Functional spec is the user guide. Technical spec describes
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1. Musa gar mail Quality Measure dates and values have been extracted from claims prescriptions Information and encounters received as of 01 16 2008 Please add in missing data from 2007 if care was given but not reflected below Please select a member to edit Y Member DOB Age PCP Measure APPLESEED JANE 67271974 JORGE V CONTRERAS MD PapTest PLEASE REVIEW MENU LINKS 6 27 1953 MICHAEL E KAN MD HBAIC LOLC ees BEETHO 4 9 1984 WRLIAMGBROADMD CHLAMYDIA Partes 121977 HEN V NGUYEN MO PAP TEST CEASER MAE 4 1964 AN NTO MD MAMMOGRAM PAP TEST KENOBI OFF WAN 4 3 1950 EMRO BURBANO MD KELING RUDYARD 1 10 5548 62 DLANA F FINK MD SCROOGE SREMEIER Wer 1946 JAMES PELLEGRIN MD SOPRANO TRA 221977 ALBERT PANGLOSS MO PAPTEST VAN GOGH LORIE 6 15 1948 ALBERT PANGLOSSMD MAMMOGRAM PAP TEST Page Support Sign OM of 1 Total Records 10 Download List Ji Back To Dashboard Measure Name All Measutes Measure Status All Data Member Last Name Provider Name All Prowdars Poweret ty Access Exoreee s fee vermos SUS C00 our pemen wl rece a 170 cea Figure 5 Detailed Member Listing By default this screen will present a list of all members assigned to your office that are eligible for the selected measure You can adjust the screen by selecting a different measure status a different provider in your office or even a different measure You can also search for a specific member by typing in a partial last name If you adjust t2. medication prescribed Read only data from external sources claims pharmacy etc is marked with an annotated number and will appear as grayed out text This information is displayed so you do not enter any duplicate data lf the member has data loaded for measures where they do not meet the official P4P requirements they will also be displayed here and annotated with a This allows you to start tracking data for this member since they become eligibility for this measure in future measurement years To count positively towards your P4P score the data entered must pass certain criteria such as a valid date range or a maximum allowed test score Care events that fail criteria will have a status message clearly explaining why the data cannot be PAY FOR PEFORMANCE MODULE Page 4 of 12 PAY FOR PERFORMANCE MODULE counted towards your score A blank care event is your prompt to input additional data that meets the criteria or schedule appropriate services with the patient Exclusions The Pay for Performance program includes a list of official exclusions that can be used to remove a member from your P4P score calculation Only official exclusions can affect your P4P score in a positive way You can register exclusions by clicking the Exclude button next to the applicable measure A new window will appear that will allow you to select from a list of exclusions Register Exclusion Microsoft Inte Quality Measure Colle
3. Address Phone Alternate ID East Sale WILLIAM G BROAD MD PCP Eff Date 81 1999 PLAN INFORMATION Health Plan Name Asina Health Plas Comenernal Effective Date 12 1 2000 Termination Date Plan ID Pian Group Plan Copay Coinsurance 24546476 04306603 PCP Office Visits 510 00 Soecisisl Ofice Viss 590 DO Unspent Officea Viats 535 00 STATUS ALERTS Quality Measure eii A MYDIA PAP TEST Data User MONDAVI ROBERT Sita PCP DEMO SITE This is a TestNamo WebSite New Eughibty Response New Massaga New Auth hoptubly depi View eboptubty Search for another member Send Emal about this member ie versar 540106 P4P status indicates a missing Chlamydia screening but a Cervical Cancer Screening was already performed this year Clicking the link will take you to the P4P edit screen which is modeled after a patient immunization chart see screen below This screen will summarize all of the measures that apply to the selected member PAY FOR PEFORMANCE MODULE Page 3 of 12 PAY FOR PERFORMANCE MODULE Health Access User MONDAVI ROBERT Site PCP DEMO SITE SOLUTIONS This is a TestDema Web Site 4 New Eligbiity Responses 4 New Message Naw Anth mepalty Edit Quality Measure Data lights Bison oot Sound Marre j terrier Ras Pian ID F 124046426 Display sument menisi Eff Date 12 1 2000 Tem Date Display Authonzarnns Sex F DOB 4 1884 Age 24 Search Authonzahons pcp WILLIAM G BROAD NO Provide
