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NYS-HCCN Analytic Tools for Team Based Care April 28 th , 2017 9:00 - PowerPoint PPT Presentation

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NYS-HCCN Analytic Tools for Team Based Care April 28 th , 2017 9:00 AM 5/1/2017 Improving Patient Outcomes Through Data CHCANYS NYS-HCCN Training April 28, 2017 2 Azara Proprietary & Confidential CONFIDENTIAL This file contains

  1. NYS-HCCN Analytic Tools for Team Based Care April 28 th , 2017 9:00 AM 5/1/2017

  2. Improving Patient Outcomes Through Data CHCANYS NYS-HCCN Training April 28, 2017 2 Azara Proprietary & Confidential

  3. CONFIDENTIAL This file contains information that is confidential to Azara Healthcare, LLC Do not view, copy, distribute, or disclose without prior consent.

  4. Agenda  Introductions  CPCI Overview  Using Your Data to Tell a Story  Registries  CPCI Demo  Dental and Behavioral Health Measures and Alerts  What else can CPCI do for me ? 4 Azara Proprietary & Confidential

  5. Introductions Greg Augustine LuAnn Kimker RN MSN Chief Operation Director of Clinical Officer Innovation 5 Azara Proprietary & Confidential

  6. CPCI – Connecting You to Success  CPCI is a reporting and analytics tool that houses data from multiple CHCANYS site’s  Captures structured EHR data and can integrate with other data sources  Provides drill-down capability Network CHC Site Provider Patient  Provides multiple levels of reporting - Aggregate, Population and Point of Care - to be used by various users that provide and support the provision of quality, evidence based care 6 Azara Proprietary & Confidential

  7. Technology – Application Architecture Hlth Ctr #x Extract X EHR / EPM Hlth Ctr #x Transformations Extract X Load Staging CPCI & Aggregations EHR / EPM Reporting & Analytics C B Hlth Ctr #x Azara CPCI Nightly Processing Extract X EHR / EPM … Rpt A Rpt Z A Health Center Specific Connector

  8. How is CPCI Being Used in New York?  CPCI is used to support many CHCANYS and Network-wide Initiatives • CDC Cancer Grant (Breast, Cervical, Colorectal Cancer) • NYS HCCN Grant • NYS AIDS Institute HIVQual • AHRQ Healthy Hearts • 1422 Grant (Diabetes, Hypertension) • DSRIP • Action Health NYC • TCPI Grant (Transforming Clinical Practice Initiative) • Payer Data Integration  CPCI is used to support individual centers with… • Daily Visit Planning • UDS Reporting • PCMH accreditation • Meaningful Use • Center-specific responsibilities in support of Network Initiatives/other grants

  9. CPCI Tools and Functionality USING YOUR DATA TO TELL A STORY 9 Azara Proprietary & Confidential

  10. Dashboards, Reports and Measures Data is presented in CPCI in either a Dashboard , a Report or the Measure Analyzer  Dashboards present data as a series of widgets in a graphical format.  3 Basic types of Reports group measures or key patient data. – Patient Visit Planning - PVP – Scorecard Reports ﹘ Aggregated Data for Meaningful Use, UDS, PCMH – Clinical Registry Reports ﹘ Patient Level Detail for specific Chronic Conditions (e.g., Diabetes, Hypertension) or Preventive Care Segments (e.g., Adult Female, Adult Male)  Measure Analyzer allows users to complete ad-hoc analysis for specific measures (e.g., A1c > 9) – Review trends – Benchmark providers – Identify outliers and disparities in care

  11. Using the Data to Tell Your Story 11 Azara Proprietary & Confidential

  12. Scorecard Report Provides a quick snapshot of a group of measures, which may or may not be related.  Performance Indicator  Measure  Result (%)  Target (%)  Numerator  Exclusions  Denominator

  13. Measure Analyzer Detailed information about one specific measure with trends and comparisons. 1. Multi-Period Trends 2. Benchmarks 3. Comparison Charts

  14. Patient Visit Planning Report  Clinical information organized by patient – conditions, risks, care gaps  The Patient Visit Planning report can be run: – Prospectively to prepare and plan for patients’ upcoming appointments – Retrospectively (based on patients’ most recent encounter) to review the success of care teams planning, preparation and execution

