FAQ

The Patient Panel Report gives you information about HMSA patients under your care.

• The number of patients in your HMSA PPO panel is shown in the P4Q count at the top of the report. PPO patients have a red checkmark (✓) next to their name. Through June, PPO patients will be shown with red checkmarks. In July, you'll see PPO and HMO patients with red checkmarks.
• The P4Q check marked patients will be part of your denominator for quality measures.
• The report also shows other HMSA members (QUEST, 65C Plus, or other Senior Plans) who are your patients.

In the primary care pay-for-quality program, your maximum quality payment will be determined by your PPO patient panel (through June 2011) and your PPO and HMO patient panel (after July).

Quality Score X Patient Panel X $2.00 PMPM = Maximum Quality Award

• HMO patients are attributed to you because they selected you when they enrolled in HMSA's HMO plan.
• PPO patients are attributed to you based on an algorithm that filters claims data for the patient's most frequently seen primary care physician (PCP) or the last seen physician in the last three years.

Go to Cozeva (Access to HBIOnline will be discontinued November 30, 2012).

On the right, you'll see icons for an Excel file download and for the printer. Click on the Excel logo and the application will create an Excel file of your patient list with the P4Q indicator (yes1176-0023 P4Q and Attribution List FAQs or no), name, gender, date of birth, date last seen, and phone number. You can save the Excel file to your computer or print the list for your staff to review.

As an alternative, you can also click the printer icon, which will print PDFs of the same information. Use print preview to see how many pages will be printed.

We issued the reports on patient data in response to requests from physicians and their staffs. The Patient Panel Report gives you an opportunity to request a change in the patient panel data.

It's important to understand:

• HMO patients are attributed to you because they selected you when they enrolled in HMSA's HMO plan.
• PPO patients are attributed to you based on an algorithm that filters claims data for the patient's most frequently seen PCP or the last seen physician.

It is possible that some HMO patients selected you as their PCP upon enrollment but have not been in to see you, or have been seeing another doctor.

You may only delete a patient from your panel for one of the following five reasons:

• Patient is deceased.
• Patient moved off island and/or lives permanently out of state.
• Patient was seen for consultation or second opinion only.
• Patient has been discharged from your practice (patient has been notified).
• Patient is under the care of another PCP.

On the main list, search by patient last name and click on Change Request. You will be taken to screens that ask you to indicate which of the five reasons apply. You can check only one reason. If the patient is being seen by another PCP, you must indicate the name and location of the doctor.

Once the request to delete a patient has been submitted, the Action field text will change from Change Request to Request Pending. When HMSA makes a determination about your request, the result will be displayed in Status.

For an HMO member, you may want to ask your staff to do outreach and ask the patient to come in for a visit to establish a relationship.

For PPO members, the patient was attributed to you because they have seen you the most frequently or recently. Again, you may want to reach out to the patient, so they understand that you will be managing and coordinating their care.

At the top left, you'll see Add a Patient to the Panel. It'll take you to an electronic form that asks you for patient demographic information. Be sure to enter the subscriber number exactly as it appears on the member's HMSA membership ID card (for example, for commercial plans you'll enter four letters followed by four leading zeroes and eight numbers, e.g., XLAR000012345678). You will then download an attestation form and attest that you are the patient's PCP. The form needs to be signed by you and the patient. Fax the form to 948-6887 on Oahu or mail it to HMSA Provider Services, Room 509, P.O. Box 860, Honolulu, HI 96808-0860.

You will have until the last day of the month to complete your first review of the report, but will continue to have opportunities every month to adjust the list. If you do not submit changes by last day of the month, the report you receive the following month will remain the same. You may want to start by sorting the list by patients who have the P4Q indicator because these patients will be in your denominator for quality measurements.

After HMSA receives your feedback, the adjusted patient list will be the basis for the next report, Gaps in Care, or Patient Registry, that will identify patients who need certain preventive services or testing done (if they have diabetes, for example). This is a prospective list that will help you address care needs for your patients.

You are free to accept the patient panel report as is.

There are two sets of quality measures, one for pediatrics and the other for adult primary care — a complete list is available in the pay-for-quality program guide, which has specifications for each measure.

While some measures will seem familiar, the pay-for-quality program uses a broader array of measures related to preventive care and chronic disease management for diabetes, heart disease, and asthma.

Cozeva patient lists include active patients as of the run date of the report. If the patient canceled their HMSA coverage after the report run date, they will not appear on the following month's report. If the patient informs you that they have a new health plan, verify if they have retained their HMSA coverage. If the patient now has dual coverage, they will appear on the HMSA patient panel list, whether HMSA is the primary or secondary carrier.

The PCP may select the Patient is under the care of another primary care provider option under the Change Request screen for a specific patient. The group or clinic's name may be entered under the First and Last Name fields.

Select Patient is under the care of another primary care provider option under the change Request screen for a specific patient. You may enter Physician name not available under the First and Last Name fields.

Provider Teleservice staff can help with user names and passwords and instructions on getting started. Call 948-6820 on Oahu or 1 (877) 304-4672 toll-free on the Neighbor Islands. Or you may email PSInquiries@hmsa.com.

The baseline report shows your 2010 performance for all pay-for-quality measures compared to national rankings. Your 2011 performance will be measured against your baseline data for quality payment purposes.

You may want to review the baseline report to identify clinical measures to work on in 2011. It also gives you an idea of the likely allocation of your quality dollars by clinical measures in 2011, assuming that your patient panel size is about the same.

The Baseline Report shows patient data and performance for the 2010 calendar year. It reports your performance and quality dollars that hypothetically could have been earned if the pay-for-quality program had been in effect last year. HMSA will not display patient data for each measure.

The Maximum Quality Pay is calculated by taking the count of all the eligible patients (PPO and HMO) in your patient panel each month, multiplied by $2.00. Based on weight factors that consider the number of patients in a measure and the relative importance of a measure, a percentage of the maximum payment is apportioned to each measure. The report tells you:

• Denominator ("Estimated Measure Panel Size") and Numerator ("Base Year Numerator Count") for each measure, and percentage ("Base Year Rate").
• How that percentage compares against national percentile rankings ("National Percentile Rank").
• The additional number of patients that would have been needed in the numerator for you to have achieved the 90th national percentile.
• The maximum quality dollars per measure is shown in the "Estimated Max Award Amount."

On the detail page for each measure, you'll see the quality payments at each of the percentile rankings – 10^th, 25^th, 50^th, 75^th and 90^th. This information may be helpful as you plan your work for 2011.

In 2012, HMSA will make quality payments based on your final 2011 rate for each measure and, more importantly, the national percentile rank. Your current performance will be compared against your baseline performance. HMSA will award performance points for the current performance and improvement points if you have moved up from the prior year's percentile ranking.

For assistance, please call these numbers:

• General questions: 948-6330 on Oahu or 1 (800) 790-4672 toll-free on the Neighbor Islands.
• Login user name and password for Cozeva: 1 (888) 448-5879.
• Care Planning Registry and care support: 1 (855) 765-7264 statewide.