Provider training videos

- [Brian] Well, good afternoon everyone and good morning to those on the west coast. Welcome to the second offering of the webinar this month titled Caring For 21 and Older Aetna Better Health Members. I'd like to welcome provider contacts from the states of Illinois, Maryland, New Jersey, Ohio, Pennsylvania, Texas, Louisiana, Kentucky, Florida, Michigan, California and Virginia. Very happy that you could fit this important webinar in your schedule today. The webinar will last approximately 50 minutes and then we'll have some time also for questions and comments at the end and I have three polling questions that I'll be posing to the audience early on in the webinar. So let me tell you how to respond to those polling questions here in a little bit but a little bit about myself and the presenters today. First off, there will be two presenters today but my name is Brian Clark, I'm your host. My title is Quality Practice Liaison and I work in Quality Management here at Aetna Better Health, specifically for the Pennsylvania Plan. And I have a Bachelors Degree in Media and Professional Communications and a Certificate in Corporate and Community Relations and I've been working on improving outcomes of care for our members for the last seven years and HEDIS has always been my main focus. And prior to Aetna Better Health I was in the service industry, I was a caddy, I worked in the coffee industry for a little while as well and had some other odd jobs prior to employment at Aetna Better Health. The two presenters today are clinical. Diana is an RN BSN and she worked in Oncology, Med Surg and a surgical step down trauma unit prior to employment at Aetna Better Health. And Debbie Barkley, she's worked in multiple inpatient and outpatient clinical areas including the ER, ICU, OBGYN and Endocrinology and has worked with HEDIS for other health plans as well. So let's, actually, before we get going on a couple other items, let's talk about how to get access to the slides. So whatever you clicked on, your Outlook reminder in Outlook to get into the webinar today, the next screen that pops up, it might've been the second screen after that that pops up, is an overview of the webinar, the date and time, the duration, the description of the webinar. And then, at the bottom, you should've seen event material right here. So, right next to event material you could've single clicked and got a copy of the presentation. So you can follow along with us today. That was the way that you could gain access to today's slides. And if you did not do that we'll make sure to send a copy of the slides to you at the end of the presentation. Just type into the Q and A or in the chat box that you need a copy of the slides. Preferably we'd like you to work in the Q and A box. That way we can gather your email and send any follow up materials to you. So a little about the company, now you know who's presenting, but a little about us here at Aetna. The vision statement or philosophy is the way we manage healthcare is you don't join us, we join you. And by joining you all on the line today in this webinar environment it's our hope that we're more effectively reaching our Aetna Better Health members. And on the screen here you see our four core values. And then, at the center of all that we do, are the people that we serve. That would be our members and our providers. Okay, so let's move on to the goals and vision and how this webinar series came about. So the main goal surrounding the webinar series is to spark conversations with providers in multiple states nationwide while attempting to explore ways to cut down on the burden of medical record review which is actually going on right now. You may be receiving requests for records that were not captured administratively through clients or the measure requires that we need to reach out for medical records. So the goal of the series is to basically go throughout the life cycle of the member, focus on various aspects of care and the NCQA approved codes that can capture care for HEDIS purposes and things like that. And all the while fielding questions and comments and tailoring the webinar series based on survey results to what our audience would like to see. So I've mentioned HEDIS a few times so far. HEDIS stands for Healthcare Effectiveness Data and Information Set. And, currently, we are in HEDIS Season 2020 which collects data for care primarily in 2019. However, the HEDIS measure look back period can depend on which HEDIS measure you're looking at. It doesn't always look at the year prior. It could look back a little bit further as you will see whenever we look at a few of the measures today. So HEDIS was developed and is maintained by the National Committee for Quality Assurance or the NCQA. And often Pay for Quality programs are linked to HEDIS scores as well. All right, so, some terms that you will hear in the future and probably have heard already in this webinar series if you have attended in the past, Administrative Data, Hybrid Review and a Hit. So Administrative Data is healthcare information captured by means other than the medical record like claims, immunization data banks and historical encounters. Hybrid Review is what's going on right now HEDIS season, it's a tight window of opportunity for health plans to gather information that is not collected during the measurement year via claims. That's when we go to the medical record to capture data. That's when Administrative Data and medical record review are used to satisfy HEDIS guidelines. And then a Hit, that's what we want, when the Administrative Data and/or medical record meet all the HEDIS requirements for a particular measure. Okay, so who uses the HEDIS data? The public may use HEDIS ratings when choosing a health plan, a regulatory body use it as well. They use HEDIS data for accreditation or enrollment purposes. And, like I said earlier, Pay for Quality programs are often linked or tied to HEDIS scores. The health plan uses HEDIS information to improve the effectiveness of care our members are receiving. And some providers utilize HEDIS data for their own internal quality improvement activities. Okay, so what are we looking at here? Some housekeeping items. Let's make sure, I think I have everyone on mute right now but if I feel that I need to take everyone off mute to engage the audience I will, but sometimes that brings on a whole bunch of background noise. So we have polling questions, usually I would like you to just utilize the Q and A box if you have a question or a comment and please send all questions or comments to all panelists. And if a question is too state specific we will be forwarding that issue on to your point of contact. And I'll be introducing you all to your point of contact at the end of the webinar. Today's agenda, first off, I thought it would be a good idea to actually look at, in more depth, the families that we serve. We will be touching on dual measures today. That means Medicaid and Medicare requires reporting on certain measures. We will be looking at four Medicare specific measures but, for the most part, this series is focused on Medicaid, Aetna Better Health Medicaid and HEDIS. And today, like I said, we're going through the life cycle of the member and focusing on different times of life as well as different aspects of care and certain topics. Today's topic is 21 and older members and the measures of focus and the NCQA recommended codes. Just some of the codes than can be used to capture care for this population of members. And, just to let you know, for a complete listing of all approved NCQA codes you can go to the ncqa.org website. Madison, if you don't mind, Madison is handling the Q and A box today she's an outreach coordinator here at the health plan, if you could type in ncqa.org just to let you know that's where you can find a copy of the technical specifications. We're going to be looking at the measure descriptions for this population today and the HEDIS measures that we're looking at. And then, just to let everyone know, today's webinar is being recorded and you do have access to previously recorded webinars at that link. Madison, if you don't mind typing in the link to the previously recorded webinars that would be great. And before we get into the webinar does anyone have any questions?

