Early life cycle of EPSDT and HEDIS ages 0 to 11

Brain Clark:

Good afternoon everyone and welcome to the second of two webinars this month. The title of today's webinar is the early stages of the life cycle, EPSDT and HEDIS. We'll be focusing on the zero to 11 years of age members today. So, this is the second offering for this webinar. This month we presented last Thursday in the morning and this is the afternoon session and prior to the webinar today you received the slides via email from me in a PDF format. I just ask that you all please follow along with us today and if you actually registered for the webinar after 2:30 today, you did not receive the slides. So if you did register after 2:30, please utilize the chat box right now and say I need a copy of today's slides.

Brain Clark:

My name is Brian Clark and I'm your host today. My title is quality translator. I work in the quality management department here at Aetna, Better health. Also, presenting today is Jacob Stipe, EPSDT coordinator and Debra Barkley, quality nurse associates. Also, both of Jake and Debbie working in the quality management department here at Aetna. So, the goal of this webinar today and in all webinars in this series is to spark conversations with providers in multiples States nationwide. We have 10 States represented today in the webinar. We're exploring ways to cut down on the burden of medical record review and maximize administrative data capture.

Brain Clark:

Currently, we are in the peak of fetus Medical Record Review season and the ideal way to capture care is administratively through claims so we don't have to reach out as much to chase down records during the season. So, it's the hope that by educating on fetus and appropriate coding throughout this webinar series, we will reduce the burden of Medical Record Review on the office and on the health care insurance plan.

Brain Clark:

So, we'll go over the agenda for this specific webinar shortly in more depth. I'd first like to welcome 10 State, Illinois, Maryland, New Jersey, Ohio, Pennsylvania, Texas, Louisiana, Kentucky, Florida and Michigan. I'm just so happy you all could fit this important webinar schedule. I know you're very busy as are we. Now, today's webinar will last approximately 50 minutes and then we'll have some time for questions at the end as always. Now, in addition to the questions at the end during the webinar, we'll be pausing for Q&A. We'll be asking some questions here and there. And participation is definitely encouraged as always. Please utilize the Q&A box to answer in response to any questions we pose to the audience. Please utilize the Q&A box and hover your mouse over the top part of the middle of your screen and find the option for Q&A. And then choose the participate drop down options and type your question or comment in the white box. And send to all panelists, please.

Brain Clark:

Okay. So, what you're looking at right here is Aetna's vision statement. The four core values. In the center of all that we do are the people that we serve. So, Aetna's vision statement or philosophy as to the way we manage health care is that you don't join us, we join you. What does that mean? So, essentially for this webinar purpose by joining you on the line today from various States, I so hope that in this webinar environment that we're more effectively reaching our Aetna better health members. So, the four core values are integrity, excellence, inspiration and caring. And like I said earlier in the center of all that we do are the people that we serve, our providers and members. As a company we act with integrity and aspire to excel each day. And the hope is to build a healthier world.

Brain Clark:

All right. So enough of that. Let's go over the agenda. The agenda items are as follows. First off, we will look at the topic of EPSDT, Early and Periodic Screening, Diagnosis and Treatment. But before we do that, Jake actually is going to pose the questions to the audience. Then after the EPSDT discussion, we'll move on into HEDIS, measures of care for the population that we're focusing on today, the young ones. Then we'll look at the state of childhood obesity in the United States of America and give you an idea as to what the state is of obesity in young children. Some good things and some bad things and some that are right in the middle.

Brain Clark:

And then we'll look at strategies as to how to increase well care adherence. And then, like I said earlier, the goal is to capture care administratively through claims. So we'll look at some NCQA accepted codes, they can capture care more effectively for the HEDIS measures that we're looking at today. Okay. Also, the quality translator that is going to be managing the inbox today is a Madison Yonlisky and she is going to answer my question right now. So do we have anything going on in the Q&A box, Madison?

Madison Yonlisky:

We do not have anything in the Q&A box at this time, Brian.

Brain Clark:

Okay. I'd like to introduce Jake Stipe, EPSDT coordinator. Jake is the first presenter. Jake, we'll first start with a question to the audience and then look at EPSDT and HEDIS measures affecting the population of members highlighted today, the state of childhood obesity and other agenda topics. So Jake, why don't you take it from here.

Jacob Stipe:

Thank you, Brian. Again, the question is for the group here and want to just get an idea of what your biggest challenges are in the office in providing care to families with children up to 11 years of age. So [inaudible 00:06:52]feel free to type in your answers in the Q&A box.

