WISEWOMAN Overview Training Background 2 Mission Provide - - PowerPoint PPT Presentation

WISEWOMAN Overview Training

Background

2

Mission

Provide cardiovascular screenings and healthy lifestyle programs and resources to eligible women in Colorado in an effort to improve control of hypertension and other cardiovascular disease risk factors.

3

WISEWOMAN

• Well Integrated Screening and Evaluation for

WOMen Across the Nation

• CDC funded
• Colorado WIS

EWOMAN is administered through the Colorado Department of Public Health and Environment

• Tied to the Women’s Wellness Connection program

(serve the same population)

• Colorado has been participating in WIS

EWOMAN since 2013

4

Program Overview

WIS EWOMAN provides eligible women with access to:

• Cardiovascular screening services and health risk

assessments

• Risk reduction counseling
• Case management
• Referrals to health care providers for medical

evaluation and management of condition(s)

• Follow up for uncontrolled hypertension
• Link participants to free or low cost medication

resources

• Referrals to health coaching and other healthy

behavior support option

6

Eligibility and Enrollment

7

WISEWOMAN Eligibility

• At least 30 years of age but less than 65
• Lawfully present in the United S

tates

• Low income
• 250%
• r less of federal poverty guidelines
• Uninsured or Underinsured
• No insurance or unable to afford co-pays or deductibles
• Currently eligible for the Women’s Wellness

Connection (WWC) Program

8

Additional Eligibility Details

• If a client’s eligibility details change within

the same year of WIS EWOMAN participation, then the client is eligible for the entire year.

• Age 64 at time of screening
• Medicaid eligibility

9

Enrollment

• Enrollment is combined with the Women’s

Wellness Connection (WWC)

• In order to enroll a client:
• Confirm client eligibility
• Have client sign the combined consent form (only
• nce- do not need to every year)
• Confirm lawful presence for client; client signs

affidavit (template on agency letterhead)

• Client completes WWC client profile tool

10

1 1

1 2

Baseline Screening

1 3

Screening

• WIS

EWOMAN pays for cardiovascular screenings

• Beneficial to offer cancer screening (WWC) at same

time as cardiovascular (WIS EWOMAN), but not required

• Visit does not need to be integrated with WWC visit
• Health risk assessment
• BMI
• Blood pressure
• Glucose
• Cholesterol
• Tobacco use assessment
• Healthy behavior questionnaire (Patient Information form)

Health Risk Assessments

• Agencies participating in WIS

EWOMAN must comply with the following requirements:

• Conduct health risk assessment for each WIS

EWOMAN client during initial screening visit.

• Have all clients complete the Patient Information form

and review the form with each client.

• Complete health risk assessment for each client prior to

initiating risk reduction counseling.

• Assessments and results must be delivered in a cult urally

competent manner and in a language the client comprehends.

15

Patient Information Form

16

Tobacco Use Assessment

• CDC requires all grantees to assess each enrolled client

for tobacco use status and promote cessation services when needed.

• Client records that lack a tobacco use assessment are not

counted

• Questions on tobacco use are included on Patient

Information form

• Referral status information is included on the Risk

Reduction Counseling form

• Policy details in WIS

EWOMAN manual

• Ask, Advise, Refer is the recommended assessment tool

17

Clinical Screening Requirements

1 8

Screening Lab Tests

• The clinical screening component assesses the

presence of chronic disease risk factors. The following assessment values are required:

• Body Mass Index (BMI)
• Blood pressure
• Laboratory tests:
• Cholesterol
• Glucose or A1C

19

Blood Pressure Readings

• WIS

EWOMAN manual includes information on blood pressure reading procedures

• S

eated with feet on floor, etc.

• WIS

EWOMAN BP Requirements:

• Two readings are strongly recommended for all clients.
• Two readings are required when first reading is greater

than or equal to 140 systolic or 90 diastolic.

• If first reading is less than 140/ 90, defer to agency

Medical Director to determine an internal policy for when a second reading must be taken.