  15. Dashboards  Select measure information organized to understand and drive the management of a population of patients or understand program performance.  A stock set of dashboards are now available that include

  16. Creating an Effective Dashboard Behavioral Health How many patients are you screening for DEPRESSION ? What % are screened or have follow up? How many patients are you treating for acute depression? How many of those treated are on medication for 12 wks? 16 Azara Proprietary & Confidential

  17. Dig Deeper  Identify what are the important aspects of the program or population that you want to understand at a quick glance… – What other measures are related? – Do you want to see a group of measures? – Do you want to see the breakdown by age?  Use the best graphic or widget to meaningfully display that information – Trendline – Scorecard 17 Azara Proprietary & Confidential

  18. Meaningfully Display of the Information Comparison Chart Gauge Counter Measure Family Trendline Mini Scorecard Benchmark 18 Azara Proprietary & Confidential

  19. Dental Dashboard How many patients have an annual dental visit? How many children have dental decay or cavities? What is the age range needs the most focus for dental exams? What percent of children had fluoride treatment? Can I see this for just my dental patients? 19 Azara Proprietary & Confidential

  20. Managing the Population REGISTRIES REDEFINED 20 Azara Proprietary & Confidential

  21. Clinical Registry Reports  Population management tool for chronic conditions and preventive care, as well as data quality  Create reports with patient level detail that can be used to – Retrospectively analyze data based on their most recent encounter – Prospectively analyze data based on their next appointment  Common set of data elements in each report (e.g., Patient Name, MRN) and a set of data element specific to the Chronic Disease or Preventive Care category 21 Azara Proprietary & Confidential

  22. Clinical Registry Reports  Result set can be sorted on any column by clicking on the column heading  Reports may be exported as either an Excel spreadsheet or PDF tearsheet  Results can be searched / filtered using the filter box at the top of each column 22 Azara Proprietary & Confidential

  23. Clinical Registry Reports - Custom In addition to the ’stock’ registries that are part of CPCI … custom registries can now be created 23 Azara Proprietary & Confidential

  24. Custom Registry Reports In addition to the ’stock’ registries that are part of CPCI … custom registries can now be created 24 Azara Proprietary & Confidential

  25. How to Create a Custom Registry Report So how do can you get a custom registry … 1. Create a support ticket and an Azara resource will reach back to understand your requirements and configure an appropriate registry 2. Reach out to a CHCANYS team member with whom you are working And if you find that you have frequent custom registry needs 3. Create a support ticket with Azara inquiring about getting the access and training to create your own registries 25 Azara Proprietary & Confidential

  26. What else can CPCI do for me?? MORE CPCI FUNCTIONALITY 26 Azara Proprietary & Confidential

  27. Payer Integration- Cost per Member Report This is an example of one of the payer integration reports that can be made available with this functionality. If you are interested in accessing this report, reach out to CHCANYS at HCCN@chcanys.org or Azara support at support@azarahealthcare.com 27 Azara Proprietary & Confidential

  28. Additional CPCI Functionality  PRAPARE – coming soon… – Available in next release due by Memorial Day – Expanded database will store the Social Determinants associated with PRAPARE – Centers can then engage with Azara to map this data from their systems for use in filters, registries, etc. with CPCI  Payer Integration – Health Centers need to know what happens outside their walls – Payers/Health Plans are assigning their “members” to centers and engaging in risk and shared savings type of arrangements – Azara has a module dedicated to integrating (a) enrollment / roster data and (b) claims / total medical expense data 28 Azara Proprietary & Confidential

  29. CPCI DEMO 29 Azara Proprietary & Confidential

  30. Measures & Alerts DENTAL AND BEHAVIORAL HEALTH

  31. Dental Measures / Alerts Measure/Alert Definition Child Dental Sealant Percentage of children, age 6-9 years, at moderate to UDS high risk for caries who received a sealant on a first permanent molar during the measurement period. Children Who Have Dental Percentage of children, age 0-20 years, who have had Decay or Cavities tooth decay or cavities during the measurement period. CMS eCQM 75v5.1 Primary Care Prevention Percentage of children, age 0-20 years, who received a Intervention fluoride varnish application during the measurement CMS eCQM 74v6.1 period. Dental Visit Alert Alert will trigger if Dental Visit has not occurred in the last 1 years. 31 Azara Proprietary & Confidential

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