Madison Yonlisky:

Okay. I'm just giving it a moment or two for some responses to come. Somebody has said, transportation, lack of resources, somebody said as well. That seems to be the only ones we're really getting in right now.

Jacob Stipe:

Those are two very common responses that we see here. I do see another response here as well.

Madison Yonlisky:

Yes. In the chat box somebody said, missed appointments or they have that contact information for their members. Somebody said, staffing for kids who received shift care services. Transportation again, that seems to always be a common one.

Jacob Stipe:

I think for kids who receive shift care services, this is a very specific... that's not an answer we get a lot in these questions. So that is a really interesting response and I'm really glad Colleen, that you mentioned that. Okay. So this is concerned. And think with this... I know we talk a lot about our special needs unit and here in Pennsylvania, there's case managers. That's something where, are a little more in depth, actually all these are a little more in depth, especially when it comes to transportation. But it's something that us as the health plan, we'll be able to assist with in our different capacities. These are very good responses and something that will take from this presentation and so thank you so much.

Jacob Stipe:

Now, take a look here at the diagram here. We're talking about care, we're talking about services and we're talking about measures. We're going to be defining these three specific terms during the presentation and mention these things over and over again. But we want to make this diagram because it's different programs or services or measures but they all come together in the middle and that in the middle will be our child under 11 years or 11 years of age or younger. It is very important that we have this child in mind. When we go through the presentation, we'll talk about different HEDIS measures that affect children in this age. The programs that will affect children at this age. But we'll also give an example of how these can all interact when it comes to dealing with a patient.

Jacob Stipe:

So we have EPSDT, well-child visit and HEDIS measures. I want to go into the history of EPSDT and a little bit about what it is in regards to Medicaid. So Medicaid was passed through the Medicare and Medicaid act in 1965, that created CMS in 1967, the SSA mandated EPSDT services for children up until age 21. However, many States were slow to implement those changes that took place. So 22 years later, 1989, Congress amended the Medicaid statute to make EPSDT statutory requirements. In that statutory requirements that we'll see on the next slide here, it states that each State should provide these services for children from newborn up until the child turns 21 years of age. So once they turned 21, are no longer eligible for EPSDT services. There's Periodic visits based on the recommended guidelines from the AAP, Bright Futures Periodicity Schedule.

Jacob Stipe:

There's also screenings and assessments based on that schedule as well. There are different components of EPSDT that are measured using the HEDIS performance metrics that we'll get into a little bit later. So you put all this together and we go to the next slide here. It will define the different parts of the acronym for EPSDT. So this first part here is taken from the statute where it defines what is the meaning behind early and periodic. So we have assessing the child's needs through initial. So as soon as the child comes into your office, initial and periodic examinations and evaluation, these are the well-baby, well-child or preventive care visits at different names. We will mention it here as the well-child visit. We also want to assure that those health problems are diagnosed and treated early before they become more complex and their treatment becomes more costly.

Jacob Stipe:

This is done through the visits, screenings but also the immunizations as well. So that's the early periodic part of EPSDT, the S stands for the screening. There are different screenings that are part of EPSDT and you have the anemia, which is the hematocrit hemoglobin screenings, the developmental delay and autism spectrum disorders screenings, blood lead level screening, which could be just the finger stick or the venous lead draw or venous blood draw, I should say. And vision and hearing screens are included as well as the dyslipidemia. Especially for children in this population at this age. Even this dyslipidemia is something that is a part of EPSDT and part of the bright futures periodicity schedule for children, nine, 10 or 11 years of age.

Jacob Stipe:

Assessments, we have physical exam obviously but also the developmental surveillance, psychosocial behavioral assessment, tobacco, alcohol and drug use assessments, height and weights. And the BMI value or percentage, are also assessments that are included in the EPSDT in the screening portion. So the last part will be the diagnosis and treatment. The statute states that healthcare must be made available to treat correct or ameliorate the defects and physical and mental illnesses or conditions that are discovered by the screenings. However, the conditions that the child may have need not to be newly discovered. So, if there is a condition that was found before they are on a Medicaid plan or CHIP plan or before they come into your office, EPSDT or for the Medicaid statute actually clarify, for Medicaid. All these conditions must be treated.