4. Health Access SOLUTIONS USER MANUAL Pay for Performance Module P4P Contents JES Aisi 2 BG C HON aee a RR A E A N 2 12 FARMEA RAE BB ST te ad RR mp Seer 2 3 VIEWING AND EDITING DATA FOR THE CURRENTLY SELECTED MEMBER cccccceescscseseseeseeeess 3 CE UES UO q A RIR EAR ENT RN EI RED A E ga en Ge hat ke Rte A AATE yak oem aans Wirt o DON PRINCESS a an DARDOS Roo NOT for mal Da OR A 7 1 4 THE P4P DASHBOARD REVIEWING ALL ASSIGNED MEMBERS cccccssceeccesccescenccescenccesccusceesees 9 V OOE AN O TSES ot al oe EAR Oe Ree RO IEA eset e AR a A aie aoe eee el 10 UND Te TOI SE CAO Se els BARS eae te Naar a Ade ecru RY ae Aa tae er Dea AAD te oe 12 PAY FOR PERFORMANCE MODULE PAY FOR PERFORMANCE MODULE 1 1 Introduction The Pay for Performance initiative evaluates and rewards those groups that consistently demonstrate high quality patient care in a number of standard clinical measures The Access Express AE P4P module is designed to help you maximize your P4P score by insuring that the latest administrative data is recorded and submitted for your qualifying members The majority of P4P data is based on claims lab results and pharmacy data collected by your administrative group This data is periodically refreshed by your administrative group but will typically lag the latest available resulis by at least 1 2 months AE displays the latest recorded data from these sources and allows you to fill in any missing informat
5. ction Exclusion Member Demographics Member Name GRIFFIN MEG DOB 1 1 1985 HMO ID 1123456789 In rare situations a member can be excluded from measure collection Please select the proper exclusion for this member Measure Exclusion Cervical Cancer Screening Pap Test SAVE EXCLUSION Exclusion selection Select an appropriate exclusion from the available list and click Save Exclusion You will be asked to confirm the exclusion selection If confirmed the exclusion PAY FOR PEFORMANCE MODULE Page 5 of 12 PAY FOR PERFORMANCE MODULE window will close and the member s P4P record will be refreshed with the assigned exclusion Many medical groups give you the option of temporarily excluding a measure from data collection The interim period should be used by the member s PCP to schedule appropriate follow up care As the end of the P4P measurement year approaches this option should be used less frequently if at all Unofficial or temporary exclusions that are registered at the end of the P4P measurement year will negatively affect your P4P score Official exclusions will be preserved throughout the measurement year but unofficial exclusions such as temporarily turn off notification should be removed the next time the administrative data store is refreshed Resetting the unofficial exclusions gives you the best opportunity to maximize your P4P scores Please note that the optional note field is intended to
6. he status filter between All Data and Measures Missing Data the total record count will change to match the numerator denominator shown in the dashboard for that measure However because bundled unbundled measures official vs unofficial exclusions etc are handled differently to make the editing process more convenient you may notice some variations If this occurs the dashboard values should be considered the most accurate reflection of your P4P scores You can click the Download List link to export the member listing to a comma separated CSV file that can be easily loaded into a tool like Microsoft Excel The list will include the member s address phone to help your office coordinate mailing of patient letters or phone calls to schedule any missing screenings PAY FOR PEFORMANCE MODULE Page 11 of 12 PAY FOR PERFORMANCE MODULE Click on a member s name to access and edit their detailed P4P records as discussed previously in section 1 8 NOTE FOR SPECIALISTS You will see a P4P Dashboard link on your main menu but clicking the link will not display any data since you do not have any assigned members To access P4P data you must look up a specific member via the eligibility search screen A summary view for specialists is not supported at this time PAY FOR PEFORMANCE MODULE Page 12 of12
7. ion that would negatively affect your P4P score As the focal point for a member s care the Primary Care Physician is responsible for insuring that the P4P data for their assigned member s is up to date in the AE system Specialists such as gynecologists may have valid data for certain measures as well Access Express provides entry points for both types of providers to contribute to the P4P data collection process 1 2 P4P Measure Data Each P4P measure for a member can fall into one of the following categories m Missing Data This implies that the member would not meet the defined P4P measure criteria based on current data In this case both specialists and PCP s should fill in any missing data that you have on file for this member If the data is truly missing the member s PCP should proactively contact the member to schedule the appropriate follow up care Any missing measures will negatively affect your P4P performance scores at the end of the measurement year Missing measures will display in BOLD RED FONT m Excluded This indicates that the member has an exclusion for not being included in your P4P performance score For example a bilateral mastectomy is an official exclusion that can be used for the Breast Cancer Screening measure The list of valid exclusions varies per measure Excluded measures will be displayed in Strikethrough Font m Passed Current P4P data indicates that this member has already passed the P4P measure c
