SIM CHIR Dashboard. User Guide. Document File Name SIM_CHIR_Dashboard_User_Guide.docx. Document Author Kendra Mallon. Created November 12, 2018

Transcription

1 User Guide Document File Name SIM_CHIR_Dashboard_User_Guide.docx Document Author Kendra Mallon Created November 12, 2018 Revision History Version Date of Release Summary of Changes Owner /12/2018 Updated with Enhancement 6.01 changes Kendra Mallon /31/2018 Updated with Release 6.0 changes Kendra Mallon 5.0 8/8/2018 Updated a few screenshots Kendra Mallon 5.0 8/3/2018 Updated with Release 5.0 changes Kendra Mallon 4.0 4/30/2018 Updated with Release 4.0 changes Kendra Mallon /28/2018 New document Kendra Mallon

2 U S E R G U I D E Copyright 2018 Regents of the University of Michigan. All rights reserved. This documentation is a work of Michigan Medicine. Any unauthorized use, duplication, or disclosure is prohibited. Michigan Medicine assumes no responsibility or liability for any errors or inaccuracies that may appear in this documentation. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, outside of Michigan Medicine, in any form or by any means, electronic, mechanical, recorded, or otherwise, without the prior written permission of Michigan Medicine. Any reference to company names or individuals in samples, procedures, or templates are for demonstration purposes only. All trademarks are the property of their respective owners. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 2 of 30

3 U S E R G U I D E Contents Copyright... 2 Contents... 3 About the SIM CHIR Dashboard... 5 Accessing the Dashboard... 5 Components of the Dashboard... 5 Display of the Dashboard Components... 6 Measures Included in the Dashboard... 7 Chronic Conditions Included in the Dashboard... 8 Getting Help... 8 Dashboard Pages... 9 Overview Page Tile Page Quality Page Utilization Page Maps Page Using the SIM CHIR Dashboard Logging In Logging Out Navigating Filtering Data Using the CHIR Filters Access Levels Viewing Benchmarks in Visualizations Viewing Tooltips Sorting Columns or Rows in Tables Viewing the Underlying Data Saving Files to Your Computer Exporting Tables and Visualizations Exporting to PDF Exporting to CSV Understanding the Data About the Data on the Dashboard Data Updates Small Sample Size No Data Patient Eligibility Attribution Demographic Assignment Benchmarks Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 3 of 30

4 U S E R G U I D E Benchmark color-coding Benchmark Methodology How Benchmarks are Calculated Additional notes about benchmarks Example 1: Quality Measure Example 2: Utilization Measure Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 4 of 30

5 U S E R G U I D E About the SIM CHIR Dashboard The CHIR Dashboard enables you to view SIM PCMH Medicaid data aggregated at the CHIR level to explore population, quality of care, and utilization. All reporting is aggregated to the CHIR level, and is not available by PO, Practice, or patient. All data is limited to the SIM PCMH population based on the POs and Practices participating in the initiative. Each page of the Dashboard aggregates data based on the following Community Health Innovation Regions (CHIRs): NOTES: Jackson Muskegon Washtenaw and Livingston Genesee Northern Michigan MDC will provide updates to the SIM CHIR Dashboard throughout the project. You can find information about new measures, features, and updates for each release in the CHIR Dashboard Release Notes. No patient-level information is available in the CHIR Dashboard. All users can see the aggregated results for all CHIRs, in addition to their own. Accessing the Dashboard For information about accessing the SIM CHIR Dashboard, see the Accessing the CHIR Dashboard Guide. Components of the Dashboard The SIM CHIR Dashboard contains the following components: Dashboard Component Description Page tabs Pages CHIR Filters Visualizations / Data option Export dropdown field A menu bar that appears at the top of the Dashboard. Use these to navigate to the following pages included in the Dashboard. Each page provides information for each data category (Overview, Tile, Quality, Utilization, ACSC, and Maps). By default, the pages display data for all CHIRs. You can use the CHIR filters to view data for one or more CHIRs. Each time you update your CHIR selection, the data displayed on a page automatically updates. Use these options to toggle between viewing the data in a visualization format (graph) or in a table format. Use this to export the current page to PDF or.csv file. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 5 of 30

6 U S E R G U I D E Dashboard Component Benchmark options Benchmark indicators Description You can select the option to see either the PCMH benchmarks or no benchmarks. Displays the PCMH benchmark for that measure. Hover your mouse over the benchmark indicator information about the benchmark. to view additional DISPLAY OF THE DASHBOARD COMPONENTS Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 6 of 30