- [Madison] We do not have any questions now.

- [Brian] Okay, no questions right now. Sounds good, let's move on. Let's see here, Deb, why don't you start off with the families that we serve and introduce who those individuals are and then we'll move to other topics involving HEDIS.

- [Debra] Sounds good, Brian, hi everyone. Let's go ahead and get started and let's go over a high level overview of what Medicaid is. So, generally, Medicaid is a federally and state funded health insurance program for low income individuals and families. It was created in 1965. As far eligibility and requirements they vary by state. So whether or not work is required depends upon the state. Some states have included work requirements to be eligible for Medicaid. So they vary from state to state. And, generally, those persons that qualify for Medicaid generally fall below the poverty line and we'll discuss that a little bit more. Next slide please. So taking a look at the information on the next slide here. So qualifying for Medicaid, the federal poverty level in 2019 looks like the family members must fall within a certain range and what's used is the modified adjusted gross income and that's used to calculate the eligibility for these families. And, down below, you'll see a graph that outlines the number of household members that are required according to the certain income levels that place people into those poverty level guidelines. And, also, there are various other eligibility considerations such as pregnancy, whether someone is elderly or disabled, all of those are regulated by the individual states. Next slide. So, we'd like to have some conversation today about some subjects that tend to be prominent in healthcare. Three subjects that we're gonna address today are millennials dropping out of healthcare, smartphone and sleep schedules, and physical activity affecting the U.S.A. Next slide. So we got some information from a platform that's used and that's ZocDoc. It's a healthcare platform that's used for booking appointments and finding providers in a certain area. But, in addition to that, ZocDoc does provide some survey information that we found very useful and that you might find helpful and interesting in this conversation. It is seen that nine out of 10, 93% of millennials either avoid going to the doctor or don't go to a doctor at all. That's very interesting, a very high number. Also, a main barrier that's listed for not getting healthcare is everyday life is just too busy and work is going on, it's too hard to schedule. Things for us to consider as healthcare professionals. And also, a lot of us, even us healthcare professionals these days, are using the internet as a tool to self-diagnose. And sometimes that's helpful but, by and large, we should be getting our healthcare information from professionals versus relying on what we find on the internet and not having that added knowledge of the professional. Generally, the last statement that you can see over here in purple, Americans are dropping out of health care amid busy lives and complex healthcare systems. And that's something that we should think about as professionals and see how we can problem solve and make that better for our society. Next slide please. So here's a question that you can type into the polling area. Here's a question that we can discuss. How does your practice address millennial's perception regarding avoidance of healthcare? So how does your practice address that? You can type your answer into the polling area and then we'll take a look at those. And, Madison, as we see those pop up I think we'll all see them pop up and we can discuss those. We'll take about a few more seconds here.

