September 28, 2022

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Anthem Quality Program Update

Thank you all again for your hard work! We recently announced the significant improvement with our Anthem contracted measure of Appropriate Testing for Children with Pharyngitis where we demonstrated to Anthem that 84% of non-compliant patients, although attributed to a TCCN provider, were not in fact seen by a TCCN provider. Not only did our investigation show that our network providers have been doing a great job with this measure, but it also provided us with valuable perspective on ways that your practices might better communicate with parents and leverage your services to reduce urgent/emergency services and thereby the inappropriate use of antibiotics and spread of sickness.

Highlight: Please keep up the improvement and thank you for helping TCCN investigate important data.

We want to keep up this momentum! Please review the updated Anthem program flyer with more details about the measures and potential for incentive payments. We will send out updated versions of the flyer every two months to reflect our current network performance. We have also included a measure definition sheet that outlines the parameters and coding requirements of each measure as well as Anthem's coding guidelines for these measures

As a reminder, in 2022 we will be sharing measure scorecards bi-monthly for three Anthem measures: 

As a network we aim to improve all three of these metrics. To do this we need your help. Please review each scorecard linked above. A secret number is listed for your practice. If you do not recall your practice’s secret number please reach out to Liz Hogan at [email protected].  

We are asking you to review your practice’s performance in each measure and discuss opportunities within your team. If you would like a list of your patients that are included in the measure please let us know. We can send you a secure message. 

If your practice is highlighted in orange, it is because your practice has not met the minimum target for the measure. Our goal is to have all practices meeting the minimum target. In some cases you may not have enough patients for a statistically relevant sample size (10 or more) patients, and we understand you may not be able to achieve the target.  

If you have any questions about the Anthem Quality Program, please reach out to us at [email protected].

Asthma Recall Lists

One thing we can do to prepare for flu season is to start recall efforts early so that we can start conversations with patients about the importance of getting their flu vaccine. The flu vaccine continues to be one of the best ways to help provide the greatest protection possible against the flu and other communicable diseases, especially for vulnerable populations including asthmatics.

To assist you in your recall efforts, TCCN is providing you a list of Asthmatic patients that are due for the flu vaccine. Please use this list as a helpful tool in your patient communication efforts.  This list is pulled from our population health management tool, Innovaccer, and is up to date as of the last time you sent claims data.

When they come in for their visit, we recommend that your staff flag the patient’s chart so the provider can be sure to code for the Asthma Action Plan at the visit. See the flagging charts resource sheet for tips on how to do this.

In addition, we also have several resources to help your practice gear up for the upcoming flu season:

Please also refer to these guidelines and tips created by TCCN and CHOA:

The recall lists have been sent to you through secure email. If you have any questions about your recall list, Asthma Action Plan, Asthma Control Test, or Flu patient education, please contact Laura Baldwin at [email protected].  

Click here to read the full Asthma Recall cover letter

2022 William F. Meyers Quality Award Recipients

Each year we are pleased to present the William F. Meyers Quality Award on behalf of TCCN at the Children's Annual Professional Staff Meeting. This award is given annually in honor of Dr. William “Billy” Meyers, pediatric gastroenterologist, who embodied the essence of what a good physician should be: caring, knowledgeable, data-driven, empathetic, and dedicated to improving care and the lives of patients.

The award is designed to recognize TCCN physicians who have gone above and beyond to advance TCCN's mission by actively engaging in using quality improvement approaches to improve the health of their patients, advance our knowledge through research and process improvement, and enhance the adoption of evidence-based protocols.

This year's Primary Care recipient is Dr. Jane Wilkov. Dr. Wilkov has practiced at Dekalb Pediatric Center in Decatur for more than 30 years and is a founding member of TCCN. She has been an active member of the TCCN Finance and Contracting Committee since 2014 where she has contributed greatly to vetting pending contracts and determining our contracting strategy. More recently she bolstered TCCN’s COVID-19 vaccination efforts by developing best practices for implementing a primary care vaccine clinic which she shared with TCCN staff to create the COVID-19 Vaccine Toolkit. Her practice served as a primary vaccination site for DeKalb County, administering 12,918 total doses in 2021.

This year's Subspecialist recipient is Dr. Andrew Muir. Dr. Muir is the Division Chief for Endocrinology at Children’s and has practiced pediatric endocrinology for more than 30 years.

He has served on the TCCN Quality Committee since 2014 and played an integral role in the conception of the TCCN quality program by developing a HEDIS-based diabetes metric. He has greatly supported our subspecialty access initiative by aiding in the development of Endocrine Referral and Obesity guidelines launched through TCCN as well as overseeing the merging of CPG Endocrinology at the Egleston and Scottish Rite campuses.

Please join us in congratulating Dr. Wilkov and Dr. Muir and thanking them for their contributions to TCCN and our pediatric care community!

Ask An Allergist: Frequently Asked Questions

As a follow-up to our Spring Clinical Quality Forum focused on allergy testing, we will periodically distribute frequently asked questions answered by our partners in CPG Allergy and Immunology. Additional FAQs were provided in the April edition of Quality Steps.

Q: I have seen a lot of babies whom I have diagnosed with GERD or cow's milk protein allergy or food protein-induced allergic proctocolitis. All these kids get placed on a cow's milk protein-free diet. I recommend that families re-introduce cow's milk protein at the 1 year mark. However, should I be encouraging families to trial re-introduction earlier?  