8. lorer Figure 4 Reduced functionality pop up window due to pop up blocker software If you see this reduced version of the pop up window you are operating under a number of disadvantages First of all the missing measures for the member are not prominently displayed in a new window for your review Instead you must manually review the measure status listing on the main AE screen Secondly you will receive additional pop up reminders every time you access the member s record instead of a single reminder until the system designated reset period expires Disable your pop up blocker software by adding the Access Express website to your list of trusted websites PAY FOR PEFORMANCE MODULE Page 8 of 12 PAY FOR PERFORMANCE MODULE 1 4 The P4P Dashboard Reviewing All Assigned Members Primary Care Physicians as the focal point for P4P data collection have an additional tool for entering missing data All PCPs should have access to a P4P Dashboard link on the main menu If you do not see the link on your menu please contact your AE help desk to insure that your user profile is setup correctly Clicking the link will take you to a dashboard summarizing the current state of your eligible members vs the P4P measure criteria The dashboard Is displayed once you select a provider from the list of provider associated to your AE site Po Beocess Caprese Net Intenet Caphorer 12 Health Access Sebetions G 2 hte ocalost leet
9. ore ante Pe ee tdo O O ureo Doren Nat eme jer Siok eo Health Access Uret SOULE TIM Site WTERNAL DEMO SITE a SOLUTIONS This is a Test emo WebSite 2 Mew Elgb itty Responsas O irequiry hr le P4P Dashboard leat Autinoetr mine Internal Work Lists Please search for a site or provider to access their dashboard W Message mall Site Poe DE Seance sites Provider aceno E Milima Care Guanes fntranes Version Datetes Milman Care Guidetines Care Pe Reports HDA tc 4 Downiad Scresreng di a preta Wuabeies Pili allie lite am lull ts litle Case Di PLEASE REVIEW MENU LINKS fc Good Lustown Liss LAreroal Sign Off 100 4 Phat Care LOL S SeTeenng i EM Lhabetes Cale Henhropstity EA 1 40 69 58 Explain GARS Powered by Antas apitia y Fae Versos SIE Toor Seem WE treat amp 487 remo Dere rT fT TTT Ert Ae e PAY FOR PEFORMANCE MODULE Page 9 of 12 PAY FOR PERFORMANCE MODULE Figure 4 P4P Dashboard The dashboard also allows you to view the individual components of bundled measures such as Diabetes LDL C HbAic and Nephropathy or Childhood Immunizations Each measure is listed using a bullet graph anna ss l a AQ 68 59 D 10 20 ao 40 50 60 The vertical black line shows a target goal for the measure each physician and your overall medical group should aim to achieve by the end of the year The shaded background
10. provide additional detail on why a member was excluded These notes are not actively reviewed and should not be used to ask for assistance with any P4P related matters If you have comments on the functionality of the P4P module please provide them using the Feedback link on your main menu If you need other assistance please use the support contacts listed on the Help link on the main menu PAY FOR PEFORMANCE MODULE Page 6 of 12 PAY FOR PERFORMANCE MODULE Pop Up Reminders When accessing a member record you will receive a pop up reminder if that member is missing required care data a Quality Measure Reminder Mic oso JO x Quality Measure Reminder Member Demographics Member Name GRIFFIN LOIS Please revie member Yr DOB 1 1 1950 exdusions fi HMO ID 1123456789 Quality Measures require your attention ASTHMA RX REVIEWS UPDATE IGNORE A pop up reminder for missing care data Use this screen as a launching point to review and enter any missing data that you may have on file for that member The pop up will not list any passed or excluded measures for the member Specialists who do not have any applicable data for the missing measure s listed should click the Ignore button These pop up windows can appear when 1 submitting a new authorization request for a member or 2 when looking up a member s eligibility record One important distinction is that the authorization request sc
