Best Practices for Data Analysis            A Chasing Logic Case Study     Wayne Pan, MD, MBA            Chief Medical Offi...
Best Practices for Data Analysis            A Chasing Logic Case Study?     Wayne Pan, MD, MBA            Chief Medical Of...
to recap....               Breaking Down the Silos for Risk Adjustment, HEDIS & Care Management:                         F...
we cannot continue to keep quality,      risk adjustment/stratification,                 cost-effectiveness,              m...
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 bonusprograms into a single coherentprogram for physicians
results: very modest gains inquality outcomes despite morethan half a billion dollars in P4Pbonuses 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 changeprovider or patient behavior
the plans didn’t save any money
sponsored byIHAP4P
two ideas....
combine quality & efficiency....
Two Strategic P4P Goals for 2011 2015Goal #1: Bend the cost trend   Targets:   •Total cost below risk adjusted, geography ...
be patient-centered....
why does that matter?
insanity: doing the      samething over  and over        andexpecting   different    results
get out of our rut?
4x4   healthcare
4processes
communication
collaboration
Case           ManagersPatients              PCPs           Specialists     coordination
anticipation
4dimensionaldata
financial
administrative
clinical
retrospective   retrospective
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 communicationchannels and communicateconsistently....
case study: SCCIPA
Santa Clara County 1,304.01 sq. miles  1,781,642 (2010)           $74,335
5 PCP 80 Specialists                                           173 PCP                                           343 Speci...
peopleprocessesplatform
peoplehospitalistsSNFistsonsite case managerscomplex case managersutilization review staff
processesP4P/CMS 5 STAR dashboardincentive bonus based on qualityAscender for HCC processpaper quarterly physician workpla...
platformcommon web-based communication platformfacilitates administrative functionsrules-based management of processesintu...
results
Inpatient	  Hospital	  Admissions	         Per	  1000	  Enrolled	  Patients	  (Commercial)70.060.050.040.0           2011	...
Bed	  Days	  Per	  1000	  Enrolled	  Population	  (Commercial)300.0250.0200.0150.0100.0                    2011	  Milliman...
Average	  Length	  of	  Stay	  (Commercial)4.33.83.32.8       2011	  Milliman	  Benchmark	  (Well	  Managed)       2011	  ...
Inpatient	  Hospital	  Admissions	          Per	  1000	  Enrolled	  Population	  (Medicare)350.0300.0250.0200.0         20...
Bed	  Days	  Per	  1000	  Enrolled	  Population	  (Medicare)20001750150012501000 750                  2011	  Milliman	  Be...
Average	  Length	  of	  Stay	  (Medicare)5.55.04.54.0      2011	  Milliman	  Benchmark	  (Well	  Managed)      2011	  Mill...
*                                 *                                 *                                 *                   ...
no
When you improve a little biteach day, eventually big thingsoccur. Don’t look for big, quickimprovement. Instead, seeksmal...
iteration
Virtually nothing comesout right the first time.Failures, repeatedfailures, are finger postson the road toachievement. The o...
don’t be afraid to FAIL....
failfast
combine quality & efficiency.
be patient-centered.
use multiple communicationchannels and communicateconsistently....
welcome tohealthcare2.0
Thank you!  wpan@ppmsi.comWWW.SNOOPY.COM
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
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Best practices for data analysis 16 jan12

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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 16 jan12

  1. 1. Best Practices for Data Analysis A Chasing Logic Case Study Wayne Pan, MD, MBA Chief Medical Officer Pacific Partners Management Services, Inc.Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012
  2. 2. Best Practices for Data Analysis A Chasing Logic Case Study? Wayne Pan, MD, MBA Chief Medical Officer Pacific Partners Management Services, Inc.Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012
  3. 3. 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 BothPractical 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 Effective Quality Improvement Partnerships A Collaborated Effort: Plans & Providers Working to Improve Clinical Outcomes Provider Education & Incentives: Creating Tools & Toolkits for Providers That They Will Use
  4. 4. we cannot continue to keep quality, risk adjustment/stratification, cost-effectiveness, medical management, network management, and member engagement in separate silos
  5. 5. that’s because....
