Late life cycle of EPSDT and HEDIS ages 12 to 21

Brian Clark:

Webinar is teenage years up to age 21, HEDIS measures, and a focus on administrative data capture. Prior to the webinar today, you should have received a copy of the slides from me, I think it was about a half hour ago I sent an email out to registrants, so please follow along with us today. If you registered within the last half hour, I'm sorry, but you just didn't get a copy of the slides, I'll make sure to get you a copy after the webinar, just use the Q&A box now and say, "Hey, I need a copy of the slides." Also, today's webinar will be recorded. It's my hope that here soon I'll be able to provide a link where you all can view a copy of the recorded webinars, both in the past and the present.

Brian Clark:

My name is Brian Clark, I'm your host. My title is Quality Translator, and I work in the Quality Management Department here at Aetna Better Health. And also presenting today: we have Diana Charlton. Diana is a nurse and she works in the Quality Management Department as well, her title is QM Nurse Consultant. And then also Erin Goodard will be presenting today, she is Prevention and Wellness Coordinator.

Brian Clark:

The goal of this webinar today and in all webinars in this series is to spark conversations with providers in multiple states, nationwide. We have provider contacts from 10 different states on the line with us today, it could be an office manager, a nurse, doctor, medical records, we have quality management people on the line, we have CEOs of big organization, so a vast array of individuals from varying parts of the industry with us today. And so the idea is to explore ways to cut down on the burden of medical record review and maximize administrative data capture.

Brian Clark:

So the agenda, we'll go over there here shortly in more depth. I mentioned there are 10 states with us, that would be Illinois, so welcome to Illinois, Maryland, New Jersey, Ohio, Pennsylvania, Texas, Louisiana, Kentucky, Florida, and Michigan, very happy you could fit this important webinar in your schedule today. The webinar will last about 50 minutes, and then we'll have some time for questions at the end. And also during the webinar, we'll be pausing for Q&A, it's very important to participate, that would be great. It's encouraged to use the Q&A box, just use your mouse and hover over the top part of the middle of your screen and find the option for Q&A and choose the Participate drop-down options and type your question or comment that you have and send to all panelists.

Brian Clark:

So what are we looking at here? This is the Aetna values wheel. Now Aetna's vision statement or philosophy as to the way we manage health care is: you don't join us, we join you. Now it's our hope that by having you all on the webinar today in this environment, that we're more effectively reaching our Aetna Better Health members. So on the screen, you see that in the values wheel, and at the center of all that we do are the people that we serve, and that would be our provider contacts, as well as our members. Surrounding the center of the values wheel are our four core values. The four core values are: integrity, excellence, inspiration, and caring. Now, as a company, we always act with integrity and aspire each day to excel and build a healthier world, which is the main goal in mind.

Brian Clark:

Today's agenda. We're going to be going over a lot. First off, I'm going to explain how we can cut down on the burden of medical record review there, or two recommendations that I think that everyone should abide by to reach that goal of not having to send us as many records during medical record review season, which is happening right now. You might be receiving requests for records that weren't captured administratively through claims, or requests for records that basically that HEDIS measure dictates that we can only reach out for records during hybrid review because maybe it's something that says, "Okay, we need the last blood pressure at the end of the measurement here," so sometimes we have to wait until medical record review to be able to ask for that information, just for instance.

Brian Clark:

So I'll go over that, and then we'll move into the 2018 HEDIS measures of care for March, specifically affecting 12-20 year old males and female members. We'll be highlighting acceptable HEDIS codes that can be submitted to capture care more effectively in an administrative way. And then a discussion regarding culture and linguistics, so that's going to be a very important discussion that Erin will have, and she'll indicate how important that is whenever it comes to continuity of care and making sure that members come in and understand what is expected of them when it comes to their medical care.

Brian Clark:

And then we'll move into the importance of documentation of anticipatory guidance and physical activity and addressing that in an office visit and how you can code appropriately for the specific HEDIS measure that addresses those two submeasures of care. And one hypothetical case story will be told and we'll see how HEDIS is addressed at the office. Then I'll give you a sneak peek as to where we're going with this webinar series in the future, I'll highlight what we'll be discussing for the next three to four months.

Brian Clark:

So there are two ways that we can cut down on the burden of medical record review. One way is to utilize your point of contact, that is an individual with the health plan that can help you access your gaps in care reports, point you in the right direction as to how to answer a question or a comment that is going on, or basically something at your organization that has gone unresolved that you need to get resolved for things to run smoothly at your office or at your organization. Attending these webinars is a very important aspect of cutting down on the burden of medical record review. We're going through HEDIS measures, we're going through the lifecycle of the member, and we're touching on all the appropriate HEDIS measures that usually fall into the annual HEDIS project, the medical record review.

