The teenage years

Madison Yonlisky: 

(silence) 

Madison Yonlisky: 

Okay. Welcome everybody to the second webinar of this month. The topic is Caring for Aetna Better Health Members Ages 12 to 21 Years Old. There were two offerings. There was one yesterday and then the one that you're currently in right now. And would want you to know that you will be receiving a copy of the presentation slides sometime in the near future. You will receive that via email. So I do want to welcome the states of Illinois, Maryland, New Jersey, Ohio, Pennsylvania, Texas, Louisiana, Kentuckey, Florida, Michigan, California, and Virginia. I'm very glad that you all could fix this important webinar into your schedule today. 

Madison Yonlisky: 

Today's webinar will last approximately 50 minutes then we'll have some time to the end for questions. My name is Madison Yonlisky. I am the host for the webinar. And I'll be presenting some portions of the webinar as well. My title is HEDIS Outreach Coordinator. I am with the Aetna Better Health of Pennsylvania plan. And I work with providers on record collection during HEDIS season, and various other projects throughout the year. I've been with the company since 2011, and I started actually with HEDIS member outreach. 

Madison Yonlisky: 

[Erin Goodwood 00:00:01:46] is one of our presenters today. And her title is Prevention and Wellness Coordinator. Between Coventry and Aetna, she has been in the Medicaid quality management department for over eight years. She manages prevention and wellness programs, which include member rewards, ship lead PIP, and member outreach by our outreach specialist vendor. She's also responsible for completing quarterly updates to the state about our activities then many of the annual analysis and reports that are due as well. 

Madison Yonlisky: 

Manning the Q&A and chat box is Megan Cross. Megan joined the Aetna Better Health of Pennsylvania's quality management team in 2018. Her current title is HEDIS Outreach Coordinator. But her previous experience includes working with behavioral health agencies. She worked with clients on alleviating their symptoms, and assisted on integrating them into the community. 

Madison Yonlisky: 

Before we get started on today's topic, I wanted to give you an overall view of what you can expect back from our webinars this year. The Aetna Better Health of Pennsylvania plan is your webinar team. And we probably present the 12 States nationwide. The purpose of these webinars are to educate on HEDIS specific measures, explore ways to reduce the burden of medical record review, and maximize administrative data capture, present NCQA HEDIS reporting codes that will help effectively capture care provider. 

Madison Yonlisky: 

We want to discuss HEDIS measures applicable to certain populations, encourage open discussion to learn how other providers are addressing HEDIS and barriers to care, and also strategies for improvement. So I'm going to click off of our slides here for a moment just to show you what we have scheduled for this year briefly. Let that load for a moment. And this is just an overview of what we have scheduled for the rest of 2019. 

Madison Yonlisky: 

We have one topic each month for our webinar series, and we have each topic held twice. So there's two different offerings each month. So you can see next month we'll be looking at Aetna 21 and older male and female membership. And April we'll be focusing on women and maternity care. And again, we have then going all the way through December of this year. 

Madison Yonlisky: 

So each Aetna Better Health plan has their own website by state. So if you do want to ask that was state, you can use this link. And Megan will actually put that in the chat box, so you can have easy access to it as well. You can go to this website, and once this populates you will see. There are two ways to access your specific plan. You can either use this tree on the side and select what state you're in that way. Or you can go to this nice little map that we have in the middle, and you can select what state you're out of that way. 

Madison Yonlisky: 

Now, we do record our webinars so you can go back and review them as you would like to. So right here is a direct link to where you can find this recording. And Megan will that in the chat box. I see she just did now. So if one of your colleagues would like to be added to our invite list, you can email me at this email address that's mryonlisky@aetna.com. Just make sure that your email includes what state that person is working out of, and then obviously, the email address that you would like to be added to the distribution list. 

Madison Yonlisky: 

So now we're going to get into the meat and potatoes of the presentation. Again, we'll be talking about caring for Aetna Better Health members, and HEDIS measures affecting 12 to 21-year-old members. So that's the population that we're focusing on today. A little bit of housekeeping before we get started. Please make sure that you are on mute so we don't get any background noise. During the webinar, we will be pausing for Q&A. And of course, participation is always encouraged. Please utilize the Q&A box. Hover your mouse over the top part of the middle of your screen and find the option for Q&A. Choose the participate dropdown option, and then take your question or comment in the white box and send to all panelists. 

