2016 BHPP Quality Measures

Transcription

1 2016 BHPP Quality Measures 1. Who do these quality measures apply to? If you are a primary care physician with attributed patients under managed contracts. This includes internal medicine (that do not admit to hospital), family practice, pediatrics, etc. 2. Where do I find my results for these measures? Log into Crimson Population Risk Management and review data quarterly; quality performance summaries will be ed to each partner quarterly. The quarterly performance summary will contain: 1. A list number of patients and cases attributed. 2. # of BHPP meetings attended 3. # of Crimson log-ins 4. Measure outcomes 3. How do I log into Crimson? Once you have authenticated your account in Crimson 1. Use the Citrix app available through APPS4MED 2. Log onto BHPP.NET and click the Crimson tab located in the top header of home page 3. Crimson direct website address:

2 4. What if I do not have a Crimson account or user ID? Contact Megan McQueen at or at megan.mcqueen@baptist-health.org 5. What if I forget my password? Click Forgot Password located within log in portal. 6. What if I have difficulty logging into my Crimson Population Risk Management account or need assistance? Contact Crimson customer support at: 7. Once I log into Crimson how do I locate the Crimson Population Risk Management Module? Go to the top right hand corner of the home page and click the option and click my Products, then click on Crimson Population Risk Management 8. Where do I go once logged into Crimson Population Risk Management? Crimson population risk management tool will open to the home page that provides an overview of the population Under contract with BHPP. The home page is an aggregate view of all physicians. Physicians using Crimson Population Risk Management are required to sign a data access agreement prior to accessing profile!!!!!! Contact Megan McQueen at megan.mcqueen@baptist-health.org to obtain user access consent. 9. How are patients attributed to me in the BHPP quality performance summary? Crimson is a claims based data repository. Claims data will be sent to Crimson Population Risk Management quality data base from payers (ie: Health Advantage) that we are contracted with and agree to submitting data into Crimson. There is a cost incurred for payers to load claims based data into Crimson and some payers may choose not to do so. Crimson Population Risk Management will never reflect the physician s entire clinic practice and established patients. The data will only be reflective of patients attributed under managed contracts and should serve as directional data. Example: Dr. Jones at Getwell Family Clinic sees an average of 45 patients/day. His total clinic population is over 1,000. Dr. Jones logs into Crimson and finds that only 68 patients have been attributed to him. Dr. Jones thinks the data is not correct because he has more than a 1,000 patients in his clinic. Dr. Jones then realizes this would be due to the fact that BHPP is currently only contracted with Health Advantage and Blue Cross to manage 2 populations and those are the only patient claims loaded into Crimson for Dr. Jones at this time. Since Dr. Jones has a majority of Medicare patients in his clinic, his Crimson data is limited. Once BHPP contracts with different payers more of Dr. Jones patients may show up in the site.

3 Measure Definitions Readmissions: 1. All Cause Readmissions- A readmission is any admission for which a single patient was admitted again within 30 days of discharge from the index admission. The all cause rate is the percentage of total admissions that resulted in readmission within 30 days of index admission. This measure will be reported as a percent of cases that readmitted for the population. The readmission will be attributed to the primary care physician and the discharging facility as a shared outcome. 2. Avoidable In-patient Admissions: Avoidable Admissions are identified based on the Agency for Healthcare Research and Quality's Prevention Quality Indicators. The AHRQ PQIs identify conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease. Avoidable in-patient admissions will be attributed to primary care physicians treating patients over the ages 18 years and older. AHRQ QI Version 4.5, Prevention Quality Indicators #90, Technical Specifications, Prevention Quality Overall Composite Prevention Quality Overall Composite Technical Specifications Prevention Quality Indicators #90 (PQI #90) AHRQ Quality Indicators, Version 4.5, May 2013 Area-Level Indicator Type of Score: Rate Description Prevention Quality Indicators (PQI) overall composite per 100,000 population, ages 18 years and older. Includes admissions for one of the following conditions: diabetes with short-term complications, diabetes with long-term complications, uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic obstructive pulmonary disease, asthma, hypertension, heart failure, and angina without a cardiac procedure, dehydration, bacterial pneumonia, or urinary tract infection. [NOTE: The software provides the rate per population. However, common practice reports the measure as per 100,000 population. The user must multiply the rate obtained from the software by 100,000 to report admissions per 100,000 population.] Numerator Discharges, for patients ages 18 years and older, that meet the inclusion and exclusion rules for the numerator in any of the following PQIs: PQI #1 Diabetes Short-Term Complications Admission Rate PQI #3 Diabetes Long-Term Complications Admission Rate PQI #5 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate PQI #7 Hypertension Admission Rate PQI #8 Heart Failure Admission Rate PQI #10 Dehydration Admission Rate PQI #11 Bacterial Pneumonia Admission Rate PQI #12 Urinary Tract Infection Admission Rate PQI #13 Angina without Procedure Admission Rate PQI #14 Uncontrolled Diabetes Admission Rate PQI #15 Asthma in Younger Adults Admission Rate PQI #16 Lower-Extremity Amputation among Patients with Diabetes Rate discharges that meet the inclusion and exclusion rules for the numerator in more than one of the above PQIs are counted only once in the composite numerator.