Brian Clark:

You want to avoid having to burden the office, burden your staff, and getting records back to us the most effective way is to cut down on that burden and submit claims. So we'll be going over appropriate coding that can capture care for HEDIS purposes throughout this series. So, utilize your point of contact, I'm going to make sure that I let you know who that person is in your state that you can reach out to, I'll give you their email if you need to get in contact with them, that's one way that you can cut down on medical record review, and then attend the webinars.

Brian Clark:

So, Madison Yonlisky is also a representative of the work here in the Quality Management Department at Aetna Better Health and she's going to be handling the Q&A box today, and I just want to pause for any questions or comments that are coming in the Q&A box right now. So, Madison, do we have anything that we need to address right now?

Madison Yonlisky:

Not at this moment, we don't, no.

Brian Clark:

Okay. All right, well, I would like to introduce Diana Charlton, QM Nurse Consultant, and Diana will take the ball from here. Diana?

Diana Charlton:

Thanks, Brian, and good afternoon everyone and thank you for joining. My name is Diana Charlton, as Brian said, I'm one of the QM nurses in the PA plan. Before we get into the HEDIS measures, we're just going to have a brief overview of EPSDT, or Early and Periodic Screening, Diagnosis, and Treatment. The services within this program for children between ages 0-20, each state must provide these services that are within the program. Period visits based on recommended guidelines from the American Academy of Pediatrics' Bright Futures Periodicity Schedule, this is one of the items that this program is based off of and the visits and the requirements for children to meet the metrics for EPSDT are included on this schedule.

Diana Charlton:

All conditions must be treated. We must provide all optional Medicaid services for children, even if the state does not cover these services for adults. Components of EPSDT are measured using HEDIS performance metrics. Some examples for the metrics that would fall under EPSDT and HEDIS would be your adolescent well care, some immunization measures as well. For your younger kiddos, you have blood screening as well that is also a HEDIS measure. Screening for depression should also take place.

Diana Charlton:

Next slide. Looking at the March 2018 HEDIS measures of care, we're going to be look at males and females between the ages of 12-20. The HEDIS data is going to be collected in two ways. To close gaps for these measures, the first and the easiest way is claims and other administrative data. Also, we can go to medical record review and collection. So HEDIS 2019 is going to be collecting data for care given primarily in 2018. So, claims is the fastest and easiest way to collect the data, as I previously said, and by capturing the [inaudible 00:10:24] claims, we're able to eliminate the need to have to call the offices and tie up phone lines, we're collecting records during HEDIS season.

Diana Charlton:

Next slide. Regulatory bodies may use HEDIS data for accreditation or enrollment purposes. The public may look at HEDIS rates when choosing a health plan. Provider pay-for-performance programs are often tied to HEDIS scores as well. And I do want to state that with the pay-for-performance programs, they are state-specific, so we'd want you to reach out to your point of contact that Brian will provide at the end of the presentation for any questions you may have regarding pay-for-performance programs for your state. Both providers and health plans can use HEDIS data results to improve outcomes as well.

Diana Charlton:

Next slide. Moving into the HEDIS measures for members between the ages of 12-20, the first one we're going to look at is your annual dental visit. This looks at the percentage of members between the ages of 2-20 that have at least one dental visit during the measurement year. So when the member's coming in for a sick care or well care or whatever type of visit they might come in for, you can ask the child if they have a dental home and, when necessary, you can refer the child to a dentist. One way to identify dentists in your area is you can go to your plan's website to find a dentist, or you can point of contact for assistance as well.

Diana Charlton:

Next slide. The next measure for members between the ages of 12-20 is adolescent well care. This is the percentage of enrolled members between the ages of 12-21 as of December 31st of the measurement year who have at least one comprehensive well-care visit with a PCP, or it can also be an OB/GYN, if the member is female, during the measurement year. Items we look for in the well-care visit would be a comprehensive health history, a physical, a mental development assessment, a head-to-toe physical exam, and then general anticipatory guidance for things not related to acute conditions, so things like nutrition and exercise counseling, limiting screen time, those types of things. So those are things that we can look for in the medical record, but you could still close gaps for this measure by using some recommended CPT codes from the NCQA, and we can show you some of the codes during the presentation, or your point of contact can provide them to you after this meeting.

