cpc practice use of attribution files - ohio medicaid€¦ · •august 22 –ohio cpc 2020...

CPC Practice Use of Attribution Files

Melodie Gee, Lower Lights Christian Health Center

Amanda Beck, ProMedica Physicians Group

1

Welcome and Agenda

• Review of Attribution Files

• Lower Lights Patient Outreach using file data

• ProMedica’s use of attribution file information

• Upcoming Webinars

2

3

Review of Attribution Files

What is the purpose of attribution?

• To provide practices with the list of all members they are responsible for in the CPC program• PMPMs are paid for all attributed members

• Clinical Quality and Efficiency metrics and Total Cost of Care Shared Savings are calculated based on a practice’s attributed members, though some attributed members are excluded from these calculations

• To share information about members with practices for the purpose of population health improvement• Members with chronic conditions

• Non-claims attributed members

Finding your attribution and payment file

Your Payment and Attribution file is available in the MITS portal, entitled Quarterly CPC Attribution and Payment Files

: Attribution and payment files

Data dictionary for quarterly attribution and payment fileField name Description

Residential county of the attributed member Text

10-digit national identification number of the practice attributed for the member Number

Number

First name of the attributed member Text

Last name of the attributed member Text

12-digit Medicaid identification number of the attributed member

FFS or name of one of the MCOs that created attribution for the member Text

7-digit Medicaid identification number of the practice attributed for the member Number

Residential state of the attributed member Text

Residential city address of the attributed member Text

Zip code of the residential address of the attributed member Number

The birth date of the attributed member Date

10-digit national identification number of the rendering provider attributed for the member Number

Contact information of the attributed member – phone number Number

The gender identified by the attributed member Text

Residential address of the attributed member Text

Name of the rendering provider attributed for the member Text

Residential address of the attributed member (continued) Text

Whether attributed member had any claims associated with the attributed practice in the past 24 months Text

Tiers 1-9, based on the first digit of the 44 risk groups generated by CRG risk adjustment tool Number

7-digit Medicaid identification number of the rendering provider attributed to the member Number

Format

Member County

Provider Billing NPI

Member Medicaid ID

Member First Name

Member Last Name

Payer

Provider Billing Medicaid ID

Member State

Member City

Member Zip Code

Member Date of Birth

Rendering Provider NPI2

Member Phone Number

Member Gender

Member Address 1

Rendering Provider Name2

Member Address 2

Claims in Last 24 Months Flag1

Risk Tier

Rendering Provider Medicaid ID2

10-digit number

12-digit number

n/a

n/a

n/a

7-digit number

mm/dd/yyyy

10-digit number

10-digit phone number

M/F

n/a

n/a

Yes/No

1-9

7-digit number

Values

Whether the member had Asthma condition based on claims in the past 12 months Text

Whether the member had Stroke condition based on claims in the past 12 months Text

Whether the member had Depression condition based on claims in the past 12 months Text

Quarterly PMPM amount for the attributed member based on assigned risk tier

Whether the member had Severe and Persistent Mental Illness condition based on claims in past 12 months Text

Whether the member had Congestive Heart Failure condition based on claims in the past 12 months Text

Whether the member had Diabetes condition based on claims in the past 12 months Text

Asthma Flag

Stroke Flag

Depression Flag

Quarterly PMPM Amount

SPMI Flag

CHF Flag

Diabetes Flag

Yes/No

Yes/No

Yes/No

>0

Yes/No

Yes/No

Yes/No

n/a

n/a

n/a

n/a

5-digit zip code

1 This flag is set as “Yes” if the attributed member has any claims in which the attributed practice is the same as the billing provider on the claim in the 24-month claim history prior to attribution date

2 Rendering provider Medicaid ID, name, and NPI are all set as “N/A” if rendering provider Medicaid ID was not available in FFS/MCP attribution files or if rendering provider Medicaid ID is the same as provider billing Medicaid ID

Number

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Lower Lights Christian Health Center

Contacting Potential Patients from the CPC Attribution File

Melodie Gee, CQO

February 22, 2019

How we view the attribution file

We believe it is important for us to reach out to whomever we can on the Medicaid attribution file, who is not currently an active patient, for a few reasons:

1. If we are accountable for patients on the attribution list, we want to make sure that we have an opportunity to effect their health outcomes.

2. People need primary care. If we don’t reach out to them, they may just use the ER as a Primary Care Provider and not work to manage their health.

3. We want to grow our practice - this is just one more way for us to reach out to potential patients

Removing Existing Patients in the File

It can take quite a bit of work to match the file against our patient base. We have found the following method works best for us, to remove existing patients.

• Perform a 3 – way match against the attribution file and a list of our unduplicated patients – First Name, Last Name and DOB. Anyone who matches all of these fields is removed from the call list.