7 U S E R G U I D E Measures Included in the Dashboard Each measure is defined based on a reporting/measurement year which is a 12-month period. The following measures are included in the Dashboard, as of Enhancement 6.01: Adolescent Immunization Adolescent Immunization: HPV Adolescent Well-Care Adult BMI Breast Cancer Screening Cervical Cancer Screening Childhood Immunization Status Chlamydia Screening in Women Comprehensive Diabetes Care: Eye Exam (retinal) performed Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing Comprehensive Diabetes Care: Medical Attention for Nephropathy Controlling High Blood Pressure Diabetes Blood Pressure Control Diabetes HbA1c Poor Control Lead Screening in Children Screening for Depression and Follow-Up Tobacco Use Screening and Cessation Weight Assessment and Counseling Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Well-Child Visits in the First 15 Months of Life Acute Hospital Admissions All-Cause Readmissions Emergency Department Visits Preventable ED Visits ACSC Adult Composite - Overall ACSC - Adult Composite - Acute ACSC Adult Composite - Chronic ACSC Adult Composite - Diabetes ACSC Pediatric Composite - Overall ACSC Pediatric Composite - Acute ACSC Pediatric Composite - Chronic Total Cost PMPM For detailed information about how the measures are calculated, see the SIM PCMH Measures Technical Guide on the SIM PCMH Support page of the MDC Website. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 7 of 30

8 U S E R G U I D E Chronic Conditions Included in the Dashboard The following chronic conditions are included on the Overview page: Asthma Diabetes Hypertension Obesity (Any, Overweight, Moderate, Severe) For detailed information about how the chronic conditions are calculated, see the SIM PCMH Measures Technical Guide on the SIM PCMH Support page of the MDC Website. Getting Help If you have any general questions about the SIM PCMH Dashboard, contact MDC at MichiganDataCollaborative@med.umich.edu. Additional support documentation can be found on the SIM CHIR Support page of the MDC Website. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 8 of 30

9 U S E R G U I D E Dashboard Pages The Dashboard includes pages for each data analysis area: overview (executive summary), tile (measure rate snapshot), quality of care, utilization, and maps. From these pages, you can view demographic information, view chronic condition data, compare measure performance against published Benchmarks, and view graphical information. The Dashboard contains the following pages: Overview Tile Quality Utilization ACSC Maps Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 9 of 30

10 U S E R G U I D E Overview Page Use the Overview page to view a quick summary of demographics, including: Number of POs/MSOs, Practices, Providers, and Patients Patients - By age - Sex - Race - Payer/Medicaid plan - Chronic condition Measures that meet PCMH Initiative benchmarks Adult and Pediatric Composite ACSC measures Total Cost PMPM Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 10 of 30

11 U S E R G U I D E Tile Page The tile page provides a snapshot of all quality and utilization measure rates for the report level you select. Each measure rate is also color-coded to indicate if it meets SIM PCMH Benchmark. Blue = meets PCMH benchmark Orange = fails to meet PCMH benchmark Gray = small sample size You can use this page to get a quick overview of how a CHIR is doing and how their rates compare to benchmark rates. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 11 of 30

12 U S E R G U I D E Quality Page Use the Quality page to review rates for quality measures. This page displays overall rates and numerators and denominators for each measure. It also includes PCMH benchmarks for each measure when available. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 12 of 30

13 U S E R G U I D E ACSC Page These measures can be used with hospital inpatient claims to identify quality of care for ambulatory care sensitive conditions (ACSC). These are conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease. A lower rate indicates better performance. You can view for more information by clicking a measure rate. A tooltip opens to display an abbreviated measure definition and the combined numerator/denominator counts for the claims. Notes: Benchmarks are not calculated for ACSC Dashboards Measures on the ACSC page are only available in the data format. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 13 of 30

14 U S E R G U I D E Utilization Page Use the Utilization page to review Emergency Department (ED) visit information. This information can help you to measure, track, and understand your population s ED utilization. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 14 of 30

15 U S E R G U I D E Maps Page Use the Utilization page to view the location of practices in each CHIR, based on the practice address zip code information including in the Provider Hierarchy file. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 15 of 30

16 U S E R G U I D E Using the SIM CHIR Dashboard This section provides instructions for working with the features of the Dashboard. Logging In Before you can log in to the SIM CHIR Dashboard, you must complete certain setup steps. These steps are provided in the Accessing the CHIR Dashboard guide. To log in to the Dashboard: 1. Access the MDC Website. 2. Click the Login button in the upper-right corner. 3. (IE only) If the following message displays, click Allow to enable Citrix to connect to the Dashboard. 4. (Firefox only) If the Launch application window opens, verify that Citrix Receiver Launcher is highlighted and click Open link. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 16 of 30