Diana Charlton:

Next slide. The next measure for members between the ages of 12-20 is weight assessment and counseling for children and adolescents, or WCC. This measures the percentage of members between the ages of 3-18 who had an outpatient visit with a PCP or OB/GYN and have evidence of all three components in the measurement year. The three components for the WCC measure are a BMI percentile documentation. When we're capturing the care for this measure on claims, we need to capture the ICD-10 codes for the BMI percentile, BMI value codes and BMI value documented on a chart will not close this gap for this measure. We also look for counseling for nutrition and assessment of physical activity as well, so we can look up codes for that on claims or documentation of either in the medical record, or we can also close gaps for both the nutrition and the physical activity component by capturing care or claims for weight and obesity counseling as well.

Diana Charlton:

Next slide. Here we have some HEDIS coding tips from the WCC measure. As I said, we need to use the BMI percentile documentation in the chart or on claims, we need to use the ICD-10 codes to capture the BMI percentile. We also have some examples here for codes that can be used to close the gap for nutrition counseling, they would be HCPC, CPT, or ICD-10. And we also have ICD-10 and HPCP codes that can be used for physical activity counseling. And I do want to say that these are just some of the examples that are recommended by the NCQA; for a full listing, we would want to direct you to the NCQA website.

Diana Charlton:

Next slide. We also have the adult BMI assessment, or ABA measure, for members between the ages of 12-20. The reason that is is because this measure captures the percentage of members 18-74 who have an outpatient visit and have their body mass index documented during the measurement year, which is now 2018, or the year prior, 2017.

Diana Charlton:

Next slide. Here we have some ICD-10 codes; again, these are the BMI percentile ICD-10 codes. For the ABA measures, for members that are 20 and under, the NCQA still recommends that we capture those stats via ICD-10 codes, the BMI percentile. Just as an FYI: members over 20, we can use the BMI value code to close gaps for those members. Again, for a complete list, we want to refer you to the NCQA website, which is www.ncqa.org.

Diana Charlton:

Next slide. The next measure is immunization for adolescents, or IMA. This is the percentage of children who turned 13 years of age during the measurement year and had the following vaccinations on or by their 13th birthday. For members between the ages of 11-13, we're looking for one meningococcal vaccine; between the ages of 10-13, we're looking for one Tdap vaccine; between the ages of 9-13, we're looking for three HPV vaccines on different dates of service. And I would want to note that the HPV vaccine is now for males and females where, in the past, it was just used for our female members, but now male and female teenagers fall under this measure.

Diana Charlton:

Next slide. We have chlamydia screening in women, or CHL. This is the percentage of women between the ages of 16-24 who are identified as sexually active on claims and then who have at least one test for chlamydia during the measurement year.

Diana Charlton:

Next slide. We do have some behavioral health measures for members between the ages of 12-20. The first one is the antidepressant medication management measure, or AMM. This is the percentage of members 18 years of age and older who were newly treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. This measure is strictly administratively captured, we don't go to the medical record for it, we look to capture the diagnosis on claims, as well as the adherence for the medication on pharmacy claims. And there are two rates that we report to the state for this measure. The first would be the Effective Acute Phase Treatment, that would be: did the member stay on the medication during the first 12 weeks of treatment? And then they move into the Effective Continuation Phase Treatment, which would be: did they remain on that medication for six months?

Diana Charlton:

Next slide. Just from strategies for improvement for the AMM, antidepressant medication management measure, you'd want to talk to the patient about the importance of continuing medication and scheduling follow up visits, even if they feel better. You want to discuss possible side effects that are more bothersome than life threatening. One of the perfect examples of these bothersome side effects could be weight gain, so we would want to talk to the member about lifestyle changes, incorporating some diet changes, or increasing physical activity.

Diana Charlton:

We want to advise the patient about the risks of discontinuing the medication prior to six months, and that that is associated with a higher rate of recurrence of depression; so basically medication adherence and how important it is. We want to also discuss the likeliness of response to treatment is increased if there is a follow-up contact within the first three months of diagnosis or initiating treatment. So, work with your point of contact in the health plan and contacting these members and encouraging them to schedule their follow-up visits and keep those visits. We'd also want to inform the member that most people treated for initial depression need to be on medication at least 6-12 months after adequate response to symptoms.

