www.uihealthalliance.com
4TH QUARTER 2015
UIHA PROVIDER NEWS
CODING: A Paradigm Shift
The Medicare Shared SavingsProgram (MSSP) for the University of Iowa Health Alliance Accountable Care Organization is a “shared risk” arrangement, which provides for incentive payments based on cost reduction and quality performance. Coding plays an important role in how quality and cost is measured by the Centers for Medicare and Medicaid Services (CMS) and other commercial carriers.
CMS assigns a risk score to individual members based on demographics and disease related factors. The risk score is dependent on accurate documentation in a patient record and coding of diagnosis codes submitted
through claims. It is important to depict an accurate risk picture of patient health so the health systems can operate to the best of its abilities in meeting the needs of our patients.
Understandably, patients with more complex diagnosis profiles have a higher cost of care and could benefit from care management resources.
A new way of thinking about coding is needed said UIHA Population Health Officer William Langley, MD. “Traditionally we tend to limit diagnosis codes to the primary problems or conditions addressed during a visit. Now, we want to make sure all applicable diagnosis codes are assessed and properly documented at least one time each year in the patient’s medical record.” ACCURATE DOCUMENTATION & CODING
ACCURATE RISK
PICTURE
5 TIPS FOR
DOCUMENTING CODES
•
Diagnosis codes can be spread throughout the year at different visits.•
Practice software typically can accept up to 12 diagnoses per visit.•
All diagnoses that are addressed during a hospitalization should be documented and coded by the physician.•
When coding complications, use both the appropriate chronic condition PLUS the complication. E.g. Diabetes with polyneuropathy (E11.65) + diabetic polyneuropathy (E11.42).•
Avoid using “history of” to describe a current condition.For more information, see Commonly Overlooked Diagnoses on page 2.
BILL LANGLEY, MD
UIHA Chief Population Health Officer
WELCOMING New Member
Great River Health Systems of West Burlington becomes the University of Iowa Health Alliance (UIHA) fifth chapter. Its physicians and clinics cover seven cities in Southeast Iowa.
“The addition of Great River Health Systems significantly strengthens our efforts to improve clinical integration throughout Iowa,” said University of Iowa Health Alliance CEO Dan Kueter. “They will also join our new UIHA Accountable Care Organization as we work together to shift from fee-for-service to value-based care delivery. We welcome their participation.”
Great River Health Systems President and CEO Mark Richardson said, “This partnership is an important step for better coordinating and expanding health care for our region. UIHA will enhance our efforts to navigate
health care reform by helping us to continue to provide high-quality care while saving valuable health care dollars.”
UIHA now includes 21 hospitals and nearly 2,100 physicians.
MARK RICHARDSON
Great River Health Systems President
& CEO
CODING: A Paradigm Shift
continued from p.1New coding best practices affect how quality and cost are measured by insurance carriers in the new “shared risk” arrangement. All applicable diagnosis codes should be assessed and documented at least one time per year to provide an accurate risk picture of the patient.
HEALTH STATUS
BK amputation status Z89.529 Breast cancer, personal history Z85.3 Colon cancer, personal history Z85.038 Dialysis patient Z99.2 Colostomy status Z93.3 Ileostomy status Z93.2
COMPLICATIONS
Diabetic nephropathy E11.21 Diabetic retinopathy E11.319 Diabetic polyneuropathy E11.42
CHRONIC CONDITIONS
Angina I20.8
Atrial fibrillation I48.2 Bipolar disorder F31.9 Breast cancer C50.919 Cardiomyopathy I42.9 Chronic kidney dis. (CKD), 1-5 N18.1-5
COPD J44.9
CVA (stroke), late effects I69.359 Deep vein thrombosis, chronic I82.509 Diabetes, controlled E11.9 Diabetes, uncontrolled E11.65 Diabetes, w/nephropathy E10.65 Diabetes, w/polyneuropathy E10.65 Diabetes, w/retinopathy E10.65 Epilepsy G40.909 Heart failure I50.9 Hypertension, w/CKD I12.9 Malnutrition E46 Obesity, morbid E66.01 Peripheral vascular disease I73.9 Polymyalgia rheumatic M35.3 Rheumatoid arthritis M06.9 Ulcer of lower extremity L97.909
UIHA Physician
Leadership Council
Chair: Douglas Van Daele, MD,
Leader of University of Iowa
Physicians, University of Iowa Health Care
Andrew Andresen, MD, Genesis
Health System
Steve Aguilar, MD, Genesis Health
System
Tim Quinn, MD, Mercy - Cedar
Rapids
Tony Myers, MD, Mercy - Cedar
Rapids
Cam Campbell, MD, Mercy - Cedar
Rapids
Alison Lynch, MD, University of Iowa
Health Care
Jim Lehman, MD, Wheaton
Franciscan Healthcare - Iowa
Bill Langley, MD, Chief Population
Health Officer, UIHA
Brad Archer, MD, Chief Clinical
Officer, UIHA
Michael McCoy, MD, Great River
Health Systems
Michael AbouAssaly, MD, Great
River Health Systems
UIHA Care Management
Workgroup
Chair: Jill Norris, UIHA Director of
Care Management
James Bell, Great River Health
Systems
Deb Bogs, Genesis Health System Kymm Ehler, Wheaton Franciscan
Heathcare - Iowa
Rebecca Jacobs, Mercy - Cedar
Rapids
Dianne Wasson, University of Iowa
Health Care A new Physician Leadership Council has been
established. The council will direct care delivery and performance management for the alliance and is accountable to the ACO board of directors.
The UIHA Clinical Integration Team has been disbanded. Some members of that group will serve on the new Physician Leadership Council while others may serve on a care-management workgroup.
