had an acute inpatient hospital stay and were seen by health-care provider within 10 days of discharge. 12. Percentage of patients age 18 years and older who were prescribed chronic Alprazolam (Xanax) during the measurement year. Arkansas Blue Cross and Blue Shield will provide data when available. 13. Percentage of patients age years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period (all payer source). The PCMH clinic will self-report this metric through the PCMH portal. 14. Percentage of patients years of age with diabetes (type 1 or type 2) whose most recent HbA1C level during the measurement period was greater than 9.0% (poor control) or was missing the most recent result, or if an Target for Program Year Beginning January 1, 2016 At least 70% At least 67% At least 45% At least 36% At least 85% At least 49% No more than 65% At least 78% At least 70% At least 76% At least 40% No more than 12% At least 55% No more than 35% 9

11 Quality Metrics HbA1C test was not done during the measurement period (All payer source). The clinic will self-report this metric through the PCMH portal. 15. Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of height, weight, and body mass index (BMI) percentile documentation during the measurement period (All payer source). The clinic will self-report this metric through the PCMH portal. Target for Program Year Beginning January 1, 2016 At least 45% Arkansas Blue Cross and Blue Shield and its family of companies will publish targets for subsequent years, calibrated based on experience from targets initially set, on the AHIN PCMH portal. Such targets will escalate over time. Arkansas Blue Cross and Blue Shield and its family of companies may add, remove, or adjust these metrics based on new research, empirical evidence or experience from initial metrics. 5c. Accountability If a participating clinic does not meet deadlines and targets for practice transformation activities and metrics as described in Sections 5a and 5b, then the clinic must submit an improvement plan to prevent a change in participation status with the program. The improvement plan should be submitted within one month of receiving their Arkansas Blue Cross and Blue Shield PCMH report notifying them of failure to meet an activity requirement. Clinics will be expected to follow the Improvement Plan policy set forth by Arkansas Blue Cross and Blue Shield. A. Activities tracked a. The participating clinic will have a full calendar quarter to complete remediation after being notified of the requirements that did not meet expectations. B. Metrics tracked i. Exception: Activity B in Section 5a where no such remediation time will be provided. a. Performance must be remediated before the end of the second full calendar quarter after the date the clinic receives notice via the provider report that target(s) have not been met. b. For purposes of remediation, performance is measured on the most recent four calendar quarters. If a clinic fails to meet the deadlines or targets for practice transformation activities and metrics tracked within this remediation time, then Arkansas Blue Cross and Blue Shield and its family of companies will terminate the clinic from the PCMH program. Arkansas Blue Cross and Blue Shield and its family of companies retain the right to confirm clinics performance against deadlines and targets for activities and metrics tracked. 5d. Provider Reports 10

12 Arkansas Blue Cross and Blue Shield and its family of companies provide participating clinics reports containing information about their clinic performance on activities and metrics. Reports will be located on the AHIN PCMH provider portal. 6 COMPREHENSIVE PRIMARY CARE (CPC) INITIATIVE CLINIC PARTICIPATION IN THE PCMH PROGRAM 6a. CPC Initiative Clinic Participation Any Practice/Provider in good standing at the completion of the CPCi program may join the Arkansas Blue Cross PCMH program. Anyone with an active improvement plan in the CPCi program may apply and include the improvement plan details with their enrollment. 7 CONTACT US 7a. Questions regarding the Arkansas Blue Cross and Blue Shield PCMH program The Arkansas Blue Cross and Blue Shield Primary Care team is available to answer questions regarding the Arkansas Blue Cross PCMH program via or by phone Monday Friday 8:00am 4:30pm CST. Phone:

Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual

Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2015 This document is a guide to the 2015 Arkansas Blue Cross and Blue Shield Patient- Centered Medical Home program (Arkansas