Diana Charlton:

Next slide. The next behavioral health measure is for members between the ages of 12-20, is adherence to antipsychotic medications for individuals with schizophrenia, or SAA. This is the percentage of members between the ages of 19-64 during the measurement year with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period. The member will fall into this measure because they have at least two visits in an outpatient, intensive outpatient, partial hospitalization, ED or non-acute inpatient setting, on different dates of service, with any diagnosis of schizophrenia. So basically we're looking for two visits during the measurement year with an accompanying diagnosis of schizophrenia, and that will have them fall under this measure. The way we close the gap for this measure would be through pharmacy claims where we capture if the member is remaining on their prescribed medications.

Diana Charlton:

Next slide. Some NCQA approved codes for SAA, we have the CPT codes for behavioral health acute inpatient stays and then there's the accompanying ICD-10 codes for schizophrenia, and then you can see the same thing, we have the UBREV codes for standalone acute visits with schizophrenia.

Diana Charlton:

Next slide. And then here we have the ED codes, and then the schizophrenia ICD-10 code. That grouping could also have the member fall into the measure, as well as the other two examples below.

Diana Charlton:

Next slide. Moving on from behavioral health, we're looking at condition-specific measures. The first one is going to be controlling blood pressure, or CBP. This is the percentage of members 18 years of age and older that have a diagnosis of hypertension and who adequately control their blood pressure during the measurement year. So we're looking for two dates of service for this measure to close the gap. We want to identify the diagnosis of hypertension in claims of the medical record prior to June 30th, and then we look at their last, or also known as the representative blood pressure in the measurement year, which would be the last one that they had. If the member has their BP controlled, based on age, I believe they could either be below 150/90 or 140/90, I'd have to go back to the specs to get those exact ages, I apologize. But as long as that last BP is in that controlled range, and we capture a diagnosis prior to June 30th, that's going to show that the member has been following with their PCP for their condition and taken their medications as prescribed.

Diana Charlton:

Next slide. Here's an example. We have the ICD-10 code that will capture the diagnosis of essential primary hypertension, and then we have the CPT code that will capture the systolic reading and the diastolic reading on the blood pressure as well.

Diana Charlton:

Next slide. The next condition-specific measure is comprehensive diabetes care, or CDC. This is the percentage of members 18-75 years of age that have either a diagnosis of type 1 or type 2 diabetes. So we look at four different sections in this measure to close gaps. The first component we have is the hemoglobin A1c. For that submeasure, we actually have two items that we're looking at. We're looking to see: did they have an A1c test done in the measurement year? Just one. And then we're looking also at the result. We want to make sure that the members are in good control; and based on the NCQA recommendations for this measure, any reading under 9% would be considered good control. So those are the two components that we would look at.

Diana Charlton:

When you're getting your gaps in care report, the way that the health plan will notify you if you have members that are in poor control based on claims data that we have, you're going to see a submeasure on the report that's "poor hemoglobin A1c greater than 9%". And when you see this measure on the report that you get from your point of contact, you would see if the member has an A1c greater than 9%, that member's going to show as adherent for that measure on the report because the "greater the 9%" HEDIS measure is capturing members that are actually in poor control. And that could be because of a few different things.

Diana Charlton:

One, they might not have had an A1c test during the measurement year, so that's automatically going to drop them into the "poor control" category. Two, which this is usually the most likely scenario, is we're not capturing the results on claims, so we won't capture the result for somebody that's automatically going to put them in the "poor control" as well. Or they might surely be in poor control based on claims data that we actually did receive a code on a claim from the provider. So, if you are seeing on your report that Jane Smith, you've been following her, you've been treating her diabetes, and you know for a fact that her last A1c is less than 9%, but she's showing as greater than 9% on your report, we'd want you to follow up with your point of contact so he can work with you and get either a claim resubmitted or get that data captured to close that gap for HEDIS.

Diana Charlton:

The next submeasure for CDC is blood pressure monitoring, very similar to the CPT measure, we just want to see that that last blood pressure in the measurement year is in good control. For diabetic retinal eye exam, ideally we recommend that they get in to see an ophthalmologist once a year. If they have not been seen in the measurement year, but they were seen the year prior, if they are showing as not having diabetic retinopathy in the previous year's exam, that would close the gap as well for HEDIS. That's the only way we can take an eye exam from the year prior to the measurement year is if it's negative for retinopathy.

Diana Charlton:

The next section would be nephropathy treatment, which would be assessing the kidney functions essentially, so if we capture a microalbumin or urine protein tests, that would close the gap for nephropathy. Or certain medications that we can get from a medication list, ACESs or ARBs are good examples, those classes of medications would close the gap for nephropathy treatment, as well as capturing care that the member actually saw a nephrologist.