Madison Yonlisky: 

Aetna's vision statement of philosophy as the way we manage health care is you don't join us. We join you. And by joining you all today on the line in this webinar environment, it is our hope that we are more effectively reaching our Aetna Better Health members. On the screen, you're seeing our Aetna values wheel. And at the center of all we do here at Aetna are the people we serve, and that's not only our members. That's our providers as well. And surrounding the center of the values wheel are our four core values. We have integrity, excellence, inspiration, and caring. 

Madison Yonlisky: 

And as a company, we act with integrity and aspire each day to excel and build a healthier world here. You see what's on today's agenda. We're going to talk a little bit about gaps and care, and how to cut down on the burden of medical record reveal. We'll talk a little bit about EPSDT. We'll go over some HEDIS measures of care, and some NCQA approved HEDIS codes that fall into our population this month. We'll talk about culture and linguistics awareness, anticipatory guidance and physical activity. And we'll also look at a hypothetical case story. 

Madison Yonlisky: 

The goal of this webinar today in all webinars in the series is to spark conversations with providers in multiple states nationwide. And we're attempting to explore ways to cut down on the burden the medical record review, and maximize the administrative data capture. And there are a few really good and simple ways to cut back on MRR. One is to utilize your point of contact. That is somebody that I will be giving you at the end of this presentation. Two, attend these webinars, which, again, we have monthly. And three, you can go to the NCQA website at www.ncqa.org. And while we give you some good examples of codes that can be used in these webinars, the NCQA website has a full list of codes that could be used. It is really helpful. It's a really helpful website available for you. 

Madison Yonlisky: 

So, let's talk about HEDIS for a moment. HEDIS stands for effective ... Oh, I'm sorry. Healthcare Effectiveness Data and Information Set. So what is HEDIS and what does it measure? It is a set of standardized performance measures developed by the NCQA. And HEDIS measures performance on specific dimensions of care and service. So why should providers and health insurance companies pay attention to HEDIS measures? It helps evaluate performance and very key areas. We look at quality of care, access to care, satisfaction with the care members receive, and it provides a clear picture of the outcomes of care members receive in specific areas. 

Madison Yonlisky: 

Why is HEDIS so important? Regulatory bodies may use HEDIS status or accreditation in enrollment purposes. The public can look at HEDIS rates when choosing a health plan. And provider pay for performance programs are often tied to HEDIS scores. Okay. So do we have any questions Megan, about what I just went over? 

Megan Cross: 

It doesn't look like we have any questions right now, Madison. 

Madison Yonlisky: 

Okay, thank you. We will move on. We will briefly talk about EPSDT a little bit. And that stands for Early and Periodic Screening, Diagnosis and Treatment. In each state they must provide these services for children zero to 20 years of age. It requires periodic visits based on recommended diet by The American Academy of pediatrics Bright Futures Periodicity Schedule. It requires that all conditions must be treated, and must provide all optional Medicaid services for children even if the state does not cover these services for adults. The components of EPSDT are measured using HEDIS performance metrics, and also a screening for depression should always take place. 

Madison Yonlisky: 

So today the HEDIS measures of care we will go over, again, we'll be focusing on the male and female members age 12 to 20 years of age. HEDIS is collected in two different ways: by claims and other administrative data, and by medical record review and collection. So for HEDIS year 2020, we're going to be collecting data for care that was primarily given in 2019. Those dates that we're collecting for may vary based of what HEDIS measure is being looked at. So some of the measures may be collecting data farther back than 2019. Overall, though, claims are the quickest and easiest way for us to collect data. 

Madison Yonlisky: 

So we're going to start to talk a little bit about the HEDIS measures, and our first measure is ADV, or Annual Dental Visits. And this is looking at the percentage of members two to 20 years of age who had at least one dental visit during the measurement year. So even if that child is in for a well visit, you can ask them if the child has a dental home and then if necessary, you can refer the child to a dentist. If you need to find a dentist or you just want to be sure that a dentist is a network, you could go to your plan's website, which is what I had showed you a few slides back, and you can search that way. 

Madison Yonlisky: 

So now we're going to talk about the components of a well child visit. And those components are needed in order to meet the parents for the HEDIS measure. They are health history, physical developmental history, mental developmental history, a physical exam, and health education and anticipatory guidance. AWC, that stands for Adolescent Well-Care. And this measure is looking at the percentage of enrolled members age 12 to 21 years of age as of December 31st of the measurement year who had at least one comprehensive Well-Care visit with a PCP, or an OB/GYN practitioner during that year. 

