SECTION M EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT
PART V – BENEFITS AND MEMBER MANAGEMENTSECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENTSECTION M – EARLY PERIODIC SCREENING, DIAGNOSIS,AND TREATMENTM.1 Describe your system for tracking each member's screening, diagnosis, and treatment including, at aminimum, the components of the system, the key features of each component, the use of technology, and the datasources for populating the system.Supporting EPSDT Today in Louisiana through an Enterprise MISLouisiana Healthcare Connections (LHCC) uses an enterprise Management Information System (MIS)maintained by our parent company, Centene Corporation (Centene), with over 30 years’ experience ininformation technology specifically for Medicaid requirements. Our MIS provides full support for earlyperiodic screening, diagnosis, and treatment (EPSDT), and other child health services, including theunique needs of children in Foster Care. Our MIS supports medical and basic behavioral healthprocessing with HIPAA compliant interoperability to exchange clinical and pharmacy data with ouraffiliate US Script, Inc. [our Pharmacy Benefits Manager (PBM)], our providers (including medicallabs), DHH and DHH’s Fiscal Intermediary, and other key stakeholders. Our MIS enables us toelectronically collect, integrate, and process all the requisite data needed for provider and DHH reportingand for the Centers for Medicare and Medicaid Services (CMS) 416 reports. Our MIS also enables us toidentify, through systematic predictive modeling, any gaps in EPSDT services for our members, andtogether with our providers ensure that all children and youth receive their EPSDT care per DHH andCMS periodicity schedules.We have reviewed and will comply with Sections 6.4.3, 6.6, 6.7.2, 6.24.1.2, 8.1.18, 8.5.4.2, 12.11.4.3,12.12.2.24, 15.6.2.11; as well Appendices O and HH, and we either currently meet these requirements perour existing Bayou Health contract, or can meet new requirements through table-driven configuration ofour MIS (no software development needed). We also have examined the BAYOU HEALTH MedicaidManaged Care Organizations System Companion Guide Version 1.0 (MCO Companion Guide), and theLAMMIS Batch Pharmacy Companion Guide (both documents dated February 2015). LHCC andCentene either currently support, or in the case of new requirements contained in the MCO CompanionGuide, can and will support, all requirements through straightforward configuration of our MIS.Tracking EPSDT from Need Identification through Service Delivery and Reporting. Our systemsand processes for EPSDT tracking include a complementary combination of: Integrated System Components – These components collect and integrate member, claims, pharmacy,lab tests, assessments, and other data (including information we receive over the phone). High Performance Data Warehousing and Predictive Analytics through Centelligence – Tosystematically and efficiently process the data collected above, and identify and alert all constituentsinvolved in the child’s care of the need for EPSDT services. Centelligence is our award winningdata integration and analytics platform (see discussion below). Tracking Diagnoses – Through the information capabilities above, we can identify members withspecific diagnoses and track via claims and other data to determine if the member is receivingappropriate services for those diagnoses, and contact providers if there are gaps. Tracking Follow-up Treatment – With EPSDT codes that we require in claims submissions, we canmonitor if children are subsequently receiving the services they need, including services that wereidentified from early screening. Monitoring Provider Performance and Tracking Education and Outreach – Once we have identifiedEPSDT service needs, we systematically contact PCPs and other providers, and members or theircaregivers, to ensure that services are delivered. We also use Centelligence information to monitorM-1