20

2 1

Disease-Level Values

• Cholesterol ƚ
• TC > 240
• LDL > 160
• TG > 200
• Glucose ƚ
• A1C > 6.5%
• FPG > 126

ƚRefer for medical evaluation if not currently being treated

22

Uncontrolled Hypertension

• 140-180 S

ystolic

• 90-110 Diastolic
• Must be referred for

medical evaluation within 30 days

23

Alert Values

• Blood Pressure
• >180 S

ystolic

• >110 Diastolic
• Glucose (fasting or non-fasting)
• < 50
• > 250

Requires Immediate Attention

• Follow-up Required within 7 days

24

Medical Evaluation

• All women in the uncontrolled hypertension or

alert level range must be referred for further care.

• Referral for medical evaluation/ Case

management

• Uncontrolled Hypertension = within 30 days
• Alert levels = within 7 days
• Medical evaluation and case management should

include medication adherence/counseling

25

Medication Counseling

• Patient-centered focus
• Motivational Interviewing
• Ident ify barriers to access and adherence
• May be delivered by:
• Provider/ clinical staff
• Non-clinical staff
• Pharmacist
• Can also be conducted/ revisited during health

coaching

• Details and tools provided in WIS

EWOMAN manual

26

Medical Evaluation & Workup

27

Risk Reduction Counseling

2 8

Risk Reduction Counseling

• Overall point is to review and explain the client’s

screening results

• Help them understand their numbers and relative risk of

developing heart disease

• Must be started in person
• Based on information available
• Remaining topics can be finished over the phone
• Provide screening results verbally and in writing
• Patient focused
• Active listening; talk with (rather than to) the client
• Conversational, non-j udgmental attitude

29

Risk Reduction Counseling

• Content:
• Review the Patient Information form to ensure

client understands questions

• Discuss client’s health risk assessment and

clinical values (BP, BMI, questionnaire and labs) and her CVD risk vs. other women her age

• Collaboratively identify priority areas
• Assess Readiness to Change level
• Facilitate access to Healthy Behavior S

upport Options

30

31

3 2

Readiness to Change

• Pre-contemplation
• Not considering any healthy changes
• Contemplation
• Ambivalent about change
• Preparation
• S

tarting to make plans or motions to change

• Action
• Taking definitive change for healthy behaviors
• Maintenance
• Ongoing lifestyle behaviors, striving to maintain

33

BP+ Overview

3 4

BP+

• BP+ is only used when a client becomes lost

to follow-up.

• Eligibility and enrollment are the same as a

regular WIS EWOMAN client

• S

ee flow chart

• Ideal is to eventually convert to full BP+

clients to full screenings whenever possible

• Bring them back in to finish labs, etc.

35

BP+

• Requirements:
• BMI
• Blood pressure
• Two readings are recommended, especially if first is

>140/ 90

• S

ame medical evaluation follow up requirements for clients in the alert and uncontrolled ranges

• Must complete Patient Information form
• Risk reduction counseling must be started
• Minimum- must review client’s relative risk of developing

heart disease based on health risk assessment (BMI, questions, BP).

36

Healthy Behavior Support Options

3 7

Healthy Behavior Support Options

• WIS

EWOMAN Clients can be referred for additional healthy lifestyle resources once their initial screening is complete

• WIS

EWOMAN has three Healthy Behavior S upport Options categories:

• Lifestyle Programs (LS

P)

• Cooking Matters
• Diabetes Prevention Program (DPP)
• Health Coaching
• Community-Based Referrals (non-reimbursable)

38

Diabetes Prevention Program (DPP)

• Diabetes Prevention Program (DPP) is an evidence-

based lifestyle change program for preventing type 2 diabetes

• Focuses on nutrition, stress and physical activity
• DPP can be offered in-house or referred out to an

established program

• DPP course completion takes about a year
• Includes 16 weekly sessions followed by six monthly

sessions

• S

pecial eligibility criteria

39

Cooking Matters

• Nutrition based health improvement program
• S

hare Your S trengths Colorado

• Facilitated by Cooking Matters staff or Train-

the-Trainer

• S

ix total sessions

• 4 sessions counts as complete for WIS

EWOMAN

• Nutrition education: food labels, shopping on a

budget

• Grocery store tour
• Each session includes an educational segment

and in-class group cooking segment.

