Together for Quality

1. Together for Quality “Quality is not an act, it is a habit” Aristotle

2. Clinical Workgroup

3. Clinical WorkgroupMeeting Date(s): Wednesdays (Bi-monthly)Time: 5:00 p.m. Co-Chairperson: Mary McIntyre, MD, MPH, Christine Ritchie, MD, John Searcy, MD PROVIDERS, OTHER PROFESSIONALS Barrow, Felicia Behringer, Melissa Berringer, Robert Biondich, Paul Blanton, Lori Reed Brannen, Sharon Calhoun, Brian Clement, Loran Colburn, Susan Cowden, Anita Curry, Bill Davis, Melinda Decker, Joseph delos Reyos, Amelia Foster, Pamela Freeman, Charlena Geyer, James Gibson, Jatuun Goodwin, Imani Gratton, Nakema Hambrick, Dollie Hataway, Jack Hicks, Dawn Holloway, AZ Hood, Hugh MEDICAID AGENCY STAFF Davis-Allen, Kim (Project Manager) Hurst, Clemice Hall, Kathy Ledbetter, Tina Littlejohn, Kellie McIntyre, Mary Richburg, Theresa Watters, Kelley Hulsey, Candace Knight, Liz Mada, Nidish Miller, Tom Moon, Robert Mullins, Butch Nason, Carroll Ouimet, Claude Powers, Richard Raulerson, Marsha Reynold, Kyle Ritchie, Christine Roach, Dan Robertson, Fred Rogers, David Searcy, John Skelton, Demazio Steil, Condit Sullivan, Greg Wedgeworth, Grover Williamson, Don Williams, Wanda Yu, Feliciano

4. Together for Quality Clinical Workgroup Mission: The Clinical Workgroup’s mission is to improve the care and outcomes of patients within the state of Alabama by facilitating access to the information needed to make informed healthcare decisions.

6. Diabetes QI Measures (Adult and Pediatric)-Final MEASURES • Annual HbA1C – percentage of patients who have had at least one HbA1C during 12 month review period (Children and Adults) • Lipid Management – percentage of patients who received at least one lipid profile (or ALL component tests) during the 12 month review period (Adults and Chidren≥16 years old) • Annual Urine Protein Screening (or microalbumin) during the 12 month review period (Adults and Chidren≥16 years old) • Annual Eye Exam – percentage of patients who received a dilated eye exam by an ophthalmologist or optometrist during the 12 month review period (Adults and Chidren≥16 years old) • Annual Influenza Vaccination – percentage of patients who received an influenza vaccination during 12 month review period (Children and Adults)

7. Diabetes Logic Annual HbA1C 1) The numerator is patients who received at least one HbA1C test, CPT 83036 during the measurement period (dates of service March 01, 2006-February 28, 2007 with paid dates through May 31, 2007). Annual Lipid Profile 2) The numerator is patients age 16 and older with at least one lipid panel, CPT 80061 or ALL Component Tests, CPT 83718 and 83721 and 82465 and 84478 during the measurement period (dates of service March 01, 2006-February 28, 2007 with paid dates through May 31, 2007). Denominator is all patients diagnosed with diabetes or on an anti-diabetic medication. The denominator will include recipients with any claims with ICD-9-CM codes 250.00-250.93, 357.2. 362.01, 362.02 or 366.41 or on any anti-diabetic medications in the AHFS class 68:20 (68:20.02, 68:20.03, etc) with the dates of service March 01, 2006-February 28, 2007 with paid dates from March 01, 2006 through May 31, 2007 (this provides a tail for the baseline so that when the baseline numbers are rerun there will not be marked changes as a result of newly submitted claims). Measurement period is 12 consecutive months. The numerator will reflect the coding required in determining the measures above.

