PCMH: Learning Session
Meeting #1
American Academy of Pediatrics –
Arkansas Chapter
October 17, 2014
Objectives
• Introductions
• SHARE Presentation: Justin Villines, MBA and Janis Bartlett
• Overview of PCMH project: Dennis Z. Kuo, MD, MHS
– Primary Care Trends/General Update: Dennis Z. Kuo, MD, MHS
– Upcoming Enrollment Metrics: Dennis Z. Kuo, MD, MHS
• Understanding How Data Drives Change: Dennis Z. Kuo,
MD, MHS
• PCMH Milestones- Cheryl Arnold, MHSA, FACMPE
• Care Plans: Jo Lynne Varner
• Medical Neighborhood: Dennis Z. Kuo, MD, MHS
• Information on Re-enrollment: Dennis Z. Kuo, MD, MHS
• Questions?
Disclosures
• Support provided by Arkansas Medicaid
Introductions
• Arkansas AAP Leadership
– Orrin Davis, MD, FAAP- President
– Dennis Kuo, MD, MHS, FAAP – Vice-President
– Chad Rodgers, MD, FAAP – Secretary
– Chris Schluterman, MD, FAAP - Treasurer
• Arkansas AAP staff
– Aimee Olinghouse, Executive Director
– Kristen Pfeifer, QI specialist
CONNECTING TO SHARE
Arkansas Academy of Pediatrics
Arkansas PCMH
October 17, 2014
Jan Bartlett, Policy Director
Justin Villines, HIT Policy Integrator
Cindy Osment, SHARE Onboarding
Arkansas Office of Health Information Technology
PRESENTATION AGENDA
1.
2.
3.
4.
5.
Overview of SHARE
How SHARE can help Clinics
Provider and Vendor Status
Getting started with SHARE
SHARE Demo
SHARE OVERVIEW
WHAT IS SHARE?
• Statewide health information exchange (HIE)
• Established with Act 891 of 2011, governed by
HIE Council
• Funded with public funds and user fees
• Infrastructure for providers, labs, pharmacies,
public health, others to share clinical data
• Available to any health care entity willing to
follow requirements and pay user fees
PATHWAY TO HEALTH DATA
Hospitals
Hospitals
Public
Health
Radiology
Centers
Labs
Clinics
Payers
Medicaid
Pharmacies
Public Health
Radiology
Centers
Labs
Clinics
Payers
Medicaid
Pharmacies
33 WAYS TO SHARE
SHARE
1. Secure Messaging
– Secure, encrypted email exchange
2. Virtual Health Record (VHR)
– View patient health data in SHARE securely online
– No EMR/EHR needed
– Clinical In box for qualified medical professionals
3. Health Information Exchange (HIE)
– Integrates with your EMR/EHR system
– Send and receive patient health data
– View SHARE patient health data online or in EMR/EHR
WHAT DATA CAN BE SHARED?
HL-7 Messages, CCDs and Unstructured Documents
• Clinical Care Summaries
• Allergies
•
Discharge Summaries
• CCDs
•
Lab Results
• Problem Lists / Diagnoses
•
Radiology Reports
• Referrals
•
Medication Histories
• Transcribed Documents
BENEFITS OF USING SHARE
Save time • Save money • Improve patient care
•
Instantly view patient health data from all points of care
• Make better-informed care decisions
• Easily coordinate care with unaffiliated providers
• Reduce administrative costs for gathering health data
• Track acute care events for your patients
VALUE OF SHARE
SHARE seeks to facilitate meeting collection and data reporting
goals for local and national health improvement activities
• Meaningful Use (MU)
• Patient Centered Medical/Health Home (PCMH)
• Accountable Care Organizations (ACOs)
• Quality Reporting/Monitoring & Measuring Outcomes
TRANSITIONS OF CARE
SHARE is a tool for facilitating transitions of care:
• Care Coordination and PCMH
– Alerts transmitted through SHARE between
providers and hospitals
– Transmission of ED/Inpatient admits and
discharge data
MEANINGFUL USE CRITERIA
Stage 1
• Stage 1, Menu Measure 9:
Capability to submit electronic
data to immunization registries or
immunization information systems
Stage 2
• Stage 2, Core Objective 15:
Provide a summary care record for
each transition of care or referral
where the recipient receives the
summary of care record via
exchange
• Stage 2, Core Objective 16:
Capability to submit electronic
data to immunization registries
WHAT’S IN IT FOR CLINICS?