Jacob Stipe:

So for those Medicaid services, for children, even if the state doesn't cover these for adults, they should be covered for children. That's through the EPSDT expanded services portion. So put all this together, you get there early and periodic screenings and the diagnosis and treatment. And you get the statutes that put this program in place that I'm sure all the providers here are aware of. So, that was just a little bit of background of what EPSDP stands for. If we get into the next part here, I want to get into HEDIS. HEDIS is the Healthcare Effectiveness Data Information Set. What HEDIS will be looking at are a set of performance measures developed by the NCQA. They measure specific dimensions of care and service. They help evaluate performance in quality of care, access to care and satisfaction with the care that the members receive. What this does is provide a clear picture of the outcomes that the members receive in these specific areas, in care.

Jacob Stipe:

So the next slide here, the importance of HEDIS, regulatory bodies may use HEDIS data for accreditation and enrollment purposes. The public also has access to HEDIS information that can assist them with choosing a plan based on how a health plan is performing in HEDIS rates. They may be interested in that information that will help them choose the best possible plan for their needs. And then a provider pay-for-performance, is often linked to these HEDIS scores as well. So, that would be the reason why HEDIS is such an important aspect of care and why I something that we focus on in regards to quality. Any questions so far? I'll give it a minute here.

Madison Yonlisky:

We didn't have any ques... actually[inaudible 00:16:28]somebody asked, if children get immunizations from local health department, how do they let us know on the claim while getting their well child exam?

Jacob Stipe:

That's a good question. So for the... so if they go for immunization at a local health departments, it may be... I get what you're saying. I know there is a database in Pennsylvania, so I think this may be a specific question for your point of contact. That's what we'll have to do is just find out what State you're in and then just have your point of contact through that. So that might take a little bit of additional research, to try to connect. Yeah, go ahead.

Madison Yonlisky:

I was just going to say, just so everybody is aware, if we're not able to answer your questions or get to your questions or if the question needs to go to your point of contact, everything you type in the Q&A and the chat box is recorded and we do forward that to your point of contact to reach out to you and address that. So again, if we don't have the answers today, you will get an answer here in the near future.

Debra Barkley:

Hi, Jake.

Jacob Stipe:

Yes.

Debra Barkley:

Hi. It's Debbie. I was just going to add to what you said and what you said is absolutely correct that many States do have a data bank where in that information is passed on, especially for Medicaid members. Also, it's really, really important and it's an opportunity for providers to reach out to past providers that the member may have seen to collect those records. So that's one way that that can be collected too. But historical banks are kept in many and as you said, the point of contact could address that for that specific State. But that is definitely an opportunity to get those records.

Jacob Stipe:

Thank you Deb. I do see that there's a question here about screening labs from Mickey. Are you talking about the screenings that are required for ages 11 to 16 years of age? During the the physical?

Madison Yonlisky:

That's how I had read that question.

Jacob Stipe:

Okay. That's something that we can answer. It's not part of this presentation today but yeah, that's something we can get answered for you, for specifically for your State. Like what are the required screenings from ages 11 to 16. [inaudible 00:19:25]

Madison Yonlisky:

And somebody else asked about Amenia and lead screening, if it needs to be done every year as well.

Jacob Stipe:

Well, lead screening is definitely a State by State. No program... that's something that different States need. So, there's the recommendations in the bright futures periodicity schedule. For anemia there's... for the anemia screen, there's a recommendation in the bright futures for age nine to 11 months. It was not... if doesn't take place at that visit, then it should take place at the 12 month visit. But again, those are the recommendations. Different States may have additional requirements. So that's something to have from your point of contact to see if there's anything in addition there. For the lead I know there's a recommendation that for this population, nine to 11 months should be a lead screening or blood draw or capillary and then also at 24 months as well.

Jacob Stipe:

But again, those are the recommendations from the bright futures peer to see schedule. And then the Tatum, again, there may be specifics for your State but we also forward the bright futures, which are the guidelines that all States based their [ATST 00:20:59] schedule on.

Madison Yonlisky:

And that looks like all the questions we have right now.

Jacob Stipe:

Very good questions because it's a very active group. Okay. If you want to talk about state of childhood obesity from the project of the Trust for America's Health and the Robert Wood Johnson Foundation. It was an article that I want to talk... discuss the childhood obesity trends. So some positive things that took place, when there is intervention, when a family with young children receive snap, which is a WIC nutrition program for low income families, for those with children ages two to four years of age in 31 States and in three U.S. territories, they've reported declines in obesity rates.

