HMSA
How many quality measures will pediatrics streamline to effective July 1, 2026?
5
What does FFS stand for? Can you explain the model?
Fee for service
How many PCPs are in CHG?
45
Who is the newest cardiologist that is a part of CHG?
Horenberger
Name three measures that are going to stay in the new payment model
Child and Adolescent Well-Care Visits, Childhood immunization status, BP, Glycemic index, depression screening, well-child visits (30 mos and 15 mos)
Can you give an example of a Do Next pearl alert?
AWV, chronic conditions review, medication adherence
How long does a provider have to submit a claim?
exactly a year
One kilogram is equivalent to this many pounds
2.2 lbs = 1 kilo
What overall performance percentage correlates to our goal of 4 stars? Bonus if you can name the tiers
80%
1: 15
2: 35
3: 55%
4: 80%
5: 95%
When does open enrollment 2026 end in Hawaii?
August
Which HHIE tab do you get records from for Queen's?
The results tab
What was the true antibiotic discovered by Alexander Fleming in 1928
Penicillin
Describe a claims based attribution approach
1. Each month, a member will be attributed to a PCP using a rolling 24-month claims look back for eligible PCP specialties. Eligible claims will be counted at the provider group level, while attribution will be assigned to an individual provider within the group. Only the CPT codes in Appendix C are used in calculating attribution. Services performed in urgent care settings are excluded in the attribution calculation.
2. The member will be attributed to the provider group who was most frequently seen or, in the case of a tie, most recently seen.
3. The member will then be attributed to the provider within the group who was most frequently seen or, in the case of a tie, most recently seen.
How long is claims run out?
60-90 days
Can you give an example of a CAPHS question
Access to Care
Doctor communication
Customer Service
What vitamin is essential for calcium absorption in bone health
Vitamin D
Can you tell me one challenge or difficulty a provider faces going from VBP to FFS?
attribution, frequency of appts, coding is different, quality measures are different, etc
Can you explain Voluntary Alignment
VA is when a patient voluntarily signs a form that is submitted to CMS declaring his/her/their PCP. CMS then reviews and submits an answer every quarter
Describe the three procedures options for depression screening
1. Positive screening follow up documentation
2. Negative screening follow up
3. Depression negative no plan required
What is the most contagious disease in the world?
Measles