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Presentation given at the Breakthrough Strategies to Boost HEDIS Scores & Quality Management meeting, Key West, January 16, 2012.
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Best Practices for Data Analysis
Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012
A Chasing Logic Case Study
Wayne Pan, MD, MBAChief Medical OfficerPacific Partners Management Services, Inc.
Best Practices for Data Analysis
Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012
A Chasing Logic Case Study?
Wayne Pan, MD, MBAChief Medical OfficerPacific Partners Management Services, Inc.
to recap....Breaking Down the Silos for Risk Adjustment, HEDIS & Care Management:
From Streamlining Charts to Capturing & Sharing the Right Data
A Complementary Duo - Risk Adjustment and HEDIS: How to Ensure a Plan is Effectively Accomplishing Objectives for Both
Practical Steps to Improve the Integrity, Quality & Timeliness of Data & Supplemental Data
How Star Rating Measures Correlate with Overall HEDIS Quality
The State of Health Care Quality – Plans, Providers and Consumers in the New World
of Star Ratings and Exchanges
A Two-Part Discussion on EffectiveQuality Improvement Partnerships
A Collaborated Effort: Plans & Providers Working to Improve Clinical Outcomes
Provider Education & Incentives: Creating Tools & Toolkits for Providers
That They Will Use
we cannot continue to keep quality,risk adjustment/stratification,
cost-effectiveness,medical management,
network management, andmember engagement in
separate silos
that’s because....
they’re all related!
with the common denominator....
the patient.
some learnings from California’s IHA P4P....
theory: combine the variousplans’ quality P4P bonus programs into a single coherent program for physicians
results: very modest gains in quality outcomes despite more than half a billion dollars in P4P bonuses paid out, since 2004
what happened?
not enough money set asidequality not linked to efficiencyproviders always have sicker, less compliant patients
the P4P program didn’t change provider or patient behavior
the plans didn’t save any money
IHAP4P
sponsored by
two ideas....
combine quality & efficiency....
TwoȱStrategicȱP4PȱGoalsȱforȱ2011Ȭ2015
Goalȱ#1:ȱȱBendȱtheȱcostȱtrendȱTargets:ȱȱ•Totalȱcostȱbelowȱriskȱadjusted,ȱgeographyȱadjustedȱ
average•TotalȱCostȱtrendȱbelowȱConsumerȱPriceȱIndexȱ+1
Goalȱ#2:ȱȱAchieveȱmeaningfulȱqualityȱ improvementsȱinȱclinicalȱcareȱandȱpatientȱ
experience,ȱandȱincreaseȱmeaningfulȱuseȱofȱ healthȱIT
4Copyrightȱ©
2011ȱIntegratedȱHealthcareȱAssociation.ȱAllȱrightsȱreserved.
be patient-centered....
why does that matter?
insanity: doing the
same thing over and over
and expecting
different results
get out of our rut?
4x4 healthcare
4processes
communication
collaboration
coordination
PCPs
Specialists
Patients
CaseManagers
anticipation
4dimensionaldata
financial
administrative
clinical
retrospectiveretrospective
reactivecare
$$$$$$
behavioral+
predictive
prediction can lead to....
proactivecare
From: Dan Roam, “American Healthcare: a 4-napkin explanation”www.slideshare.net/danroam/healthcare-napkins-all
one more thing....
all providers are not the same
use multiple communication channels and communicate consistently....
case study: SCCIPA
Santa Clara County1,304.01 sq. miles
1,781,642 (2010)$74,335
5 PCP80 Specialists
57 PCP104 Specialists
173 PCP343 Specialists
11 PCP30 Specialists
SCCIPAfounded in 1986physician-owned, physician-governed800+ physicians - 240+ PCPs, 550+ specialistsall 9 hospitals - including a tertiary care center9 health plans (Commercial and Medicare Advantage)
peopleprocessesplatform
hospitalistsSNFistsonsite case managerscomplex case managersutilization review staff
people
P4P/CMS 5 STAR dashboardincentive bonus based on qualityAscender for HCC processpaper quarterly physician workplanhospitalists perform HCC coding
processes
common web-based communication platformfacilitates administrative functionsrules-based management of processesintuitive user-interfaceembed quality reminders into office/provider workflowprovider feedbackprovide actionable clinical data at point of careallow patients to access their own dataallow patients to provide feedback and enter their own data
platform
results
40.0
50.0
60.0
70.0
Inpatient Hospital Admissions Per 1000 Enrolled Patients (Commercial)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Admits per 1000 (Commercial)
100.0
150.0
200.0
250.0
300.0
Bed Days Per 1000 Enrolled Population (Commercial)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Bed Days (Commercial)
2.8
3.3
3.8
4.3Average Length of Stay (Commercial)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Average Length of Stay (Commercial)
200.0
250.0
300.0
350.0
Inpatient Hospital Admissions Per 1000 Enrolled Population (Medicare)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Admits (Medicare)
75010001250150017502000
Bed Days Per 1000 Enrolled Population (Medicare)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Bed Days (Medicare)
4.0
4.5
5.0
5.5Average Length of Stay (Medicare)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA ALOS(Medicare)
*
*
***
increase/same scores in 21 of 26 measures
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
iteration
Virtually nothing comes out right the first time.Failures, repeated failures, are finger posts on the road to achievement. The only time you don’t want to fail is the last time you try something. One fails forward toward success.
Charles F. Kettering
don’t be afraid to FAIL....
failfast
combine quality & efficiency.
be patient-centered.
use multiple communication channels and communicate consistently....
welcome tohealthcare2.0