17 U S E R G U I D E 5. Log in to the Virtual Places website with your user name (the uniqname portion of your Michigan Medicine login), Level-2 password, and Duo preference. 6. Accept the Duo two-factor authentication request. 7. In the Virtual Places website, click the CHIR Dashboard icon. (It may take a minute or two for the Dashboard to open.) 8. The Attestation pops up in a new window. Click I agree. NOTE: When you access the SIM CHIR Dashboard, you are accessing a virtual PC behind the Michigan Medicine firewall. Regardless of which browser you are using on your own PC, the virtual PC will open the SIM CHIR Dashboard in Internet Explorer. After you log in to the dashboard, the main page displays, similar to the following: Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 17 of 30

18 U S E R G U I D E Logging Out When you are done using the Dashboard, you can log out by closing the web page and then closing the browser. Navigating Use the page tabs at the top of the Dashboard to navigate between pages. Your navigation menu will look similar to the following: Filtering Data Using the CHIR Filters By default, the pages display data for all CHIRs. You can use the CHIR filters to view data for one or more CHIRs. Executive Summary CHIR filters: CHIR filters on all other pages: Access Levels Data is provided at the project and CHIR levels. (No patient-level data is available at this time.) Managing Organizations (MOs) are defined as either physician organizations (POs) or multi-site organizations (MSOs). All users can view aggregated data at the project level and CHIR-level data for all CHIRs. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 18 of 30

19 U S E R G U I D E Viewing Benchmarks in Visualizations In the Quality and Utilization visualizations, you can choose to display the PCMH benchmarks or no benchmarks. For additional information about benchmarks, see Benchmarks. Viewing Tooltips When you hover your mouse over certain components of the Dashboard, a tooltip appears, which provides additional information. For example, the following tooltip opens when you hover your mouse on the Diabetes: Eye Exam bar in the visualization: Sorting Columns or Rows in Tables When you view a table, you can click a column or row heading and then click the ascending descending sort icons to re-order the columns or rows. or Viewing the Underlying Data To view the underlying summary data that is used to create a table or visualization, click the measure name, then click the View Data icon. The following example shows the underlying data used to create the Percent/Rate, Numerator, Denominator, and benchmark data for Emergency Department Visits: Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 19 of 30

20 U S E R G U I D E Saving Files to Your Computer To save a file on the Report page to your computer, complete the following steps: 1. Select the report file that you want to save. 2. A message window opens. Click Save as. (The Save as window varies based on your browser.) Firefox Explorer The following error message opens. IMPORTANT! You can download the file onto your own PC even though this error appears. (This error refers to downloading files onto the virtual PC, which the Dashboard runs on.) 3. Click OK to continue. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 20 of 30

21 U S E R G U I D E 4. In the Save As window, navigate to the location where you want to save the file, and then click Save. 5. If the window shown here opens, click Permit all access. 6. Verify that you can find and open the file by navigating to it using Windows Explorer on your PC. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 21 of 30

22 U S E R G U I D E Exporting Tables and Visualizations You can export the data from each page to PDF or CSV. EXPORTING TO PDF To export to PDF: 1. Click the Export dropdown and select PDF. The Download PDF window displays, similar to the following: 2. Keep the defaults for all selections. 3. Click Download. 4. A window opens with a message that the PDF file has been generated. Click Download. 5. To save the file onto your computer, click the Save dropdown arrow, and then select Save as. 6. The following error message opens. IMPORTANT! You can download the file onto your own PC even though this error appears. (This error refers to downloading files onto the virtual PC, which the Dashboard runs on.) 7. Click OK to continue. 8. In the Save As window, navigate to the location on your computer where you want to save the file, and then click Save. IMPORTANT: Make sure you are saving the file onto your own computer and not the virtual PC. The Virtual PC is at the top of the left pane. To see your computer s directory, scroll down. 9. Access the file by navigating to it using Windows Explorer on your PC. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 22 of 30

23 U S E R G U I D E EXPORTING TO CSV To export to CSV: 1. Click the Export dropdown and select CSV. 2. In the Download window, click Download. 3. To save the file onto your computer, click the Save dropdown arrow, and then select Save as. 4. The following error message opens. IMPORTANT! You can download the file onto your own PC even though this error appears. (This error refers to downloading files onto the virtual PC, which the Dashboard runs on.) 5. Click OK to continue. 6. In the Save As window, navigate to the location on your computer where you want to save the file, and then click Save. IMPORTANT: Make sure you are saving the file onto your own computer and not the virtual PC. The Virtual PC is at the top of the left pane. To see your computer s directory, scroll down. 7. Access the file by navigating to it using Windows Explorer on your PC. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 23 of 30