8. Diabetes Logic - Continued Annual Urine Protein Screening 3) The numerator is patients age 16 and older with any test for urine protein (microalbuminuria), CPT 81000-81003, 81005, 82042, 82043, 82044, 84156, 84160 or 84166 during the measurement period (dates of service March 01, 2006-February 28, 2007 with paid dates through May 31, 2007). Annual Eye Exam 4) The numerator is patients age 16 and older who received a dilated eye exam, CPT 92002-92014 during the measurement period (dates of service March 01, 2006-February 28, 2007 with paid dates through May 31, 2007). Annual Influenza Immunization 5) The numerator is all patients who received an influenza vaccination, CPT 90655-90660 or G0008 or V04.81 during the measurement period (dates of service March 01, 2006-February 28, 2007 with paid dates through May 31, 2007).

9. Diabetic Data for All Counties Straight Claims a Based on NCQA Medicaid Hedis 2005 National Average except for the Annual Flu Shot b NCQA Commercial Hedis 2005 National Average

10. Diabetic Data for All Counties Straight Claims a Based on NCQA Medicaid Hedis 2005 National Average except for the Annual Flu Shot b NCQA Commercial Hedis 2005 National Average *Changes have been made in the denominator to address issues surrounding the recommended frequency for testing in children with type 1 diabetes which prevents annual reassessment. Only adults and children 16 years and older have been considered for these 3 measures.

11. Diabetic Data for Pilot Counties Straight Claims a Based on NCQA Medicaid Hedis 2005 National Average except for the Annual Flu Shot b NCQA Commercial Hedis 2005 National Average *Changes have been made in the denominator to address issues surrounding the recommended frequency for testing in children with type 1 diabetes which prevents annual reassessment. Only adults and children 16 years and older have been considered for these 3 measures.

12. Diabetic Data for Pilot Counties Straight Claims a Based on NCQA Medicaid Hedis 2005 National Average except for the Annual Flu Shot *Changes have been made in the denominator to address issues surrounding the recommended frequency for testing in children with type 1 diabetes which prevents annual reassessment. Only adults and children 16 years and older have been considered for these 3 measures.

13. Asthma QI Measures and Logic-Final MEASURES • Asthma Controller Use – 1a) Percentage of patients with an asthma related ED visit and/or hospital admission who subsequently fill <1 prescription every three months for an inhaled steroid, either alone or in combination, 1b) Percentage of patients who fill >2 short acting bronchodilator prescriptions every year who subsequently fill <1 prescription every three months for an inhaled steroid, either alone or in combination, or fill < 2 prescriptions every three months for leukotriene modifiers or mast cell stabilizers. • Annual Influenza Immunization – Percentage of patients with an asthma diagnosis who receive an influenza immunization during each calendar year • Emergency Department Visits – Percentage of patients with an asthma diagnosis who have ≥1 ED visit during a calendar year • Hospitalization – Percentage of patients with an asthma diagnosis who have ≥1 inpatient admission for asthma treatment during a calendar year.

14. Asthma QI Measures and Logic-Final LOGIC Denominator is all patients age one and older, diagnosed with asthma or on at least two short acting beta adrenergic agents during the measurement period. The denominator will include recipients with any claims with ICD-9-CM codes 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.81, 493.82, 493.90, 493.91, and 493.92 (excludes 493.20, 493.21 and 493.22) or on two or more short acting beta adrenergic agent (Short Acting Beta Adrenergic Agents-Table D) with the dates of service March 01, 2006-February 28, 2007 with paid dates from March 01, 2006 through May 31, 2007 (this provides a tail for the baseline so that when the baseline numbers are rerun there will not be marked changes as a result of newly submitted claims).

15. Asthma QI Measures and Logic-Final-Continued Measurement period is 12 consecutive months. The numerator will reflect the coding necessary to obtain the specific measures chosen by the TFQ Clinical Workgroup. 1. Asthma Controller Use 1a. Numerator is patients with an asthma related ED visit (procedure codes 99281-99285) or asthma related hospital admission (Claim Type S – straight and PT=05 and Provider Specialty=W6) AND fill < 1 prescription every three months for an inhaled steroid (Table A) 1b. Numerator is patients with > 2 short acting bronchodilator prescriptions (Table B) during the measurement period AND fill < 1 prescription every three months for an inhaled steroid (Table A) or fill < 2 prescriptions every three months for leukotriene modifiers or mast cell stabilizers (Table C) 2. Annual Influenza Immunization Numerator is patients with influenza vaccination CPT 90655 - 90660 or V04.81 or G0008 during the measurement period (dates of service March 01, 2006-February 28, 2007 with paid dates through May 31, 2007).