More information

Medicaid Managed Care Services (MMCS) PCP Packet

Medicaid Managed Care Services (MMCS) PCP Packet Medicaid Managed Care Services (MMCS) PCP Packet Arkansas Health Care Payment Improvement Initiative (AHCPII) www.paymentinitiative.org Patient Centered Medical Home (PCMH) n 24/7 Best practices n Care

More information

MaineCare Value Based Purchasing Initiative

MaineCare Value Based Purchasing Initiative MaineCare Value Based Purchasing Initiative The Accountable Communities Strategy Jim Leonard, Deputy Director, MaineCare Peter Kraut, Acting Accountable Communities Program Manager Why Value-Based Purchasing

More information

Oregon Standards for Certified Community Behavioral Health Clinics (CCBHCs)

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

More information

Patient Centered Medical Home

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.

More information

2013 ACO Quality Measures

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

More information

Physician Practice Connections Patient Centered Medical Home

Physician Practice Connections Patient Centered Medical Home Physician Practice Connections Patient Centered Medical Home Getting Started Any practice assessing its ability to achieve NCQA Physician Recognition in PPC- PCMH is taking a bold step toward aligning

More information

ProviderReport. Message from the CEO. Provider Relations adds Provider Partnership team

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

More information

Behavioral Health Phase 3: Standards Under Review

Behavioral Health Phase 3: Standards Under Review Behavioral Health Phase 3: Standards Under Review Measure Number Title Description Measure Steward 0108 Follow-Up Care for Children Prescribed ADHD Medication (ADD) The percentage of children newly prescribed

More information

Enhanced Personal Health Care Program

Enhanced Personal Health Care Program Enhanced Personal Health Care Program Documents included in the Recruitment Packet: Program Summary FAQ Checklist List of Program Information Form Questions Member Medical History Plus (MMH+) access form

More information

HEDIS/CAHPS 101. August 13, 2012 Minnesota Measurement and Reporting Workgroup

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

More information

CQMs. Clinical Quality Measures 101

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

More information

Chapter Three Accountable Care Organizations

Chapter Three Accountable Care Organizations Chapter Three Accountable Care Organizations One of the most talked-about changes in health care delivery in recent decades is Accountable Care Organizations, or ACOs. Having gained the attention of both

More information

Behavioral Health Quality Standards for Providers

Behavioral Health Quality Standards for Providers Behavioral Health Quality Standards for Providers TABLE OF CONTENTS I. Behavioral Health Quality Standards Access Standards A. Access Standards B. After-Hours C. Continuity and Coordination of Care 1.

More information

MEASURE C01: Breast Cancer Screening. MEASURE C02: Colorectal Cancer Screening. MEASURE C07: Adult BMI Assessment

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

More information

Explanation of care coordination payments as described in Section 223.000 of the PCMH provider manual

Explanation of care coordination payments as described in Section 223.000 of the PCMH provider manual Explanation of care coordination payments as described in Section 223.000 of the PCMH provider manual Determination of beneficiary risk Per beneficiary amounts Per beneficiary amounts 1 For the first year

More information

Continuity of Care Guide for Ambulatory Medical Practices

Continuity of Care Guide for Ambulatory Medical Practices Continuity of Care Guide for Ambulatory Medical Practices www.himss.org t ra n sf o r m i ng he a lth c a re th rou g h IT TM Table of Contents Introduction 3 Roles and Responsibilities 4 List of work/responsibilities

More information

Patient-Centered Medical Home (PCMH) 2014

Patient-Centered Medical Home (PCMH) 2014 Patient-Centered Medical Home (PCMH) 2014 Part 1: Standards 1-3 All materials 2014, National Committee for Quality Assurance Agenda Part 1 Content t of PCMH 2014 Standards d and Guidelines Standards 1

More information

Ohio Health Homes Learning Community Meeting. Overview of Health Homes Measures

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,

More information

Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program

Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program Greg Moody, Director Governor s Office of Health Transformation Webinar for Primary Care Practices

More information

POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk

POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk Julia Andrieni, MD, FACP Vice President, Population Health and Primary