Dr. Gerald Lee: There are recent reports that children with food protein-induced allergic proctocolitis (FPIAP) (also called cow’s milk protein allergy and/or intolerance or non-IgE-mediated milk allergy) have approximately a two-fold higher risk of IgE mediated food allergy. (Reference:


Therefore, there is some momentum to consider reattempting cow’s milk protein earlier than 12 months of age. The international milk allergy guidelines recommend rechallenging to milk within 4 weeks to reconfirm the diagnosis to avoid unnecessary avoidance of cow’s milk. They also risk stratify infants with or without eczema on how best to reintroduce milk. I know that this level of complexity doesn’t occur in the US but I am linking the reference and proposed algorithms to you for your consideration.


In my opinion, in a higher-risk child with eczema, shared decision making can be done to see if the parent is willing to reattempt the milk as a tiebreaker to confirm the cow’s milk protein allergy and potentially reduce the risk of milk allergy.


See international milk allergy guidelines here:

Q: With a family history of anaphylaxis to shellfish in both parents, how do we approach evaluation of the child? Any thoughts on shellfish allergies and cross reactions?


Dr. Tricia Lee: Generally, there is no data to support that a family history of shellfish allergy is a significant risk factor for the child to have shellfish allergy.


The universal recommendation for infants is to introduce allergenic foods early and shellfish testing is not necessary prior to first ingestion, especially because there can be false positives. One of the reasons for false positive testing is because of cross reactivity with cockroach and dust mite allergens. However, children can be allergic to shellfish (shrimp, crab, lobster) but not scaled fish (salmon, cod, tuna) and vice versa.


Parents may be understandably nervous to do this on their own, and therefore the allergist/immunologist can offer shellfish introduction under medical supervision to alleviate anxiety if necessary.


Q: Do you use Zyrtec (cetirizine) or Benadryl (diphenhydramine) for mild reactions? AAP guidelines seem to recommend Zyrtec (equal onset, longer duration).

Dr. Gerald Lee: In our allergy/immunology clinic, we have replaced cetirizine for the treatment of histaminergic urticaria and angioedema, with a dose of 0.3mg/kg (maximum 10mg). Cetirizine has an onset of action of 20-60 minutes which is equivalent to the onset of action of diphenhydramine of 15-60 minutes. Multiple studies have also demonstrated similar efficacy in treatment of urticaria, allergic reactions, and cutaneous food allergic reactions. However, the safety profile of cetirizine is vastly superior to diphenhydramine. Diphenhydramine has been associated with sedation, motor vehicle accidents, reduced school performance, and anti-cholinergic side effects. Finally, as you have stated, cetirizine has a much longer duration of action of 24 hours.

At this time, our practice uses diphenhydramine when the oral route is not available and we have to give antihistamine IM/IV or if we are attempting to provide comfort at night for children who are itching due to eczema by using diphenhydramine for sedation.

Reminder: 2-Week Data Submission Requirement

As participants in the TCCN network, we recognize the benefits of active and effective use of information technology by each of you in operational and performance measures. Since 2018, we have successfully collected claims data for all patients and providers through a defined process. In doing so, we have met the requirements of a clinically integrated network while improving accuracy of scorecards and recall lists, thus improving overall care to our patients. In addition, our actions support contract management, which is key to our financial success, as well as to maintaining clinical integration across the Network. 

While we have successfully performed this requirement in submitting data to our population health management tool (PHM Tool) in a “manner and timeframe as proscribed by the agreement between the TCCN network and the Network Participants,” we have not required a specific timeframe for submitting such data, but rather a suggested submission of claims data within 14 days of the encounter date.

In March 2022 we reviewed the current frequency by which all Network Participants are submitting claims data and found the following information:

  • 60% of all PCP TCCN practices submit data within 14 days/less
  • 14% submit data between 15-21 days
  • 7% submit data between 22-28 days
  • 19% submit data more than 28 days after the encounter

With 40% of practices falling outside of the recommended 14 day period for submission, we must institute a submission requirement for all practices. As stated previously, this new requirement should result in improved accuracy of scorecards and recall listsaid transition to the Innovaccer PHM Tool, support our contract management efforts, and lastly, reduce the amount of time and resources spent in managing non-compliant practices.

After a review of the above information, the TCCN Board of Directors met on May 18, 2022, and revisited the initial recommendation made in 2018. At this time, by vote of the BOD (as allowed by the TCCN agreement with Network Participants), the TCCN BOD requires all practices to submit claims data to the PHM Tool within 14 calendar days of the most recent encounter date. This requirement went into effect beginning August 1, 2022.

If you have any questions regarding this revised requirement, please don’t hesitate to reach out to Laura Baldwin at [email protected].

Stephanie V Blank Center for Safe and Healthy Children

Are you unsure how to handle potential child abuse and neglect cases that you encounter in your practice? The team at the Stephanie V Blank Center for Safe and Healthy Children at Children’s is here to help. The Blank Center sees patients referred to them by community providers to conduct full assessments for suspected child physical abuse, sexual abuse, and neglect. To make a patient referral, please click here to complete the patient referral form. If you have questions about making a referral, please call 404-785-3833. If you would like to arrange a presentation for your staff, please contact your physician liaison to make arrangements to have the team from the Blank Center present to your staff.

Marcus Autism Center Baby Siblings Clinic

Siblings of children with autism spectrum disorder (ASD) are more likely to have developmental delays, speech problems, and autism. To help monitor and mitigate those concerns, Marcus Autism Center has created a new clinic specifically to meet the needs of these children. Children ages 6 months to 24 months who are the siblings of children with ASD qualify for this clinic.

Please download the flyer linked here and share this opportunity with any families of children eligible for this clinic. For more information, please contact Stormi White, PsyD and Natalie Brane, CCC-SLP at [email protected] or 404.785.8501.

In Case You Missed It (please use the links below to review)

TCCN Requirements

TCCN Resources

Community Updates


We are here for you. Please reach out to [email protected] with any questions.