40

Health Coaching

• Health coaching is a client-led and client-tailored

healthy behavior support option

• Priority area(s) determined collaboratively with

client

• Individual or group settings
• Can be done in-person or over the phone
• Motivational Interviewing (MI) techniques utilized to

elicit and strengthen motivation for behavior change

• WIS

EWOMAN Health coaches must be trained in MI

41

Health Coaching Delivery

• Clients should be encouraged to set initial session

within 2 weeks of referral

• Minimum number of sessions required for program

completion is 3

• Maximum number of billable sessions is 8
• S

essions should be 20-60 minutes in length

• S

essions should be staggered at intervals that consider client preference and maximize support

• f self-efficacy

42

Health Coaching vs. Risk Reduction Counseling

• Must be distinct and separate from Risk

Reduction Counseling (content)

• RRC- relative risk and readiness to change
• Health coaching- actual goals and personal

progress

• May be delivered:
• S

ame day

• Different day

43

Community-Based Referrals

• General resources or community programs

that supplement other Healthy Behavior S upport Options

• Offer additional support for unique client

needs (ex. walking groups or specific community programs)

• Not reimbursable by WIS

EWOMAN

• Resources should be low or no-cost

44

HBSO Follow Up

• Assesses short-term health outcomes in

women who participate in any healthy behavior support option

• Occur within 4 weeks of client’s final health

coaching or lifestyle program session

• Conducted using the Follow-up Assessment

form

• In-person and telephone options

45

Follow-up Screening

• Conducted in-person
• Requirements:
• Follow-up assessment questionnaire
• Height/ weight (BMI)
• Blood pressure
• WIS

EWOMAN provides additional incentivizes for in person follow up

46

Follow-up Assessment

• Minimum requirement for client follow up
• Questionnaire only
• Can be done via telephone
• Recommended if the agency is unable to

get the client back into the clinic for in- person follow up.

47

48

Rescreening

• WIS

EWOMAN program is built to encourage

• ngoing yearly participation from clients
• Clients are eligible to re-start the screening

process one-year after initial visit

• Minimum 11 months
• 12-18 months is preferred
• It is expected that agencies are tracking re-

screening dates and reminding clients about annual check-ups

49

Lost to Follow-Up Policy

• 3 Documented contact attempts must be made
• OR-
• Verbal or written refusal of care from client
• All contact attempts must be documented in medical

record

• Documentation should include the method of contact, the date

and the outcome.

• Certified letter is only required for alert levels
• Lost to follow up flow chart tool in WIS

EWOMAN manual

50

Reimbursement

5 1

WISEWOMAN Reimbursement

• Reimburse via the Bundled Payment S

ystem (BPS )

• This is an outcome-based payment structure
• S

imilar to the WWC BPS implemented in 2010

• Reimbursement consists of increasing levels
• f payments based on the services a woman

receives while participating in the program

52

WISEWOMAN Reimbursement

• Bundled services are based on WIS

EWOMAN- approved service delivery flow chart

• Includes payment for:
• Baseline screening (Health risk assessment, labs, RRC)
• LS

P fees or health coaching

• Case management
• Data entry
• Administrative overhead
• WIS

EWOMAN agencies agree to accept these fees as payment in full.

• May not charge the client for WIS

EWOMAN services.

53

WISEWOMAN Reimbursement

• Different from WWC payment system
• WIS

EWOMAN reimbursement is available incrementally as the client navigates through the program

• Reimbursement is paid out after the completion of

each level

• Case does not need to be “closed”
• Reimbursement is automatically calculated

and disbursed based on data entry

54

Reimbursement

5 5

Level Definition of Level Reimbursement W1 S creening services. Results are normal and require no further action.

**If a client is lost to follow-up before risk reduction counseling can be completed, agencies may request reimbursement at a level I. Please email WIS WOMAN program staff for administrative approval in these cases or with any questions.