Madison Yonlisky: 

WCC stands for Weight Assessment and Counseling for children. And this is looking at the percentage of members and the age range here is 3 to 17 years old who had an outpatient visit with, again, a PCP or OB/GYN, and had evidence of all three of the following components in the measurement year. A BMI percentile documentation, counseling for nutrition, and counseling for physical activity. Now, on this spot slide we see some numerator codes for all three of those components. The first section we're looking is the BMI percentile ranges. Below that, we have ICD 10 CPT codes, and some hick picks for nutritional counseling. And then below that you have separate ones for physical activity counseling. 

Madison Yonlisky: 

Now, the next measure I want to briefly go over is ABA, and that stands for Adult BMI Assessment. This measure starts at 18 and goes to age 74. It's looking at numbers in that age range who had an outpatient visit, and whose body mass index was documented during the measurement year, or the year prior to the measurement year. And we saw a few slides back but here we see some codes again for the BMI percentile. So we're seeing documentation for a BMI percentile that is in the less than 5th percentile for age, all the way to a BMI percentile for greater than or equal to the 95th percentile for age. And I do want to make a note that these just are just examples of code CPUs. So for a complete list of codes you can go to that NCQA website there. And you might hear me say that a couple more times because we will look at some more codes for other measures here soon. 

Madison Yonlisky: 

Next up is IMA, and that stands for it Immunization for Adolescents. And it looks at the percentage of children who turned 13 years old during the measurement year, and had the following vaccinations on or by their 13th birthday. So then the meningococcal, which is from ages 11 to 13, the Tbap, which is from ages 10 to 13, and the HPV vaccine which is from ages 9 to 13. And I do want to make a note that HPV vaccine is now required for both males and females. Next we have the CHL measure and that is chlamydia screening for women. And this is looking at the percentage of women age 16 to 24 years old who were identified as sexually active, and who had at least one test for chlamydia during that measurement year. Okay. So at this point, we have a hypothetical case story. I'm going to hand it over to Erin to go over this with you. 

Erin Goodwood: 

Thanks, Madison. So today we're going to look at Gloria, Amy Gloria. She is a 12-year-old who is currently in the sixth grade. She's currently at her new PCPs office for an initial office visit having just moved to the United States recently from Portugal. Unfortunately, she's not as active as she was when she was living in Portugal. And she's spending a lot more time at home because she hasn't really made many friends yet. And she's spending most of her time online, Snapchat, Instagram as do a lot of teenagers and 12-year-olds. Unfortunately, she's also behind on immunizations due to her family's move. And she hasn't established a dental home yet either with a dentist. She does require an English translator. Having just moved to the United States from Portugal, Portuguese is her primary language at the moment. 

Erin Goodwood: 

Next slide. So what are some HEDIS measures that can be addressed while Gloria is in the office? Well, the first is the annual dental visit, or ADV. As I mentioned, no dental home has been established. So it's important to have the conversation with her and her parents that she really needs to pick a dentist, choose a dentist, and establish a dental home to make sure she gets in for her regular dental checkups, and that her oral health is on in, in good shape because we all know that oral health tends to tie into your overall health as well. 

Erin Goodwood: 

The second is the Adolescent Well-Care, which is AWC. And this looks at things like mental and physical development, height, weight, a physical exam. And it has supporting guidance, which includes screen time. It also includes things like nutrition and diet, physical activity and exercise, safety and other things along those lines. Of note for the AWC is that these components can be done not only at a well visit but also a sick visit. So if a member is in for a sick visit and they're not going to be in for a well visit, say they're not due for a while for a well visit, these components can actually be captured at that sick visit including the anticipatory guidance. But if you have a handout that's available on that, you can just give to the member as they're concluding their visit and review the anticipatory guidance that will indeed count. 

Erin Goodwood: 

Next is the Weight Assessment and Counseling, or WCC. This looks at BMI percentile nutrition counseling and physical activity counseling. As with the AWC, these components can also be done in a sick visit and not just a well visit. So again, if a member is in for a sick visit and isn't due for a well visit for a while, you can cover these components and talk to them about nutrition and physical activity while they're in there. And then lastly, we have the Immunizations for Adolescence, IMA. And again, this looks at the meningococcal vaccine, the Tdap vaccine, and the HPV vaccine to make sure that these are all completed by the age of 13. Next slide. So are there any questions about the hypothetical case study and any of the measures that could have been covered while she was in the office? 

Megan Cross: 

There are no questions, Erin. 