- [Brian] Yeah, Deb, let's give it about a little bit less than a minute for everyone to think about their response and to type it in. I do encourage responses here, it really helps us here on the webinar team because the next time we present this topic I would like to share some previously recorded responses with the audience. And, just to let everyone know that this is how some practices or groups are addressing this topic in the office.

- [Debra] Very good.

- [Brian] So it will be great if you could respond, we'd appreciate it.

- [Debra] Thank you Brian.

- [Brian] Mm hmm.

- [Debra] And, just to talk a little bit while we're getting those responses in, we know that the millennial age group, as with everyone, youths, there's that thought of invincibility or their bodies are generally pretty healthy. People aren't feeling any symptoms unless they sometimes have had chronic things going on or pre-existing known diagnoses. So, just in general, a lot of times we find out that people are just going to the doctor when there's something incidental, something acute happening. Maybe an injury or something like that. So it's good to know how do we encourage this age group to get preventative care because the old adage is an ounce of prevention is worth a pound of cure.

- [Brian] Deb it looks like we still have five people still typing. Now three, so let's just wait on those three to finish their response. Oh, now we have just two typing. Let's give it a little bit more time for those two to finish up.

- [Debra] Alrighty.

- [Brian] Okay, I'm gonna close the poll. Let's just give it some time for the responses to generate.

- [Debra] Very good and we've got some responses here. And it says some practices use music and interacting with the millennials on activities they enjoy. Meet them there and do hip hop interactions. That's interesting, that's a very innovative way. We offer not only family practice but urgent care so that they have more options, very good. And then, after they're being seen at the urgent care center that group also encourages them to see their PCP, very good. Thanks so much for those responses. So Brian, we got a chance to read a couple of those, I think we can move on to the next one to see what kind of responses we get. Now let's talk somewhat about cellphones and sleep schedules. So we know that, we hear about it all the time in the news, about the lack of sleep and how important sleep is. And, wherein, sleep is shown to be related to heart conditions, diabetes, obesity, high blood pressure, stress, which seep into all of those. Even some cancers could be associated with an interruption in the sleep cycle. And it's recommended for adults to get seven to nine hours. Sometimes we get that, sometimes we don't. And, for college students, one survey shows that they actually average between six to nine hours. Those are some college students that are getting a good amount of sleep. I'd have to ask my daughter and see if that corresponds with her sleep cycle. So, also, one factor that plays into the sleep cycle and just well-being in general, whether it's mental, health or just general health, it's the use of smart devices. One thing we know about is the blue light emission that sometimes interrupts the sleep cycle. And then, also, we have heard reports of increased stress as far as social media and things like that. So there's an article that you can click on and get some information about whether or not smartphones sabotage sleep. Let's go on to the next slide and see what else we're gonna discuss. Here's another polling question here that we can get a response from, we'd like to know your response. How does your practice address sleep and cellphone usage? And in these questions, of course, we always have in mind the Aetna Better Health member, the Medicaid population. And, in conversations about this, it's applicable to all of your patients and we know that you focus on the whole person and the well-being of the whole person. So how do you address that in the appointments and the encounters as far as sleep and cellphone usage? For adults, young adults, even some of you that see patients from the age of zero to the end of the life span. How do you address that for all of your age groups? That would be interesting to know. And you can go ahead and type your answers in.

- [Brian] All right Deb, let's give it a little bit of time for those who are typing to finish up. We have some folks that are in progress finishing up their responses here. I do encourage, once again, that you do respond to this. It really helps us out so we can engage the next audience on best practices whenever addressing particular items like this addressing sleep and smartphone usage. So I do encourage a response here from everyone if possible.

- [Debra] Right, Brian, and historically some of these questions have helped other practices develop processes of their own.

- [Brian] That's right.

- [Debra] So these conversations are very good to have.

- [Brian] Okay, a couple have finished. We still have four that are still typing. Three are typing. Give it about 20 more seconds and then I'll close the poll and we'll take a look at the results.

- [Debra] Sounds good. You know the thing that's really getting smart, some of the phone manufacturers and the builders of some of these platforms are aware of how the blue light can interrupt our sleep so they're starting to develop or modify their operating systems so that they emit less light. I know I just had an update on my Samsung that did that. So everyone is acutely aware of how the blue light affects us.

- [Brian] All right, for all those that are still typing just finish up, I'm gonna close the poll and we'll take a look at the results. Still have about 15 more seconds to respond if you're typing right now.