CLINICS AND PCMH
PCMH practices are required to participate in SHARE:
•
•
•
Obtain patient admission/discharge data
from affiliated hospitals
EMR integration is not required until 2015
OHIT is working with AFMC, AAP, and
Qualis to ensure practices are properly
connected to SHARE for PCMH
compliance
SHARE FOR PCMH
Arkansas Medicaid’s PCMH initiative
requires providers join SHARE to
receive in patient discharge and
transfer information. These “event
notifications” will alert the practice of
ED and hospital
admissions,
enhancing coordination of care for
follow up visits and reducing the cost
of care.*
*See Arkansas Medicaid PCMH Handbook, 240.000 – Metrics &
Accountability for Incentive Payments, Measure J.
SHARE FOR PCMH
When a Patient whose providers are
connected to SHARE is admitted to or
discharged from the hospital:
Participating SHARE providers receive
an instant notification of the patient’s
hospital status in the EMR inbox or
SHARE’s VHR inbox.
This allows timely follow up and care
management.
SHARE SECURE MESSAGING
System with expanded features
• Cloud-based
• Provides notifications to 3rd party
email systems
• Web-based user interface
• Functions like traditional email
• Facilitates HISP services
• Alerts when a message is
successfully or unsuccessfully
processed /sent
IMMUNIZATIONS REPORTING
Automate Immunizations Reporting through SHARE:
•
•
•
•
•
•
SHARE has built an interface with ADH
Send immunizations data directly to ADH through SHARE
Simplify workflow by reducing duplicate data entry
Immunizations Registry is “Live”
ELR and Syndromic Surveillance are “Live”
No additional cost to SHARE participants
PARTICIPATION UPDATE
WHO SHARES?
287
Health care sites participate,
including 27 hospitals with
(15) Live and 260 practices
in 99+ cities.
*As October 16, 2014
CONNECTED PARTICIPANTS NOW INCLUDE
HOSPITALS
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NARMC
AR Children’s Hospital
UAMS
JRMC
Ashley County
McGehee Hospital
Bradley County
White River Health System
Ark Methodist Medical Center
Stone County Medical Center
Conway Regional
Conway Regional Rehab Hospital
Howard Memorial
Magnolia Regional Med. Center
Saline Memorial Hospital
PRACTICES
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Family Medicine Clinic
Family Doctors Clinic
Claude Parrish CHC
Main Street Medical
Marshall Family Practice
Ronald Reese, M.D.
Newton County Family Practice
Andrew Coble – General & Specialty Surgeon
Internal Medicine Diagnostics, Inc.
UAMS Regional Center – Pine Bluff; Fort Smith
Boston Mountain Rural Health Center (7 sites)
East Ark Health Center (5 sites)
Jefferson Comprehensive Care (6 sites)
Lee County Cooperative Clinic (4 sites)
Willow Street Health
NEA Baptist (37 sites)
Fonticiella Medical Center
CONNECTING PARTICIPANTS
HOSPITALS
•
North Metro Medical Center
•
Chicot Memorial
•
•
Izard County
Pinnacle Point Hospital
PRACTICES
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UAMS Regional Centers (4 sites)
ARcare (23 sites)
Apache Drive Children’s Clinic
Conway / Greenbrier Children’s Clinic
Conway OB/GYN
Cornerstone Clinic for Women
Little Rock Pediatric Clinic
The Pediatric Clinic, NLR
Ozark Internal Medicine and Pediatrics
Pocahontas Medical Clinic
The Children’s Clinic of Jonesboro
Sager Creek Pediatrics
MANA
North Central Arkansas Medical Associates
Community Physical Group
The Breast Center
Paragould Pediatrics
Plus many more…
CONNECTED PARTICIPANTS
Behavioral Health PRACTICES
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AR Psychiatric Clinic PA
Behavior Management Systems Inc.
Center For Individual &Family
Community Service Inc
Cooper Clinic – Ozark
Dayspring Behavioral Health
Ascent Children's Health Services Youth
Home Inc.
