CAPG StarQuest Presentation 1 Mar11

Wayne Pan, MD, MBAHealth Access Solutions

CMS “5 STAR” Rating System

How to effectivelymanage the

Agenda• The basics

• The approach

• The roll-out

• The demo

• Q&A

The basics• Communication link among all

contracted providers

• Easy to use

• Integrated into the office workflow

• HIPAA-secure

• Web-based

The basics• Dashboard of actionable items

• Who needs something done?

• What is it that they need?

• When do I need to do it?

• Why do I need to do it?

• How can my office reach them?

The basics• Dashboard also functions as:

• Feedback on progress of to-do list

• Compare my office progress with the rest of my peers

• Link to office data entry portal

• Display of bonus achieved thus far

The approach• Involvement of multiple stakeholders

• Primary care physicians

• Specialty physicians

• Ancillary professionals

• Office staff

• Patient

What does this mean?• Involvement of multiple stakeholders

• Provider portal

• Office staff portal

• Patient portal

The roll-out• Stages of a program roll-out

• Level 1: manual process

• Level 2: electronic, provider-centric process

• Level 3: electronic, patient- and provider-centric process

Level 1• Periodic production and distribution of

encounter/lab data in a paper-based physician dashboard (quarterly)

• Manual collection of provider-based data

• Manual entry of provider data into tracking database

• Letters to patients to remind them of missing items

Level 1• Asynchronous data exchange

• Resource-intensive

• Not scalable

• Still with positive ROI, if done well

• Need provider buy-in

Level 2• Use of electronic tools to push

information to providers and office staff

• Goals

• Patients needing contact/services

• Provide near-realtime feedback regarding progress towards goals

• Tying bonus to achieving goals

Level 2• Two audiences

• Office staff

• Providers

• Create a team-based approach to achieving goals

• Provide simple-to-use tools

Level 2• Office staff portal

• Provides communication link

• Reactive approach: when patient shows up in the office

• Proactive approach: when providing patient outreach

Level 2• Office staff portal: reactive approach

• Incorporate into existing workflow

• Eligibility and patient co-pay information

• Pop-up messaging for missing items in provider quality workplan

• Use of portal traceable through auditing

Level 2• Office staff portal: proactive approach

• Generates patient list to support office staff outreach efforts

• Office staff to call patients to schedule appointments for missing items

• MSO member services staff could assist smaller offices to do outreach calls

Level 2• Office staff portal: proactive approach

• Data entry by provider office staff

• Automated IVR outbound appointment reminder calls

Level 2a• Involving the provider through his/her

work environment/workflow

• Paper-based

• Integration with EMR

• Provide electronic tools to help provider track his/her progress towards goals

Level 2a• Physician portal: reactive approach

• Dashboard driven data presentation

• Fully integrated within physician work portal (e.g., EHR)

• Auto creation of necessary referral auths based on missing items

• Auto generation of patient clinical information sheets

Level 3• Involving the patient in addition to the

physician

• Providing self-service patient portal

• Pull - in addition to the push from the provider end

Level 3• Patient portal: proactive approach

• Provide patients with their own clinical data (engage with patients)

• Remind patients of preventive care items that still need to be completed

Level 3• Patient portal: proactive approach

• Reinforce provider messages regarding preventive care (e.g., daily exercise, smoking cessation, need for DXA, etc.)

