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

¡ ONAF ¡submission ¡ ¡ Requirement ¡ ¡ Codes/Modifier ¡ ¡ Payment ¡ ¡ Ini;al ¡visit ¡ ¡ Fax ¡within ¡7 ¡days ¡of ¡ visit ¡ ¡ ¡ 0500F ¡with ¡HD ¡ modifier ¡ ¡ ¡ $100.00 ¡ ¡ List ¡of ¡all ¡visits ¡ ¡ Submit ¡a?er ¡delivery ¡

• r ¡with ¡postpartum ¡

submission ¡ ¡ ¡ 0500F ¡with ¡HD ¡ modifier ¡ ¡ ¡ $100.00 ¡ ¡ Postpartum ¡visit ¡ ¡ ¡ 21-­‑56 ¡days ¡ ¡ ¡ 0503F ¡with ¡HD ¡ modifier ¡ ¡ ¡ $100.00 ¡

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

(EPDS)

• Beck Depression Inventory (BDI 1a,II)
• Postpartum Depression Predictors

Inventory-Revised (PDPI-R)

• Center for Epidemiologic Studies

Depression Scale (CES-D)

• Patient Health Questionnaire (PHQ)-2 and

PHQ-9 Tools

• Zung Depression Rating Scale (Zung SDS)
• Hamilton Rating Scale for Depression

(HRSD)

• General Health Questionnaire (GHQ-D)
• Montgomery-Asberg Depression Rating

Scale (MADRS)

• Primary Care Evaluation of Mental Disorders

Patient Health Questionnaire (PRIME-MD PHQ)

Agency for Healthcare Research and Quality (AHRQ) “Efficacy and Safety of Screening for Postpartum Depression” (3/9/2012):

• Bromley Postnatal Depression Scale

(BPDS)

• Postpartum Depression Screening Scale

(PDSS)

• Leverton Questionnaire (LQ)
• Hospital Anxiety and Depression Scale

(HADS)

• Generalized Contentment Scale

Other validated tools not listed by AHRQ:

• Inventory of Depressive Symptomatology,

Clinician Rating (IDS-C)and Self-Report (IDS-SR)

• Quick Inventory of Depressive

Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR)

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?

Thank You!