Focus on Quality HEDIS 2015

Transcription

1 Focus on Quality HEDIS 2015 April 22, :30 1:30 p.m., EST Natalie Coble, PMP & Pat Conroy, BSN, CCM BlueCross BlueShield of NC 2014 The Carolinas Center for Medical Excellence

2 Continuing Medical Education Disclaimer This is to certify that Natalie Coble and Pat Conroy have disclosed no relevant financial relationships to this presentation.

3 Objectives After this webinar you will understand: What HEDIS is How provider practices impact HEDIS scoring How the HEDIS scoring impacts providers Tools BCBSNC has available for providers BCBSNC s commitment to achieve Excellent HEDIS ranking 3

4 What is HEDIS, and how does it support better health outcomes and affordability + The Healthcare Effectiveness Data and Information Set (HEDIS) is one of three accreditation tools used by NCQA. it is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. It makes it possible to compare the performance of health plans on an "apples-to-apples" basis. Health plans use HEDIS results to determine where to focus their efforts for improvement Employers, consultants, and consumers use HEDIS data, along with NCQA information, to help them select the best health plan for their needs. Patients who receive evidence based care have improved health outcomes and cost less than those who do not

5 What is NCQA The National Committee for Quality Assurance (NCQA) is a non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations NCQA is considered as the good housekeeping stamp of approval for quality health plans Accreditation from NCQA or another accrediting entity is required for participation on the Health Insurance Marketplace (formally Health Insurance Exchange) NCQA accreditation status is considered by some large national employer groups for Health Plan selection

6 The NCQA score is made up of three categories Category HEDIS Rates: BCBSNC provides a sample of PPO membership for a pre-determined set of HEDIS Measures. Data is collected by looking at claims data (administrative) or by a combination of chart review and claims (hybrid). CAHPS Score: CAHPS is a member facing survey focusing on provider and plan satisfaction and quality. Maximum Points Available July 2013 new point allocations Standards: Comprehensive assessment of a health plans processes and procedures TOTAL:

7 HEDIS, Medicare STARS, CMS-PQRS, Marketplace QRS- where do they intersect CMS PQRS Medicare STARS Marketplace QRS HEDIS 7

8 Where the Measures Intersect 8

9 Where the Measures Intersect continued 9

10 Why HEDIS is Important to BCBSNC + Quality measures that improve health outcomes for our members have been established by evidence-based research + HEDIS focuses on these quality measures + Higher HEDIS ratings reflect the quality care our members are receiving. + Provide a competitive advantage over our competitors for new customers + Marketplace requires a minimum of NCQA Accredited status in order to participate

11 Comparison of PPO Health Plans in NC 11

12 Why HEDIS is Important to Providers + Generating better health outcomes for your patients through quality of care + Quality ratings are becoming more important to physician reimbursement as we move to a consumer-driven market + All HEDIS quality initiatives have been proven effective in decreasing cost + Quality ratings are being put in public view Technology has provided consumers with immediate access to quality rating information and a platform to express satisfaction or dissatisfaction + CAHPS Survey questions related to providers for Commercial, Marketplace and Medicare patients

13 BCBSNC Find a Provider Website 13

14 Public View of Provider with Quality Scores 14

15 Detailed Quality Information 15

16 Public Websites for Quality Indicators 16

17 Patient s and Their Healthcare Providers + Aspects of the physician-patient relationship, especially trust, have been shown to have a significant effect in patient compliance. ¹ + Health Promotion Counseling by providers is more effective than outsourcing counseling to a specialist or health coach, in part because patients view GP s as the most trusted source of health information. ² + 81% of U.S. adults use the internet and, of those, 72% say they have looked online for health information in the past year ³ + An Educated Consumer is the Best Customer- Sy Simms NYC, NY circa 1960 s 17

18 BCBCNC Medicare Advantage Survey 18

19 BCBSNC CAHPS Survey 19

20 Practice Management Survey Questions + In the last 12 months, when you needed care right away, how often did you get care as soon as you needed? + In the last 12 months, how often did you get an appointment for a check-up or routine care at a doctor s office or clinic as soon as you needed? + Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time? + In the last 6 months, when you phoned a doctor s office or clinic after regular office hours, how often did you get an answer to your medical question as soon as you needed? + In the last 6 months, when you phoned a doctor s office or clinic after regular office hours, how long did it take for someone to call you back? 20

21 Provider Specific Survey Questions + In the last 12 months, did you and a doctor or other health provider talk about specific things you could do to prevent illness? + In the last 12 months, did you and a doctor or other health provider talk about starting or stopping a prescription medicine? + In the last 12 months, how often did your personal doctor explain things in a way that was easy to understand? + In the last 12 months, how often did your personal doctor listen carefully to you? + In the last 12 months, how often did your personal doctor show respect for what you had to say? + Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor? 21

22 Why HEDIS is Important to Patients + HEDIS allows patients to compare results on important dimensions of care and service for providers and insurance companies + Quality scores are used by health plans to evaluate the need for improvement and communications/initiatives that directly impact members/patients + Quality scores are published regionally and nationally online as well as in Consumer News and World Report

23 US News and World Report Provider Information Best Hospitals Doctor Finder Finder 23

24 Patient Feedback - Provider Quality and Social Media + Respondents were aware of and more willing to pay for GP s with higher quality ratings.⁴ + There have been findings that consumers tend to choose high-quality providers. Consumer choice of primary care physicians appears to be based more on quality.⁵ + Over 40% of people with chronic diseases go to social media for support and information Those seeking information are more likely to turn to conventional digital sources, while those in need of emotional support will be more drawn to social media platforms 24