- [Debra] Alrighty then, let's take a look. It says one we see says that they try to invite family time. Leave all smartphones alone for an hour and interact with the family and a way to relax from all smartphone interaction. Very good. One also says it's generally not done in the family medical offices. And this is an opportunity for us to respect that and for consideration. And it says we provide sleep studies, huh. So I believe that our practice addresses good sleep habits right at the time of the study, very good. And let's move on to the next part here. Last item of discussion that we're gonna talk about is about inactivity. And just to get right to it, 45% of adults don't have sufficient amount of activity. 117 billion dollars in healthcare costs is related to the lack of physical activity. And 25% of young adults are ineligible for the military due to weight and lack of physical activity. So we know that obesity and inactivity is having a profound effect on our society, more than just those things that are obvious, but even in our military. Next slide please. And the last question here, how does your practice address physical inactivity? And you can go ahead and start typing your answers in. That is something that's being looked at across the board, especially in our children. But it's not just in our children, also in our adults too. As more and more jobs involve computer activity and that's being thought about more and more. The advantage sometimes of working in the outpatient care center a lot of times there is a lot of activity, moving the patients around. However, there are some jobs across the board where computers are used primarily. And so, that increases the amount of inactivity for us all. Also, when we are not at work, we now have access to our favorite shows on various streaming services so we get the opportunity to watch a whole season maybe in a weekend. So that is a luxury that we now have but it can lend to our physical inactivity. So how is that addressed in the practices?

- [Brian] All right Deb, we'll just give everyone some time to finish their responses. We have a couple individuals that are still typing so let's wait for them to finish up and then we'll close this poll. We're running just a little bit behind so let's finish up everyone and then we'll move on to some other topics involving HEDIS.

- [Debra] Sounds good Brian.

- [Brian] All right, I'll give everyone another 20 or 30 seconds and then I'll close the poll and we'll look at the results. Okay, it looks like we just have one person that's finishing up, I'm gonna close the poll, you still have time to finish typing. Let's close this poll and we'll look at the results here shortly.