Outpatient Clinic Southwest AR
Counseling Arkansas
Behavioral Healthcare Counseling
Services Of Eastern AR - Forrest City
Family Psychological Center Health
Resources of AR Hometown Behavioral
Health Services Hope Behavioral
Healthcare Jerry Blaylock MD
Behavioral Health PRACTICES
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Families Inc. Counseling Services Corporate Office
Baptist Health Behavioral Service Community
Counseling Services Inc Cornerstone Community
Counseling
Delta Counseling Associates
Centers For Youth And Families
Life Strategies Counseling Inc (Little Rock)
Life Strategies Counseling Inc (Osceola)
Life Strategies Counseling Inc (Paragould)
Life Strategies Counseling Inc (Piggott)
Life Strategies Counseling Inc (Trumann)
Life Strategies Counseling Inc(Jonesboro)
Life Strategies Counseling Inc
Perspectives Behavioral Health Ma Corp
Counseling & Education Center Inc.
Psychiatric Associates of AR PLLC
Mid-South Health Systems
•
Plus many more…
893,596
More than
patients participate in SHARE
STATEWIDE AGREEMENTS
SHARE is helping the provider community by:
Negotiating statewide contracts
with EHR vendors THAT:
1. Reduce or waive one-time
vendor interface fees to
connect to SHARE
2. Shorten the implementation
timeline
BASIC PRICING FOR PRACTICES
SHARE Fees
Estimated Cost
One-Time Setup Fee
Waived
Unlimited VHR and SM (for paper
$50 per month
EMR and/or Non Interfaced System practices)
Interfaced System with One VHR
$50 per month
Primary Clinical User and Clinical SM
Interfaced System with Unlimited VHR
$75 per month
Primary Clinical Users and SM
EMR/EHR Vendor Fees
Estimated Cost
One-time Fee
Varies per vendor
Monthly or Annual Fees
Varies per vendor
HOW TO JOIN SHARE
ONLINE OR BY PHONE
Register online at
SHAREarkansas.com
OR
Call 501.410.1999
Thank you!
Questions?
Now the DEMO!
Patient-Centered Medical Home
Overview
.
Arkansas Medicaid PCMH
• PCMH: “team-based care delivery model led by PCPs
who comprehensively manage patients’ health needs
with an emphasis on health care value”
• Goals
– Encourage population health management (all children,
regardless of whether they are coming in or not)
– Align financial incentives with good preventive care
– Supports primary care physicians as key partners
Terms
• Practice transformation: “adoption, implementation, and
maintenance of approaches, activities, capabilities and tools”
to encourage team-based care and population management
– It’s all about the population management
– And being proactive with patient care
• Care coordination: “ongoing work of engaging beneficiaries
and organizing their care needs across providers and care
settings”
– This is particularly valuable for children with disabilities and special
health care needs – i.e. the high resource utilizers
Pediatric Practices
• 47 practices enrolled
• Arkansas AAP is assisting 15 practices
– Monthly webinars
– Weekly contacts
– Listserv
– Personal discussions
– Review of reports
Activities
Activity
Commit to
PCMH
Month 0-3
1▪ Identify office lead(s) for both care coordination and practice
transformation1
2▪ Assess operations of practice and opportunities
to improve (internal to PCMH)
3▪ Develop strategy to implement care coordination and
practice transformation improvements
4▪ Identify top 10% of high-priority patients
(including BH clients)2
5▪ Identify and address medical neighborhood barriers to
coordinated care (including BH professionals and facilities)
6▪ Provide 24/7 access to care
7▪ Document approach to expanding access
to same-day appointments
8▪ Complete a short survey related to patients’ ability to
receive timely care, appointments, and information from
specialists (including BH specialists)
9▪ Document approach to contacting patients who have not
received preventive care
10
▪ Document investment in healthcare technology or tools that
support practice transformation
11
▪ Join SHARE to get inpatient discharge information from
hospitals
12
▪ Incorporate e-prescribing into practice workflows3
13
▪ Integrate EHR into practice workflows
1 - At enrollment; 2 - Three months after the start of each performance period; 3 - At 18 months
Completion of activity
and timing of reporting
Start your
journey
Month 6
Evolve
your
proce-sses
Month 12
Continue
to innovate
Month 1618
Month 24
Well?
• HOW’S IT GOING????