Jacob Stipe:

We've seen improvements... different variations in different places which we find positive. So there were double digit increases found in Eastern Massachusetts, which is a more populated part of the country. Also, in places like Kearney, Nebraska, which is not as densely populated. So when we see that there is intervention and we see that there's participation from the families and education, then we do see impact on obesity rates for young children. With that said, there are still some concerns that we see 18.5% of children ages two to 19 are obese. Which adds up to 12 million U.S. children are about one out of every six children, which puts them at high risk for high blood pressure, high cholesterol, sleep apnea, bone and joint problems, asthma, diabetes and then also social issues. Mental health issues like bullying and also depression as well.

Jacob Stipe:

Also, concerns about diet and exercise found that children... very, very large percentage of children have poor diets, maybe meeting their recommended nutrition guidelines and when it comes to vegetable and fruit intake and also we're finding that less than half of children get their recommended 60 minutes of daily exercise as well. So with that said, there are ways to address obesity and lack of physical activity for children ages three to seven. We do have a HEDIS measure called the WCC, which is weight assessment and counseling for nutrition and physical activity for children and adolescents. The sub measure of the WCC HEDIS measure looks at documentation coding for physical activity and for nutrition. So, this is part of the well child visit and again, the age that we're looking at are ages three to 17 years of age, that this would apply to. So this falls into our 11 and under population then.

Jacob Stipe:

Okay. So taking a look at council for nutrition, there's different methods that this can take place in the office. So, I'll go over the current nutrition behaviors of the child, review checklists indicating that nutrition was addressed, counsel or refer for nutrition education have education materials on nutrition during a face-to-face visit, anticipatory guidance for nutrition, weight or obesity counseling as well, would apply for this sub measure for WCC and address the issues we're seeing with obesity. So, we do have example codes where this can be captured administratively. We have the dietary counseling and surveillance, ICD-10 code and CPT code for nutrition counseling. There are also HCPCS codes in here as well for nutrition counseling, from a dietician visit and face-to-face behavioral counseling for obesity.

Jacob Stipe:

We also have a counseling for physical activity and this can be done again with a checklist that indicates physical activity was addressed. I'm looking at current physical activity, exercise routine that the child is currently doing. Participation in sports activities or an examination for sports participation, counseling or referral for physical activity, having educational materials, anticipatory guidance for physical activity. Again, weight and obesity counseling as well. ICD-10 code, that's listed here will be for the encounter for examination for participation in sport. And there are also HCPCS codes. Again, the face-to-face behavioral counseling will apply here. Also, the HCPCS for exercise classes from a nonphysician provider. To note, anticipatory guidance that is solely related to safety. So, helmet safety, water safety without specific mention of physical activity does not meet this criteria. So again, there must be a specific mention of physical activity during counseling portion to meet that sub measure.

Jacob Stipe:

Okay. Do you want to take a look at additional measures for HEDIS when it comes to our newborn, two 11 year old population. First of all, take a look at it and we'll be the W15, which is the well child visits in the first 15 months. And us will be looking at the number of well visits with a PCP a child has had since the first 15 months of life. With the expectation of there being at least six visits and we've looked at it the period of PCP schedule that we'll make sure we get out to the groups. And so we had some questions about that. We'll see that they're not visits to satisfy this measure that are requested there. So that's why they have this measure as being at least six visits.

Jacob Stipe:

And then the WCC, which we mentioned, this would be the full measure. So that will be the percentage of the members ages three to 17 years of age who've had an outpatient visit with a PCP or an OB GYN. And they're being evidenced through documentation of the counseling for nutrition, physical activity that we already mentioned but also the BMI percentile during the measurement year. So the next one here is another well-child measure that will apply to this population that's a W34 for which your well-child visits from three to six years of age. That's looking at the percentage of those children, who've had one or more well visit with a PCP during the measurement year.

Jacob Stipe:

There's also the childhood immunization measure here as well, CIS. That's when we're looking at, the percentage of children who turned two years of age during the measurement year who have had the vaccines based on the vaccination schedule. That's listed there by their second birthday. We also have the lead screening measure as well. We did mention a little bit about lead screening. This will be looking at the percentage of children two years of age who've had one or more capillary or venous lead blood test for lead poisoning by their second birthday. Also, annual dental visits. So this will be looking at the percentage of members from two to 20 years of age who've had at least one dental visit during the measurement year. So again, a lot of these measures we're looking at when it comes to the lead screenings, when it comes to the W15, there's a minimum that's there that there's a little bit below the actual recommendations.

