Baby Partners Provider Incentive Obstetrical Needs Assessment Form - PowerPoint PPT Presentation

Baby Partners Provider Incentive Obstetrical Needs Assessment Form

Contact information Linda Watt, RN, BSN, CPHM Manager, Baby Partners Health Partners Plans 215-967-4592 lwatt@hpplans.com KATHRYN L. MCMILLIAN, CPHM Network Account Manager 215-991-4384 (Phone) 267-515-6637 (Fax) kmcmillian@hpplans.com

Obstetrical Needs Assessment Form (ONAF) Provider Incentives • Background • Impact on Baby Partners Program • Current ONAF Incentive • Transition to Maternity Quality Care Plus (QCP) • Connection to Healthcare Effectiveness Data and Information Set (HEDIS) chart collection

Background • Incentive for form submission since 2007 • Current incentive format since 2012 • State requirement for Managed Care Organization (MCO) data collection – HEDIS Maternity measures – External Quality Review Measures • Low birth weight • C-section (NTSV) Rate • Maternity Risk Factor Assessment (MRFA) – Screening for depression, tobacco, substance use & domestic violence • Baby Partners member rewards

Baby Partners Program • Case management services • Collaboration with behavioral health • Doula services and/or skilled nursing home care visits • DME for high risk pregnancies • Linkage to smoking cessation, childbirth classes and MANNA meals • 24 hour breastfeeding helpline • Referrals to community resources (e.g. Nurse Family Partnership, Congreso, Cribs for Kids) • Transportation to medical & behavioral health appointments • Pregnancy website at www.everybodygethealthy.com/hpp

Baby Partners Staffing Manager Team Leader Two Social Workers Nine Nurses Obstetrics Practice-Based Care Coordinator QM II Coordinator – RN One Peer Coach Two Outreach Coordinators Nutritionist

Baby Partners Member Rewards • Reloadable gift card upon enrollment in Baby Partners • Dollar General, Family Dollar, Rite Aid and Walmart • Claims data and ONAF data • Eligible for a total of $100 – $25 timely first prenatal visit – $25 dental visit – $25 timely postpartum visit – $25 bonus if all three completed

Current ONAF Incentive ¡ ¡ ¡ ¡ Requirement ¡ Codes/Modifier ¡ ONAF ¡submission ¡ Payment ¡ ¡ ¡ ¡ ¡ ¡ ¡ Ini;al ¡visit ¡ $100.00 ¡ Fax ¡within ¡7 ¡days ¡of ¡ 0500F ¡with ¡HD ¡ visit ¡ modifier ¡ ¡ ¡ ¡ ¡ ¡ ¡ List ¡of ¡all ¡visits ¡ $100.00 ¡ Submit ¡a?er ¡delivery ¡ 0500F ¡with ¡HD ¡ or ¡with ¡postpartum ¡ modifier ¡ submission ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ Postpartum ¡visit ¡ 21-­‑56 ¡days ¡ $100.00 ¡ 0503F ¡with ¡HD ¡ modifier ¡

Initial Prenatal Visit • Initial notification of pregnancy for 25.5% of referrals • Case-managed women have higher attendance rates • Submit within seven days of the members first appointment • Submit if member transfers to or from site – Multiple providers can submit if member changes practices • Fax completed ONAF to 215-967-4492 • Use billing code 0500F with HD modifier

ONAF

Validated Screening Tools • The Edinburgh Postnatal Depression Scale • Bromley Postnatal Depression Scale (EPDS) (BPDS) • Beck Depression Inventory (BDI 1a,II) • Postpartum Depression Screening Scale (PDSS) • Postpartum Depression Predictors Inventory-Revised (PDPI-R) • Leverton Questionnaire (LQ) • Center for Epidemiologic Studies • Hospital Anxiety and Depression Scale Depression Scale (CES-D) (HADS) • Patient Health Questionnaire (PHQ)-2 and • Generalized Contentment Scale PHQ-9 Tools • Zung Depression Rating Scale (Zung SDS) Other validated tools not listed by AHRQ: • Hamilton Rating Scale for Depression • Inventory of Depressive Symptomatology, (HRSD) Clinician Rating (IDS-C)and Self-Report • General Health Questionnaire (GHQ-D) (IDS-SR) • Montgomery-Asberg Depression Rating • Quick Inventory of Depressive Scale (MADRS) Symptomatology, Clinician Rating (QIDS-C) • Primary Care Evaluation of Mental Disorders and Self-Report (QIDS-SR) Patient Health Questionnaire (PRIME-MD PHQ) Agency for Healthcare Research and Quality (AHRQ) “Efficacy and Safety of Screening for Postpartum Depression” (3/9/2012):

List of Prenatal Visits • Submit on delivery notification with DOS of last visit or • Submit with postpartum visit • Provide complete list of visits • Do not record visits before they occur • Auditors request medical records to verify ONAF data • Fax completed ONAF to 215-967-4492 • Use billing code 0500F with HD modifier

Postpartum Visit • Visits must occur within 21-56 days after delivery • Delivery information section must be fully completed – Date & type of delivery – Weeks gestation at delivery & birth weight – write in numbers – Vertex Yes/No; Elective Yes/No – Depression screen • Use billing code 0503F with HD modifier • If member is a no-show – Submit form for list of visits only and code 0500F only – Document no show – Care coordinators will outreach to member

Postpartum ONAF

Future Transition to Maternity QCP • 2016 - Continue with current ONAF incentive – Separated payments of $100 for a total of $ 300 per member • 2017 – Payment for ONAF submission by claims codes will stop • QCP look back period is one year • Make process improvements now • ONAF submission % will be a separate measure on scorecard • 50% of members required to have ONAF submission • ONAF submission also ensures visits count for HEDIS measures – Timeliness of first prenatal visit – Frequency of prenatal care – Postpartum visit

Connection to HEDIS Data Collection • Auditors request medical record verification of ONAF • Submitting ACOG with postpartum submission – Meets auditing requirements – Reduces traffic in office sites during HEDIS collection season

Questions?

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