Diana Charlton:

Next slide. Here are some codes for closing gaps for the comprehensive diabetes care submeasure. For closing the results or that poor hemoglobin A1c submeasure I was talking about on your reports, we'd want to capture the CPT code for: are they less than 7? Are they greater than 9? Are they between 7-9 for their levels? And then we have the CPT code for capturing the A1c test and closing that gap.

Diana Charlton:

Next slide. Here are some examples of medical attention for nephropathy codes. As I said, urine protein tests. We can also close that gap by using ICD-10 codes for either type 1 or type 2 diabetes, or other specified diabetes mellitus with diabetic nephropathy. And then we have the dilated retinal eye exam code that are CPT code. These are going to be submitted by the ophthalmologist, but just for your information here, we have CPT codes for a diabetic retinal screening, a diabetic retinal screening that has a result of negative, and then diabetic retinal screening with an eye care professional.

Diana Charlton:

Next slide. And then, finally, we have the blood pressure code, same CPT code we used for CBP that captured both the systolic and the diastolic levels of the BP.

Diana Charlton:

Next slide. So I know that was a whole bunch of information, I did see that we had some questions coming into the chat box, Madison.

Madison Yonlisky:

Yeah. We do. We have a few different questions. There's a couple of questions about the HPV vaccine. A couple of people had asked because, from their understanding, it was two HPV that was required for ages 9-13. So, I'm guessing we maybe just needed a little bit of clarity on that.

Diana Charlton:

Yeah, I can go back to the HEDIS specs and review. I believe that, with regards to HEDIS purposes, we can use two HPV vaccines, but I think they have to be administered, I would want to get the exact number of days, but it's something like 140 or 150 days apart, and then we can use two vaccines to close the gap that way. But I'll take that back as a takeaway and then the point of contact to follow up with them after the presentation. But I believe that if they are within a certain number of days apart, with regards to HEDIS, we can take two. But usually it is three. But point of contact will follow up with you after the presentation with confirmation on that.

Madison Yonlisky:

And then somebody else did ask about the HPV vaccine, that it's not required in their state, so they were asking if they would be penalized if the family declined and if they document that the family refused, does that still count? Which I believe it doesn't count if it's a refusal, but I wanted to bring that up out loud in case anybody else had that question.

Diana Charlton:

That is correct. I have the question here in the chat box. You will not get penalized if the family declines a vaccine. It is always good to document the refusal, as you are doing, that way we can report that at the end of the year with our HEDIS reporting. Regarding the state-specific question, if it's required, I would want to direct that to that provider's point of contact. But for Pennsylvania, we do report on the HPV vaccine, but there is no penalty if the member's family refuses.

Madison Yonlisky:

And the last question somebody asked about billing: if a PCP can bill for a certain code for obesity counseling? The code they listed was G0447.

Diana Charlton:

Okay. I'm going to have that as a takeaway. I'm going to be passing the ball off to Erin shortly on some hypothetical case stories, I'm going to write that code down, and then before the end of the presentation, I will confirm if we can use that code.

Madison Yonlisky:

Perfect. Thank you, Diana, that was all that we had at this moment.

Diana Charlton:

And I see someone said 180 days, so I was off a little bit on the spacing between the HPV vaccines, so it seems to be 180 days; if there's 180 days between the two vaccines, we can take the two for HPV. Thank you for putting that in the chat box and, at this point, I will pass the ball over to Erin who will go over hypothetical case stories.

Erin Goodard:

Thanks, Diana. Again, my name is Erin, I'm a Prevention and Wellness Coordinator here at Aetna Better Health in the Quality Management Department. Today, we're just going to look over a hypothetical case story of a member who could potentially come into your office.

Erin Goodard:

Today, we're going to meet Georginne. Georginne is a 16 year old high school sophomore. She and her family recently moved to the United States from Spain and she speaks limited English. She's coming to the office today because she's having an issue with some reoccurring headaches and blurred vision. One thing to note is that she is not as active as she was when she was living in Spain, due to the move, and is spending more time playing video games and using social media on her phone. So because of the move, she's still meeting friends and getting to know her surroundings, so she's spending more time indoors, playing video games and texting with her friends back in Spain, etc., so she's having more screen time. Because of the move, she's also behind on her immunizations and she hasn't yet established a dental home.

