Auditing and Reporting

Reports on chart review measures

Practices get reports annually which include their QMAF measures. This has been formatted in 3 different ways in accordance with requests from the practice. One view has this year’s results for the practice. The second view shows this year’s results compared with last year’s results for the practice (shown below). The third view shows this year’s results for the practice compared to with just this year’s results for the practice’s network, and the statewide CCNC enrollment as well as NCQA, HEDIS and IPIP benchmarks.

Outcome indicators

Outcome indicators are typically gathered from claims data and the process indicators from external chart reviews. Community Care has contracted and partnered with Area Health Education Centers (AHECs) for nurse reviewers to perform randomized chart audits that provide practice specific feedback and monitoring on these process measures. To manage the expanding scope of the chart review process, we moved from a paper chart abstraction tool to a fully electronic, streamlined system in 2009. This tool is used to audit either paper or electronic medical records -- close to 30,000 medical record reviews are now performed in over 1350 primary care practices statewide on an annual basis. Nurse reviewers use Medicaid claims to generate a random sample of eligible patients with a given diagnosis and to pre-populate audit tool elements according to an individual’s identified chronic conditions. Secure client-server software allows independent auditors to work offline when Internet access is not available in the clinic location. When access to Internet is available, the system automatically synchronizes data with the server. Data is fully encrypted offline and in transit. Data sent to the server automatically updates a variety of process, progress, and analysis web-based reports. Practices and CCNC networks then have immediate access to chart review results through a secure web-based report site, with patient-level information as well as practice-level statistics.