Jacob Stipe:

There's more than six visits recommended for children by 15 months. But looking at HEDIS we want to make sure that there is at least six, when we look at the annual dental visit, obviously we know that we want children to go twice a year but this was looking at, do they have access, are they going, are they getting there at least once a year?

Brain Clark:

Hey Jake, can I jump in for a second?

Jacob Stipe:

Sure.[crosstalk 00:29:54]

Brain Clark:

I just want to clarify one thing. We've mentioned two words, measurement year, a couple of times so far. So depending on what HEDIS measure you're looking at, dictates how far back the look period is and what measurement year you're looking at. But measurement year, currently, right now we're in HEDIS 2019 looking at care primarily given in 2018. So the measurement year is 2018 right now. And the goal here, in the webinars series is to capture care administratively. So, that comes HEDIS 2020. We don't have to look at records as much for MRR, for HEDIS 2019. So measurement year currently that we're in right now is 2018.

Jacob Stipe:

Okay. Thank you Brian. Then questions, I do see Madison is going through and answering questions as they come in and she's doing a great job here.

Madison Yonlisky:

Thank you. We do have a lot of the questions are regarding billing, payments like incentive. So being that those things are State-specific, we do forward those questions to your point of contact. They do reach out to you fairly quickly. So again, unfortunately regarding billing and things of that nature, we will have to forward this questions along.

Jacob Stipe:

Okay. Thank you very much. We're going to go ahead and turn it over to Deb Barkley, who's our quality management and nurse associates at the Better Health, Pennsylvania.

Debra Barkley:

Thanks Jake. Well, everyone, let's just continue on where Jake was talking about of measures. We're going to just add a couple more measures in and that can be covered for this age group. So let's take a look at this one. This is URI and that's the appropriate treatment for children with upper respiratory infection. So this measure looks at the percentage of children ages three months to 18 years of age who were given a diagnosis of respiratory infection, upper respiratory infection and who were not dispensed an antibiotic during the measurement period and either in an outpatient or ED visits.

Debra Barkley:

So, the bottom line of this measure is that with antibiotic overuse and trying to prevent that and drive that down, it's actually an inverse measure. So the goal is to see whether or not these antibiotics were prescribed appropriately. So the lower the rate for this measure, the better. The measurement year for this particular measure is a little bit different. So it is the measurement period is the measurement year of the year prior to the measurement year, starting in July 1st. So that would be... if we're looking at information for this webinars for HEDIS 2019, so that would be starting in 2017, July 1st through June 30th of 2018.

Debra Barkley:

So, that measurement period is a little bit different because most times the measurement period for many measures started at the beginning of the year, which would be for HEDIS 2019 would be January 1st of 2018 through December 31st of 2018 but this one's a little bit different. So just be aware of that one. Next slide, let's take a look at the next measure that we're going to talk about. This is MMA and that's medication management for people with asthma. It's the percentage of members who are five to 64 years of age during the measurement of year. This one is the calendar year, who were identified as having persistent asthma and who were dispensed the appropriate medication that remained on their treatment for the treatment period.

Debra Barkley:

So two stratifications are looked at here. So the first one are those that stayed on the medication 50% of the time and those that stay on the medication 75% of the time. So you say, how do we look at that? And that's all done through the pharmacy claims that are sent in because there's no other way that we would know whether or not people were taking their medications except for the fact that they were getting their prescriptions filled. Next slide please. Next measure is ADD. And that's follow-up care for children prescribed ADHD medication. So it's looking at the percentage of six to 12 year olds who were newly prescribed ADHD medication and who had at least three followup visits within 10 month period.

Debra Barkley:

So, that first followup visit would need to be within 30 days after that medication was first prescribed for that number. So, it's really important to just see where those kids are. So this measure is looking at whether not those kids got in for those three visits in a 10 month period with that first one being in that 30 day period. Next slide. So we're going to take a look at some codes here for the next couple of slides. Jake talked about WCC and that's the weight assessment. So here are the codes for BMI percentile, I want to really emphasize the fact that this measure looks at or needs the BMI percentile captured versus merely the BMI value. So, here are the codes that can be used for that and we'll talk about that a little bit more throughout this webinar.

