How star rating measures correlate with overall hedis quality (full) 16 jan12
Transcript of How star rating measures correlate with overall hedis quality (full) 16 jan12
How Star Rating Measures Correlate withOverall HEDIS Quality
Wayne Pan, MD, MBAChief Medical OfficerPacific Partners Management Services, Inc.
Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012
RETIRED Measures
From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
? New Measures
From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
Average Stars ofNew Measures
From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
PART C Measures
HEDIS: Health Effectiveness Data and Information Set
HEDIS: Health Effectiveness Data and Information Set
HEDIS: Health Effectiveness Data and Information Set
*
**
Only applies to plan enrollees 65+ years old
CAHPS: Consumer Assessment of Health Providers and Systems
HOS: Health Outcomes Survey
CMS DATA: Data Collected by CMS from Plans
PART D Measures
WEIGHTING
Outcomes 3x
Intermediate Outcomes 3x
Patient Experience 1.5x
Patient Access 1.5x
Process 1x
From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
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a simpler way to manage your P4P/CMS 5 Star quality program
wayne pan, md, mba
overview• who are the key players that need to be
involved in this process?
• how can you engage the players in an effective, systematic way?
• how can you measure performance and provide feedback?
• how can you engage patients?
how are you going to coordinate all three stakeholders?
healthplans
need a bidirectional messaging platform
need a cost-effective way to communicate with patients
need a way to consolidate all health plans into one platform
NOT
office manager’s view
Senior
doctor
patients
physician’s view
Senior
doctor
patients
doctor patient
how can you affect changein the physician’s office?
payer-provider collaborationis a team sport
patient
patient
front desk staff
analog to digitalconverter
analog to digitalconverter
eligibility check
MARY SMITH1234567890
1121/1/2011
$5.00$10.00$25.00
how to engage your team in quality improvement efforts?
put hot triggers in the path of
motivated peopleBJ Fogg, PhD
Director, Persuasive Technology LabStanford University
TRIGGERS: Are people being triggered at the most appropriate time and in their workflow (path)?
ABILITY: Have I made it easy for people to act? How can I make it even simpler?
MOTIVATION: Are incentives aligned properly? How can I increase their motivation?
Introducing...
ACCESSEXPRESSQ
ACCESSEXPRESSQ
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
IN THE PATH
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
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
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
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
ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
ACCESSEXPRESSQ New Message (3)New Eligibility Response
digital to analog converter module
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
ACCESSEXPRESSQ New Message (3)New Eligibility Response
Description ofmeasure
Capability forphysician officeentry
Capability forphysician officeentry
ABILITY
ACCESSEXPRESSQ New Message (3)New Eligibility Response
how can you affect changein the physician’s office?
engage your team in quality improvement efforts
“put hot triggers in the path of motivated people”
BJ Fogg, PhDDirector, Persuasive Technology LabStanford University