- [Debra] Alrighty, let's take a look and we'll just read off. Let's see, oh, here's one that's interesting. They have billboards around time encouraging physical activity, talk, walk, quiet time, riding bikes, outings with family and friends, very good. And there's a point, various health plans, just to keep this in mind, various health plans may offer memberships to gyms or YMCA's just to keep that in mind, the provider's office to offer that and encourage members to check with their health plans and see if that's a part of it. Thank you so much for your answers. I believe some of those answers were visible to you that you'll be able to take a look at those and get some insight on what some other groups are doing. So let's get right into these HEDIS measures. Let's go to the next slide. As you can see here's the list, I'm not gonna read every one of them 'cause we're gonna go through them individually, but we have a list of six on this page. Next slide. And here are a few more HEDIS measures that we're gonna go through. In additional to those that are written out and listed here we're also gonna talk about some Medicare only HEDIS measures. Next slide. First measure I'd like to talk about is generally a performance measure that is very important and that's Comprehensive Diabetes Care. And that's looking at the percentage of members that are 18 to 75 years of age that have Type One or Type Two diabetes. So what's viewed as important as far as care is concerned and what's measured in HEDIS is whether or not the members get an eye exam with an eye professional, whether there's an attention or treatment for nephropathy and what's the blood pressure looking like for those person with diabetes, also if the person has had a hemoglobin A1c drawn over the past year. So that should be done at least once a year and that's being looked at. So how do they fall into the measure? Whether or not they've had a couple of outpatient visits with a diagnosis of diabetes, an inpatient visit with a diagnosis of diabetes or they've been prescribed medication like insulin or other anti-hypoglycemics. Next slide please. So, as we talked about before as Brian said, this webinar is already getting you ready for next year's HEDIS. That's the purpose of this whole webinar series is to get you ready for HEDIS next year. So we hope to see every year a decline in the number of records that are requested. And the way that is done is by effectively coding. And when these codes are received most of the information is captured administratively and fewer medical records are required during this HEDIS season. So right here we're showing you some of the CPT2 codes that can be used to document the value, or range of values, for hemoglobin A1c. Also there's a CPT code below that shows that an A1c test was done. Next slide. Here are some codes that can be used, CPT codes at the top, for like a urine protein, like a urine dipstick that can used and coupled along with ICD-10 codes for diabetes. And the codes on the bottom are for the eye exam. And what's important to remember about the eye exam, that's a two-year look back period. If there was no retinopathy seen, the eye exam, we can take up to two years as far as looking back to see if the member has had that done. Next slide please. With the blood pressure, as well as the hemoglobin A1c, we're looking for the last value of the year. And that can now be captured, as far as the blood pressure is concerned, with the CPT2 codes. In the past, groups started using CPT2 codes even though they were not used or accepted by NCQA, now they are. In addition to that, if your members have a machine or a device wherein they can transmit their blood pressure to you, we will now accept those. We didn't take member reported, and still don't take member reported blood pressure, unless they're done through a device that's downloaded to the provider. Next slide. Controlling high blood pressure. That looks like the percentage of members that are 18 to 85 years of age who have a diagnosis of hypertension and have it adequately controlled and what's considered with control for the purpose of HEDIS is a blood pressure below 140/90. We know ideally you look for something that's closer to 120/80 or even lower or better than that. However, 140/90 below that is accepted as good control for HEDIS purposes. Next slide. A couple of things to consider when taking the blood pressure in the office is sometimes people come into the office and just the mere stress of coming in they may have an elevated blood pressure. Easy thing to do is to retake that blood pressure and when you have that documented in the record, every blood pressure that's submitted, we can take the best value of the systolic and diastolic and come up with a representative blood pressure for that encounter. And if it's the last blood of the year, we can take those values, that representative blood pressure and count that member as adherent. And that's one thing to keep in mind along with also having the member scheduled for visits so that the blood pressure can be monitored and the medication effectiveness can be monitored. Next slide please. Here are some codes that are used. Both CPT2 codes same ones mentioned for diabetes, can also be used for the hypertension and you can capture that blood pressure. And let's talk about the adult BMI values and that's for 18 to 74 years old and that's a two-year look back on that one. For members that are 20 year of age and older all we're looking for, according to the HEDIS guidelines, is documentation of the weight and BMI value, what that actual number is. And for those members that are younger than 20 years of age as of the date of service that they came in what needs to be documented is the height, weight and BMI percentile. And that's usually seen sometimes in the BMI growth chart. Sometimes it's calculated in your EHR system. So having that documented in your system is vital for those that are under the age of 20 to be counted as adherent for HEDIS. Next slide. So here are some codes that can be used to show those values. Some ICD-10 codes over on the left with the range for BMI percentile and some very specific ICD-10 codes on the right that actually show BMI value for those that are 21 and older. And next slide please. So let's talk about MMA and that's the Medical Management of people with Asthma. And it's looking at the percentage of members that are five to 64 years of age who have been identified as having persistent asthma and that they're using an inhaler. The guidelines dictate that we take a look at whether or not they're using their inhaler 50% of the treatment period or 75% of the treatment period. How is that done? That's done through pharmacy codes and whether or not those prescriptions are being filled. So that's generally the way. It's believed that when members or people are getting their prescriptions filled that they're using their inhalers and, ultimately, that should limit acute episodes or exacerbations of their asthma. Next slide please. So do we have any questions?

- [Madison] We do not have any questions.

- [Debra] Perfect, I'm gonna pass it on to Diana. Thank you so much. Diana?