Debra Barkley:

Next slide. Now, here are some codes that would be a used for the immunization. So these are pretty commonly entered claims just submitted for these immunizations but these are the codes that are used for immunizations. Next slide. And here are some various codes that we're going to talk about or look at real quickly here and some for lead screening, some for upper respiratory infection here, some ICD-10 codes that would give that diagnosis. For MMA, the medical management for asthma, people with asthma here's some diagnosis codes for that. And here's some CPT codes over here for the ADD measure for standalone visits and telephone visits for ADD.

Debra Barkley:

Next slide... actually we're going to go forward two slides, Brian, because we're going to add these codes in with the other ones real quickly here. So here are some codes that would be applicable for W15 and that's looking at those kids up until the 15 months of age and those visits. So here are the CPT codes, the ICD-10 codes and HCPCS codes that can be used to capture that care. So, we can stay right here on this slide. And let me just ask, do we have any questions about these measures we just talked about? Madison, go ahead.

Madison Yonlisky:

Hi Deb. Not regarding the measures itself, just again regarding bill codes and things of that nature. Those are all that will be forwarding along to their points of contact.

Debra Barkley:

Okay. Very good. So we can move along to the next slide, Brian. So let's pose the question. Let's have a little conversation here once again. So what have you found to help to get family then with young children, those that are 11 on younger, how do you strategize and get them in for the care that they need. And you can type your answer into the Q&A box or chat box and we'll just see what kind of answers we get. I can imagine that some provider groups have been creative and we know that sometimes there can be challenges with getting a member then or patients in for care. So what have you found helpful? Any answers so far we have, Madison?

Madison Yonlisky:

Given in a moment. Okay. Somebody did reply. They had better luck during summer months. Because it seems obviously the times that children are out of school, so there's probably some more availability then.

Debra Barkley:

That's right. Yes. That is a challenge because kids are in school and we've got a segment of this age group that are in school or in daycare and the parents may be at work and so it might be challenging in the daytime. So trying to juggle two schedules, the child's schedule and the parent's schedule. So, sometimes in summer at least the child's schedule is a little more freed up and there's no interruption of school. The last webinar that we had someone mentioned that in their group they send out reminder texts or reminder robocalls and whatever the case may be. And those are extremely helpful. I know personally I love them. They helped me get in for my care. So, any other answers before we move on?

Madison Yonlisky:

We did get a couple more answers than somebody said that they offer a Saturday clinic. Which I'm sure is very beneficial for a lot of people's schedules as well. Somebody said phone calls and working health plans for office health fairs, was another response.

Debra Barkley:

Very nice. Very nice. Yes. So, we've got a lot of great responses there and there may be a... we appreciate you giving those answers because sometimes what you do in your office can spur thinking in other practices and people can take those hints and develop them for their practices or for their organization. And that way, we drive healthcare and get more people in for the care that they need. So thank you so much for sharing that. I think we're going to move along now. We'll go to the next slide, Brian. Let's talk about meeting HEDIS standards in the absence of well care, how do we meet these HEDIS standards when there is no well care? And that's the challenge because the goal is always to get people in for the well care visits, the well child visit. But for various reasons that may not happen.

Debra Barkley:

For instance, if a child has a chronic condition, they may come in multiple times in a year for care and the parent may not for whatever reason bring them in for the well care because they've been in so many times or they may be seeing specialists or there may be barriers, other reasons. So what happens when that care's not captured during a well care visit? So you... or coding is done during that well care visit. What is another opportunity as far as HEDIS is concerned to captured that care and it can be counted and those members can be possibly counted as caring for various HEDIS measures. That's what we're going to talk about during this segment, about how credit can be given for that care.

Debra Barkley:

Next slide. One thing that we know that ideally the best way to capture that care or the easiest way is to capture that care through claims. We know that when it's captured through claims that it reduces that part and as we've been talking about a Medical Record Review, we know we're in the middle or just at the start of the HEDIS season and many of you may have been sent a request for records or you may have reviewers coming out to your office and collecting records. So, what happens is we tend to come out, maybe the measure requires us to come out and get those records. Also, we could be coming out because somehow that was not captured through claims. So, with that being said, when we come out to get those records, the proof or the evidence that the care was given as much more stringent than if it were captured through codes.

Debra Barkley:

For instance, if a code for well care is given, it is assumed by NCQA that all of the parts of a well care visit was taken care of. And so that code would take care of everything. The member would be counted as adherent administratively and they wouldn't be on the list for a medical record review. However, if a code is not sent in, so that's when a record is requested. And so we would go in and request those records and we would look for that care. And look for those various components. So the best way, once again is through coding.