25 Working Together for Excellence

26 Collaborative Approach to Quality Healthcare BCBSNC This approach will result in quality improvements, preventive care, compliance and management of chronic conditions with physicians Develop tools provide education & interventions Reports PQM results Rewards performance with members Education, Intervention, prevention, incentives, care reminders Opportunities to share best practices BCBSNC verifies and analyzes data claims & medical records, provide BCBSNC with abstracted data 26

27 BCBSNC Supports Members + Preventive screening reminders Cholesterol, diabetes, pneumococcal, breast, colon and cervical cancer screening and childhood immunizations + Diabetes Progress Report Gift card incentive + Disease Specific Member Mailings Use of Beta Blocker after Acute MI, Asthma, COPD, Depression + Case Management Nurses, Social Worker MSW, Care Coordination, Education + Disease Management Nurse health coaches, 70 different care reminders for patients with chronic conditions, numerous printed member education tools + Community awareness programs Flu Clinics BCBS Association support throughout the community CDC 27

28 BCBSNC Blue Connect Member Portal 28

29 Provider Support

30 BCBSNC Supports Providers + Provider and Provider Office Education HEDIS Tools, Provider Claims filing Tips Red, White and Blue NC Training, tools and resources to help current and former servicemen and woman + Provider Performance Analytics/Provider Quality Management Multiple care gap reports Medical record management Authorizations + Quality Management Consultants + Provider Portal Medical Policies Pharmacy, Network Participation, Blue Medicare, Quality Based Programs 30

31 Provider Support Tools

32 Provider Support Tools + Provider Portal HEDIS Tools HEDIS Toolkits Medical Policy 32

33 Provider Portal Options 33

34 BCBSNC Medical Policies Available Online to Providers 34

35 HEDIS Provider Information Available Online 35

36 HEDIS Tools

37 HEDIS Provider Tools Contain + Title of Measure + Measure Description + How to improve HEDIS/PQM score + Codes to identify the population + How to code to obtain HEDIS credit + Additional resources 37

38 HEDIS Overview Tool Optimizing Provider Quality Measurement (PQM) Scores Understanding HEDIS Additional tools Footnotes, and URLs for NCQA and HEDIS specs 38

39 HEDIS Measures of Focus 2014

40 Diabetes Care: 4 Specific Diabetes Measures 40

41 Antidepressant Medication Management Adult BMI 41

42 HEDIS Provider Tools &Patient Education Materials HEDIS Quality Measures We have outlined the details of specific measures, including how to code in order to receive appropriate credit. Improving HEDIS Scores HEDIS Provider Measures of Focus overview document Improving HEDIS Scores - overview document Condition Management Topics HEDIS Measure: Cholesterol - testing (LDL-C) for patients with cardiovascular conditions HEDIS Measures: Diabetes Care - subset of measures HEDIS Measures: Antidepressant - medication management HEDIS Measure: Beta blocker - persistence of beta blocker treatment after a heart attack HEDIS Measure: Spirometry - testing for patients with COPD HEDIS Measures: Attention Deficit Hyperactivity Disorder (ADHD) - follow-up care for children prescribed ADHD medication HEDIS Measures: COPD - medications after an acute exacerbation HEDIS Measure: Pharyngitis - appropriate testing for children HEDIS Measure: Acute Bronchitis - avoidance for antibiotic treatment in adults with acute bronchitis HEDIS Measure: URI - appropriate treatment for children with upper respiratory infection (URI) Web links for resources and patient education materials regarding appropriate antibiotic use: CDC page for outpatient providers CDC homepage on appropriate antibiotic use 42

43 HEDIS Measure: URI 43

44 CDC Campaign Get Smart - Appropriate Use of Antibiotics 44

45 Resources to download and print or order 45

46 Posters and Rx pad to order from CDC 46

47 Prevention materials available 47

48 Many resources available from the CDC 48

49 CDC Tips for Developing Chlamydia Screening in your office 49

50 Our Community

51 BCBSNCFoundation.org 51

52 BCBSNC Foundation Partnering with our Communities 52

53 Blog blog.bcbsnc.com 53

54 Resources for Community Health Services 54

55 Community Resources 55

56 BCBSNC Multi Pronged Approach Family BCBSNC Patient Healthcare Provider Community 56

57 BCBSNC s Plan for Excellence Collaborate with Providers to improve member s health Explore every opportunity to enhance member engagement in their health Maximize all data streams Examine internal processes for maximum effectiveness 57

58 How you can help Provide feedback regarding HEDIS tools Suggestions for new resources Other Suggestions.Contact or Call Quality Management voic box at

59 QUESTIONS.COMMENTS 59

60 To Get HEDIS Provider Tools for your Practice + Go to bcbsnc.com and type tools in the search bar allows you to view and print HEDIS tools, and request free items to support your practice Patricia.Conroy@bcbsnc.com or

61 References 1. Ly Dan P., Glied Sherry A., Disparities in Service Quality Among Insured Adult Patients Seen in Physician Offices. J.Gen Intern Med 25(4): NIH Public Access published in final edited form as: J R Coll Physicians Edinv December; 39(4) 3. Pew Health Online Report (2013) 4. Clancy, Carolyn M, Patient Engagement in Health Care Health Service Research.2011 Apr; 46(2) Arnold, PhD. Sharon B., Improving Quality Health Care: The Role of Consumer Engagement. Robert Wood Johnson Foundation October 2007 Brief 1 of

62 Thank you for participating today 62

63 Upcoming Webinars Quality Outcomes and Pay for Performance Transformation in Physician Practices Wednesday, May 20, :30-1:00, EDT Meaningful Use Stage 2: Understanding and Implementing Measures Wednesday, June 17, :30-1:00, EDT

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