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

AETNA BETTER HEALTH OF MISSOURI

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

More information

Medicaid ACO Pediatric Quality Measures and Innovative Payment Models

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

More information

Adirondack Region Medical Home Pilot

Adirondack Region Medical Home Pilot Adirondack Region Medical Home Pilot John Rugge, M.D Adirondack Health Institute Patient-Centered Primary Care Collaborative February 10, 2011 Demographics Population ~ 200,000 Micropolitan (2)/Rural/Frontier

More information

Meaningful Use 2014 Changes

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

More information

Key Performance Measures for School-Based Health Centers

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

More information

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid

More information

NCQA Standards Workshop Patient-Centered Medical Home PCMH 2011. Part 1: Standards 1-3

NCQA Standards Workshop Patient-Centered Medical Home PCMH 2011. Part 1: Standards 1-3 NCQA Standards Workshop PCMH 2011 Part 1: Standards 1-3 Agenda: Part 1 Overview Content of PCMH 2011 Standards 1 3 Documentation examples* * Examples in the presentation only illustrate the element intent.

More information

Clinical Quality Reporting: Value Modifier

Clinical Quality Reporting: Value Modifier Clinical Quality Reporting: Value Modifier General Internal Medicine Grand Rounds August 13, 2013 Gail Albertson, MD Associate Professor of Medicine Chief Operating Office, University Physicians Future

More information

Business Impact Analysis

Business Impact Analysis Business Impact Analysis Agency Name: Ohio Department of Medicaid (ODM) Regulation/Package Title: Patient Centered Medical Home Rule Number(s): 5160-1-71 and 5160-1-72 SUBJECT TO BUSINESS IMPACT ANALYSIS:

More information

NCQA PCMH 2011 Standards, Elements and Factors Documentation Guideline/Data Sources

NCQA PCMH 2011 Standards, Elements and Factors Documentation Guideline/Data Sources NCQA PCMH 2011 Standards, Elements and Factors Documentation Guideline/Data Sources Key: DP = Documented Process N/D = Report numerator and denominator creating percent of use RPT = Report of data or information

More information

Texas Medicaid Managed Care and Children s Health Insurance Program

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

More information

Project Objective: Integration of mental health and substance abuse with primary care services to ensure coordination of care for both services.

Project Objective: Integration of mental health and substance abuse with primary care services to ensure coordination of care for both services. Domain 3 Projects 3.a.i Integration of Primary Care and Behavioral Health Services Project Objective: Integration of mental health and substance abuse with primary care services to ensure coordination

More information

Patient-Centered Medical Home (PCMH) 2014

Patient-Centered Medical Home (PCMH) 2014 Patient-Centered Medical Home (PCMH) 2014 Part 1: Standards 1-3 All materials 2015, National Committee for Quality Assurance Agenda Part 1 Content of PCMH 2014 Standards and Guidelines Standards 1 3 Documentation

More information

Patient-Centered Medical Home

Patient-Centered Medical Home 2016 Primary Care Commercial and QUEST Integration HMSA Patient-Centered Medical Home Getting Started and Ongoing Management P R O G R A M G U I D E An Independent Licensee of the Blue Cross and Blue Shield

More information

Arkansas Health Care Payment Improvement Initiative

Arkansas Health Care Payment Improvement Initiative Arkansas Health Care Payment Improvement Initiative Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement Arkansas System Transformation Strategy Workforce

More information

A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS

A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS 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

More information

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 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

More information

Department of Human Services Health Care Reform Review Committee Representative George Keiser, Chairman March 19, 2014

Department of Human Services Health Care Reform Review Committee Representative George Keiser, Chairman March 19, 2014 Department of Human Services Health Care Reform Review Committee Representative George Keiser, Chairman March 19, 2014 Chairman Keiser, members of the Health Care Reform Review Committee, I am Julie Schwab,