Bodenheimer, Ann Fam Med 2014
Best practices for transformation
• Culture of QI – develop formalized team
process and dedicate time
• Family-centered care – recruit and utilize
parent partners to motivate and visualize
• Team-based care – play to everyone’s
strengths, collaborate
• Care coordination –develop care plans,
dedicate time and staff, collaborate to develop
patient-centered goals
McAllister et al. Ann Fam Med 2013
Successes
• Looking more closely at/tracking specific information (like
24/7 access) helped to provide consistency within offices.
• Tracking patients better to see when they need WCCs, PFTs,
etc.
• Hired additional nursing positions/PCMH Care
Coordinators.
• Monitoring PFSH components filled out by MD on first visit
with new patients.
• Adding EMR software.
• Better chart documentation by the physicians.
• Opening of walk-in clinic model allowing immediate access
Challenges
• Lag in data
• Time (webinars & care plans and audits, oh my! ;)
• Inconsistencies with what qualifies as meeting
metrics (often based on subjective judgment of
reporting form answers)
• Not having resources to track down patients/get
them scheduled
• Some [consultants] more helpful than others
• Medicaid enhanced payment set to expire at the
end of 2015 (unless reauthorized)
National trends in primary care
• Reminder: ACA – test innovative payment
methods
• Projects that focus on children with medical
complexity
– High value proposition
– Co-management
• Payments may be increasingly tied to
adoption of EHR, data, and care plans
What’s ahead in 2015?
• Enroll by 11/17/14
• Practices may pool with any number of
PCMHs to form a shared savings entity
– Statewide pool also an option
• Beneficiary level data available
– Cost data: Q4 2014
– Metric data: Q1 2015
What’s ahead in 2015?
• Shared savings – likely to be determined by Q2
2015
• Possible changes in targets
– Process metrics may all rise a little
– Shared savings – a few will rise
• ADHD, Asthma, adolescent wellness visits
• Considering demonstration of extracting data
from EHR
Also-
• Enrollment/Re-enrollment opportunity
available here today and at the Pediatric
Forum held at ACH tomorrow October 18th
2014
• Please see Kristen for more details.
Questions?
• .
Understanding How Data Drives Change:
Dennis Z. Kuo, MD, MHS
Data
• Objective measure of performance
– Patient
– Physician
– Practice (or care team)
• Sources
– Payer
– EMR
– Manual review of chart
– Measure patient experience
Data, continued
• Use of data for quality improvement
– Set targets
– Understand if variation
• Time
• Between provider
• Understand performance
• Communicate findings
• Identify areas for improvement
Concept: Model for Improvement
• What are we trying to accomplish?
• How do we know that a change is an
improvement?
• What change can we make that will result in
an improvement?
Model for Improvement
• What are we trying to accomplish?
– Increase the number of children who have their teeth
brushed
• How do we know that a change is an
improvement?
– Measurable change
• What change can we make that will result in an
improvement?
– Know your system
– Develop SMART Objectives
– Plan-Do-Study-Act cycles
Where does data come in?
• Data drives change
– Establish where you are now
– Establish your target
– Tells you if you are making an improvement
• Data can be very complicated or very simple
• You need some sort of objective measure
WHY DATA?
• Essential building block for high-performing
primary care
• Measure progress
• Understand successes and areas for
improvement
• Communicate findings to others
What constitutes data?
• Count data – a raw number
• Proportions
– Numerator – the number of children for whom
the intervention was successful
– Denominator – the total number of children being
measured
• Understand the numerator and denominator
Displaying results
• Run chart
– Very simple
– Very powerful
• Over time
% Hospitalized patients discharged and seen within ten days
100%
90%
Hospitalists
review data
80%
1st Unit
Secretaries Trained
6/10/14
Last Unit Secretaries
Trained 9/10/14
Up
Is
Best
70%
60%
Cards printed for
distribution
50%
Median, 48%
40%
Median, 34%
30%
Target
20%
10 days
10%
Median
0%
Target
What about our data reports?
