This document describes a population health management system for a health plan. It includes supporting systems like claims management, laboratories, and member services. The system focuses on colorectal cancer screening metrics and uses data from various sources to calculate screening rates. It extracts, cleans, and loads this data into data marts and warehouses. Dashboards, reports, alerts and ad hoc queries are then used to monitor screening rates and identify opportunities for outreach and provider interventions to improve preventive care services.
PROactive evaluation of function to Avoid CardioToxicitydirectoricos
This study is intended to evaluate a new more in-depth and higher resolution cardiac MRI, MyoStrain®, to
transform the early detection of cardiac damage that can occur frequently as a result of cancer
chemotherapy. By detecting cardiac damage early, cardiologists can provide optimal cardio-protection
and allow continued use of life-saving cancer treatment for patients.
Understanding and Predicting Breast Cancer Events After Treatmentdirectoricos
our primary outcomes will help define the relationships between cancer therapy,
CV injury, exercise intolerance and fatigue, while also accounting for the relative contributions of age,
menopause status, race/ethnicity, radiation therapy, and psychosocial and behavioral risk factors. In
addition, we will assess pre-existing cardiac risk factors (hypertension, smoking, diabetes, coronary artery
disease, dynamic changes in body mass
index, blood pressure, serum lipids and
fasting glucose, physical activity, and
chemo- and immunotherapy).
CardiovaScUlar toxicity in cancer and improvement In recoverydirectoricos
Patient charts should be reviewed for suspected cardiac events at each follow up time point.
Site PI’s will likely need to go through the form with the coordinators for the first 10 patients to ensure accuracy of data entered.
In Arm 1: Visit Data, there is a suspected cardiac event form to be completed at each follow up time point.
This form is basically just asking if you reviewed the patient’s chart for suspected cardiac events.
If the patient does have a suspected cardiac event, you would then complete Arm 3: Suspected Cardiac Events for that patient.
When entering information into Arm 3: Suspected Cardiac Events, the first part of the form is assessing the event from a cardiology perspective. The second part of the form is assessing the event based on CTCAE v5.0 criteria.
Medicare Advantage Ad - Testing Patients with IndicationsChristian Trygstad
This was created to support the use of PADnet in the Medicare Advantage space by testing patients with primary indications for peripheral artery disease
PROactive evaluation of function to Avoid CardioToxicitydirectoricos
This study is intended to evaluate a new more in-depth and higher resolution cardiac MRI, MyoStrain®, to
transform the early detection of cardiac damage that can occur frequently as a result of cancer
chemotherapy. By detecting cardiac damage early, cardiologists can provide optimal cardio-protection
and allow continued use of life-saving cancer treatment for patients.
Understanding and Predicting Breast Cancer Events After Treatmentdirectoricos
our primary outcomes will help define the relationships between cancer therapy,
CV injury, exercise intolerance and fatigue, while also accounting for the relative contributions of age,
menopause status, race/ethnicity, radiation therapy, and psychosocial and behavioral risk factors. In
addition, we will assess pre-existing cardiac risk factors (hypertension, smoking, diabetes, coronary artery
disease, dynamic changes in body mass
index, blood pressure, serum lipids and
fasting glucose, physical activity, and
chemo- and immunotherapy).
CardiovaScUlar toxicity in cancer and improvement In recoverydirectoricos
Patient charts should be reviewed for suspected cardiac events at each follow up time point.
Site PI’s will likely need to go through the form with the coordinators for the first 10 patients to ensure accuracy of data entered.
In Arm 1: Visit Data, there is a suspected cardiac event form to be completed at each follow up time point.
This form is basically just asking if you reviewed the patient’s chart for suspected cardiac events.
If the patient does have a suspected cardiac event, you would then complete Arm 3: Suspected Cardiac Events for that patient.
When entering information into Arm 3: Suspected Cardiac Events, the first part of the form is assessing the event from a cardiology perspective. The second part of the form is assessing the event based on CTCAE v5.0 criteria.
Medicare Advantage Ad - Testing Patients with IndicationsChristian Trygstad
This was created to support the use of PADnet in the Medicare Advantage space by testing patients with primary indications for peripheral artery disease
Meaningful Use: Programs, Penalities, and PaymentsBen Quirk
Meaningful Use is not dead!
MIPS may be just around the corner, but MU is still very much in the picture. There is enough time, however, for your practice to optimize 2016 reporting and increase 2018 payments and avoid penalties.
This presentation takes you through the steps needed to successfully attest for 2016 and be prepared for upcoming changes.
Are you:
Keeping up to date with your risk scoring?
Missing out on reimbursement premiums?
Ensuring accurate health profiles for your patients?
Proper risk adjustment is important, not only to ensure your patients' quality of care, but also to improve your bottom line. This CareOptimize presentation will take you from the basic tenets of risk adjustment to specific ways you can increase your risk scores and get the highest premium payments.
The prestigious ACR accreditation is awarded only to facilities that prove during a rigorous peer-review evaluation that they meet specific Practice Guidelines and Technical Standards developed by the ACR.
This is the third consecutive time that South Nassau has earned the national mark of excellence, which is awarded to eligible ACS accredited cancer programs every three years.
Risk adjustment documentation and coding overviewScott Quick
A collection of information from publicly available sources to help you:
• Know what Risk Adjustment (RA) is and why it is important to Medicare Advantage providers
• Understand Hierarchical Condition Categories (HCCs)
• Become familiar with Risk Adjustment Documentation and Coding Requirements
Peter Jones, Smriti Shakdher, Prateeksha Singh
Clinical Synthesis Map: Cancer Care Pathways in Canadian Healthcare
Jones PH, Shakdher S and Singh P. Systemic visual knowledge translation for breast and colorectal cancer research. Current Oncology 2017 (in press).