More information

Crowe Healthcare Webinar Series

Crowe Healthcare Webinar Series New Payment Models Crowe Healthcare Webinar Series Audit Tax Advisory Risk Performance 2014 Crowe Horwath LLP Agenda Bundled Care for Payment Improvements Payment Models Accountable Care Organizations

More information

Practice Readiness Assessment

Practice Readiness Assessment Practice Demographics Practice Name: Tax ID Number: Practice Address: REC Implementation Agent: Practice Telephone Number: Practice Fax Number: Lead Physician: Project Primary Contact: Lead Physician Email

More information

Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care

Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care CASE STUDY Utica Park Clinic Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care The transition from fee-for-service to value-based reimbursement has been a challenge

More information

Washington Common Measure Set on Healthcare Quality. Behavioral Health Measure Selection Workgroup Meeting #2 September 14, 2015

Washington Common Measure Set on Healthcare Quality. Behavioral Health Measure Selection Workgroup Meeting #2 September 14, 2015 Washington Common Measure Set on Healthcare Quality Behavioral Health Measure Selection Workgroup Meeting #2 September 14, 2015 Today s Meeting Agenda 1. Welcome, Member Introductions 2. Review: Public

More information

MEASURING CARE QUALITY

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

More information

ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION)

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

More information

Provider Stakeholder Group November 4th, 2015

Provider Stakeholder Group November 4th, 2015 Provider Stakeholder Group November 4th, 2015 1 Update on Episodes of Care strategy Primary Care Transformation updates Primary Care Transformation TAG process PCMH payment streams and supports Health

More information

Tennessee Payment Reform Initiative

Tennessee Payment Reform Initiative Tennessee Payment Reform Initiative State Innovation Model Public Roundtable Meeting July 31, 2013 PRELIMINARY WORKING DRAFT, SUBJECT TO CHANGE Agenda for State Innovation Model Public Roundtable meeting

More information

Department of Health Services. Behavioral Health Integrated Care. Health Home Certification Application

Department of Health Services. Behavioral Health Integrated Care. Health Home Certification Application Department of Health Services Behavioral Health Integrated Care Health Home Certification Application (Langlade, Lincoln, and Marathon Counties) December 18, 2013 1 Behavioral Health Integrated Care Health

More information

QUICK-REFERENCE GUIDE FOR CHRONIC CARE MANAGEMENT SERVICES

QUICK-REFERENCE GUIDE FOR CHRONIC CARE MANAGEMENT SERVICES QUICK-REFERENCE GUIDE FOR CHRONIC CARE MANAGEMENT SERVICES Department of Business Analytics April 2015 Documentation. Pursuant to this Agreement, Customer may receive copies of or access to certain written

More information

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization Pediatric Alliance: A New Solution Built on Familiar Values Empowering physicians with an innovative pediatric Accountable Care Organization BEYOND THE TRADITIONAL MODEL OF CARE Children s Health SM Pediatric

More information

Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team

Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team Ethan Chernin, MBA Director 1 Objectives Understand

More information

THE EVOLUTION OF CMS PAYMENT MODELS

THE EVOLUTION OF CMS PAYMENT MODELS THE EVOLUTION OF CMS PAYMENT MODELS December 3, 2015 Dayton Benway, Principal AGENDA Legislative Background Payment Model Categories Life Cycle The Models LEGISLATIVE BACKGROUND Medicare Modernization

More information

Kaiser Permanente of Ohio

Kaiser Permanente of Ohio Kaiser Permanente of Ohio Chronic Disease Management Program March 11, 2011 Presenters: Amy Kramer and Audrey L. Callahan 1 Objectives 1. Define the roles and responsibilities of the Care Managers in the

More information

New Hampshire s Community Health Centers

New Hampshire s Community Health Centers New Hampshire s Community Health Centers Bi-State Primary Care Association PCA for New Hampshire and Vermont Since 1986 Vision: Healthy individuals and communities with quality health care for all. Mission:

More information

PCMH and Care Management: Where do we start?