• Next, we run through the people who match DOB and First or Last Name. We check our system to see if they have changed their name – sometimes checking old addresses, etc. helps to identify the person.

• Lastly, we try to match the Medicaid # in the list against the Medicaid # we have on file against the remaining people on the list.

Contacting the Potential Patient

We have Care Coordinators contact the remaining people on the list. We don’t look at this as a cold call a salesperson might make to get a customer. This is a call that literally could save someone’s life. The script would go something like this, once we have the person on the phone:

“ This is xxx from Lower Lights Christian Health Center. You were assigned to us by Medicaid as your Primary Health Care Provider. We would like to set up an initial visit with us to establish you as a patient with one of our Doctors or Nurse Practitioners.”

At this point, the prospective patient usually tells you if they are seeing another provider – or they allow you to set up an appointment.

Contacting the Potential Patient (cont.)

• If the person is seeing another medical provider, we ask them to contact Medicaid and let them know who their provider is – we don’t try to talk them into coming to see us.

• If we reach voicemail – we simply leave a message stating who is calling and leaving a call back name and number.

• If we have reached out to someone 3 separate times and don’t speak with them, we may send a letter - provided they have a legitimate address.

Other Uses of the Attribution File

• We also may use the Attribution File to assign an initial risk score to patients prior to seeing them for an appointment.

Questions?

14

ProMedica Physicians Group

This is a confidential ProMedica document. You are prohibited from duplicating or otherwise disseminating

any of the information contained herein.

ProMedica Physicians GroupAttribution Process



Who

we are

Our System

• Health system serving

communities in 28 states

• Headquarters in Toledo, OH

• 13 acute care facilities

• 2,600 providers

• 400+ senior care facilities

Our CPC

• 26 PCP sites included are

included in our our CPC

• 920 providers

• 35,000+ attributed CPC

members

• 600,000+ lives covered

through Paramount



Attribution Challenges

Members attributed to PPG, have not establishedMember choice

Insurance assigned PCP

Lag in updating provider rosters

Different identifiers and/or insurance report formatMaiden Name

Abbreviated F/L name

Baby Girl/Baby Boy

Hyphenated

Suffix

Patients identified as “new members,” but not new patients to PPG

Epic empanelment

Sending supplemental data

Bi-directional data sharing



Internal Process

1. Download the OH CPC file from the MITS portal

2. Membership list is uploaded to a SQL Server for formatting

3. Membership list is uploaded into Epic Data Warehouse (EDW)

4. Match the insurance membership list to unique patients in Epic:

a) First Name

b) Last Name

c) Date of Birth

d) Gender

5. A successful match will link the insurance member to Epic patient

a) A manual MRN match file is generated for the remaining unmatched members

b) Using Epic, locate the Enterprise number (not the MRN) to match patient

6. Locate the Epic PCP, last appointment date, and next appointment date

7. Report is generated to show discrepancies between the attributed PCP and Epic PCP

8. Perform patient outreach to establish or re-establish with PPG



Outreach Letters



Epic SmartText



End Result of Patient Attribution

PPG patients receive:

13 month out scheduling

Automated Appointment Reminders

Access to ProMedica MyChart

Care Coordination

Care Navigation

SDOH screening



Thank you

Amanda Beck

Director, Care Transformation

[email protected]

Florica Balonek

Supervisor, Care Coordination

[email protected]

Tiffany Laney

Care Transformation Specialist

[email protected]

Aaron Lee

Care Transformation Specialist

[email protected]

mailto:[email protected]




Questions?

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Upcoming Webinars

Key upcoming dates: Best Practice Sharing Webinars

• March 29

» Topic: Using non-clinical providers to enhance your CPC practice

• April 26

• May 31

• June 28

• August 30

• September 27

• October 25

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Last Friday of the Month, 11:30a-12:30p

Tentative topic for April: Using Practice Reports

Is your practice utilizing practice reports to meet CPC program requirements?

We are still looking for practices to present on April 26, and for other future dates!

Key upcoming dates: Monthly Webinars

• January 17 – Understanding your Ohio CPC Payment & Attribution Files

» Now posted to the ODM website!

• February 14 – Review of 2017 Ohio CPC Outcomes

• March 14 – Overview of Ohio CPC Activity Requirements

• April 18 – Understanding your Quarterly Practice Reports

• May 9 – Understanding your Quarterly Referral Reports

• June 13 – What to Expect from Practice Monitoring

• August 8 – Total Cost of Care Shared Savings Methodology Review

• August 22 – Ohio CPC 2020 Pre-Enrollment Webinar

• November 14 – Review of 2018 Ohio CPC Outcomes

• December 19 – Ohio CPC 2020 Introductory Webinar

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11:30a-12:30p

cpc practice use of attribution files - ohio medicaid€¦ · •august 22 –ohio cpc 2020...

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