ManagedCare.com HEDIS Support Services

Core Management Tools

1.	Capture (and related validation reporting) of all data sources including, but not limited to, claims, pharmacy and lab values;
2.	Complete on-line reporting of all measures from administrative data throughout the year, including presentations at the organizational, PCP, and patient levels;
3.	Presentation of exception patients in physician dashboards and other reports;
4.	Files to support periodic mailings to target members and physicians;
5.	Drill-down to allow easy validation of relevant "numerator" (and denominator) events;
6.	Access to all report presentations by both administrative staff and physicians;

Submission Tools

7.	Generation of CAHPS® survey samples and samples for hybrid measures;
8.	A Chart Audit application for collecting chart data and importing it into the MCC data warehouse (see below);
9.	MCC will oversee automated submission of measure results via NCQA Data Submission Tool (including production of XML files for the IDSS) and patient level files (per published spec) to CMS;
10.	Reports profiling final measure performance;
11.	Completion of the Vendor portion of the ROADMAP;
12.	Other general audit support (including updates/corrections to the MCC HEDIS reports, all necessary validation support, Q/A, training, etc.); and
13.	All necessary training on use of the CAT (see below)

Chart Abstraction Tool

The Chart Abstraction Tool (CAT) is a complementary software application for organizing and managing collection of data to support hybrid measures. It is a stand-alone software module that is installed from the ManagedCare.com web site. It is a "thin client" application that uses proprietary web services to obtain background sample data from the MCC warehouse and transmits chart audit information back to the MCC data warehouse.

The following is a brief summary of the program's functionality (please note that additional enhancements are anticipated throughout the balance of 2008 as a result of ongoing user testing and review):

• Microsoft .NET WinForms multi-tier architecture
• Secured data storage on client computers via SQL Server CE
• Sync feature that allows any changes to be replicated from a client computer to the MCC data warehouse and from the MCC data warehouse to all client computers
• General project management features including:
• Selection of hybrid measures, configuration of targets, and ability to generate survey samples
• Manages assignment of patients/providers among auditors (and revisions to prior assignments)
• Customizable measure-level, member-level, auditor-level, provider-level, practice-level file status reports
• Batch printing of project status summaries by auditor, provider, location, or measure
• Tracking of auditor-level production statistics (by resolution status – e.g. completed, abandoned, reassigned, etc.)
• Auditor scheduling or calendar function (viewable across all auditors) – including a lookup function to avoid repeat appointments
• Dynamic re-prioritization of measures and reassignment of audit resources
• User creation tool that allows management to create new users to the system
• Provides alternatives to either:
• Populate forms via the user interface, or
• Produces paper summary packets (provider demographic data, patient lists, data collection forms for each measure/patient combination) for on-site data capture
• Customized data input screens and validations configured for the measure being updated
• Provides integrated definitions for each measure including descriptions of permissible event dates, coding (e.g. CPT, ICD-9, revenue, NDC) guidelines, etc.
• Pre-populates all measure calculations and associated reports with pertinent administrative data (incl. prior numerator events, qualifying criteria)
• Provider-level sample assignment/management, including:
• Assigns patient samples across multiple providers
• Contains customizable "chase" logic, enabling the user to identify and prioritize providers included in the audit
• "Click and drag" assignment/re-assignment of samples
• Feature for adding or editing providers and associated demographic data
• Ability to easily associate patients to known providers where associations do not currently exist
• Supports document management via a "Bates stamp" sequential numbering system

Chart Audit Services

Through its strategic partnership with Total Therapeutic Management, Inc. (www.rxttm.com), ManagedCare.com will be offering integrated chart review services to our HEDIS clients in 2010. To learn more about TTM, follow the link above.

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