incentivizing and aligning providerswayne pan, md, mba
chief medical officerpacific partners management services, inc.
The RISE 2nd Annual Summit on Integrating Risk Adjustment and Quality Measures • Westlake Village, CA • July 23, 2012
...standingon the
shouldersof giants
Sir Isaac Newton
QUESTION
ACHIEVING100%
WHY NOT?
PROBLEM
insanity: doing the
same thing over and over
and expecting different
results
from: http://step-dad.blogspot.com/2010/04/step-back.html
Let’s take astep back...
humanbehavior
somebasics
humannature
humannaturelazy
humannaturesocial
humannaturecreaturesofhabit
humannaturenotgood@change
lazysocialhabit
humannaturesocialnorms
lazysocialhabit
humannaturestatusquo
lazysocialhabit
humannaturesocialnorms
lazysocialhabit
doctornature
doctornaturecompetitive
doctornatureindependent
doctornaturecurious
doctornatureformsilos
competitiveindependentcurious
doctornaturenotgood@cooperation
competitiveindependentcurious
doctornaturenotgood@collaboration
competitiveindependentcurious
doctornaturecurious
competitiveindependentcurious
doctornaturecompetitive
competitiveindependentcurious
doctornaturecompetence
competitiveindependentcurious
doctornaturemastery
competitiveindependentcurious
leverageour nature
leverageour nature4 behavior change
assumptions aboutimprovingquality andaffordability
clinicians care about bothwant to improve bothwant feedback on both
assumptions aboutimprovingquality andaffordability
michaelvandurenmdmba
sutterhealth
variationreduction
Drug Utilization PatternDrug ADrug BDrug CDrug D
PREFERRED
NON-PREFERRED
prescribing preferreddrug increases
prescribing preferreddrug increases
average drugcost drops
prescribing preferreddrug increases
average drugcost drops
savings over baseline
accumulate
prescribing preferreddrug increases
prescribing preferreddrug increases
average drugcost drops
prescribing preferreddrug increases
average drugcost drops
no adverse effect on
quality
prescribing preferreddrug increases
average drugcost drops
savings begin to accrue
no adverse effect on
quality
how did that happen?
motivation1.0
motivation2.0
motivation3.0
MOTIVATION
Learning & Challenging Incentives & Punishmentintrinsic extrinsic
MOTIVATION
Learning & Challenging Incentives & Punishmentintrinsic extrinsic
Learning & Challenging Incentives & Punishmentintrinsic extrinsicV
reframe
easy
easyaccessible
easyaccessibledesign for failure
easyaccessibledesign for failureachievement
easyaccessibledesign for failureachievementfeedback
from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
it’smorethanjust data
it’salsoaboutwhomyourserving data to
DAT
A
savvy consumers
not currenterror proneMPASTEE
no comparator
unadulterated
nonjudgemental
showmetheDATA
“put hot triggers in the path of motivated people”BJ Fogg, PhDDirector, Persuasive Technology LabStanford University
Are incentives aligned properly?How can I increase their motivation?
Have I made it easy for people to act?How can I make it even simpler?
Are people being triggered at the most appropriate time and in their workflow (path)?
putting it all together: how does it work?
patient
patient
front desk staff
patient
front desk staffanalog to digitalconverter
analog to digitalconverter
eligibility check
MARY SMITH1234567890
1121/1/2011
$5.00$10.00$25.00
analog to digitalconverter
AMERICAN HEALTH PLAN
Click here to registerfor a password or
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Powered by Access ExpressQ-v5.0.#.0.1 Build 2011.04.04.00
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AMERICAN HEALTH PLAN
ACCESSEXPRESSQ New Message (3)New Eligibility Response
IN THE PATH
AMERICAN HEALTH PLAN
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
POP-UP
digital to analog converter module
digital to analog converter module
x
xx
xxx
x
x
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD CLICK HERE
AMREICAN HEALTH PLAN
AMREICAN HEALTH PLAN
AMREICAN HEALTH PLAN
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
HOT TRIGGER
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
ENABLINGFRONT OFFICE
STAFF
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
SIMPLECARE PLAN
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
ACCESSEXPRESSQ New Message (3)New Eligibility Response
ACCESSEXPRESSQ New Message (3)New Eligibility Response
ACCESSEXPRESSQ New Message (3)New Eligibility Response
MOTIVATIO
N
ACCESSEXPRESSQ New Message (3)New Eligibility Response
ACCESSEXPRESSQ New Message (3)New Eligibility Response
ACCESSEXPRESSQ New Message (3)New Eligibility Response
Description ofmeasure
Capability forphysician officeentry
Capability forphysician officeentry
ABILITY
ourresults@SCCIPA
40
50
60
70
80
commercialadmits/1000
JAN10
APR10JU
L10
OCT10
JAN11
APR11JU
L11
OCT11
Milliman - Well-Managed
Milliman - Moderately-Managed
Milliman - Loosely-Managed
SCCIPA
commercialbeddays/1000
Milliman ’11 Well-Managed
Milliman ’11 Moderately-Managed
Milliman ’11 Loosely-Managed
SCCIPA
150
175
200
225
250
275
Milliman - Well-Managed
Milliman - Moderately-Managed
Milliman - Loosely-Managed
SCCIPA
JAN10
APR10JU
L10
OCT10
JAN11
APR11JU
L11
OCT11
commercialalos
2.5
3.0
3.5
4.0
4.5
Milliman - Well-Managed
Milliman - Moderately-Managed
Milliman - Loosely-Managed
SCCIPA
JAN10
APR10JU
L10
OCT10
JAN11
APR11JU
L11
OCT11
medicareadmits/1000
200
250
300
350
400
JAN10
APR10JU
L10
OCT10
JAN11
APR11JU
L11
OCT11
Milliman - Well-Managed
Milliman - Moderately-Managed
Milliman - Loosely-Managed
SCCIPA
1,000
1,200
1,400
1,600
1,800
2,000
2,200
medicarebeddays/1000
JAN10
APR10JU
L10
OCT10
JAN11
APR11JU
L11
OCT11
Milliman - Well-Managed
Milliman - Moderately-Managed
Milliman - Loosely-Managed
SCCIPA
4.0
4.5
5.0
5.5
6.0
medicarealos
JAN10
APR10JU
L10
OCT10
JAN11
APR11JU
L11
OCT11
Milliman - Well-Managed
Milliman - Moderately-Managed
Milliman - Loosely-Managed
SCCIPA
*
*
***
increase/same scores in 21 of 26 measures
anessentialaspect ofcreativity isnot beingafraid tofail- edwin land
failfast
no
When you improve a little bit each day, eventually big things occur. Don’t look for big, quick improvement. Instead, seek small improvement one day at a time. That’s the only way it happens - and when it happens, it lasts.
John Wooden
iterate
a journey of a thousand miles,begins with a single step
- Lao-Tzu
don’t beafraid totake the plunge