1. Population Health Management System – Health Plan
Supporting systems
Member
Services(eligibility)
Member
Services(eligibility)
Claims ManagementClaims Management
LaboratoryLaboratory
Colorectal Screening
Metrics and Reports
This measure requires adults ages 50-75 receive
colorectal cancer screenings.
Extract
Clean
Dashboards
LoadStatic Reports
(Distribute
Standard
Periodic reports)
Dynamic Reports
(Drill down to
investigate
problems)
Data Mining
(Automatic search
for unexpected
patterns)
Numerator:
Only those Compliant
(Numerator)
CPT/HCPCS
LOINC
Numerator:
Only those Compliant
(Numerator)
CPT/HCPCS
LOINC
Data
Marts
B
I
U
s
e
s
KPIs
Email Alerts
Information to
Drill Down
reports
One Click
Reports
Ad Hoc
Reports
Denominator:
Identify Those Eligible
(Denominator)
Age, Except: Cancer/Colectomy,
CPT/HCPCS, ICD Diagnosis, ICD
Procedure
Denominator:
Identify Those Eligible
(Denominator)
Age, Except: Cancer/Colectomy,
CPT/HCPCS, ICD Diagnosis, ICD
Procedure
CPT: 44388-44394, 44397, 45355,
45378-45387, 45391, 45392
CPT: 44388-44394, 44397, 45355,
45378-45387, 45391, 45392
LOINC: 2335-8, 12503-9, 12504-
7, 14563-1, 14564-9, 14565-6,
27396-1, 27401-9, 27925-7,
27926-5, 29771-3, 56490-6,
56491-4, 57905-2, 58453-2
LOINC: 2335-8, 12503-9, 12504-
7, 14563-1, 14564-9, 14565-6,
27396-1, 27401-9, 27925-7,
27926-5, 29771-3, 56490-6,
56491-4, 57905-2, 58453-2
HPCS: G0328HPCS: G0328
FOBT
Flexible
sigmoidoscopy
Colonoscopy
HPCS: G0105, G0121HPCS: G0105, G0121
HPCS: G0104HPCS: G0104
CPT: 45330-45335, 45337-45342,
45345
CPT: 45330-45335, 45337-45342,
45345
CPT: 82270, 82274CPT: 82270, 82274
Member ID • Name • DOB • Gender • SSN
Providers Health Plan
Patient
• Reminder and recall
systems for healthcare
providers via email or web
portal
• Assessment and feedback
interventions for
providers.
Reminder systems
for patients and
targeted small
media including
educational
materials via mail,
email, web portal
Reports on 5 star program metrics
EnrollmentEnrollment
• Patient buys health plan with best ratings
Statistics to decide on
alternative clinic hours or
delivery settings, simplified
administrative procedures