Erin Goodard:

Next slide. So what are some HEDIS measures that can be addressed whenever she comes into the office? The first thing is the annual dental visit. Because she hasn't established a dental home yet, it's important to talk to her about getting a dentist and establishing that dental home so that she can go in and get her check-up and make sure everything is going fine with her oral health.

Erin Goodard:

The next is the adolescent well care visit. Of note to this is that these components can be done at a sick visit, as well as a well visit. So anytime that a member comes in that would fall into the adolescent well care measure, these components can be addressed with them, so this includes things like the mental and physical development, height, weight, physical exam, anticipatory guidance including screen time. Of note is that the increased screen time that Georginne has been spending may account for the increase in her headaches and the vision issues.

Erin Goodard:

A great way to have the anticipatory guidance component covered at all visits is to have the Bright Futures handout available, and anytime a member comes in, you can just hand it to them and that would cover the anticipatory guidance. Also, the weight assessment and counseling and, again, these components can also be addressed not just at a well visit, but also at a sick visit, and this includes things like the BMI percentile, nutrition counseling, and the physical activity counseling. If you remember, she's behind in her immunizations, so that would be the immunizations for adolescents, and this includes the meningococcal vaccine, the Tdap vaccine, and the HPV vaccine.

Erin Goodard:

Next screen. One thing in the anticipatory guidance and physical activity, because we know that this is an increasingly issue in the United States as well as other countries, there was a recent 20/20 episode that focused on digital or screen addiction. If you think about the average American worker, your own typical day, you spend a lot of time behind a screen. The average worker spends between 6-8 hours behind a screen, and that's just typically during your work day. If you think about after you go home, you usually spend even more time behind a screen, either looking at TV or a tablet or your phone.

Erin Goodard:

There's an average of 17 devices in a home of five people, and this includes everything, including smartphones, laptops, TVs, video games, and tablets. Because of this, visits to the eye doctor have surged and really increased because of all the screen time that we spend, our eyes looking at screens, so we have a lot more vision issues, blurred vision and such. A good thing to remember is the 20/20/20 rule: for every 20 minutes you're looking at a screen, to look away 20 feet for 20 seconds to give your eyes a rest. On the continent of Asia, there's already over 300 digital addiction rehab centers, this has been a really huge problem over there for a very long, but it is obviously becoming a much bigger issue in the United States with children and adults spending more and more time behind a screen.

Erin Goodard:

Next slide. At this point, I'm going to ask you: how do you address screen time and physical activity in your office with patients? You can just type your answer in the Q&A box, and whenever they start coming in, I will have Madison read some off.

Madison Yonlisky:

We'll give it a couple of moments here to let people type their answers.

Erin Goodard:

Quiet group today.

Madison Yonlisky:

It is. Just to clarify, also, the question is referring more towards how you address with the patients in your office, and not so much yourself, but how you address it with your patients. Okay, somebody said that the provider addresses it in the room and they provide the patients with handouts.

Erin Goodard:

That's great. All right, well, I'm actually just going to speak up and give a couple recommendations or suggestions that I have come up previously. One, the handouts is a great thing, like I mentioned about the Bright Futures handout, handouts are a great way to address any kind of the anticipatory guidance as well as physical activity and screen time, in particular.

Erin Goodard:

Another thing is to encourage family activity; when a member comes in, particularly an adolescent that comes in with his parent, it's great to be able to address the family as a whole to suggest that they become physically active all together, things like: taking a walk after dinner, particularly when it's nice out in spring/summer/fall; going to the park on weekends, going outside and just playing catch. Another thing is, for days that the weather is not so great, whether it's snowing, raining, cold, etc. even though it would be requiring to be in front of a TV, there are a lot of video game systems that have very active games, Wii and Wii Fit is one, there's also a lot of dance games, so that even though you're utilizing the TV, you're being very active while you're doing it, and you can actually burn off a lot of calories and work up a sweat while you're doing those games.

Erin Goodard:

Another thing is to encourage any physical activity: start off small and set goals. Things like walking around your house for 5-10 minutes a day during the evenings, say during commercials. Another thing is to set timers: have parents set timers for their kids, where they allow them to be on the screen for a half an hour or 45 minutes, and then they set a timer to where they have to get off for 15 minutes and do something else, and then limit the total time as well.