PCMH and Care Management: Where do we start? PCMH and Care Management: Where do we start? Patricia Bohs, RN, BSN Quality Assurance Manager Kelly McCloughan QA Data Manager Wayne Memorial Community Health Centers Honesdale, PA Wayne Memorial Community

More information

Proven Innovations in Primary Care Practice

Proven Innovations in Primary Care Practice Proven Innovations in Primary Care Practice October 14, 2014 The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. 2014 Society for Healthcare

More information

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Domains of Function

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Domains of Function BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Domains of Function Interpretive Guidelines 2014-2015 V1.0 5.0 Extended Access Goal: All

More information

Value-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians

Value-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Value-Based Programs Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Issue: U.S. healthcare spending exceeds $2.8 trillion annually. 1 With studies

More information

Comprehensive Primary Care (CPC) Assessment

Comprehensive Primary Care (CPC) Assessment Comprehensive Primary Care (CPC) Assessment Meaningful Use: The Building Block for CPC By Denise Anderson, Ph.D. NJ-HITEC February, 2013 The Centers for Medicare and Medicaid Services (CMS) jump-started

More information

Delivery System Innovation

Delivery System Innovation Healthcare Transformation Concepts and Definitions Our healthcare transformation process is invigorated by many stakeholders with differing backgrounds. To help them with new terms and all of us to use

More information

PCMH Quality Metrics Report Deadline: March 31, 2015 Guidance Packet

PCMH Quality Metrics Report Deadline: March 31, 2015 Guidance Packet PCMH Quality Metrics eport Deadline: March 31, 2015 Guidance Packet Monica J. Lindeen Commissioner of Securities & Insurance Montana State Auditor 840 Helena Ave. Helena, MT 59601 Phone: 406.444.2040 or

More information

The Patient-Centered Medical Home & You: Frequently Asked Questions (FAQ) for Patients and

The Patient-Centered Medical Home & You: Frequently Asked Questions (FAQ) for Patients and The Patient-Centered Medical Home & You: Frequently Asked Questions (FAQ) for Patients and Families What is a Patient-Centered Medical Home? A Medical Home is all about you. Caring about you is the most

More information

ACO Shared Savings Program: Adolescent Health Measures

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,

More information

Meaningful Use: Registration, Attestation, Workflow Tips and Tricks

Meaningful Use: Registration, Attestation, Workflow Tips and Tricks Meaningful Use: Registration, Attestation, Workflow Tips and Tricks Allison L. Weathers, MD Medical Director, Information Services Rush University Medical Center Gregory J. Esper, MD, MBA Vice Chair, Neurology

More information

Performance Results for Health Insurance Plans

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

More information

Meaningful Use - The Basics

Meaningful Use - The Basics Meaningful Use - The Basics Presented by PaperFree Florida 1 Topics Meaningful Use Stage 1 Meaningful Use Barriers: Observations from the field Help and Questions 2 What is Meaningful Use Meaningful Use

More information

There have been significant

There have been significant Managing Clinical Quality Measures for Meaningful Use and PQRS Using the EHR Method These tips will make it easier to qualify. By Seth Flam, DO Charlieaja Dreamstime.com There have been significant changes

More information

11/2/2015 Domain: Care Coordination / Patient Safety

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

More information

Beacon User Stories Version 1.0

Beacon User Stories Version 1.0 Table of Contents 1. Introduction... 2 2. User Stories... 2 2.1 Update Clinical Data Repository and Disease Registry... 2 2.1.1 Beacon Context... 2 2.1.2 Actors... 2 2.1.3 Preconditions... 3 2.1.4 Story

More information

Health Care Homes Certification Assessment Tool- With Examples

Health Care Homes Certification Assessment Tool- With Examples Guidelines: Health Care Homes Certification Assessment Form Structure: This is the self-assessment form that HCH applicants should use to determine if they meet the requirements for HCH certification.