PART V – BENEFITS AND MEMBER MANAGEMENTSECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENTprovider compliance with EPSDT requirements, and provide information to providers on their EPSDTperformance. We contact and follow up with providers whose compliance is below DHH and LHCCstandards. Innovative Tools To Promote Engagement – We continue to invest in new information technologyapplications to engage members or their caregivers in their health, including new tools delivered onincreasingly prevalent mobile devices and tablets.LHCC System Components Drive EPSDT Periodicity ComplianceEach of the core system components in our integrated MIS plays a role in our EPSDT activities today,from capturing and tracking information; to encounter data and DHH and CMS reporting; to alerting ourproviders, members (and/or caregivers), and our own Customer Service and Case Management/MedicalManagement/Quality Improvement staff to take action on any identified gaps in EPSDT services.Please see Table M.1-A below for a summary description of the role each of our integrated systemcomponents plays in ensuring our members receive EPDST care per DHH and CMS requirements. Formore information on other aspects of these system components, please see Section W.1.Table M.1-A: How LHCC System Components Support EPSDT AdministrationIntegratedSystemComponentHow Component Supports EPSDTTracking and ReportingGeneral FunctionAMISYSAdvance(AMISYS)Medical and Behavioral HealthClaims and Encounter ProcessingAMISYS captures all detail service line claims data, includingrendering provider, member identifiers, date of service, type ofservice (e.g. EPSDT), and all subsequent claim adjustment history.AMISYS electronically sends all processed claims data to theCentelligence Enterprise Data Warehouse (EDW—see below) forreporting and predictive analytic care gap (including EPSDT caregap) identification, to support LHCC follow up interventions withproviders.TruCareCase and UtilizationManagement.TruCare is our member-centrichealth management platform forcollaborative care coordinationand case, behavioral health,disease, and utilizationmanagement.TruCare supplies referral and authorization data, as well as CarePlan, clinical member contact, and other data to our Centelligence informatics system (see below) to aid in care gap identification andEPSDT reporting. In addition, our Case Management staff canadminister health risk screenings and health risk assessments (HRAs)over the phone with providers, members, or caregivers (e.g. parents).If an unmet need for EPSDT services is identified either by ascreening or by other means (e.g. provider discussing a child’s casewith an LHCC Case Manager over the phone), our staff can indicatea need for EPSDT services in TruCare and it will flow to ourCentelligence , Member Relationship Management (MRM—seebelow) and Provider and Member Portal systems to alert allstakeholders involved in the child’s care.MemberRelationshipManagement(MRM)Member data management andservice support.MRM receives, validates,integrates, manages, transmits,and reports on all levels ofmember demographic andadministrative data; and (throughits Customer RelationshipManagement (CRM) capability)MRM plays three key roles in our EPSDT program:1) LHCC’s tracking of EPSDT screening and services begins withthe member enrollment file from DHH’s enrollment broker.MRM processes the enrollment files, identifies key linkages forthe member (e.g. to a parent who may also be a member),identifies and processes retro-eligibility, and identifies theappropriate EPSDT age cohort (for use by our EPSDTperiodicity schedule logic per DHH requirements). Beginning in1Q 2015, we also will systematically validate each member’sM-2
PART V – BENEFITS AND MEMBER MANAGEMENTSECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENTIntegratedSystemComponentHow Component Supports EPSDTTracking and ReportingGeneral Functionintegrates all service inquiries wereceive, and our responses tomembers and/or their providers.The CRM component of MRM isalso used by our CustomerService Representatives (CSRs)to respond to member andprovider calls, emails, letters, orfaxes.2)3)Provider PortalSecure, web-based set ofintegrated administrative andclinical functions for LHCCproviders, including authorizedout-of-network (OON) providers.MemberPortalSecure, web-based Portal formember’s self-servicefunctionality (e.g. change PCPs,order ID cards), and for memberaddress in real time via the SmartyStreets US Postal ServiceCASS (Coding Accuracy Support System) certified validationservice. We also will validate each member’s identity using theLexisNexis nationwide data management service (e.g. tosystematically tie together alternate names the member mayhave or had in the past, and to identify the member’s most recentaddress).If our Centelligence analytics platform determines an EPSDTcare gap through predictive modeling analytics (see below),and/or if an EPSDT care gap is captured by a TruCare user (seeabove), the care gap will be posted prominently in CRM (theservice component of MRM) for the CSR whenever s/heaccesses the member’s record (e.g. while taking a call). Pleasesee