• Survey patients routinely after physician office visits

The demo

Scenario 1 - Reactive

Sample workflowPatient arrives

at office

1


at office

1Office staff

checks patient in

2


at office

1Office staff

checks patient in

2Office staff

checks eligibility

3


at office

1Office staff

checks patient in

2Office staff

checks eligibility

3Pop-up member

questionnaire

4


at office

1Office staff

checks patient in

2Office staff

checks eligibility

3

Collect questionnaire,

give patient info

5

Pop-up member

questionnaire

4


at office

1Office staff

checks patient in

2Office staff

checks eligibility

3


give patient info

5

Office staffputs reminder(s) on patient chart

6

Pop-up member

questionnaire

4


at office

1Office staff

checks patient in

2Office staff

checks eligibility

3


give patient info

5


6Physician sees

patient with reminder(s)

7

Pop-up member

questionnaire

4


at office

1Office staff

checks patient in

2Office staff

checks eligibility

3


give patient info

5


6Physician sees


7

Patient receives appropriate care

8

Pop-up member

questionnaire

4


at office

1Office staff

checks patient in

2Office staff

checks eligibility

3


give patient info

5


6Physician sees


7


8P4P/HCC/5STAR metrics achieved

for this patient

9

Pop-up member

questionnaire

4

SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD

1/1/2000

1234567890

Quality MeasuresCMS 5 STAR

MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD

Check eligibility


1/1/2000

1234567890




1/1/2000

1234567890



MEDICARE PATIENT

CLOSE x

QUESTIONNAIREHCC

Pop-upmessage


1/1/2000

1234567890



MEDICARE PATIENT

CLOSE x

QUESTIONNAIREHCC

Click toprint


1/1/2000

1234567890



MEDICARE PATIENT

CLOSE x

QUESTIONNAIREHCC Click to

print


1/1/2000

1234567890



Click onmeasures

MARY SMITH1234567890


1/1/2000

1234567890



Medicare Dashboard

MammographyColorectal Cancer ScreeningCardio CareDiabetes CareHypertensionGlaucomaChronic Meds MonitoringFlu VaccinePneumo VaccineBone Density TestingRheumatologic MedicationSpirometry for COPDUrine leakage counselingFalls counselingExercise counselingAppointment easePhysical/emotional health

25FEB111MAR1125FEB1125FEB111MAR1115FEB111MAR118FEB111MAR1125FEB118FEB111MAR111MAR111MAR111MAR111MAR111MAR11

xxxxxxxxxxxxxxxxx

DOC MeasureComplete?

Scenario 2 - Proactive

Sample workflowOffice staff

opens dashboard

1


opens dashboard

1Prints list of

patients needing care

2


opens dashboard

1Prints list of


2Outreach to patients on

list

3


opens dashboard

1Prints list of


2Office staff

checks eligibility and prints

questionnaire


list

3


opens dashboard

1Prints list of


2


give patient info

5

Office staffchecks eligibility

and prints questionnaire


list

3


opens dashboard

1Prints list of


2


6


give patient info

5




list

3


opens dashboard

1Prints list of


2


6Physician sees


7


give patient info

5




list

3


opens dashboard

1Prints list of


2


6Physician sees


7


8


give patient info

5




list

3


opens dashboard

1Prints list of


2


6Physician sees


7


8P4P/HCC/5STAR metrics achieved

for this patient

9


give patient info

5




list

3

Click onmeasure

MARY SMITH

SANDRA SMITH

ANDREW SMITH

PAULA SMITH

Click onpatient

MARY SMITH

SANDRA SMITH

ANDREW SMITH

PAULA SMITH

MARY SMITH1234567890

Click todownload

MARY SMITH

SANDRA SMITH

ANDREW SMITH

PAULA SMITH

SMITH ANDREW SMITH MARYSMITH PAULASMITH SANDRA

MFFF

MARY SMITH


1/1/2000

1234567890



Alice

Betty

Charles

David

Edward

Frank

Georgette

Henry

Illana

Jackie

Kelly

Lori

Mary

Nancy

Octavia

Paul

Quincy

Robert

Samantha

Tom

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Smith

Discussion

Thank you

Wayne Pan, MD, MBAHealth Access Solutions

[email protected]

CMS “5 STAR” Rating System

How to effectivelymanage the

CAPG StarQuest Presentation 1 Mar11

Documents

Transcript of CAPG StarQuest Presentation 1 Mar11