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5 dangerous ideas

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    5 dangerous ideas 5 dangerous ideas Presentation Transcript

    • SCCIPA A Pacific Partners Medical Group5 dangerous ideas*Wayne Pan, MDSanta Clara County IPA
    • but first, some audience questions
    • PLEASE STAND IF:you are concerned about STAR ratings
    • PLEASE REMAIN STANDING IF: you are a provider
    • PLEASE REMAIN STANDING IF:you are part of a delegated group
    • PLEASE REMAIN STANDING IF:your group has a common EHR
    • PLEASE REMAIN STANDING IF:your common EHR is helping you with your STAR rating program
    • NOW, LOOK AROUND YOU
    • we ALL can learn from those left standing
    • it’s NOT about the EHR
    • it’s about people and processes
    • supported by the right technology
    • dialog (noun) ˈdī-ə-ˌlȯg, -ˌläg2a: a conversation between two or more persons
    • dangerous idea: # 1
    • “Ask not what yourhealth plan can do for you; ask whatyou can do for your health plan.”
    • partnership (noun) -ˌship3: a relationship resembling a legal partnership andusually involving close cooperation betweenparties having specified and joint rights andresponsibilitiesfrom: merriam-webster.com
    • Seniordoctor patients
    • Seniordoctor patients
    • doctor patientproviders clinically treat patients all the same
    • www.iha.org
    • www.iceforhealth.org
    • • Provider programs - work with providers to ensure nonduplicative efforts• Member outreach - help providers with things they can’t do well• Clinical data - old data is worse than no data
    • dangerous idea: # 2
    • • Consistent communication plan - providers do not like surprises• Use multiple channels - providers are unique, each has preferred method• Embrace office staff - not everything needs to go through the provider
    • dangerous idea: # 3
    • feedback
    • • Progress toward set goals• Performance comparison with peers• Customized help for improvement
    • iteration
    • dangerous idea: # 4
    • • Set aside money in advance• Clear performance targets• Transparent incentive program
    • dangerous idea: # 5
    • address the whole patient
    • • Link to annual HCC process• Link to all quality improvement programs• Use HCC risk scores to target outreach
    • it’s not just about STAR ratings
    • it’s really about patient care
    • too many of these
    • Santa Clara County 1,304.01 sq. miles 1,781,642 (2010) $74,335
    • 5 PCP 80 Specialists 173 PCP 343 Specialists 57 PCP 104 Specialists 11 PCP 30 SpecialistsSCCIPA founded in 1986 physician-owned, physician-governed 800+ physicians - 240+ PCPs, 550+ specialists all 9 hospitals - including a tertiary care center 9 health plans (Commercial and Medicare Advantage)
    • full disclosure
    • SCCIPA GroupA Pacific Partners Medical
    • • Internal: • 2 RN’s - one CCM, one UM • 2 LVN’s - one CCM, one UM • 1 EMT • 1 clinical data analyst • 4 non-clinical• External: • 2 RN’s - onsite CM • 1 MSW - onsite @ SNFs • Hospitalist group (9 physicians) • 1 SNFist
    • 1how do we partner with health plans?
    • review & utilize health plan resources
    • provider training/education materials disease management programs patient-specific initiatives incentive programs quarterly sync-up meetings
    • 2require all physicians to use AccessExpress
    • our common communication platform
    • HIPAA-compliant secure communications eligibility resource electronic referral authorizations claims and authorization status
    • how do you make a platform helpful?
    • integration into the office workflow
    • how do you make a platform effective?
    • engage office staff
    • patient
    • patient front desk staff
    • analog to digital converter
    • 112 MARY SMITH 1/1/2011 1234567890 $5.00 $10.00 $25.00analog to digital eligibility check converter
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
    • ACCESSEXPRESS Q New Eligibility Response New Message (3) SMITH, MARY 8/15/1945 1234567890 MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
    • ACCESSEXPRESS Q New Eligibility Response New Message (3) SMITH, MARY 8/15/1945 1234567890 MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
    • digital to analog converter module
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • 3used same communication platform for provider feedback
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • 4physician bonus program based on achieving set targets
    • 2011 Bonus Structure PCPs: 2011 IHA P4P and HCC CMS 5 STAR rating measuresParticipation in patient satisfaction training (4 meetings)Patient satisfaction scores (based on the CAHPS survey)Responsiveness to PPMSI Med Management inquiries
    • 2011 Bonus Structure Specialists: billing or SCCIPA unique patient volumeOverall achievement of SCCIPA in the CMS 5 STAR Rating Program Participation in patient satisfaction training program (4 meetings) Patient satisfaction scores (based on internal survey) Use of Excelicare Clinical HubResponsiveness to PPMSI Medical Management inquiries (timeliness)
    • 5how do we focus on the whole patient?
    • send patient reminders for annual visit provide providers checklist prompt front office staff HOS survey full HCC review by hospitalists 48hr discharge follow-up post-discharge office visit follow-uppost home health initiation follow-up
    • send patient reminders for annual visit provide providers checklist prompt front office staff HOS survey full HCC review by hospitalists 48hr discharge follow-up post-discharge office visit follow-uppost home health initiation follow-up
    • send patient reminders for annual visit provide providers checklist prompt front office staff HOS survey full HCC review by hospitalists 48hr discharge follow-up post-discharge office visit follow-uppost home health initiation follow-up
    • 5 dangerous ideas• find ways to partner with your health plans• have a consistent, multi-faceted communication strategy• provide ample, data-driven feedback• put money where your goals are• focus on the whole patient
    • discussion
    • thankyou
    • SCCIPA A Pacific Partners Medical Groupwpan@ppmsi.com