Debra Barkley:

Next slide. So, here are components of a well care visit. In addition to most of these parts being a part of a well care visit, they are also a part of many sick visits. So let's take a look at these. We've got the health history that would be a part of any visit that the member would come in for. We've got physical development history and mental history of physical exam. Of course that's going to be done. Then we've got listed here, health education and its anticipatory guidance. Next slide. So let's talk about the components here and look at how the documentation can show that the care was given. So for the health history, here are some items that NCQA accepts and will account these members as adherent for these various parts because it's included in the medical records.

Debra Barkley:

So for the very young, we're talking about those that are zero to 15 months of age, we've got a health history looking at the APGAR score when they were born, allergies and any immunizations that were given, social history for the physical exam. If these parts... if these systems were looked at, if their documentation are vital signs, whether there was an evaluation of their gait or their scan appearance. For mental development, just want to jump down to the second a flock here. You'll see here documentation that a member or patients is well developed and well nourished, that will also cover in mental development and physical development.

Debra Barkley:

There are some others here that you can take a look at. And then for the health education and its anticipatory guidance, there's information here. If handouts are given or documentation is in the record that the provider talked to the member about these various parts then credit will be given even in that sick visit for anticipatory guidance. I just want to make a notation here about anticipatory guidance. One, two subjects that will cover several measures will be talking to members about nutrition and physical activity. If that's covered in the sick visit as well as the well visit, it will cover not only anticipatory guidance for the well visit also for the weight assessment. So just keep that in mind and the documentation for that.

Debra Barkley:

Next slide. So we here we have a similar graph. This is for just the older age group. For the W34. You'll see various... some of the same things are repeated. And here we are again under mental development and physical development. We're looking at a well documentation that a member is well developed and well nourished, well developed and well nourished. So that covers a two and along with other pertinent information. So the goal is to document what is actual and true and just giving some hints that these are acceptable pieces of documentation for NCQA.

Debra Barkley:

Next slide. So this is one of my favorite parts. So, let's take a moment here. We're going to do a hypothetical story about a member here. So this will be your opportunity at the end of this, after we talk about this member, this patient and you'll get a chance to type in some answer in the chat box and we'll discuss that a little bit further. So Alisha here, she's six year old, female and she historically has come into the PCP office for illness. She had an appointment about three weeks ago and was diagnosed as ADHD. At that appointment she got a prescription for Ritalin and she also has a history of asthma. The PCP receives a documentation that this child was in the ED about a week ago after an acute asthmatic episode. And last time and the last visit to her dentist was over a year ago.

Debra Barkley:

Next slide. So in preparation for Alisha's appointment, the office recognizes the fact that this is going to be... that she's already got an appointment scheduled for her ADHD medication that was prescribed about a month ago and it's an opportunity to follow up for that ED visits that she has a week ago. So the office reaches out to her, contacts the parent and to confirm that appointment for the member. Next slide. So when Alisha comes in, this is pretty standard, happens all the time for every appointment. Especially for children. The vital signs are taken along with the height and the weight and the BMI percentile.

Debra Barkley:

Now, we wanted to bring out the point of the BMI percentile. Especially during this time period of Medical Record Review. Sometimes it is definitely documented that what the BMI value is, whether it's 29 point whatever. But sometimes what's missing... that piece that's missing is the BMI percentile. Just like with other growth charts, the percentile is documented for the height and the weight. One thing that is important to document on a graph or in the medical record, whether it's through the EHR, is that BMI percentile.

Debra Barkley:

Next slide. So during the examination, the provider talks to Alisha and her mom and asked about school, nutrition and the physical activity. Three systems are examined and the provider asks her and asked mom about how she's doing on her Ritalin and everything seems to be going well with that. No major side effects. Then the question comes up about that ED visits and it's found out the reason why she went into the ED with the asthmatic episode is because she ran out of her inhaler. So at the end of this visit, her prescriptions are filled and a prescription is given and hand out is given for diet, exercise and bicycle safety. Then also she is advised to see a dental care provider.

Debra Barkley:

Next slide. So here we go. Here's the opportunity to answer this question. What HEDIS and quality of care elements have been addressed at this appointment? This is your opportunity. You can type in A, B, C, D or E or F. So for the W34 or the WCC. For A, ADD, for B, ADV, for C, MMA, for D and E, the quality of care, the followup for that ED visits or all of the above. So, Madison, what kind of answers are we getting?

Madison Yonlisky:

We are slowly getting answers and right now the only answer I'm seeing is for option F, all of the above.