Erin Goodard:

All right, next screen. Now we're going to go over culture and linguistics competency. How culture is perceived directly impacts how care is delivered and received. A lack of culturally competent care directly contributes to poor patient outcomes, reduced patient compliance, and increased health disparities. Different cultures and religions may also have varying birth rituals, dietary constraints, and even have requirements for the gender of their doctor. So it's important to deliver culturally competent care because if the member, say there's a language barrier, or for whatever other reason may not understand what the instructions are for their health care, they're more likely to have gaps in care, where they don't go get labs done that are needed, they don't go for any kind of follow up, they may not take the medication properly, and so they end up in the ER. So it's really important to make sure that they understand what instructions you're giving them and what is needed for their health care.

Erin Goodard:

Next slide. It's important to avoid stereotyping and jumping to conclusions based on any outward appearances, and this includes things like race, age, gender, clothing, and primary language. And then it's also really important to document the assessment of any cultural needs in the member's medical record, and this helps to serve as a really great reminder to make sure that they're receiving the most appropriate health care. Say they prefer instructions in Spanish or they speak Spanish as their primary language, and any other possible requirement they could have for their health care, it's really important to make a note of that so every time they come into the office, they're receiving that proper care.

Erin Goodard:

Next screen. Some things that can be done to make sure that they're receiving the most appropriate care that they can is to utilize a certified language translator; again, if there is a language barrier, this helps to bridge that gap to where they understand the instructions and whatever else is needed for their health care, any kind of follow up, etc. Also, it's important to get to know the member, this is the best way to find out what they need culturally and linguistically. Understand what the member thinks about their current health care. And then also utilize the teach back method, and this is where the member would teach back to you what you've instructed them, so making sure that they understand what their health care needs are and that they understand the instructions are the best way to make sure that they're going to be proactive in their health care and do everything they need to do for their own health care, like I said, do any follow ups that they need to, go for any labs and take their medications properly, as well as anything else that could potentially fall into that category.

Erin Goodard:

Next screen. It's really important to make the most out of every visit and understand the patient and his or her background. So, again, by making sure they receive the most culturally appropriate care helps to cut down on ER visits and it eliminates the need for repeat follow-up visits. If they understand what they need to do, they may not end up in the ER because they didn't take their medication, or for some other reason that they're ending up in the ER for a visit or they're having to come into your office for repeat follow-up visits because they didn't go get a lab or for whatever other reason.

Erin Goodard:

Next screen. All right, so at this point, I'm going to ask if there is any questions about what I just covered?

Madison Yonlisky:

At this time, Erin, there are no questions in the Q&A box.

Erin Goodard:

All right. So there's no questions at this point, I'm going to throw it back to Brian.

Brian Clark:

All right, thanks, Erin. And, Diana, thank you as well for presenting today. And, Madison, thanks for managing the Q&A box. What I'm going to do now is give you ideas to where we're going in the future with this webinar series.

Brian Clark:

I'm going to highlight what is going to be discussed in April's webinar in the webinar titled "An in depth look at Aetna's 21 and older membership". First off, we'll be looking at millennials dropping out of health care, smartphones and sleep schedules, the topic of physical inactivity affecting the USA. And then obviously HEDIS is a big focus of all these webinars, so who uses it, what does it measure, which HEDIS measures fall into this population of members, and we'll see how HEDIS can be addressed in the office, and another hypothetical case story will be told, and one additional topic regarding meeting HEDIS standards of care, how to do that more effectively. Those will be the agenda topics for April.

Brian Clark:

I believe I have the webinar scheduled for the 18th and 19th, once in the morning on the 18th, I think at 10:00. The invites will go out the week of the second in April for those two offerings. The one on the 19th will be at 2:30.

Brian Clark:

And then, in May, there's actually going to be two webinars. The first webinar will focus on "Caring for members with serious mental illness and serious emotional disturbance". I'd highly encourage everyone to get involved with that webinar, please attend that one, as well as there's going to be another one in May focused specifically on all HEDIS codes that we have been looking out throughout this webinar series, we're going to touch on every single one of them for each HEDIS measure. And then, also, there are four additional measures, with have Ohio with us in this webinar series, and they're a dual-eligible plan, so there will be four additional measures that are just Medicare measures, but all the rest will be Medicaid/commercial measures.

Brian Clark:

So then in June, what are we doing in June? June, I believe we are focusing ... I don't want to lie, I forget what's going on in June, but I'll let you all know in May what we'll be focusing on in June.

Brian Clark:

Now what I'd like to do is encourage you to reach out to your point of contact. We've been mentioning there's a way to access your gaps in care report when it comes to HEDIS. This point of contact can answer any questions that you have throughout the measurement year. The main goal in mind is to prep for HEDIS 2019, currently we are in that season which is primarily looking at care in 2018, so the measurement year is 2018, currently.