- [Diana] Thank you Deb and good afternoon everyone. My name's Diana Charlton. I'm one of the health care project managers with Aetna Better Health of Pennsylvania and I'm gonna continue on today with some additional HEDIS measures. The first group I'm gonna look at are the Medicare only HEDIS measures. So, Brian, you can go to the next slide. The first measure we're gonna look at is the Care of Older Adults. This is looking at the percentage of adults 66 years of age or older who had each of the following during the measurement year. Advance care planning which could include your Advance Directives, Actionable Medical Orders, Living Will, Surrogate Decision Maker. Medication review to occur probably just once a year. We want to see that any new medications that might be prescribed by another doctor are getting reconciled with their PCP. We want to look at functional status assessments as well. Those would be reviews of activities and daily living and instrumental activities of daily living. So activities of daily living are more looking at personal care. So are they able to feed themselves, dress themselves, what is their toileting like and their bathing. What about they're enter transferring as well. Whereas, with the instrumental activities of daily living, those are including some activities that we learn as teenagers that might include some more critical thinking and things that we do during our daily living. Things like managing finances, shopping and meal preparation, housecleaning and home maintenance, managing communications such as are they able to use the telephone, are they able to go to the post office and send mail, and also managing their medications. And then, finally, we want to see a pain assessment occur once a year for this age group as well. Next slide. Here are some NCQA coding tips. With CPT and CPT2 codes where each component of the COA measure. I do want to note that not all the codes that we present today, it's not an all-inclusive list. We want to refer you to the NCQA website for a full listing of codes or to reach out to your point of contact at the end of the presentation. Next slide. We have medication reconciliation post discharge. This is the percentage of discharge from January 1 through December 1 for the calendar year for member 18 years of age and older that have their medications reconciled the date of discharge through 30 days after they were discharged. So we're looking at a 31 total day period. And because of the reconciliation period, this is why this measure is going to end on December 1 as opposed to December 31. We want to capture that medication reconciliation by December 31 of the calender year. Also want to note that if the member is discharged and is followed by either a readmission or direct transfer to an acute or non-acute inpatient care setting on that same date as that first discharge, we're gonna take the date of the discharge that occurs after that second readmission or after that transfer. And here are some codes as well for that medication reconciliation piece. Next slide. We have the Transitions of Care or TRC measure. This is the percentage of discharges for members 18 years of age and older who had each of the following during the measurement year after their discharge. So we want to see if they are receiving a notification of inpatient admission. So a documentation of receipt of notification on the day of admission or the following day. Receipt of discharge information or their discharge instructions. This should occur on the day of admission or the following day. Patient engagement after inpatient discharge. We're looking for documentation of this patient engagement to occur such as a follow up visit with their PCP, a home care visit or telehealth. And we're looking to see that this patient engagement after discharge occurs 30 days after the discharge. And then, again, a medication reconciliation documentation of medication reconciliation on the day of discharge or through 30 days. And again, this medication reconciliation is very important 'cause when a person is admitted to the hospital we might have some medications added, dosages changed. So it's very important for these members to follow up with their PCP to make sure that that PCP has the most updated list of medications. Next slide. Here are some NCQA coding tips. We have the coding tips for the patient engagement. So you have the transitional care management codes, seven day, 14 day. Also some telephonic visit codes. Then we have the medication reconciliation codes. I do want to point out that for the admission and discharge instruction, PC would have to go to the medical record for that as there's no administrative reporting available for those two indicators. Next slide. We have Colorectal Cancer Screening. This is the percentage of members 50 to 75 years of age that had appropriate screening for colorectal cancer. Any of the following tests would meet criteria and, as you can see, each test has it's own look back period. So fecal occult blood test, that can occur only during the measurement year to close the gap. Flexible sigmoidoscopy is during the measurement year or four years prior. Colonoscopy is measurement year or nine years prior. CT colonography is measurement year or four years prior. And then we have the FIT-DNA test which can be measurement year or two years prior. Next slide. And here we have the CPT codes as well as the look back period for each component that can close the gap for the colorectal screening measure. Next slide. So at this point, before I proceed on to the next group of measures that is for both Medicare and Medicaid, are there any questions on the Medicare only measures?

- [Madison] Diana, we do not have any questions.

