Focus on Care &

Attestation Overview

Dr. Michael Steffan, Sr., MD

Don McKee

Mary Haltigan

Overview

• WellMed Vision

• Business Structure and Model

• Focus on Care Screenings and Interpretations

• Attestations

– What are attestations?

– Why is it important?

• MPG FOC and Attestation Process Overview

– To change the face of

healthcare delivery for

seniors by providing

quality, proactive

patient care with a

focus on prevention.

Vision

UnitedHealth Group

Business Model

Physician Centric

Primary Care

Driven

Assuming and

Managing Medical

Risk

Supported by Robust

IT

Impacting High Acuity

Patient Populations

Shared Incentives

with Physicians

• Mutually beneficial

relationships with PCP

• High quality medical

care

• Focusing on access,

care coordination and

care delivery resulting

in lower healthcare

costs

• Shifts away from

traditional acute and

episodic medicine

Focus on Care

(FOC)

Focus on Care Screenings

Spirometry

Depression

Neuropathy

Vascular

• Use best FEV1/FVC ratio for result. If ratio is < 0.7, it is consistent with obstruction. Next, look at the FEV1 (% predicted) to determine severity. Use your clinical interpretation. An outlier reading may give false positive machine interpretation.

FEV1 (% predicted) Obstruction

>80% mild

50-79% moderate

30-49% severe

<30% very severe

Spirometry

GOLD Criteria:

Depression - Patient Health Questionnaire (PHQ9)

• Initial diagnosis:

– Consider major depressive disorder if 5 positive responses in shaded area and at least one of them is to question # 1 or question #2.

– Rule out other medical reasons for depressive symptoms, normal bereavement, or bipolar disorder.

Total Score Severity of Depression

1-4 Minimal Depression

5-9 Mild Depression

10-14 Moderate Depression

15-19 Moderately Severe Depression

20-27 Severe Depression

Depression

Interpretation of severity of depression:

Vascular

dABI result for each foot Interpretation

0.00 - 0.40 Flow Obstruction

0.41- 0.49 Borderline, clinical correlation advised

0.50- 1.00 Normal

Flochec: (Note: There will be a transition to Quantaflo.)

• Both amplitude and conduction velocity values can’t be 0. If they are, it is considered an inaccurate test.

• Amplitude < 4 or conduction velocity < 40 on either leg is consistent with neuropathy.

• Amplitude of 4-32 and conduction velocity of 40-70 is considered normal.

Neuropathy

Attestation

What is a Diagnosis Attestation?

• A mechanism for communication – Diagnosis codes are suggested for the patient.

– Provider “attests” to those codes that are applicable to their individual patient.

• A diagnosis on an Attestation sheet can be generated by: – Clinical chart review

– Processing Team validation

– Other data sources such as CMS/claims/encounter data/eDataMining

Why is it important?

• Accurately reflects the condition of the patient and ensures appropriate reimbursement to care for patient

• Conditions provider may not be aware of prompting early intervention

• Decrease likelihood of CMS audit

• Coding language is different than clinical

MPG Internal FOC &

Attestation Process

MPG FOC Process

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• Patients will be scheduled for their screening at one of the 13 designated locations (may or may not be the PCPs office)

• MPG Staff trained by WellMed will conduct the screening

• Screened patients will be scheduled for a follow-up appointment within 5 days with PCP to review the FOC results

• FOC results will be in Athena within 24 hours of screening

• MPG will submit each completed FOC form to WellMed after patient’s visit with PCP

MPG Providers Role-

Focus on Care (FOC)

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• Access to your schedule for the follow-up visit after the screening is completed

• Review the screening results and apply appropriate clinical Guidance

– Identify and code any newly discovered diagnoses in Athena to the fullest specificity

• Complete the FOC form if required at the time of the follow-up visit

FOC Benefits

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• Patient – Early identification of chronic diagnoses

– Increase patient provider engagement

• You – Improve screening and preventive care for patients

– Improve capture rate of HCCs

• MPG – Improve capture rate of HCCS

– Improve payer-provider contract compliance

Diagnosis Attestation form

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Section 1

Section 2

Section 3

Section 4

MPG Attestation Process

• The MRA Team/Practice shared workflow was created to provide a more consistent means of having the WellMed Attestation forms completed and submitted. These forms ensure the carrier has the most accurate information on the patients condition.

• MPG has a process which allows tracking for completion, provider engagement and maximization of the financial incentive offered for completion of the Attestation.

Attestation Workflow

• The MRA Team will complete open diagnoses already documented by PCP for each Attestation form

• Diagnoses not yet documented or confirmed by the PCP are left as open opportunity for the PCP

• The Attestation form will be scanned into the Clinical Document section of the chart and labeled Pre-Visit Attestation*

* Waiting for Athena final approval for document titles we have requested and subject to change

Attestation Workflow in Athena

• The MRA Team will review the Wellmed Attestation form via the Wellmed online portal.

• The MRA Team will address those items the provider has documentation to support already identified and “close out” those conditions, thereby leaving only those items with either new opportunity or requiring the provider to address at the visit and ultimately on the Attestation.

• The Attestation form will be scanned into the Clinical Document section of the chart and labeled Pre-Visit Attestation* for the office to print and give to the provider to complete during the face-to-face encounter. After the visit the office will rescan the form and should label it Post-Visit Attestation*. The MRA team will take the completed forms and complete the submission process with Wellmed.

Attestation Workflow in Athena

• For those conditions you feel are not applicable to the patient you will select the DISAGREE box. For those conditions that are valid and you have addressed during the visit and documented, you will select the AGREE box. A copy of your encounter documentation is submitted with this form. If the condition indicated is historic and not under active treatment i.e. colon cancer etc. you will select RESOLVED. If you identify new conditions not indicated on the Attestation you can write them on the form and they will also be submitted. If you are unable to address the condition(s) during this encounter please let the condition blank.

Questions?

Thank you!