24 U S E R G U I D E Understanding the Data In this section, you ll find guidelines for how to interpret the data you encounter as you use the SIM PCMH Dashboard. About the Data on the Dashboard Each release in the SIM CHIR Dashboard uses a 12-month reporting period. MDC will continue to update and add data regularly throughout the SIM PCMH Initiative. The data in the Dashboard is based on claims/encounters, eligibility, and attribution data from Medicaid. MDC added QMI data to all measures, starting with Release 6.0. There is a 2-month run-out period for claims. Quality measures are displayed as percentages. Utilization measures, chronic measures, and ACSC measures are displayed as rates per 1,000 qualifying patients (as defined by the measure specifications). For information about the measures included in the Dashboard, see the SIM PCMH Measures Technical Guide. For information about the data timeframes used in the Dashboard, see the CHIR Dashboard Timeline. DATA UPDATES Updates to the data are scheduled to occur regularly. Watch for announcements about new data releases via communications and on the SIM CHIR page of the MDC Website. SMALL SAMPLE SIZE Dashboard measures must meet one of the following minimum requirements to be calculated: a numerator of 5 a denominator of 30 If the denominator is less than 100 it is color-coded gray. If you click on a denominator value that is colorcoded gray, the underlying data displays with a Small Sample Size label. The percent/rate is displayed if the numerator criteria is met. Numerator and denominator values, regardless of sample size, are available to view at all levels: project, managing organization, practice, and provider. NOTE: Small sample size criteria does not apply to ACSC measures. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 24 of 30

25 U S E R G U I D E NO DATA When you view certain filter combinations, you may see None display, similar to the graphic below. This indicates that the filter combination resulted in no data. For example, a provider may not have enough data to display the results for a certain measure. Patient Eligibility MDC receives a monthly Provider Hierarchy file from MiHIN in conjunction with the SIM Participation File (SPF) from MDHHS. The Provider Hierarchy file contains information on which physicians belong to which practices and which Managing Organizations (MOs). This list is used to determine the MSO-Practice- Physician relationship for each member. Because the relationship between physicians, practices, and managing organizations is constantly changing, MDC uses a snapshot in time taken from the Hierarchy files. We use the list closest to the end of the reporting period for the Dashboard release and for each trend period to determine which physicians are SIM participants when we process the data. You can find the monthly list used for the Dashboard is included in the Dashboard Release Notes. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 25 of 30

26 U S E R G U I D E Attribution Attribution dates for the Dashboard can be found on the CHIR Dashboard Timeline. The following guidelines apply to patient attribution on the SIM CHIR Dashboard: Identification of SIM PCMH patients with their associated managing organizations, practices, and providers is aligned with the end of the measurement period. For example, if the measurement period ends on June 2017, then the June 2017 SIM member list will be used to identify the SIM members for that Dashboard release. The SIM population will vary from month to month as patient/provider relationships change. The measures are calculated according to the patient population with associated relationships to a provider for a particular 12-month reporting period. A patient will always be associated with their primary care physician. However, if the physician moves to a new practice or managing organization, the most recent managing org #page=4anizationpractice-physician relationship is what determines how the patient s claims are assigned even if the patient saw the physician during the reporting period when the physician was at a different practice. Variation in provider and patient relationships occurs over time. Many patients remain consistent with their provider while others may change more frequently. Examples (Using a Reporting Period of Jan 2017 Dec 2017: - Example 1: If patient Jane Doe was attributed to Dr. Jones for the entire Dashboard reporting period, then this patient s information will be attributed to Dr. Jones. - Example 2: If patient John Doe was attributed to Dr. Jones for Jan - Nov 2017 but in Dec 2017 is attributed to Dr. Smith, then John Does measure performance will be attributed to Dr. Smith for the Dashboard release. DEMOGRAPHIC ASSIGNMENT MDC calculates the demographics (age, sex, race) of the beneficiary based on the information included in the SIM Participation File (SPF) associated with the Dashboard release. For Release 5.0, the reporting period ends on March 31, 2018 and the patient birth dates are used from the March 2018 SIM PCMH filtered attribution file. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 26 of 30