11. r ma ndaLS Quality Measure dates and values have been extracted from Claims prescriptions and encounters Procedure received as of 01 15 2008 inpert Authosiemtioss Please add in messing data from 2007 if care was given but not reflected below Escala Chlamydia Chlamydia Screening Cide meintato Medical group pobcy is for all woman between the ages of 16 and 26 to have a test for Chlamuda each Support calendar year This can be done when a Pap test ts performed or can be a separate urine test for Etta aia faites Chiamydia Enter the date of the chlamydia test in te box below CUSTOM LINKS Sign OM Chiemydia Test Datis EEE Pap Test Cervical Cancer Screening Please record date of most recent Pap test Enter date of known Pap test even if you were nat the one that obtained tes Pap Previous hysterectomy is an obvious vaid reason for not doing thes test which needs to be documented as a selected exclusion Should be done al least every 3 years PapTest Dates DEE Fie versos 525 0006 Powered by nocas Express v 1 tue cessa ed treo H 120 wes Viewing and Editing P4P Data for a Member Each measure is clearly labeled and includes a short description of the measure and any specific guidelines outlined by your administrative group Beneath the description recent and missing care event data is displayed sorted by date Each care event may include additional required information such as lab test scores or the type of asthma
12. reen shows only missing P4P measures while the eligibility screen shows all P4P measures Once displayed the pop up window will not appear again for that member until a system configurable time period has expired This reset period is typically set to 2 hours PAY FOR PEFORMANCE MODULE Page 7 of12 PAY FOR PERFORMANCE MODULE Health Access User MONDAVI ROBERT Sae PCP DEMO SITE SOLUTIONS This is a TestDemo WebSite e oS Naw Elgibity Response Naw Message New Auth oa trsquatry Py Referral Auth Mest Astor Atos o sos Exfurcal Auth Svemir Required Field Adesi 2 E Acthorization Member BEETHOVEN MARY Member s Mossagasil mall PCP WILLIAM G BROAD MD een Missing Quality Measures CHLAMYDIA Support PLEASE REVIEW MENU LINKS Patient CUSTOM LINKS Requested Sign OFF Category Routine Use for standard Requests Referred WILLIAM G BROAD MD Family Practice 143 E MAIN ST from Referred Selact a physcian J to Place of i Select POS ake Service or C Office Viewing P4P Missing Measures on the Submit Authorization Request screen NOTE ON POP UP BLOCKING SOFWARE Some computers may have pop up blocker software current versions of IE Yahoo Toolbar Google Toolbar etc installed that will prevent the reminder from displaying In this case you will receive a less functional reminder that tells you to review the member s listed Quality Measures Microsoft Internet Exp
13. riteria for the current year and will count positively toward your P4P score No further action is required As a Primary Care Physician your goal is to have 100 of your members in this status by end of each calendar year Passed measures will display as normal text It is important to note that members who do not meet the P4P eligibility requirements for a measure due to age restrictions terminated eligibility etc will appear in AE as if they have no P4P data loaded PAY FOR PEFORMANCE MODULE Page 2 of 12 PAY FOR PERFORMANCE MODULE 1 3 Viewing and Editing Data for the Currently Selected Member When reviewing a member s record in AE physicians will see a link labeled Quality Measure Data if the member meets any of the eligibility criteria for one or more P4P measures see screen below If a patient is eligible for multiple measures all will be listed in the same link Each measure name will vary in appearance depending on the current status of the individual measure Health Access SOLUTIONS Te gt input Antharitatens Messages mall in ormetion Suppor PLEASE REVIEW MEMNU LINKS USTOSI LINKS Sign OF Powered by doces Express v Your sessean we regue h 115 maes SELECTED MEMBER View auhonzatons Search authorizaions Subm history Visa PCP capitahos payments View clams MEMBER DEMOGRAPHICS Name BEETHOVEN MARY Date of Birth aioe Sex F 123 MAIN ST LOS GATOS CA 95033 4085551212
14. shows the current average for all physicians in your group The solid horizontal black line tracks your own current status The blank line is based on dividing the number of members who meet the standards of care defined for the measure numerator by the total number of members who meet the measure s eligibility criteria denominator If you lag behind both the group average and the target goal the line will be displayed in red to indicate that your performance is below acceptable levels The A icon is also used to highlight the measure for color blind users who may have difficulty seeing the red shading CC EEE 99 193 51 bl 10 20 30 40 50 60 70 a0 Some components such as LDL C and HbA1c may be listed multiple times if they are measured in multiple ways Please note that in some cases such as HbA1c Poor Control the graph plot is reversed to indicate that better scores are reflected by lower numbers Member Action Lists To edit the underlying data click the measure name in the Dashboard to access the detailed member action listing that provides the numerator denominator values reflected in the dashboard PAY FOR PEFORMANCE MODULE Page 10 of 12 PAY FOR PERFORMANCE MODULE Health Access User MONDAY ROBERT Sita PCP DEMO SITE SOLUTIONS This is a Test Demo WebSite gt lt New Sigit Response New Meseags New Auth ot Inquiry Quality Measures Input Awthoricalrons
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