Erin Goodwood: 

Thanks, Megan. At this point, I'm going to turn it back over to Madison. 

Madison Yonlisky: 

Thank you, Erin. And we're going to continue on a little bit more with some HEDIS measures. Next up is AMM, or Antidepressant Medication Management. And this is looking at the percentage of members 18 years of age or older who are newly treated with antidepressant medication, and had the diagnosis measure depression. And who remained on antidepressant medication during their treatment. So two different rates are reported in this measure. We look at the effective acute phase treatment, which means that they have to be on that medication for at least 12 weeks, and the effective continuation phase treatment, which means that they remained on those medications for six months. One thing I want to note is that this is a medication-only measure. It is captured administratively through pharmacy claims. 

Madison Yonlisky: 

And continuing on a little bit further on the AMM measure and some strategies for improvement, it's important to talk to the patient about the importance of continuing medication and scheduling follow-up visits even if they're feeling better. Discuss the possible side effects that are really more bothersome than life-threatening. Advice the patient about the risks of discontinuing the medication prior to six months, and that it is associated with a higher rate of recurrence of depression. Likeliness of response to treatment is increased if there is a follow-up contact within three months of the diagnosis or initiating treatment. And it's important to inform the member that most people treated for initial depression need to be on medication for at least 6 to 12 months after adequate response to symptoms. So those were just some strategies for improvement to keep in mind. 

Madison Yonlisky: 

Next up, I want to talk a little bit about adherence to anti-psychotic medications for people with schizophrenia. This measure is also called SAA. And the measure looks at the percentage of members age 19 to 64 years old during the measurement year with schizophrenia who were dispensed and remained on anti-psychotic medication for at least 80% of their treatment period. So a number will have fallen into the SAA measure because they had at least two an outpatient, intensive outpatient, partial hospitalization, ED, or non-acute inpatient setting on different dates of service, and with any diagnosis of schizophrenia. 

Madison Yonlisky: 

And we are going to look at some NCQA approved codes for this measure. On this slide, there are some codes for an acute inpatient and for schizophrenia diagnosis. And then on the next slide, we are seeing some more codes for ED visits than outpatient visits. And as always, like I said before, you can go to that NCQA website, ncqa.org, for a full list of approved codes. Okay. I want to take a moment to pause for questions. Megan, are there any questions? 

Megan Cross: 

There are no questions, Madison. 

Madison Yonlisky: 

Okay, great. Thank you. And I want to go over two more really important measures before I hand it back over to Erin. Those measures are controlling high blood pressure, and comprehensive diabetes care. So first, we're going to talk about controlling high blood pressure, or CDP. And this measure looks at the percentage of members 18 years of age or older who had a diagnosis of hypertension, and who have adequately controlled their blood pressure during the measurement year. 

Madison Yonlisky: 

So adequately controlled for this HEDIS measure would be a blood pressure reading that is less than 140 over 90. Now, at an appointment, if the patient's blood pressure is high, make sure that you retake it at the end of the appointment. This HEDIS measure would accept the lowest systolic and the lowest diastolic at that appointment. So that's something to keep in mind also. 

Madison Yonlisky: 

And here we have some NCQA approved codes for CDP. And we'll actually be seeing these again here in a few slides. The next step is Comprehensive Diabetes Care, or CDC, and this is looking at the percentage of members age 18 to 75 years old with type one or type two diabetes. And there are multiple components to this measure. We look for an A1C, blood pressure monitoring, a diabetic retinal eye exam and nephropathy treatment. 

Madison Yonlisky: 

And these are some CPT codes for an A1C. You have one for the A1C tests, but then we have codes also that are the specific to the results. So we have some for an A1C less than 7%, from seven to 9%, and one that is greater than 9%. And there are some codes for medical attention to nephropathy, and a dilated retinal eye exam. And here you see those codes again for the blood pressure. Okay. So that is all I have for the HEDIS measures. Are there any questions before I give it back to Erin? 

Megan Cross: 

There's no question. Just move on. 

Madison Yonlisky: 

Okay, great. Thank you, Megan. Erin, it's back over to you. 

Erin Goodwood: 

Great. Thanks, Madison. So now we're going to take a look at cultural linguistic awareness. This takes a look at how culture is perceived by the member and the provider, and how it directly impacts how their care is delivered and received. So a lack of culturally competent care directly contributes to poor patient outcomes, reduced patient compliance, and increase health disparities. And what this means is that a member who is not receiving the culturally appropriate care, they have more ER visits because they don't understand what they're supposed to do. If there's a language barrier, they may not understand the instructions you're giving them for things like medication adherence, follow-up visits, labs, if they had to go see a specialist. 