27 U S E R G U I D E Benchmarks MDC calculates benchmarks for the quality and utilization measures in the SIM PCMH Initiative. The benchmarks are calculated using the entire SIM PCMH population, including practices outside of the CHIR regions. These benchmarks are displayed in the visualizations on the following pages: Quality NOTES: Utilization Comparisons These benchmarks are for viewing and comparing purposes only; they are not used for calculating performance incentives. Benchmarks are not calculated for the ACSC measures. BENCHMARK COLOR-CODING If a measure meets the benchmark, it is colored blue. If a measure fails to meet a benchmark, it is colored orange. If a measure has a numerator less than 100, it is colored gray. BENCHMARK METHODOLOGY The following considerations were used to define the benchmark methodology for quality measures: Use Best-in-class methodology: This creates an achievable benchmark rate at 5 percentage points (50 rate per 1,000) below the 75 th percentile on a given measure. Calculate one benchmark rate: One benchmark rate is calculated across all payers and other categories. This rate is reported as the benchmark alongside managing organization, practice unit, and physician rates. Rolling benchmark rates: Benchmark are re-calculated with every Dashboard release to correspond with the reporting year used for the data included in the Dashboard. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 27 of 30

28 U S E R G U I D E HOW BENCHMARKS ARE CALCULATED MDC uses the following method to calculate benchmarks for metrics. Step 1: For a given metric, rank order practice units based on performance. - For all quality measures higher percentages indicate better performance. To identify rank, sort in the following order: 1. Descending by percent 2. Descending by qualifying patients (denominator) - For all utilization measures a lower rate indicates better performance. To identify rank, sort in the following order: 1. Ascending by rate 2. Descending by qualifying patients (denominator) Step 2: Identify the percentage/rate at the 75 th percentile for the metric. To account for varying practice sizes, the 75 th percentile will be based on the qualifying patients (denominator), not the number of practices. Step 3: Identify practice units within 5 percentage points (50 rate per 1,000) from the 75 th percentile. - For quality measures, subtract 5 percentage points from the percentage at the 75 th percentile. - For utilization measures, add 50 to the rate per 1,000 at the 75 th percentile. ADDITIONAL NOTES ABOUT BENCHMARKS All practices are included in the percentile calculation, regardless of whether they meet the minimum numerator and denominator requirements to be included in dashboard graphs. This is consistent with HEDIS benchmark methodology (NCQA PCS Response to Case # on 1/23/2017). To account for different practice sizes, percentiles are based on a count of qualifying patients and not a count of practices. Percentiles are based on qualifying patients and not attributed patients to account for different types of practice populations. Non-relevant patients should not influence weighting. The final benchmark adjusts the 75 th percentile by 5 percentage points. Using an unadjusted 75 th percentile would mean that when results are aggregated to the project level, all measures will fail the meet the benchmark. Subtracting 5 percentage points allows project level measures to meet the benchmark especially when there is little variation in performance across practices. Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 28 of 30

29 U S E R G U I D E EXAMPLE 1: QUALITY MEASURE (10 POs, 20 practice units) Step 1: Practices ranked from highest to lowest by percent Step 2: Identify the percentage at the 75th percentile for the metric th percentile based on qualifying population: Total qualifying population: 394 X.25 = Rounds to patient #99 - Patient #99 falls within Practice 14, so the 75 th percentile is 85.7% Step 3: Subtract 5 percentage points from the 75 th percentile =80.7% - 8 Practices, representing 40% of practices and 33.8% of qualifying patients, are above the benchmark. Number of practices and patients included will fluctuate based on measure and variability between practices. Rank MO Practice Attributed Members Metric Numerator Metric Denominator Metric Percent Cumulative Count of Qualifying Patients 1 A % 8 2 B % 28 3 H % 42 4 J % 76 5 J % 87 6 A % 97 7 E % E % C % H % I % D % C % B % G % A % F % B % E % J % 394 Total % Color Legend: 75 th Percentile Above Benchmark Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 29 of 30

30 U S E R G U I D E EXAMPLE 2: UTILIZATION MEASURE (10 MOs, 20 practices) Step 1: Practices ranked from lowest to highest by rate per 1,000. Step 2: Identify the rate at the 75 th percentile for the metric th percentile based on qualifying population: Total qualifying population: 394 X.25 = Rounds to patient #99 - Patient #99 falls within Practice 7, so the 75 th percentile is Step 3: Add 50 to the rate per 1,000 at the 75 th percentile = Practices, representing 50% of practices and 46.4% of qualifying patients, are above the benchmark. Number of practices and patients included will fluctuate based on measure and variability between practices. Rank MO Practice Attributed Members Metric Numerator Metric Denominator Metric Rate per 1000 Cumulative Count of Qualifying Patients 1 J E B A F G B C D I H C E E A J J H B A Total Color Legend: 75 th Percentile Above Benchmark Revised: SIM_CHIR_Dashboard_User_Guide.docx Page 30 of 30