• Learn from them
• Shortcomings
– Delay means they do not provide immediate
feedback
– Rolling 12 month averages absorb outliers but
mean that recent changes will not be reflected
Know your data reports
• Medicaid Q3 data reporting up to March 31,
2014
– Dependent on claims
– Data cleaning
• Patient-level data
– Discussion about making data available on request
• Cost in Q4 2014; Metrics in Q1 2015
• Discuss with HP service desk
• Need to produce your own data
PCMH Milestones/Audit:
Cheryl Arnold, MHSA, FACMPE
PCMH Audit
AFMC
Central Arkansas Pediatric Clinic PA
Cheryl Arnold, MHSA, FACMPE
Pilot Audit with AFMC
 Friday, August 29
 On-Site Visit: 2 AFMC representatives
 Interview
 Review of Assessment
 Review of Documentation
 Take-Aways
AAP: Learning Session & Pediatric Forum, October 17, 2014
67
Interview
Informal discussion of activities that
CAPC has completed or has in
process.
“What we are doing” -- daily basis,
especially pertaining to HPBs
AAP: Learning Session & Pediatric Forum, October 17, 2014
68
Review of Documentation
 Completed Assessment
 Documented Strategies for Practice
Transformation & processes for
implementation
 Timeline for Practice Transformation
Implementation
AAP: Learning Session & Pediatric Forum, October 17, 2014
69
Review of Documentation
 Documented Strategies for Care
Coordination & processes for
implementation
 Timeline for Care Coordination Priorities
Implementation
AAP: Learning Session & Pediatric Forum, October 17, 2014
70
Review of Documentation
 Documented Barriers to Care
 Documented Approaches to Coordinated
Care
AAP: Learning Session & Pediatric Forum, October 17, 2014
71
Proof of Patient
Communication for After-Hours
Access
 Website
 Phone Message
 Posted on Public Entries
AAP: Learning Session & Pediatric Forum, October 17, 2014
72
Same Day Appointment
Access
 Reviewed written process
 Reviewed actual schedule – historic
and future
AAP: Learning Session & Pediatric Forum, October 17, 2014
73
Take Aways --
 They thought I was doing better
than I did!!!
 Document everything you are
doing!
 Rapid Cycle/ Small Change Process
for evaluating and continuing to
improve (informal).
AAP: Learning Session & Pediatric Forum, October 17, 2014
74
Medical Neighborhood and Care Plans:
Dennis Z. Kuo, MD, MHS
The Chronic Care Model
From Wagner EH. Figure from Antonelli R (2005). Adapted from Bodenheimer (2002)
Medical complexity
• High value proposition
– Small # -> High dollars
– Reduce preventable ER and inpatient visits
– Increase outpatient management?
• Adult models
– Identification based on frequent encounters/high
resource use
– Intensive outpatient case management
Allocation of Spending Across Groups
Percentage of Total Spending
in Each Group
80
Hospital Care
Outpatient/community Care
Pharmacy Care
Emergency Care
60
40
20
0
Least 80% Next 15%
Next 4%
Spending Group
Top 1%
Kuo et al. Pediatric Academic Societies abstract, 2014
Outpatient Spending Across Groups
Relative Difference in Spending
Compared with the Least 80% Group
125
Specialty Care
Pharmacy
100
75
50
25
Primary Care
0
Least 80%
Next 15%
Next 4%
Top 1%
Spending Group
Kuo et al. Pediatric Academic Societies abstract, 2014
Providing medical homes for children
with complex/chronic care needs
• Population management
– Primary care may be underutilized
– How much investment in additional primary care
would result in a return on that investment?
• What are the mutable (i.e. preventable) costs?
– May not get a big “signal” of excessive costs
– Need to identify children at risk up front
– Proactive management in outpatient setting
• What are the desirable outcomes?
But wait…there’s more
• “New morbidity”
• Psychosocial needs also drive health care use
and needs
• Care plan can potentially tie all of this
together
Care mapping
• A comprehensive snapshot of all of a family’s
needs
• Useful to illustrate the BIG PICTURE and what
families face
• Think about broad categories and then fill in
the individual providers
• Start with the child and family in the middle
Case
•
•
•
•
•
1 year old, CHARGE syndrome
Thymus transplant, immunocompromised
Dysphagia, G tube dependent
Bilateral colobomas
Choanal atresia
• ….think about the number of specialists she
needs to see, the services she needs and what
her family is facing
Care Plans:
Jo Lynne Varner
Care plan
• Documentation of Chief Complaint/Current Problems
• Plan of care integrating contributions from health care team
(including behavioral health professionals) and from the
beneficiary
– Problem based detail of plan of care occurring twice during a 12
month time frame
• Instructions for follow-up
– Documentation supporting instructions for follow-up
• Assessment of progress to date
– Clear documentation identifying the course of a specific problem and
the status
BONUS VIDEO
• W. E. Deming Red Bead Experiment
• http://www.youtube.com/watch?v=ckBfbvOX
DvU
Information on
Re-enrollment:
Dennis Z. Kuo, MD, MHS
Re-Enrollment Reminder
• Enrollment is September 1 through November
17th, 2014
• Current PCMH practices are REQUIRED to reenroll.