More information

ADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS

ADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS ADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS 1.0 PURPOSE The purpose of this Addendum is for OHCA and PROVIDER to contract for PCP services in OHCA s SoonerCare

More information

DRAFT Health Home Concept Paper

DRAFT Health Home Concept Paper DRAFT Health Home Concept Paper 1. How are health home services provided? Illinois Medicaid has been primarily a fee-for-service system, involving thousands of healthcare providers who have provided invaluable

More information

THE ROLE OF HEALTH INFORMATION TECHNOLOGY IN PATIENT-CENTERED CARE COLLABORATION. 2012 Louisiana HIPAA & EHR Conference Presenter: Chris Williams

THE ROLE OF HEALTH INFORMATION TECHNOLOGY IN PATIENT-CENTERED CARE COLLABORATION. 2012 Louisiana HIPAA & EHR Conference Presenter: Chris Williams THE ROLE OF HEALTH INFORMATION TECHNOLOGY IN PATIENT-CENTERED CARE COLLABORATION 2012 Louisiana HIPAA & EHR Conference Presenter: Chris Williams Agenda Overview Impact of HIT on Patient-Centered Care (PCC)

More information

Chronic Care Management (CCM) Services Handout

Chronic Care Management (CCM) Services Handout Chronic Care Management (CCM) Services Handout January 23, 2015 Presented by: WPS Medicare Every reasonable effort has been made to ensure the accuracy of this information at the time of publication. However,

More information

State Innovation Model

State Innovation Model State Innovation Model P a t i e n t C e n t e r e d M e d i c a l H o m e W e b i n a r M a y 1 1, 2 0 1 6 1 Agenda SIM Overview & Updates Patient Centered Medical Home Overview Questions 2 1 SIM Overview

More information

Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care

Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care Ann S. Torregrossa, Esq. Director Governor s Office of Health Care Reform Commonwealth of Pennsylvania WORKING TO ACHIEVE

More information

NY Medicaid EHR Incentive Program. Eligible Professionals Meaningful Use Stage 2 (MU2) Webinar www.emedny.org/meipass

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

More information

TABLE OF CONTENTS. Claims Processing & Provider Compensation

TABLE OF CONTENTS. Claims Processing & Provider Compensation TABLE OF CONTENTS Claims Address... 2 Claim Submission... 2 Claim Payment... 2 Claim Payment Adjustments.... 2 Claim Disputes... 2 Recovery of Overpayments... 3 Balance Billing... 3 Annual Health Assessment

More information

ENGAGING PHARMACISTS IN 1305

ENGAGING PHARMACISTS IN 1305 ENGAGING PHARMACISTS IN 1305 UTAH EXAMPLES NICOLE BISSONETTE, MPH, MCHES EPICC PROGRAM MANAGER UTAH PROJECTS INVOLVING PHARMACISTS Prior to 1305 Select Health Pharmacist Hypertension Management Team Based

More information

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 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

More information

Federal Employee Program (FEP) Service Benefit Plan Coverage for Federal Employees

Federal Employee Program (FEP) Service Benefit Plan Coverage for Federal Employees Service Benefit Plan Coverage for Federal Employees In this Section The following topics are covered in this section. Topic Page Federal Employee Program (FEP) Overview H 2 No PCP or Referrals H 2 Enrollment

More information

Accountable Care Organizations 101. MultiCare Connected Care October 20 22, 2014

Accountable Care Organizations 101. MultiCare Connected Care October 20 22, 2014 Accountable Care Organizations 101 MultiCare Connected Care October 20 22, 2014 1 Objectives 1. Describe what an ACO is and why we believe developing an ACO is important 2. Describe examples of what integration

More information

Implications for I/T/U

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

More information

SoonerCare Choice Value Based Purchasing Options

SoonerCare Choice Value Based Purchasing Options SoonerCare Choice Value Based Purchasing Options The Pacific Health Policy Group July 2015 Introduction As health care costs continue to rise, payers seek payment approaches that recognize quality care

More information

Meaningful Use for Eligible Providers. Session One: ARRA Meaningful Use Overview

Meaningful Use for Eligible Providers. Session One: ARRA Meaningful Use Overview Meaningful Use for Eligible Providers Session One: ARRA Meaningful Use Overview How to Navigate This Session Articulate offers many features that may assist with using recorded training. Please check out

More information

Clinical Quality Measures (CQMs) What are CQMs?