$155 Integrated office visit is paid separately by WWC (not included here). Reimbursement includes risk assessment, laboratory tests, risk reduction counseling**, patient navigation, administrative fee and a follow up medical visit, if needed. W2 Completion of 1 to 3 Diabetes Prevention Program (DPP) sessions OR Completion of 1 Health Coaching session $210 $155 services from level 1 + $55 for:

• DPP fees OR health coaching costs,
• case management,
• barrier reduction/incentives,
• administration fee

W3 Completion of 4 to 6 Diabetes Prevention Program (DPP) sessions OR Completion of 2 Health Coaching sessions OR Completion of 1 Cooking Matters session $265 $210 services from level 2 + $55 for:

• DPP fees OR health coaching costs,
• case management,
• barrier reduction/incentives,
• administration fee

Follow Up Reimbursements

• Follow up screening
• Conducted in-person
• Minimum requirements: BMI, BP reading, follow up questionnaire
• Additional reimbursement beyond BPS

is provided

• Follow up assessment
• Questionnaire only (telephone)
• Included in bundled payment system previous levels
• No additional payment for follow up
• Previous payments may be rescinded if follow up is not

completed

56

BP+ Reimbursement

Requirements:

• Eligibility/ enrollment, BMI, BP, health risk questionnaire, RRC
• $30 reimbursement
• Can convert to full screening by completing remaining

requirements

• $30 is retracted and Level I reimbursement ($155) is added

57

Reimbursement Process

• Reimbursement to WIS

EWOMAN agencies is generated through eCaS T after:

• All errors identified through eCaS

T have been resolved

• Data indicate clinical services are ready for level

reimbursement

• You are provided with the tools to track these cases!
• Contractors may not submit for payment in

any other way. MUS T be approved through eCaS T.

58

Reimbursement Process

• Grant activity statements based on eCaS

T data entry are generated automatically on the 15th day of every month.

• Payment is provided based on these monthly

statements (bill runs)

• If the 15th is on a weekend or state holiday, the bill

run is generated on next business day

• There is no bill run in July of each fiscal year
• Final grant activity statement is generated 30

days after end of each fiscal year.

59

Tracking Spending and Billing

60

• The Grant Activity S

tatement lists each client counted for reimbursement and the level of

• reimbursement. This statement can be viewed

in eCaS T .

• This report provides information on bills processed,

not necessarily data entered, within a given month.

• Agency fiscal staff may be granted access to

eCaS T OR data entry staff may run these reports for fiscal staff once they are available within eCaS T .

Data and eCaST

6 1

Data Forms

• WIS

EWOMAN forms encompass all CDC required data elements

• Agencies may not substitute client charts or health

records for any WIS EWOMAN forms without prior approval from CDPHE staff

• Completed WIS

EWOMAN forms should be scanned into EMRs or retained in client records

62

So… What is eCaST?

• Database to report services provided
• Contains breast, cervical, and cardiovascular

screenings

• YOU will use eCaS

T to:

• S

ummarize services provided through WIS EWOMAN (reports)

• Manage client care
• Track service delivery reimbursement
• Manage screening budgets

63

Billing system

• eCaS

T Billing S ystem

• Reimbursement for services is based on data entry

(invoices generated from eCaS T – same as WWC)

• Data Errors = Loss of Money
• eCaS

T reports and TA can help minimize risk of bad data and loss of money

• Budget Tracking
• Grant Activity S

tatement

• S

creening Case Management

• Clients Referred for Healthy Behavior S

essions

• S

creenings with Errors

64

How do CDPHE staff use eCaST?

65

• For program management to monitor quality and

types of services

• To monitor service delivery budgets
• To compile cardiovascular surveillance data on

population served

• To demonstrate continued need for funding

(WMDEs)

• To submit required client -level data to CDC
• Reported in April & October on past 18 months

Gaining Access to eCaST WISEWOMAN

66

• All eCaS

T users must attend an eCaS T WWC/ WIS EWOMAN training before they will be granted access to the cardiovascular module

• Request eCaS

T access through the eCaS T website

• The agency should report any changes to staff

members responsible for WIS EWOMAN data entry to WIS EWOMAN program within 15 days of the change

• Unless otherwise approved, WIS

EWOMAN data personnel must train new staff members before they are given access to eCaS T

eCaST Communications

67

• S
• me of the reasons you will hear from us:
• Review a client’s information;
• Data entry issues and trends;
• Changes to the system;
• HIP

AA

• Always, always, always… use the eCaS

T ID

Data Clean-up Project

• Agencies are required to participate in a

data cleanup proj ect before each biannual data submission to the CDC.