- [Diana] Okay, all right Brian, I think we're pretty safe to proceed on then. So this first group of measures that we're gonna look at, these are gonna be driven primarily by pharmacy claims. So we have both medical and behavioral health measures that we're gonna be looking at in this section. The first is a medical measure is the avoidance of antibiotic treatment in adults with acute bronchitis. This measure looks at the percentage of adults between the ages of 18 to 64 with a diagnosis of acute bronchitis and are not dispensed an antibiotic prescription. So, basically, this measure is looking to capture data and it will help us identify members that might be getting prescribed antibiotics when there really is no need. We really wanna try to prevent the further exacerbation of superbugs that are occurring from the overprescription of antibiotics. One thing to note, that the member can either be seen in and outpatient setting or an ED visit during the intake period. That is when we capture the diagnosis of bronchitis. So that can occur in the hospital on an ED visit or an outpatient setting with a PCP. The measure is reported an an inverted rate so a higher rate will indicate appropriate treatment of adults with acute bronchitis, i.e. meaning the proportion of members that do not get prescribed antibiotic. Next slide. We have Pharmacotherapy Management of COPD Exacerbation. This is another medical measure. And again, this is pharmacy driven, so we're looking to see if the members are filling their prescriptions. This is the percentage of COPD exacerbations for members 40 years of age and older that had an acute inpatient discharge or ED visit on or between January 1 and November 30 of the measurement year. You'll notice that this is not a full calendar year. That is because we are looking at the medication dispensed dates and we want to capture that by December 31. So, with this group, we wanna make sure they're getting dispensed appropriate medication so this can either be seen outpatient or ED visit during the intake period when the diagnosis is captured. The two rates that are reported are the medication dispensed events. So, first, we're looking to see that a systemic corticosteroid was prescribed within 14 days of the event with the diagnosis or if they already have an active prescription that will close the gap. And then we're looking for a bronchodilator to be dispensed within 30 days of that event with the COPD exacerbation or if they have an active prescription that we captured on pharmacy claims that will also close the gap. And here we have codes that put the members in the measure with COPD diagnoses. Next slide. All right, we are shifting gears slightly now, we're gonna look at behavioral health measures. The first one is adherence to antipsychotic medications for individuals with schizophrenia. So these are specifically members between the ages of 19 to 64 during the calendar year with schizophrenia that are dispensed and remain on the antipsychotic medication for at least 80% of their treatment period. So, basically, we're looking to capture are these members staying on their medications. We know the providers are prescribing them but are they going to pharmacy, filling that prescription so that we can close that gap on pharmacy claims. Just so you know, the members will fall into this measure because we captured two visits with a diagnosis of schizophrenia. So they can occur outpatient, intensive outpatient, partial hospitalization, ED or non-acute inpatient settings. The events, with the diagnosis, must occur on different dates of service. Next slide. And here on the next few slides we just have some examples of how the members will fall into the measures. So you can see the schizophrenia ICD-10 code with BHA inpatient or stand alone acute inpatient. Next slide. Here an ED visit with schizophrenia outpatient or stand alone outpatient with diagnosis will also put the member in the measure. But the members will have their gaps closed when they fill their prescriptions. Next slide. We have Antidepressant Medication Management. This is the percentage of members 18 of age and older that are treated with antidepressant medications. They also have a diagnosis of major depression and we're looking for this measure, again this is medication adherence, we're looking that they are staying on their antidepressant mediation treatment regimen. Next slide. So we're looking at two different rates for medication adherence. First is the effective acute phase of treatment. Percentage of members in this group that remain of their medication for at least 12 weeks. After that time period passes we look at the effective continuation phase of treatment which would be the same percentage of members, are they remaining on their antidepressant medication for at least 180 days or six months. Next slide. Some antidepressant medication strategies for improvement and this could really be for any patient with behavioral health issues. It's always important to talk to the patient about the importance of continuing medication and scheduling follow up visits even if they feel better. Sometimes if the patient feels better they might stop taking their medications. That can result in rebound or the recurrence of the depression and it could be worse than it was before. We want to discuss the possible side effects that are more bothersome than life threatening. Things like weight gain is something that can occur with some medications that are prescribed. You can always talk to the member about lifestyle changes such as diet and exercise that can combat that bothersome side effect of weight gain. You want to advise the patient of the risks of discontinuing the medication prior to six months and that that is associated with a higher rate of recurrence of depression. The likeliness of response to treatment is increased is there is follow up contact within three months of diagnosis or initiating treatment. So that basically just shows the more that a patient follows up with their prescribing physician the more likely they are to stay on their medications and talk about their condition. You want to inform the member that most people treated of initial depression need to be on medication at least six to 12 month after adequate response to symptoms to be sure that that condition remains controlled. Next slide. These are some of the codes that will drop the member into the measure. As you can see it's a major depression diagnosis coupled with various visit type codes such as inpatient, ED or stand alone visit codes. The way that the gaps are closed though for this whole section has been pharmacy. So the members have to fill their prescriptions, the pharmacy has to bill the health plan and then we can close that gap. Next slide. So at this point we can take a pause for questions before we proceed onto the next measure which is gonna be maternity and women's health.

- [Madison] Diana, we do not have any questions.