• Please make sure all of your participating
physicians information is up-to-date, if you
have new contact leads its important that you
update this on the new RE-enrollment forms
that will be submitted to HP
New in 2015
• Practices may pool with any number of practices
to determine a shared savings entity (5,000
patients)
• Otherwise, statewide pool for shared savings
– For those looking for pooling partners, several
resources are available:
• List of enrolled PCMH names and locations on the APII
website:
http://www.paymentinitiative.org/medicalHomes/Pages/Us
eful-Links.aspx
• AFMC provider reps
ARKANSAS MEDICAID PATIENT-CENTERED MEDICAL HOME
PROGRAM PRACTICE RE-ENROLLMENT AGREEMENT
September 21, 2014
Dear Arkansas Medicaid Provider:
Arkansas Medicaid is updating information for current PCMH Providers. Please complete, sign, and
return this form to Arkansas Medicaid by email at arkpii@hp.com or fax at 501-374-0549. The form
must be returned with updated contacts even if there are no changes to your information. Please
return this form and any changes attached by 11/17/2014.
PCMH ID: <Provider/Group Name, Provider Number>
I wish to stay enrolled as a PCMH Provider with Arkansas Medicaid and have no
changes to my current information as shown on the list provided.
I wish to stay enrolled as a PCMH Provider with Arkansas Medicaid, have updates
to my enrollment information, and have completed the remainder of this form.
By signing below, the practice, __________________________, hereby agrees to remain enrolled in
the PCMH program and agrees to provide the necessary information to update their participation
information:
_______________________
Authorized Practice Representative
______________________
Medicaid Billing ID Number
_________________
Date
Your practice lead will be the primary contact for the PCMH program. All notifications will be sent to
the information provided below.
Primary Contact
Secondary Contact
Name: __________________________
Name: ____________________________
Phone: __________________________
Phone: ____________________________
Email: __________________________
Email: ____________________________
PCMH PRACTICE UPDATE/CHANGE REQUEST FORM
ADD PHYSICIANS
Please list the required information for the physicians you want to enroll under your practice:
NOTE: Please add the date of the recently joined physicians below to be added to your PCMH.
1.
2.
3.
4.
5.
Physician Name:
______________________________________
Individual Medicaid Provider ID:
______________________________________
NPI:
______________________________________
Date joined:
______________________________________
Signature:
______________________________________
Physician Name:
______________________________________
Individual Medicaid Provider ID:
______________________________________
NPI:
______________________________________
Date joined:
______________________________________
Signature:
______________________________________
Physician Name:
______________________________________
Individual Medicaid Provider ID:
______________________________________
NPI:
______________________________________
Date joined:
______________________________________
Signature:
______________________________________
Physician Name:
______________________________________
Individual Medicaid Provider ID:
______________________________________
NPI:
______________________________________
Date joined:
______________________________________
Signature:
______________________________________
Physician Name:
______________________________________
WITHDRAW PHYSICIANS
Please list the required information for the physicians you want to withdraw from your practice:
NOTE: Please remove only physicians who have recently left your practice, and include the date the
physician left.
1.
2.
3.
4.
Physician Name:
______________________________________
Individual Medicaid Provider ID:
______________________________________
NPI:
______________________________________
Date left:
______________________________________
Physician Name:
______________________________________
Individual Medicaid Provider ID:
______________________________________
NPI:
______________________________________
Date left:
______________________________________
Physician Name:
______________________________________
Individual Medicaid Provider ID:
______________________________________
NPI:
______________________________________
Date left:
______________________________________
Physician Name:
______________________________________
Individual Medicaid Provider ID:
______________________________________
NPI:
______________________________________
Date left:
______________________________________
PARTICIPATING PHYSICIANS
PCMH ID: <Provider/Group Name, Provider Number>
We have provided a list of the physicians currently enrolled in your practice. Please reference this
when updating your status.
<Insert Excel Table Here>