Figure M.1-B: Care Gaps Display below this table for anactual screen snapshot. Our CSRs document in CRM when theyhave reviewed care gaps with members, providers, or caregivers.LHCC’s EPSDT Coordinator (Coordinator) and our HEDIS CallCenter use MRM’s Proactive Outreach Manager (POM)predictive auto-dialer for automation-assisted outbound calls toproviders to proactively notify them of the need for EPSDTservices for their assigned LHCC children and youth.Beginning in 2015, our CSRs will also have the ability tosecurely fax information on members scheduled for EPSDTvisits to those providers who use HIPAA compliant faxmachines. LHCC’s HEDIS Call Center focuses specifically onensuring LHCC members are receiving primary care per HEDISmeasures and that children and youth are receiving EPSDTservices.LHCC providers can instantly see EPSDT and other care gaps inthree complementary ways on our Provider Portal:1) When checking eligibility, the provider can easily view anyEPSDT care gaps in the member’s summary eligibility recorddisplayed on the screen.2) When viewing the summary “face sheet” in our onlineCentelligence Health Record (CHR), which is incorporatedseamlessly in our Provider Portal. CHR incorporates all themedical, behavioral health, pharmacy, lab test, assessment, caregap, and other clinical data and documents we have onmembers, presented in a well-organized, tabbed “health record”interface (please see Sections W.1 and W.6 for moreinformation on CHR).3) For PCPs and Patient Centered Medical Home (PCMH)providers, EPSDT care gaps (along with all care gaps) arepresented in our Online Member Panel Roster, which listssummary demographic, special needs, major disease states,Emergency Department utilization indicators, and care gaps forall LHCC members assigned to that provider. Please see FigureM.1-C: Online Member Panel Roster Care Gaps below thistable for an actual screen snapshot.Members over the age of 18 (in compliance with Federal and Statelaws) and eligible for EPSDT services can access their own healthinformation and care gaps, including EPSDT care gaps, through theMy Health section of our Member Portal. We present care gaps onM-3
PART V – BENEFITS AND MEMBER MANAGEMENTSECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENTIntegratedSystemComponentHow Component Supports EPSDTTracking and ReportingGeneral Functionengagement in their own heathcare through presentation ofclinical information in consumerfriendly, yet actionable formatthe Member Portal in a consumer-friendly, descriptive format, alongwith other clinical utilization information for the member.In addition, in 2015, we will offer members over 18 (who register touse our secure Member Portal) the option of receiving emailnotifications as soon as our Centelligence platform (see below)identifies care gaps. These e-mails will supply a link for the memberto click, prompting the member to login to the Portal. Once loggedin, the member will immediately go to their care gap information.Centelligence Enterprise DataWarehouse(EDW)High performance datawarehousing, reporting, predictivemodeling, and analytics.Once processed claims and encounter data are fed into our EDW byAMISYS, Centelligence integrates that information, along withcase management information from TruCare; member demographicdata from our MRM system; and other data we receive electronicallyfrom external sources, including lab test results, pharmacy claimsdata (from US Script); health risk screening and assessment datafrom TruCare; and our secure Provider and Member Portals (seebelow).The Centelligence integrated predictive modeling component thenapplies analytics to this data to determine any care gaps for themember (including EPSDT gaps in care), and automatically “pushes”these online care gaps to TruCare (for our clinical staff), MRM forour Customer Service Representatives (CSRs), our secure ProviderPortal for providers, and our Member Portal for members who areover the age of 18.Through its integrated reporting and online dashboard capability,powered by MicroStrategy, Centelligence also produces allEPSDT reports for DHH and CMS (including CMS-416 as requiredin Appendix HH of the RFP).Encounter DataManager (EDM)Designed specifically forMedicaid encounter processing,Encounter Data Manager (EDM)is our workflow-enabledencounter reporting systemconfigured for all DHH encountersubmission edits, rules, andtimeframes.EDM processes adjudicated claims and corresponding service linedetails (including all EPSDT adjudicated claims) fromCentelligence , and prepares all encounter