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

More information

Informational Webinar for Interested Providers 2013

Informational Webinar for Interested Providers 2013 Informational Webinar for Interested Providers 2013 + NC PATH Program Overview Technology Solutions PRESENTATION OVERVIEW Program Requirements Why NC PATH? Allscripts ProSuite Demo + NC PATH Identity NC

More information

Clinical Decision Support and Care Coordination Using Certified Electronic Health Records

Clinical Decision Support and Care Coordination Using Certified Electronic Health Records Clinical Decision Support and Care Coordination Using Certified Electronic Health Records Cynthia Wallace & Vickie Duncan Bureau of TennCare Quality Oversight Participants today should leave with: A general

More information

Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment

Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Donna Zazworsky, RN, MS, CCM, FAAN Vice President: Community Health and Continuum Care Carondelet Health

More information

Introduction to the GLPTN Program. Provider Office & Physician Organization Briefing

Introduction to the GLPTN Program. Provider Office & Physician Organization Briefing Introduction to the GLPTN Program Provider Office & Physician Organization Briefing What is the GLPTN? The GLPTN is one of 29 Practice Transformation Networks (PTNs) funded under the brand new CMS Transforming

More information

Meaningful Use Stage 2: Important Implications for Pediatrics

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

More information

Highlighting HEDIS 2015

Highlighting HEDIS 2015 Provider Remittance How to read your Facility Provider Remittance Ancillary Providers: Refer to this guide only when working with Facility providers. Highlighting HEDIS 2015 This booklet captures articles

More information

Health Home Program (Section 2703) Iowa Medicaid Enterprise. Marni Bussell Project Manager December 13, 2013

Health Home Program (Section 2703) Iowa Medicaid Enterprise. Marni Bussell Project Manager December 13, 2013 Health Home Program (Section 2703) Iowa Medicaid Enterprise Marni Bussell Project Manager December 13, 2013 1 Two Health Home Programs: Same Triple Aim Goals Chronic Condition Health Home: Primary Care

More information

Stage 1 Meaningful Use Requirements for Eligible Professionals (EPs)

Stage 1 Meaningful Use Requirements for Eligible Professionals (EPs) Stage 1 Meaningful Use Requirements for Eligible Professionals (EPs) The information contained in the public health measure specifications, menu-set measures nine and ten, was created in collaboration

More information

Call-A-Nurse Location

Call-A-Nurse Location Call-A-Nurse A 24-hour medical call center, specializing in registered nurse telephone triage, answering service, physician and service referral, and class registration. Call-A-Nurse Location Call-A-Nurse

More information

Iowa Medicaid Integrated Health Home Provider Agreement General Terms

Iowa Medicaid Integrated Health Home Provider Agreement General Terms Iowa Medicaid Integrated Health Home Provider Agreement General Terms This Agreement is between the state of Iowa, Department of Human Services, (the Department ) and the Provider (the Provider ). The

More information

Our Patient-Centered Medical Home a Process, not a Click

Our Patient-Centered Medical Home a Process, not a Click Our Patient-Centered Medical Home a Process, not a Click Richard Johnston, M.D. President, Medical Clinic of North Texas, P.A. Medical Clinic of North Texas, P.A. MCNT Physician Owned Primary Care Medical

More information

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 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

More information

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) Weight Assessment and Nutrition and Physical Activity for Children/Adolescents (WCC) Description The percentage of members 2 17 years of age who had an outpatient visit with a PCP or OB/GYN and who had

More information