The Clinical Map visually represents breast and colorectal cancer processes across Canadian provincial and territorial systems. A roadmap metaphor illustrates a system-wide view of patient flow across the stages of cancer care. Green “road signs” identify clinical cancer stages across the roadmap: Pre-Diagnosis, Peri-Diagnosis, Diagnostic Interval, Diagnosis, Treatment, Rehabilitation, After Care, and Survivorship (with Palliative Care expressed as an end point). The visual metaphor of seasonal trees visually connects these stages to the patient’s cancer journey from pre-diagnosis (summer) through treatment (winter), followed by new growth (spring) in survivorship.
The levels of primary, secondary and tertiary care guide the vertical dimension. Information and communications technology reaches across levels and stages, but is shown disconnected from primary care. The road-like pathways are colour-coded where experts differentiated care pathways between breast cancer (pink) and colorectal (blue). Where not distinguished (white), the pathways indicate current practices shared across the cancer journeys.
Yellow navigation signs indicate cancer events across primary care pathways. Starting with Prevention and ending with Long-term Care, these events show points for primary care continuity during cancer treatment. A parallel path below the stages indicates where some patients may also employ complementary or alternative therapies.
Significant areas of complexity generalized across cancer care are revealed in peri-diagnosis and the diagnostic interval pathways. A patient can be screen-detected (and then present to a family physician, shown in the breast cancer pathway) or may be initially diagnosed in primary care (white pathway). The circular pathways in the diagnostic cycle suggest multiple possible tests within primary care. With a primary care diagnosis, patients are referred and flow to secondary/tertiary cancer care. The stages of intake, biopsy, pathology, and confirmed diagnosis are shown, and the complex pathways of cancer treatment, shown on the map in a typical (not definitive) order of surgery, radiation/chemotherapy, and continuing treatment through assessment of outcome.
Meaningful Use: Programs, Penalities, and PaymentsBen Quirk
Meaningful Use is not dead!
MIPS may be just around the corner, but MU is still very much in the picture. There is enough time, however, for your practice to optimize 2016 reporting and increase 2018 payments and avoid penalties.
This presentation takes you through the steps needed to successfully attest for 2016 and be prepared for upcoming changes.
Are you:
Keeping up to date with your risk scoring?
Missing out on reimbursement premiums?
Ensuring accurate health profiles for your patients?
Proper risk adjustment is important, not only to ensure your patients' quality of care, but also to improve your bottom line. This CareOptimize presentation will take you from the basic tenets of risk adjustment to specific ways you can increase your risk scores and get the highest premium payments.
The prestigious ACR accreditation is awarded only to facilities that prove during a rigorous peer-review evaluation that they meet specific Practice Guidelines and Technical Standards developed by the ACR.
This is the third consecutive time that South Nassau has earned the national mark of excellence, which is awarded to eligible ACS accredited cancer programs every three years.
Risk adjustment documentation and coding overviewScott Quick
A collection of information from publicly available sources to help you:
• Know what Risk Adjustment (RA) is and why it is important to Medicare Advantage providers
• Understand Hierarchical Condition Categories (HCCs)
• Become familiar with Risk Adjustment Documentation and Coding Requirements
Peter Jones, Smriti Shakdher, Prateeksha Singh
Clinical Synthesis Map: Cancer Care Pathways in Canadian Healthcare
Jones PH, Shakdher S and Singh P. Systemic visual knowledge translation for breast and colorectal cancer research. Current Oncology 2017 (in press).
The Clinical Map visually represents breast and colorectal cancer processes across Canadian provincial and territorial systems. A roadmap metaphor illustrates a system-wide view of patient flow across the stages of cancer care. Green “road signs” identify clinical cancer stages across the roadmap: Pre-Diagnosis, Peri-Diagnosis, Diagnostic Interval, Diagnosis, Treatment, Rehabilitation, After Care, and Survivorship (with Palliative Care expressed as an end point). The visual metaphor of seasonal trees visually connects these stages to the patient’s cancer journey from pre-diagnosis (summer) through treatment (winter), followed by new growth (spring) in survivorship.
The levels of primary, secondary and tertiary care guide the vertical dimension. Information and communications technology reaches across levels and stages, but is shown disconnected from primary care. The road-like pathways are colour-coded where experts differentiated care pathways between breast cancer (pink) and colorectal (blue). Where not distinguished (white), the pathways indicate current practices shared across the cancer journeys.
Yellow navigation signs indicate cancer events across primary care pathways. Starting with Prevention and ending with Long-term Care, these events show points for primary care continuity during cancer treatment. A parallel path below the stages indicates where some patients may also employ complementary or alternative therapies.
Significant areas of complexity generalized across cancer care are revealed in peri-diagnosis and the diagnostic interval pathways. A patient can be screen-detected (and then present to a family physician, shown in the breast cancer pathway) or may be initially diagnosed in primary care (white pathway). The circular pathways in the diagnostic cycle suggest multiple possible tests within primary care. With a primary care diagnosis, patients are referred and flow to secondary/tertiary cancer care. The stages of intake, biopsy, pathology, and confirmed diagnosis are shown, and the complex pathways of cancer treatment, shown on the map in a typical (not definitive) order of surgery, radiation/chemotherapy, and continuing treatment through assessment of outcome.
Presentation for mHealth Israel by David Farber, Partner, King & Spalding, about US Reimbursement. The path from approval to market and navigating the world of reimbursement. The lecture introduces the basics of Medicare reimbursement, explores strategies to maximize reimbursement in certain key areas, distinguishes the differences between CMS’s mission and FDA’s mission, and emphasizes steps in an early reimbursement strategy for successful product development.
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