data submissions toDHH’s Fiscal Intermediary and LAMMIS operator. We fully supportDHH’s existing HIPAA 837 Companion Guides for encountersubmission and HIPAA 835 Remittance Advice for DHH encounterprocessing results, including the storage and reporting of all dataelement values (e.g. claim type, provider type and specialty, servicetype) related to EPSDT encounter submissions.US Script, Inc. LHCC’s Pharmacy BenefitsManager (PBM) affiliateEvery 24 hours, US Script, Inc. electronically sends processedpharmacy claims data to our Centelligence EDW for incorporationinto reporting and care gap identification, including care gaps relatedto medication regimens that resulted from health issues identifiedfrom EPSDT services. These care gaps are then electronicallytransmitted from Centelligence to MRM, TruCare, and theProvider and Member Portals.Although medication utilization is not a direct EPSDT service, weuse pharmacy data to help inform us of potential outreach orinterventions we should take related to EPSDT or care for children ingeneral. For example, if our EPSDT Coordinator sees that a memberis using prenatal vitamins via our pharmacy data, one of our HealthCheck Coordinators (HCC) will contact the member to offerinformation on our StartSmart for Your Baby Program (StartSmart), and the importance of EPSDT services after the birth of theirchild. Start Smart is our pregnancy management program.M-4
PART V – BENEFITS AND MEMBER MANAGEMENTSECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENTPer RFP Section 22.13. Proprietary and/or Confidential Information, this information is confidential and hasbeen redacted from this copy.M-5
PART V – BENEFITS AND MEMBER MANAGEMENTSECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENTFigure M.1-C: Online Member Panel Roster Care GapsM-6
PART V – BENEFITS AND MEMBER MANAGEMENTSECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENTCentelligence : The Engine that Drives LHCC ESPDT TrackingOur Centelligence data integration and informatics platform lies at the heart of our EPSDT tracking,management, and reporting capabilities. The Centelligence EDW, powered by Teradata’s highperformance relational database technology, acts as the central hub for service information that allowscollection, integration, and reporting of clinical claim/encounter data; financial information; medicalmanagement information (referrals, authorizations, disease management); member information (currentand historical eligibility and eligibility group, demographics, member outreach); and provider information(participation status, specialty, demographics). This data is refreshed nightly from internal systems(AMISYS, TruCare, etc.) and external sources as discussed above.Centelligence can (and does) accept data from State Immunization Registries, and we will be happy towork with DHH and the Louisiana Office of Public Health (OPH) on any potential protocols that wouldenable MCOs to receive regular data extracts from the Louisiana Immunization Network for KidsStatewide (LINKS). For example, our Texas affiliate, Superior Health Plan (Superior), has supported adata interface with the Texas Department of State Health Services’ IMMTRAC immunization registry forover five years. Although we access LINKS today, that access is via online method only. Animmunization data extract would allow us to import and integrate immunization data on our members,and further expand the “overall health picture” we have on our child and youth members. This expandedview would further enhance our ability to identify needed EPSDT and other child health service needs.Housing all information in EDW allows staff to generate standard and ad hoc reports from a single datarepository, using our Centelligence suite of reporting systems to build and tabulate key performanceindicators. It also provides drill-down capability to the individual provider or member level to trackEPSDT screening, diagnosis, and treatment adherence to recommended periodicity schedules. Weconfigure Centelligence reports and predictive modeling rules in support of DHH’s EPSDT periodicityschedule.Tracking EPSDT Performance. Using Centelligence , LHCC monitors several metrics related toEPSDT including the CMS 416 Screening Ratio, tracking performance against our goal of 80%compliance. Centelligence also supplies clinical quality reporting software to expand the extent ofprovider profiling information and reports we produce. These provider profile reports, when combinedwith our TruCare platform, allow LHCC to deliver targeted, risk-adjusted clinical