- [Diana] All right, Brian, it's safe to proceed on then. So here we're gonna be looking at four measures that are screenings for women and then also maternity care. So, next slide Brian. First measure we're looking at is Chlamydia Screening in Women. This is the percentage of women 16 to 24 years of age who are identified as sexually active and had at least one test for chlamydia during the measurement year. Here you can see the CPT codes for the chlamydia test. For this measure and that's also one of the other measures we're gonna be looking at in the section, this is driven specifically only through claims. We cannot go to the medical record to close gaps for the CHL measure. We have to capture that data on claims to close gaps and give your office credit for closing that gap. Next slide. We have Cervical Cancer Screening. This is the percentage of women 21 to 64 years of age that are screened for cervical cancer using either of the following criteria. So it's higher age grouping in this measure which is women 21 to 64. We're looking to have a cervical cytology or PAP performed every three years. But for women in this group from the ages of 30 to 64 they can have a cervical cytology HPV co-test done every five years to close the gap. And with that second grouping, I do have to point out, has to be a co-test it can't be an HPV reflex test. So the HPV and the PAP must be done on the same day of service and on the same lab draw. And here we have the CPT and HCPCS codes for cervical cytology. CPT codes for HPV tests And then, if we're going to exclude a member from the measure, we can do that using the absence of cervix CPT or ICD-10 codes. Next slide. Breast Cancer Screening. This is the percentage of women 50 to 74 years of age who have had a mammogram to screen for breast cancer. The time frame for this would be October of the year prior to the measurement year through December 31 of the measurement year. So it's almost a two-year look back period. For this, in order to encourage women to go get the screening done, it's always good to educate women about the importance of early detection and treatment starting at age 50. It's always good to refer women to local mammography imaging centers and also follow up to verify completion. And use reminder systems for check ups and screening reminders. And on that last piece I do want to note that Aetna Better Health in Pennsylvania, their case management is very engaged with follow ups for members that are in case management that need to get these services done. We also have reminder texting and calls that go out to members for various HEDIS measures to encourage them to keep appointments and also comply with getting those gaps closed. We want to make sure that we're helping our provider network gain credit for the care they're providing our members. And here we have the mammography codes. It can be CPT, HCPCS or UBREV. Next slide. The last portion of my part of the presentation is gonna be looking at the maternity measures which is prenatal and postpartum care. For the timeliness of prenatal care this is the percentage of deliveries that occur between November 6, 2018 and November 5, 2019 that received a prenatal visit in the first trimester, or if the member's not enrolled during the first trimester, within 42 days after they enroll with the health plan. Then we look at postpartum care. This is the percentage of deliveries between November 6, 2018 and November 5, 2019 that complete a postpartum visit on or between 21 to 56 days after delivery. And this postpartum care measure is why the measurement year is different, it's not a full calendar year 2019. We need to capture postpartum visits by December 31 of the calendar year, that's why we have a cut off of November 5 of the calendar year for the last delivery for that measurement period. Next slide. And, at this point, I'm going to pass the ball back to Brian so he can provide you with your point of contact. So if you have any questions that pop up afterwards on the presentation you can reach out to your point of contact that Brian's gonna provide you now. Thank you.

- [Brian] Thank you Diana. And Deb, thank you as well for presenting today. And Madison thanks for keeping an eye on that Q and A box. We're coming up on the end of the hour so I am going to move rather quickly toward the end here. You all should have a copy of this presentation so you should have the ability to look at the following slides as I move through. So the point of contact is a rep at the health plan here at Aetna Better Health that can help you work these gaps in care related to the HEDIS measures that we focused on today and any HEDIS measures that we're focusing on in this series. You can always just turn to this individual if you have any questions or concerns throughout the measurement year regarding quality experts or anything related to your practice or your organization. So the following contacts are the points of contact for each state that is involved with this series. So if you're signing in from Florida, your contact's Michelle. Texas, that would be Joanna. Pennsylvania's contact is Diana, she was a presenter today. Louisiana's contact is Frank. Michigan, that's Dante'. And, as you see, there is an email link to each individual point of contact here on the slide. That is how you can get ahold of your point of contact via email. Illinois, your contact's Anya. Maryland, that would be Don. New Jersey, that is Sami. Ohio's contacts are Sara and Valerie. Kentucky, you want to reach out to Kathy. California, your contact is Melissa. Virginia's point of contact is a new one. Kim is now your point of contact, director of quality management at the Virginia plan. So this was a repeat offering for March so we are done with this presentation. No more offerings for this month but, next month, we have HEDIS measures with a focus on women. Specifically we're going to focus just on women. And then, an additional topic regarding maternity care and how to reduce your practice no-show rate. And, Madison, if you could type in the chat box the link to the 2019 webinar schedule I'd appreciate that. You can take a look at what is to come here in the webinar series in the future. And then, all previously recorded webinars, you can go and check them out. In 2018 we have a lot of webinars up there. And today's webinar was recorded as well as last month's and we'll have both of those up on the website soon so that you an view those. If you want to include an individual within your organization in the invite list so that we can send the invite for each webinar each month to some colleagues that you work with please email Madison. We need the state that the person works out of as well as the email of the person wishing to be added to the invite list. All right, well, thank you everyone for attending. I hope you have a great day and a good weekend and I hope you come back to the next webinar which will be toward the end of the month next month in April. Thanks a lot and have a great day. Now, Madison, for those that need to get going that's fine, if anyone has a question or a comment please type it into the Q and A box or the chat box and we will field your question. Is there anything in there right now Madison that we need to look at?

- [Madison] No, we have a quiet group today Brian so there's nothing we need to address out loud. But, as Brian said, please continue to type questions in there if you think of anything.

- [Brian] All right, sounds good.