Debra Barkley:

That is the perfect answer. All of these can be addressed and coded for or documented for and documented for, the ones that are either or. It can be coded for and documented for during this visit. So, if it's documented for, there's a great possibility that there will be this member may not need Medical Record Review. However, if they should, if the documentation is there, they can be counted as here for all of these. So, I just want to say thank you very much and I'm going to pass it on to Brian but before I do, are there any questions before we move on?

Madison Yonlisky:

There are no question for this time Deb.

Debra Barkley:

Perfect, Brian.

Brain Clark:

All right. Thank you Deb. And Jake, thanks for presenting today. I appreciate it. What I'm going to do now is wrap up the presentation and introduce you all to your point of contact. The point of contact in your State is someone who you can turn to if you have any questions at your organization or at your office. If you want to access your offices, gaps-in and care-reports, that person can pull that report for you or link you up to the program online on the website, in your State where you can access those reports.

Brain Clark:

It's basically someone you can establish a relationship with in the future. So, if there was a question or a comment that went unanswered today in the Q&A box, I'm going to be following up with your points of contact and getting those questions that went unanswered or comments to your point of contact. And someone will be in contact back within 24 hours or a day or two after today's webinar. So anyways, if you're signing in from Florida today, your point of contact is Michelle. Texas, that would be Joanna. If you're signing in from Pennsylvania, Diana is your point of contact. Louisiana, that would be Frank. In Kentucky, that's Kathy.

Brain Clark:

Ohio, there are two points of contact, that's Sarah or Valerie or both. And then in Michigan, Dante. Illinois, your point of contact is Anya. In Maryland that would be Donald. And New Jersey, your point of contact is Sami. I know I went a little bit fast through the points of contact. My hope is that you've all received the slides so you have access to those specific contact emails. If you didn't get a copy of the slides, utilize the Q&A box and let me know that you need a copy of the slides.

Brain Clark:

So, upcoming webinars in March, next month we'll be focusing on the teenage years up to age 21. I do have dates in mind and times in mind for those two webinars. March 21st and March 22nd, one in the morning and one in the afternoon as you see here on the 21st at 10 and the 22nd at 2:30. I believe that's a Wednesday and Thursday. We'll be focusing on gaps-in-care, how to cut down on the burden of MRR, the measures of care for the teenage years to age 20.99 for males and females. We'll look at some NCQA approved HEDIS codes. We'll have an additional focus on culture and linguistics and how that relates to continuity of care. And then we'll also, like we did today, address the hypothetical case story and see how HEDIS is addressed in the office and then additional topics including anticipatory guidance and physical activity.

Brain Clark:

We'll focus on something that's in the new regarding this age range as well. That's next month. The following month that would be April. We'll focus on 21 and older membership and the agenda is as follows. We'll look at millennials and how it seems they're dropping out of healthcare, smartphones and sleep schedules, how that age group and pretty much everybody seems to be tied to smartphones and how that's affecting sleep schedules as well. Physical inactivity effecting the USA. And then three more topics, HEDIS as always, the NCQA codes that affect the measures that we'll be focusing on as well.

Brain Clark:

Meeting HEDIS standards of care for that population of members and a hypothetical case story. And then in May, serious mental illness and serious emotional disturbance. A very important topic, caring for members with serious mental illness and serious emotional disturbance and how integrated care is important. Tips for successful office visit, resources for additional support in the office. And then the HEDIS measures of care affecting that particular webinar will be looked at as well as NCQA approved codes.

Brain Clark:

Anyways, so that's what you have to look forward to. I appreciate everyone taking the time out of your day to sign into today's webinar. I hope it was informative, enlightening and if you find that in the future you're going to want to come back. We'd love to have you. So, right now what I'll do... what time is it? It's about three more minutes until 4:30. I'm going to leave the Q&A box open for another 10 to 15 minutes. If there are any questions that come in, we'll respond as best we can. If we can't, if it's a state specific question, your point of contact will be in touch with you within about a day or two after this webinar. But right now, why don't we address any comments or questions that are coming into the Q&A box on the line right now. If there are any, Madison?

Madison Yonlisky:

There are not any at this moment. I think we're set to go.

Brain Clark:

Okay. Great. I'll leave the Q&A box open and the presentation open for another 10 minutes. If you have anything you'd like to address, please type in the Q&A box. And everyone, thanks a lot. I hope you enjoy the rest of your day. Bye now.