10. Agenda
• Home Access - Introduction
• NCQA – 2015 Technical Standards
• At-Home Laboratory Services for HEDIS and
Star Improvement Programs
• Case Studies
• Questions
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11. Home Access - Introduction
Recognized Leader in at-home Laboratory Testing
• Product development
• Specimen collection kit manufacturer
• Serve all 50 states and Puerto Rico from our
central facility (Chicago)
• Services exclusive to laboratory testing using
mailed-in specimens
• Reference Lab Certifications of Accuracy
• CRMLN and NGSP
• CAP-accredited laboratory
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12. NCQA - 2015 Technical
Specifications for Health Plans
“47. Member-Collected Samples and Biometric Values
Test results from member-collected samples may be used
for FOBT, urinalysis testing and blood spots for HbA1c,
LDL-C, glucose and total cholesterol. Member collected
samples must be sent to the laboratory or provider’s
office for analysis.
Other member-collected biometric values (i.e, blood
pressure [BP], body mass index [BMI], height and
weight) may not be used for HEDIS reporting.”
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13. Services in Sync with NCQA
• Self-collected finger-stick blood - HIV-1 .
Hepatitis C . Total Cholesterol . HDL-cholesterol .
Triglycerides . Hemoglobin A1c . direct LDL-cholesterol .
Blood Glucose . ALT Liver Enzyme
• Self-collected stool specimen – iFOBT (Colorectal
Cancer)
• Self-collected urine specimen - Urine Albumin .
Urine Albumin/Urine Creatinine Ratio
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14. HEDIS . Star Improvement Programs
1. Engagement
2. Kit Distribution
3. Laboratory Testing
5. Results
Distribution
• Patient
• Patient’s PCP
• Health Plan
4. Alert Notification and
Specimen Management
6. Data and Reporting
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15. Case Studies
Distribution through In Home Assessment
Advantages
• Maximum utilization (blood and urine used during visit)
• Stool specimen collection Kit left with Patient
• Reminder Calls – Encourage Use of iFOBT Kit
• Laboratory results to IHA organization
• IHA organization manages Alert notification
• IHA manages results distribution to Patient/PCP
• Add-on service to Risk Assessment services
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20. 20
Members and Providers Respond to Alerts
Member
“After getting the FIT results,
I contacted my doctor who referred me
to a gastroenterologist to schedule a
colonoscopy. My family has a history of
colon cancer. My sister died from it just
two years ago. I am very emotional and
anxious about the results, but very thankful
for being tested.”
“When I was contacted by the nurse
about my test results, I scheduled an
appointment for further testing and
evaluation for possible colonoscopy.
I have a history of colon cancer with
eight inch colon resection.”
Provider
“After receiving a positive FIT, a member
scheduled an appointment with a
gastroenterologist, and then refused a
colonoscopy. The gastroenterologist asked
the Care Center RN to call the member.
We spoke with the member and his daughter
and the daughter called confirming that an
appointment was scheduled.”
“Member’s PCP contacted the Care Center
after a member’s positive FIT results were
faxed to his office and asked the Care Center
to contact the member to schedule an
appointment for a colonoscopy. The Care
Center RN called the member, who agreed
and scheduled the appointment for further
testing.”
25. SolutionsSituation
In-Home Health
Assessment
In-Home Screening
Case Study—Close Gaps and Impact Care
Health plans targeting 400k MA members in 2014 to
capture data on 4 key measures to close HEDIS
gaps. Matrix used exclusive NP network to
administer In-Home Health Assessments and In-
Home Screening simultaneously to maximize
HEIDS gap closure.
Care ImpactResults
By collecting samples in the home, where the member
was more comfortable, the health plans:
Member contacted
by PCP’s nurse after
receiving fax with positive
results from Care Center
RN. The PCP scheduled
member with
gastroenterologist.
Improved
collection rates
Impacted care
with alert identifications
69%—A1C tests 3%—Uncontrolled sugar
66%—Urine protein tests 24%—Kidney disease risk
35%—FIT 10%—Colon cancer risk
Update with new numbers