The Physician Leadership Council is operated with two physicians from each member organization (chapter). One physician will be from a primary care setting and the second from a specialist setting. Appointments are for one year with renewals annually. A council chair will be appointed and also serve on the ACO board of directors.
The council will review and adopt clinical strategies, as well as provide clinical oversight, needed to achieve population health and value-based metrics, objectives and deliverables. Members will also work within their own chapters to share and elicit physician input and participation in UIHA efforts.
NEW PHYSICIAN
LEADERSHIP COUNCIL
UIHA WELCOMES
NEW STAFF MEMBER
Jill Norris, RN, MPH, has joined the University of Iowa Health Alliance as Director of Care Management. Her new role is focused on designing, implementing and managing UIHA care management programs, processes and performance. She will chair the care management workgroup and facilitate collaboration among the UIHA chapter's care management leaders.
Norris has a diverse and extensive background in the health care field including population health management, practice transformation and quality improvement. She has worked in the clinic, hospital, insurance, corporate health/benefits and academic settings. She comes to UIHA from Mercy Health Network ACO in Des Moines.
She holds a B.Sc. in Community Health and Preventive Medicine from Iowa State University, and a Masters in Public Health from Des Moines University - Osteopathic Medical Center.
JILL NORRIS UIHA Director of Care Management DR. VAN DAELE Physician Leadership Council Chair
Re-admission of patients
discharged from the hospital within 30 days is costing our nation as much as $25 billion annually. And by all accounts, it’s a largely preventable situation.
While care intervention has proven to reduce readmission rates by as much as 30 percent, providers across multiple organizations and systems frequently don’t have the technical capability to easily exchange information and monitor patient compliance.
A new alert system seeks to streamline that exchange of information to improve
communications and reduce gaps in care. Care teams are frequently not aware of occurrences that are
taking place outside their facility such as:
•
Discharge from another hospital•
Unexpected emergency roomvisit
•
Missed or unscheduled follow up appointment•
Unfilled prescriptionIowa’s Statewide Alert
Notification System
University of Iowa Health Alliance members (chapters) are participating within a federally-funded grant to the Iowa Department of Human Services to use a statewide alert system to notify care coordinators when a patient is treated in another facility. Their focus is on Iowa Medicaid members with primary care provider assignments. The Iowa Statewide Alert
Notification System will share real-time information on emergency
department discharges, inpatient admissions and inpatient
discharges.
By receiving enough information, UIHA chapter care coordinators can work with patients to improve outcomes. In the future secure alerts will be sent to the UIHA ACO chapters.
Genesis is First UIHA
Chapter Online
Genesis Health System went online with the alert system in November. Genesis Information Architect Mary Gardner-Karcher said, "I’m excited about this project because it leverages the Health Information Exchange framework to enable more effective care coordination. Event notifications to care
coordinators will help control cost and improve quality by increasing awareness of health care utilization at any Iowa hospital."
New System For Better
Coordinated Care
Managed Care Organizations
Iowa’s $4 billion Medicaid program is transitioning virtually all its populations and services to four managed care organizations (MCOs) for a start date of
January 1, 2016.
The Iowa Department of Human Services selected these plans:
•
Amerigroup Iowa, Inc.•
AmeriHealth Caritas Iowa, Inc.•
UnitedHealthcare Plan of theRiver Valley, Inc
•
WellCare of Iowa, Inc. Services traditionally offered through the hawk-i program and the Iowa Health & Wellness Plan are now part of these new plans. The plans will have contractual performance and qualityrequirements they must meet, as well as shouldering the financial risk. We anticipate the MCOs will use more extensive member
information and management activities, as well as utilization management and medical management processes.
UIHA is currently discussing 2016 value-based contracts on behalf of its chapters with the MCOs. Additional information regarding the Medicaid managed care contracts will be shared as the process moves forward.
© 2015 UNIVERSITY OF IOWA HEALTH ALLIANCE. ALL RIGHTS RESERVED. ITEM 192 20151201
4TH QUARTER 2015
UIHA PROVIDER NEWS
UIHA STAFF
Dan Kueter, President & CEO
Jennifer Vermeer, COO
Brad Archer, MD, Chief Clinical Officer
William Langley, MD, Chief Population HealthOfficer
Bonnie Braatz, Program Manager
Jill Norris, Director of Care Management
Brooke Kensinger, Business Health Director
Maggie Eischeid, Program Coordinator
Steve Palmersheim, Manager, Population HealthAnalytics
OUR MEMBERS
The University of Iowa Health Alliance represents some of the largest health care provider organizations in Iowa and its surrounding states. Its membership includes nearly 2,100 physicians and 21 hospitals with key locations in Cedar Falls, Waterloo, Cedar Rapids, Davenport, Iowa City and Burlington.
Our membership includes:
Genesis Health System
Great River Health Systems
Mercy — Cedar Rapids
University of Iowa Health Care
Wheaton Franciscan Healthcare — IowaMedicare Shared Savings
Program
Update
As we’ve previously reported, the University of Iowa Health Alliance Accountable Care Organization seeks to create its first consolidated contract with the Centers for Medicare and Medicaid Services (CMS).
Two existing Medicare Shared Savings Program (MSSP) ACO organizations will consolidate and merge into the new UIHA ACO. These are Genesis Health System and the Mercy - Cedar Rapids/University of Iowa Health Care ACO. All UIHA chapter members will be a part of the new MSSP ACO.
MSSP establishes financial
accountability for the quality and total cost of care for lives covered under the ACO. Our learnings from the
MSSP experience will also translate to future ACO agreements with commercial payer agreements.
Application in Review
The initial application for the MSSP was submitted in July and is presently in its third and final review cycle with CMS. It is anticipated we’ll know more about its approval status by early December. This is an important development for the UIHA ACO moving towards a value-based system of care.
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CONTACT US:
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