Brian Clark:

Right now, what I would like to do is introduce you all to your points of contact in your state. If you are signing in from Florida, your point of contact is Michelle. Michelle is Health Care Quality Management Consultant, and there's her email right there. I'll be providing you, obviously, in the next few slides with a name, a title, and then an email contact that you can reach out to, that's your point of contact. In Texas, that will be Joanna, she's in Provider Relations.

Brian Clark:

Pennsylvania, Diana was actually a speaker today, she is your point of contact for PA. In Louisiana, your point of contact is Frank. Kentucky, that would be Kathy. In Ohio, one of two individuals, Sara or Valerie. In Michigan, that would be Dante. In Illinois, that would be Anya, or Diana actually, Diana's been fielding questions for Illinois as well. And then Maryland, that would be Don. New Jersey, that would be Sami.

Brian Clark:

Now, in the future, we are going to have new speakers, so I would encourage you to come back and listen to a fresh voice, a new approach, and brand-new look to a webinar. We like to keep these webinars fresh each month with new topics and keep you all engaged and coming back, but the main goal is to, obviously, maximize administrative data capture and spark conversations with providers in multiple states and, all the while, we would like to make the lives better for our members and make them more healthy.

Brian Clark:

So, with that, what I'd like to do is just thank you all for being with us today. I know we're ending a little early, but I like to end early so we can address some questions or comments that are in the Q&A box. If you have something you'd like to ask or if you have a comment, we'll be here until 3:30. If you need to get going, that's fine, I can give you back about 10-13 minutes of your time. But if you have a question, please go ahead and utilize the Q&A box and send to all panelists. For all those that need to get going, thanks for being here and enjoy the rest of your day.

Brian Clark:

So, Madison, do we have anything in the Q&A box that we can address right now? And then, obviously, I think, Diana, you were going to do some research on that one question. Do we have an answer for that yet?

Diana Charlton:

Yes, I put it in the chat box. That obesity counseling code can be used.

Brian Clark:

Nice, okay.

Diana Charlton:

[crosstalk 00:47:44] specification, so counseling for obesity will close the gap for both nutrition and the physical activity component of the WCC measure.

Brian Clark:

Okay. Thanks for looking into that. Madison, anything in the Q&A box right now?

Madison Yonlisky:

Right now, Brian, we do not have any questions, just a lot of thank-yous, and we appreciate everybody for attending. I did want to let you know, regarding June's webinar though this year, the webinar we have listed as "Takeaways from HEDIS season 2018".

Brian Clark:

That's right. Okay, yeah, so for that webinar, we're basically going to just summarize how this medical record review season went, what were some positives, what were some negatives, what did we learn, how could we make next year a little bit more smooth when it comes to the review season. So, please attend that webinar as well. I saw, Madison, that there was a question that came in, "Please address the HPV question," I believe we did, regarding the two dose, three dose, and as long as ... let me not misspeak, but I think the question was, "Can't we go with two doses of HPV?" Well, yes, as long as there's 180 days in between the first and the second, I believe we came to that conclusion.

Madison Yonlisky:

Right.

Diana Charlton:

Yep.

Brian Clark:

If there's 180 in between the first and the second, then that's fine. But other than that, it's typically a three dose schedule.

Madison Yonlisky:

Right. And we actually got an HPV question as you were bringing that up. Somebody just stated that HPV is age-restricted. They had a patient who was traveling and did not get the shot within time and the claim was denied, so they're asking what they would do in that situation?

Diana Charlton:

With regards to HEDIS data capture, even if the claim is denied, it should still close the gap, as long as it happens between the 9th and 13th birthday. That counts for other HEDIS measures as well. For example, if the member came in for an adolescent well care visit and you billed it and the claim got denied, even though the claim got denied, it's still going to count towards HEDIS data capture. Any issues, of course, with claims being denied, we want you to reach out to your point of contact as well for those issues so that we can get you linked up with Provider Relations, who are the experts on getting those issues remedied.

Madison Yonlisky:

And any questions that you do post in the Q&A box, it is documented and we do forward all of those questions to your point of contact for them to reach out to you.

Brian Clark:

Okay, thanks, Diana, and thanks, Madison. Is there anything else in the Q&A box that we can address right now?

Madison Yonlisky:

I do not see anything that we can address right now.

Brian Clark:

Okay. Well, if you think of anything, everyone, please type into the Q&A box and we will see you in the next webinar. Thanks for being here today.