Agn g Incent es to Ach ve the Quadrup...
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4/21/2017 1 Aligning Incentives to Achieve the Quadruple Aim: Session Code: C3 http://www.preventiongroup.com/wellness-incentives/ Ben Keidan, MD, FACP Medical Director of Quality Improvement and Population Health Lauren Hyer, RN, MSN Performance Excellence Specialist Kristin Robson, MPH Clinic Manager Marc Sobel IMAL Patient Advisor & PFAC Member *These presenters have nothing to disclose Presenters:
Transcript of Agn g Incent es to Ach ve the Quadrup...
4/21/2017
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Aligning Incentives to Achieve
the Quadruple Aim: Session Code: C3
http://www.preventiongroup.com/wellness-incentives/
Ben Keidan, MD, FACP Medical Director of Quality Improvement
and Population Health
Lauren Hyer, RN, MSNPerformance Excellence Specialist
Kristin Robson, MPHClinic Manager
Marc SobelIMAL Patient Advisor & PFAC Member
*These presenters have nothing to disclose
Presenters:
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Learning Objectives1. Discuss tools, challenges and engagement strategies to
operationalize a provider incentive program aligning with the
quadruple aim.
2. Identify strategies to successfully integrate the patient voice
in quality improvement efforts.
3. Implementing a comprehensive program to educate
providers, nurse care coordinators and front-line staff on
advanced customer service skills. Strategies included: active
listening techniques, empathy training and motivational
interviewing.
Boulder Community Health
• Community owned-and-operated not-for-profit health
system in Colorado
• 170 bed hospital
• 7 specialty clinics
• 12 primary care clinics
• PCMH Level 3 certified
• CPC+/SIM
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We want your opinion…
• Do you believe financial incentives in health
care, and specifically primary care, are an
effective strategy for improving quality, patient
satisfaction and value?
• Do you believe individual incentives or team
based incentives are more effective?
• Does your institution currently incentivize
quality, patient experience, and value?
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Incentives?
Pros
• Rewards achievement of
agreed upon goals (and
potentially teamwork)
• Leverages natural self
interest
• Recognizes inherent
challenges
• Transparency
Cons /Alternatives
• Unintended consequences
• Change can be challenging
• Moral argument
• Alternative model: salary-
with strict accountability for
performance
Creating Buy-In
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Annual Physician Incentive Scorecard2016
Productivity*
60-80%* > 80%
% MGMA Median wRVU
by Specialty1% Bonus 2% Bonus 0-2 % Bonus
*Productivity bonus must be met to be eligible for annual incentive
Quality Metrics
75 – 90th Percentile > 90th Percentile
Diabetes Control 1% Bonus 2% Bonus 0-2 % Bonus
Hypertension Control 1% Bonus 2% Bonus 0-2 % Bonus
Colon Cancer Screenings 1% Bonus 2% Bonus 0-2% Bonus
Patient Satisfaction
75 – 90th Percentile > 90th Percentile
Provider Rating 1% Bonus 2% Bonus 0-2 % Bonus
Total Annual Incentive Earned: Up to 10 %
Base Pay
Provider Scorecard
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The Cultural Shift:
Five Stages of Grief
Five Stages of Data Grief, Jeni Tennison 12/03/2013https://theodi.org/blog/five-stages-of-data-grief
Denial
• Your data must be
wrong!
• No one is going to get a
bonus.
• This will not improve
quality; we’re just
checking boxes.
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Anger
• Who is responsible
for these errors?
• Who decided on this
program?
• My patients are….
Bargaining
“What if I….”
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Depression• There’s no way we can do this.
• There isn’t enough time in the day.
Acceptance
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Supporting the Care Teams:
Quality
• On demand access to patient registries
• Centralized patient outreach
• Nurse Care Managers in each clinic
• Diabetic educator and chronic disease self-
management classes
• Behavioral health practitioners
Supporting the Care Teams:
Utilization
• Emphasis on shared decision making
• Choosing Wisely
• Variance reduction
• GDR
• Not a current incentive metric
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Supporting the Care Teams:
Caregiver Experience
•
Supporting the Care Teams:
The Patient Experience
• Communication Skills
– Motivational interviewing training
– Clinic presentations on best practices in patient
communication
– Patient experience scorecards
– Customer service training for front desk staff
• Patient partnerships
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Patient Partnership
It is reassuring to a patient to see that behind the white coats, acronyms, and technical terminology there are real people trying to improve what they do for and with their patients. Not magic but complicated, conscientious work. It's also personally thrilling to see, from time to time, that what seems to be a simple question can help.