16. Asthma QI Measures and Logic-Final-Continued 3. Emergency Department Visits Numerator is patients with ≥ 1 asthma related ED visits as identified via ED visit codes (procedure codes 99281-99285) AND also has an asthma diagnosis code ICD-9-CM codes 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.81, 493.82, 493.90, 493.91, and 493.92 as the primary diagnosis on the emergency room claim during the measurement period (dates of service March 01, 2006-February 28, 2007 with paid dates through May 31, 2007). 4. Hospitalization Numerator is patients with ≥ 1 inpatient hospital admissions (Claim Type S – straight and PT=05 and Provider Specialty=W6) AND also has an asthma diagnosis code ICD-9-CM codes 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.81, 493.82, 493.90, 493.91, and 493.92 as the primary diagnosis on the inpatient hospital claim during the measurement period (dates of service March 01, 2006-February 28, 2007 with paid dates through May 31, 2007).

17. Asthma Data for All Counties Straight Claims (Age 1 or Older) Benchmarks have not been finalized for these measures with the exception of the Annual Flu Shot measure which will be the same as that chosen for diabetes.

18. Asthma Data for Pilot Counties Straight Claims (Age 1 or Older) Benchmarks have not been finalized for these measures with the exception of the Annual Flu Shot measure which will be the same as that chosen for diabetes.

19. PILOT COUNTIES Eleven pilot counties have been chosen to test the effectiveness of this health information exchange initiative. Electronic Clinical Support Tool (ECST) County Care management

20. Provider Information Technology Status Completion of the following survey will help Medicaid assess the level of information technology currently available in pilot counties. My Office is a: □ Clinic consisting of ___ 1-10 Practitioners ___ 11-25 Practitioners ___ Over 26 Practitioners □ Private Practice consisting of ___ 1-10 Practitioners ___ 11-25 Practitioners ___ Over 26 Practitioners. Basic Provider Information Technology (IT) Status My office: □ Does not utilize computer(s). Please indicate the reason(s): __________________________________________ □ Does utilize computer(s). There are approximately (how many) __________ computers. The computers are (check all that apply) ____ PCs/Laptops ____ Macs ____ PDAs ____ Tablets. Access the internet. □ Yes. Please specify internet connection ___Dial-up ___DSL/Cable ___Don’t Know. □ No. Why not? ____________________________________________________

21. Survey (Continued) Utilize an Electronic Medical Record (EMR) system. □ Yes. Please specify name and version:________________________________________________________ □ No. Why not? _________________________________________________ Utilize electronic billing. □ Yes □ No. Why not?_ ________________________________________________ Utilize e-Prescribing. □ Yes. How often?______ (Approximate time used monthly) □ No. Why not? _________ Utilize Blue Cross Blue Shield Info Solutions. □ Yes. How often?_____ □ No. Why not?___________________________________________________________________________ □ Has access to computers in exam rooms. □ Has internal/external interfaces linked to _____ Other Offices ____ Hospitals _____ Laboratories. Would you be willing to participate in our Pilot project? ______ Yes ______ No______Maybe (Need additional info) Contact Person__________________________________ Phone _________________________________________________ Name of Practice ________________________________ Name of Physician _______________________________________ Provider or Group #______________________________ Email Address___________________________________________ Please fax or mail survey responses by August 2, 2007 to: ATTN: Rita Bell @ (334) 353-3856 (FAX) or mail Alabama Medicaid Agency 501 Dexter Ave. P.O. Box 5624 Montgomery, AL 36103-5624.

22. Grant Requirements • Within grant period: • TFQ will develop, test, and implement a system of data and information exchange with at least one health and human service agency • TFQ will develop EHR for Medicaid recipients and work toward partnerships for development of records for the uninsured • TFQ will enhance and provide electronic clinical support tool for providers • TFQ will develop quality improvement model for chronic diseases

23. Working Together,We Can… Succeed in transforming Medicaid