4 AHRQ QI Version 4.5, Prevention Quality Indicators #90, Technical Specifications, Prevention Quality Overall Composite Denominator Population ages 18 years and older in metropolitan area or county. Discharges in the numerator are assigned to the denominator based on the metropolitan area or county of the patient residence, not the metropolitan area or county of the hospital where the discharge occurred. The term metropolitan area (MA) was adopted by the U.S. Census in 1990 and referred collectively to metropolitan statistical areas (MSAs), consolidated metropolitan statistical areas (CMSAs), and primary metropolitan statistical areas (PMSAs). In addition, area could refer to either 1) FIPS county, 2) modified FIPS county, 3) 1999 OMB Metropolitan Statistical Area, or 4) 2003 OMB Metropolitan Statistical Area. Metropolitan Statistical Areas are not used in the QI software. What is meant by '/1k'? This refers to the utilization of any services per 1000 members. (currently 14k in population) ED by '/ 1k'-This refers to the utilization of services (visits to the ED that did not become admissions) per 1000 members 'Percent Generic'-The portion of prescribed drugs within the therapeutic class that were generic as categorized by Medispan. How is 'Percent Generic' calculated? Percent Generic is calculated as the number of 30-day adjusted prescriptions filled for generic and over-the-counter drugs divided by the total number of 30-day adjusted prescriptions. For a particular prescriber, what do "% of Generic Usage" and "Cost Per Unit (Avg)" mean? "% of Generic Usage" is the percent of generic prescriptions that a given prescribers writes in the selected drug class. "Cost Per Unit (Avg)" is the average cost of a prescription in a given drug class for a particular provider. 'EBM'-EBMs are evidence-based measures. What is the clinical basis of an 'EBM'? Evidence-based measures (EBMs) are defined by the NCQA and are part of the HEDIS methodology. What does it mean to be compliant with an EBM? Compliance means having performed the required test or procedure according to the frequency demanded by the measure. How is my Overall EBM Compliance Rate calculated? Overall Compliance Rate is number of members in compliance across all measures divided by the total number of eligible members across all measures. What is the source of the Evidence-Based Measures? Measures are compiled from multiple sources, including HEDIS and AHRQ.

5 Adult Evidence Based Measures Definitions: 1. Measure CDC-HBA1C: Diabetics who had a HbA1c test The percentage of patients years of age with diabetes (Type 1 and Type 2) who had an HbA1c test during the prior 12 months. Population Patients with diabetes, who are years old in the 12 month measurement period. Continuous Enrollment The measurement period with no more than one gap in enrollment of up to 45 days during the measurement period. Two methods identify diabetic patients. Pharmacy data Claim or encounter administrative data 2. Measure CDC-LDLC: Diabetics who had a LDL-C test The percentage of patients years of age with diabetes (Type 1 and Type 2) who had a LDL-C test performed during the measurement year. Population Patients with diabetes, who are years old in the 12-month measurement period. Continuous Enrollment The measurement period with no more than one gap in enrollment of up to 45 days during the measurement period. Two methods identify diabetic patients. Pharmacy data Claim or encounter administrative data 3. Measure BCS: Women who had a Mammogram (not penalized for screening prior or after specified age range) The percentage of women years of age who had a mammogram to screen for breast cancer. Women years as of the end of the measurement year. The measurement year and the year prior to the measurement year with no more than 1 gap in enrollment of up to 45 days during each year of continuous enrollment. Numerator Specifications One or more mammograms during the measurement year or the year prior to the measurement year. A woman had a mammogram if a submitted claim/encounter contains any relevant code. Denominator Specification The eligible population. 4. Measure LPA: Lipid Profile Annually The percentage of members 18 to 85 years of age who had a diagnosis of hypertension and who had a lipid profile during the measurement year that includes total cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides. Age 18 to 85 years of age as of the end of the measurement year. Numerator Specification Those beneficiaries in the denominator who have had a lipid profile in the measurement year that includes total cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides. Denominator Specification The denominator for the HEDIS measure, Controlling High Blood Pressure, most recent edition.

6 Pediatric Evidence Based Measures 1. Measure ADD: Follow-Up Care for Children Prescribed ADHD Medication The percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported. Initiation Phase. The percentage of members 6 12 years of age as of the IPSD with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with practitioner with prescribing authority during the 30-day Initiation Phase. Continuation and Maintenance (C&M) Phase. The percentage of members 6 12 years of age as of the IPSD with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. 2. Measure CWP: Appropriate Testing for Children with Pharyngitis The percentage of children 2 18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. A higher rate represents better performance (i.e., appropriate testing). Intake Period :A 12-month window that begins on the first day of the seventh month of the year prior to the measurement year and ends on the last day of the sixth month of the measurement year. The Intake Period captures eligible episodes of treatment. 3. Measure URI: Appropriate Treatment for Children with Upper Respiratory Infection The percentage of children 3 months 18 years of age who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription.