04-05-2021 - Responding: Using Data for Social Interventions

Tiger Team - Responding SI Presentation 4-5-2021.pdf

PRAPARE data documentation file

Enabling services implementation toolkit 

• PRAPARE SI coding is a 3 step process ( Response Categories, Activity Codes, Supplementary Documentation)  
  • The Response Categories (slide 12-13) is the first step- after patient is screened using PRAPARE and SDOH needs are identified 
  • There are 23 social intervention response codes 

  • For each social intervention, there is a possibility of responding in multiple ways to address the PRAPARE social need (assessment of eligibility for public programs/resources, social care management, and referral as well as referral status.)

    The Activity Codes (Slide 14) are used to identify how the needs are being addressed 

    • Tracking the comprehensive activities performed by a care team member will provide better specificity needed to communicate to care or social service providers the information to track what activities may have already been attempted and what else may be needed to close the loop and social care gaps for the patient.

    • Code AM001- PRPAPARE Assessment 

      • General social risk assessment using the PRAPARE instrument. This activity code is used to recognize organizations for the time used to conduct the general PRAPARE assessment.

    • Code RF002- Follow up on Social Services, Closed Loop, Referral Status 

      • Follow up with a patient who was previously referred to an external organization or other department. Please indicate care team follow-up status of social intervention using the following categories:

        0 = Patient social need was not met and requires follow-up to address social need (select reason)

        • Patient has not yet followed up with referral dept/organization

        • Patient unable to be served at referral dept/organization

        • Patient lost to follow up 

        • Other, please specify:_____

1 = Patient social need was met through social intervention 

2 = Patient no longer needs service

• • • • • Patient used different organization
        • Patient chose not to use referral resource; Patient requested not to be called again
        • Patient situation changed and no longer needs service
        • Other, please specify:_______

3 = Other, please specify:_______

• • There are a total off 11 activity codes - Many taken from ESDC and are meant to align with other national initiatives including Gravity
  • Supplementary Documentation- 3rd Step (slide 17) 

    • Can be documented to provide context about the PRAPARE social intervention. The data will be useful for reporting and conducting evaluations of your social interventions to better understand the impact and intensity by intervention.  In most cases, organizations may already document this information in their existing EHR or electronic system and the information can be auto-populated or transferred into the EHR or provider electronic template.

    • By designating these variables here, we can ensure that these variables will be linked in the same system as the social intervention codes for more feasible analysis.

      
      

Discussion Questions:

1. Is your organization documenting social interventions or enabling services in response to PRAPARE social needs?

• • Yes- 8 Responses 
  • No- 4 Responses 
  • Not Sure- 2 Responses
  • Not Applicable-  13 Responses 
    • Population Health Management System
    • PCA/HCCN 

2. Who is already documenting closed loop referral and how is it different from the PRAPARE protocol?

• Some activity on this aspect but challenging- standardization is needed

3. What codes (SI) are missing that are critical to document for action? What’s missing that you’d like to document in your practice?

• Required items that are needed to report to Medicaid Agency for the CHW program (Local /state requirements) 
• Items in blue  "Length of SI, Encounter Type, Appointment Type, Scope of Service"- could be made required especially for claims/paid for the work 
• Transportation- * Noted that is part of the current protocol 

4. What is most helpful to know when it comes to integrating these codes in EHRs? E.g. Should it be integrated with the PRAPARE template or keep it as a separate template?

• If the information can flow from the PRAPARE template to an assessment and no duplicate entry is required, that would be fine. Even with the best laid plans, data does not always flow as intended/desired.
• If it's not within the PRAPARE template, it will result in extra clicks/steps
• Need for automation of codes when documentation in EHR  is met
• Our health centers want less steps so if it's integrated with PRAPARE or other templates, that would be helpful.  Maybe a standalone option as well.
• Integrated-many have commented it would be nice to document interventions directly with positive PRAPARE response.

Questions:

• How are these cross walked with the Z-codes for SDOH?  Payers are beginning work on SDOH screening/interventions.  What is the source of the code?
  • Z-codes are not primarily intervention based- and that is the current focus. There is a crosswalk in the PRAPARE data documentation file that notes Z-codes.
• Are these codes used by FQHC's also?
  • Not yet used by FQHC as what is being presented is a first draft. AAPCHO and NACHC are working with a technical expert panel to develop the codes. 
• Will you be proposing/identifying standard codes for the interventions?
  • Yes- once developed and finalized with approval from stakeholders will then propose/identify standard codes for interventions 
• Are the intervention codes from a national source?  If we are working with payers they tend to accept work from National sources?  If not, what is the plans to move to having these be mainstreamed nationally?
  
  • Yes- an environmental scan was completed and the codes came from several national sources (i.e. APPCHO enabling services protocol).