profiling information soproviders can compare their performance to relevant peer groups in the providers’ geographies (e.g. rural,urban). With Centelligence , we are able to compute the CMS 416 participation ratio at the providerlevel to identify PCPs whose EPSDT screening rates for assigned members are below the 80% threshold.The HEDIS reporting capabilities of Centelligence , powered by Quality Spectrum Insight (QSI),support performance measurement and Quality Improvement (QI) reporting. QSI is an NCQA-CertifiedSoftware system that produces results for Healthcare Effectiveness Data and Information Set ("HEDIS ")measures; Pay for Performance ("P4P") measures; internally designed Quality Improvement ("QI")studies and performance improvement projects; and Provider Reporting studies. Although it is not anexact measure of EPSDT performance and compliance, we monitor HEDIS well child measures as apredictor of member utilization of EPSDT services.Compliance with the EPSDT Screening Periodicity Schedule. We use Centelligence to createroutine reports to monitor our Screening Ratio in accordance with the CMS 416 methodology. We alsoare able to report our Screening Ratio at an overall health plan aggregate level, and drill down andproduce Screening Ratio information at the provider level. This capability enables us to identify providerswhose members are not receiving services, and follow up with these providers by phone and site visits.M-7
PART V – BENEFITS AND MEMBER MANAGEMENTSECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENTTracking DiagnosesLHCC uses Centelligence to track diagnoses for our members and using the predictive analyticscapability of Centellig
PART V – BENEFITS AND MEMBER MANAGEMENT SECTION M: EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT M-1 SECTION M – EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT M.1 Describe your system for tracking each member's screening, diagnosis, and treatment including, at a
The Periodic Table Chapter summary 6:1 History od the Periodic table 1) Mendeleev’s Periodic table 2) Problems with early periodic tables 6:2 Modern Periodic table 1) Key points: Periodic law, Periods and Groups, 3 broad classes of elements
History of Periodic Table 1869: Dmitri Mendeleev organized the periodic table based on atomic weights “Father of the Periodic Table” 1913: Henry Moseley rearranged the periodic table based on the positive charges in the nucleus Lead to the periodic law: the states that a periodic pattern appears in
Periodic Table and Bonding I. Handout: Periodic Table and Bonding Notes II. Periodic Properties and the Development of the Periodic Table i. Mendeleev's First Periodic table I. The first periodic table was arranged by Dimitri Mendeleev in 1869. i. He was a professor of Chemistry. at the University of St. Petersburg in Russia and was
Early and Periodic Screening Diagnosis and Treatment Program 7 Program Overview Title 42 CFR, Part 441, Subpart B Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a federal preventive health care benefit. The purpose of this program is to periodically screen clients age 20 and younger to detect physical and mental health problems.
4.4 Emerging and re-emerging infections 43 4.5 Clinically insignificant transfusion-transmissible infections 44 5 Blood screening, quarantine and release 45 5.1 Blood screening process 45 5.2 Approaches to blood screening 45 5.3 Pooling for serological assays 47 5.4 Sequential screening 47 5.5 Blood screening and diagnostic testing 48 5.6 Emergency screening 48 5.7 Screening plasma for .
Unit 3.2: The Periodic Table and Periodic Trends Notes . The Organization of the Periodic Table. Dmitri Mendeleev was the first to organize the elements by their periodic properties. In 1871 he arranged the elements in vertical columns by their atomic mass and found he could get horizontal groups of 3
Periodic Trends Remember from the "Periodic Table" Notes. The periodic table is a tabular display of the chemical elements, organized by their atomic number, electron configuration, and recurring properties. Periodic law: There is a periodic repetition of chemical and physical properties of the elements when
Tank 6 API-653 In-Service, Internal Inspection Report less severe corrosion than the west perimeter. The average thickness of the sketch plates away from the west perimeter was 0.281”. Other than the perimeter corrosion noted, the remainder of the tank bottom showed no signs of significant metal loss and the thickness readings appeared consistent with the readings from the 2004 robotic .