• Occurs in March and S

eptember;

• Review all cases failing CDC set benchmarks

and cases with data entry issues.

68

Administrative and Other Requirements

6 9

Support Funds

• WIS

EWOMAN started offering additional funds for infrastructure and professional development in 2016

• Monthly invoices for these funds are required

(per WIS EWOMAN contracts)

• Due within 45 days of end of each billing period
• All months must be accounted for
• $0 invoices should be submitted for months with no

expenditures

70

Support Funds

• S

upport funds are divided into Operating S upplies and Travel line items in agency budgets

• Allowable Purchase List on WIS

EWOMAN website

• No prior approval needed for included items
• Invoices should be provided on CDPHE

template

• All physical items must be received (in

inventory) by June 30 of each fiscal year

71

All Agencies Calls

• Occur monthly on 3rd Thursday of every other month
• Forum for all WIS

EWOMAN service delivery contractors to meet via conference call or webinar

• Opportunity to share and gather information
• Topics of discussion include technical assistance and

training in various areas:

• Clinical
• Data
• Fiscal

72

Performance Measures

1. Assure at least 75%

• f WWC patients receive at least one

WIS EWOMAN screening. 2. Assure that BP+ cases account for no more than 20%

• f total

women served. 3. Assure that 100%

• f women with abnormal blood pressure

values receive a medical follow-up visit (or are documented as loss to follow up according to the Program Manual guidance). 4. Deliver risk reduction counseling to 100%

• f women screened.

5. Assure that 95%

• f WIS

EWOMAN participants who use tobacco and prioritize tobacco cessation during risk reduction counseling are referred to tobacco cessation resources.

Performance Measures

6. Assure that at least 80%

• f WIS

EWOMAN participants referred to health coaching or lifestyle program attend at least one session. 7. Assure that at least 60%

• f WIS

EWOMAN participants who participate in a lifestyle program or health coaching meet the completion criteria for the program. 8. Assure that at least 80%

• f WIS

EWOMAN participants who complete a lifestyle program or health coaching conduct the follow-up assessment within four weeks of completing health coaching or lifestyle program. This can be completed by phone

• r in-clinic as part of a follow-up screening visit.

9. Assure that at least 30%

• f WIS

EWOMAN participants return for a re-screening visit.

• 10. S

ubmit biannual data clean up report with no more than a 5% error rate.

Contract Monitoring System

• S

tate database for contract performance evaluations that is required by law since 2009

• Applicable agencies (depending on contract type) will

be evaluated once per year

• Evaluation categories: deliverables/ requirements,

timeliness, quality, price/ budget, and business relations/ customer service

• Agencies are given a standard or below standard

rating based on established criteria

• CDPHE is creating reports in eCaS

T for agencies to monitor their own performance

75

Program Evaluation

• Purpose is to evaluate effectiveness of the program in

Colorado

• Areas of evaluation:
• Efforts to address uncontrolled hypertension
• Impact of LS

Ps and health coaching to WIS EWOMAN clients in Colorado

• Demonstrating significant value of WIS

EWOMAN in Colorado

• Agency role in evaluation plan implementation:
• Information collected during site visits, progress reports, etc.
• Other activities: focus group, surveys

76

Wrap up

7 7

CDPHE WISEWOMAN Contact Information

Program Questions Nicole Brasseur / 303-691-4919 / nicole.brasseur@ state.co.us Michelle S hultz / 303-692-2496 / michelle.S hultz@ state.co.us Data and eCaST Questions S teven Bromby / 303-691-4930 / steven.bromby@ state.co.us

78

Thank you!

79