Patient Advisor
WHERE
Patient Partnership
Rationale
• Unique opportunity to
improve the patient
experience
• QI committee work
becomes more patient
centered
Best Practice
Active PFAC
WHY?
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Patient Partnership
Recruitment Strategy
– Patients known to the clinic
– Ask for Provider recommendations
– Post flyer for volunteers
Considerations
– Background and experience
– The “Whole Patient” Perspective
WHO?
Patient Partnership
Initial Contact by Nurse Care Coordinator or Office
Manager to assess patient interest
Meet and Greet with:
– QI team
– Nurse Care Coordinator
– Office Manager
– Other patient advisors
WHAT?
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Patient Partnership
Onboarding
• Robust Volunteer program at BCH
– Utilize Volunteer training/orientation
– Help the patient feel they are part of something larger
• Paperwork
– HIPAA
– Confidentiality Agreement
– Background Check
Patient Partnership
Structure and Information for Clinic QI Team
– Awareness of Jargon
Definition Sheets for Patient Advisor
– Explain acronyms
– Define metrics
Ground rules for meetings
– Collect distributed data at the end meetings
WHERE & WHEN?
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Patient Partnership
Patient Partnership
• Quality Improvement is not magic
• Improvement in both traditional and
new metrics
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Patient Partnership:Personal Experience and Motivation
http://i.imgur.com/pDZqt7o.jpg
• Personal experience as an “Interesting” patient
• Opportunity to help
• Sense of the stakes
• Can be useful
Patient Partnership:
Challenges
TLA’s
Percentile/Percent
Onboarding/Orientation can
address learning curve
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Patient Partnership:
Lessons Learned
Practicality
Focus on items where people
can “take action”
65%72% 71%
77%
0%
20%
40%
60%
80%
100%
2013 2014 2015 2016
BCH Primary Care-NQF 0018
Hypertensive Pts in Control
(Last BP < 140/90)
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49% 51%
65%72%
0%
10%
20%
30%
40%
50%
60%
70%
80%
2013 2014 2015 2016
BCH Primary Care-NQF 0034
Colorectal Cancer Screening Rates
35%
26%22% 21%
0%
10%
20%
30%
40%
2013 2014 2015 2016
BCH Primary Care-NQF 0059
Diabetics in Poor Control (HbA1c >9)
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76.3% 75.9%
73.9%
76.2%75.5%
74.7%
78.3%
85.4%
90.5%91.8% 91.1%
91.9%91.0%
92.9%93.7%
95.3%
76.6%77.8%
76.3%
78.6% 79.3%80.90% 80.7%
85.8%88.4%89.9% 88.4% 89.4% 88.80%
90.70%91%
95.4%
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
BCH Ambulatory
Patient Experience Data
Rate Your Provider Listen Carefully
Medical History Provider Communication
6987
7769
9294
11223
12374
0
2000
4000
6000
8000
10000
12000
14000
2012-13 2013-14 2014-15 2015-16 2016-2017
Flu Shots Administered
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Current state
2015
(Productivity Based )
2016
(Productivity + Quality
Based)
Percentage of Providers
Bonused
8% 65%
Number of Providers
Bonused
4 28
Total Dollars Distributed $44,000 $222,000
Productivity Increased 5% from 2015
Current state
Metric Q2 2016 Distribution Q4 2016 Distribution
Total Quality Points
Earned
136 171
Total Patient Experience
Points Earned
9 19
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Lessons Learned: Successes
• Local control
• Patient centered
• Balanced
• Carrot not a stick
Lessons Learned: Potholes
• No stick
• Data distribution – RVU threshold
• Celebrating successes
• Utilization data
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Future State
• Team based bonuses
• Expansion of incentive program to
specialists and more metrics
• Spread to inpatient providers
• Truly Value Based: Utilization metric
Thank You!
Questions?