Erin Goodwood: 

So they may miss out on some of those things and doing them. And as a result, may end up in the ER when it could have been prevented. It also may lead to more follow-up visits in your office. And again, them not adhering to their medication regimen, not following up with labs and things like that. So all that can have reduced outcomes. So it's really important to make sure that they're receiving culturally competent care, and that they're proactive in their health and understanding what they need to do. So it's also important to understand that different cultures and religions have varying things that they need. And this may be around things like birth rituals, dietary constraints, and even the requirements for the gender of their doctor. 

Erin Goodwood: 

Next slide. So it's important to avoid stereotyping and jumping to conclusions based on things like race, age, gender, language, and any other kind of outwardly appearances. It's really important to document the assessment of the culture needs in the medical record to make sure that when a member comes in, if this hasn't been done to make sure you do an assessment of what they need to make sure that they're receiving the culturally appropriate care. And then document that because it helps to serve as reminders so that every time they come to the office, they consistently receive that appropriate care. 

Erin Goodwood: 

Next slide. So what are some of the things that you can do to make sure they're receiving the appropriate care? One is to utilize a certified language translator. Aetna Better Health does have a language line to help alleviate that and to help reduce that barrier. If there is a language barrier that you can call the language line and they will help with the translator. Get to know the member. When they come in, have a conversation with them and make sure that they don't need anything special. Or if they do, that it can be provided appropriately. 

Erin Goodwood: 

Understand what they think about their current medical care. Make sure they understand. One of these things that you can do is the teach back method, and that is when the member would teach back to you what you have to talk to them as a way to make sure that they're fully comprehending and understanding what's being told to them and what you're instructing them to do. Again, things like medication adherence, follow-ups, labs. If they do need to see a specialist that they really understand what it is you're telling them, and what they need to do for their health care. 

Erin Goodwood: 

Next slide. So it's important to make the most out of every visit and really understand the member and his or her background. And again, by doing this, it will help cut down on any unnecessary ER visits because they don't understand what they need to do, and end up in the ER. And also, eliminates the need for repeat follow-up visits. Again, they may end up in your office for more visits than needed. That could have been taken care of in one because they didn't either follow through with something that they needed to because they didn't understand, or they just didn't follow-up with the same medication, and then back in your office when it really could have been prevented. Next slide. Any questions about cultural and linguistic awareness and healthcare? 

Megan Cross: 

There are no questions, Erin. 

Erin Goodwood: 

Thanks, Megan. So Madison, I'm going to turn it back over to you. 

Madison Yonlisky: 

Thank you again, Erin. And now we're going to have some time to utilize the Q&A box. We had a really quiet crowd today, so if you think of anything, you will have an opportunity to continue to post questions in them. If we do not have the answer to your question because it's state-specific, we will forward that on to your point of contacts and I'll be giving you those in a moment. But again, if we can't answer a question for you today, we'll forward that to your point of contact, and then they will reach out to you with an answer. 

Madison Yonlisky: 

So I'm going to go through these. They are our point of contacts by whichever state you're in. And also, just know that you will be getting a copy of the slides in the future. So that's a good reference also that you could refer back to know who you need to reach out to for questions. So if you're in Florida, you will reach out to Michelle. If you're in Virginia, you will reach out to Jennifer. And Pennsylvania, Diana. In Louisiana, you'll reach out to Frank. Kentucky, your point of contact is Kathy. In Ohio, you can either reach out to Sarah or Valerie. In Michigan, your point of contact is Dante Gray. If you are in Illinois, Anya is your contact. Maryland, Donald. New Jersey, Sammy. I'm going a little bit just in case anybody wanted to write down their points of contact email address. If you are in California, Melissa is your point of contact. And if you're in Texas, Joanna is your contact. 

Madison Yonlisky: 

So, that concludes the webinar today. I want to thank everybody so much for attending. I will leave the Q&A open for a few more minutes. And if you have any colleagues again that you would like added to our invite list, please send me an email with their name, their email address, and what state they're in, and they will start to receive invites for our future webinars. And that's really all we have again today. So again, I will leave the Q&A open for a little bit. And I want to thank everybody for their attendance, and I hope that you'll have a great day. 

Madison Yonlisky: 

(silence)