  6. 6. they’re all related!
  7. 7. with the common denominator....
  8. 8. the patient.
  9. 9. some learnings from California’s IHA P4P....
  10. 10. theory: combine the variousplans’ quality P4P bonusprograms into a single coherentprogram for physicians
  11. 11. results: very modest gains inquality outcomes despite morethan half a billion dollars in P4Pbonuses paid out, since 2004
  12. 12. what happened?
  13. 13. not enough money set asidequality not linked to efficiencyproviders always have sicker,less compliant patients
  14. 14. the P4P program didn’t changeprovider or patient behavior
  15. 15. the plans didn’t save any money
  16. 16. sponsored byIHAP4P
  17. 17. two ideas....
  18. 18. combine quality & efficiency....
  19. 19. Two Strategic P4P Goals for 2011 2015Goal #1: Bend the cost trend Targets: •Total cost below risk adjusted, geography adjusted average •Total Cost trend below Consumer Price Index +1Goal #2: Achieve meaningful quality improvements in clinical care and patient experience, and increase meaningful use of health IT Copyright © 2011 Integrated Healthcare Association. All rights reserved. 4
  20. 20. be patient-centered....
  21. 21. why does that matter?
  22. 22. insanity: doing the samething over and over andexpecting different results
  23. 23. get out of our rut?
  24. 24. 4x4 healthcare
  25. 25. 4processes
  26. 26. communication
  27. 27. collaboration
  28. 28. Case ManagersPatients PCPs Specialists coordination
  29. 29. anticipation
  30. 30. 4dimensionaldata
  31. 31. financial
  32. 32. administrative
  33. 33. clinical
  34. 34. retrospective retrospective
  35. 35. reactivecare
  36. 36. $$$$$$
  37. 37. + behavioral
  38. 38. predictive
  39. 39. prediction can lead to....
  40. 40. proactivecare
  41. 41. From: Dan Roam, “American Healthcare: a 4-napkin explanation”www.slideshare.net/danroam/healthcare-napkins-all
  42. 42. one more thing....
  43. 43. all providers are not the same
  44. 44. use multiple communicationchannels and communicateconsistently....
  45. 45. case study: SCCIPA
  46. 46. Santa Clara County 1,304.01 sq. miles 1,781,642 (2010) $74,335
  47. 47. 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)
  48. 48. peopleprocessesplatform
  49. 49. peoplehospitalistsSNFistsonsite case managerscomplex case managersutilization review staff
  50. 50. processesP4P/CMS 5 STAR dashboardincentive bonus based on qualityAscender for HCC processpaper quarterly physician workplanhospitalists perform HCC coding
  51. 51. platformcommon 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
  52. 52. results
  53. 53. Inpatient  Hospital  Admissions   Per  1000  Enrolled  Patients  (Commercial)70.060.050.040.0 2011  Milliman  Benchmark  (Well  Managed) 2011  Milliman  Benchmark  (Moderately  Managed) 2011  Milliman  Benchmark  (Loosely  Managed) SCCIPA  A dmits  per  1000  (Commercial)
  54. 54. Bed  Days  Per  1000  Enrolled  Population  (Commercial)300.0250.0200.0150.0100.0 2011  Milliman  Benchmark  (Well  Managed) 2011  Milliman  Benchmark  (Moderately  Managed) 2011  Milliman  Benchmark  (Loosely  Managed) SCCIPA  Bed  Days  (Commercial)
  55. 55. Average  Length  of  Stay  (Commercial)4.33.83.32.8 2011  Milliman  Benchmark  (Well  Managed) 2011  Milliman  Benchmark  (Moderately  Managed) 2011  Milliman  Benchmark  (Loosely  Managed) SCCIPA  A verage  L ength  of  Stay  (Commercial)
  56. 56. Inpatient  Hospital  Admissions   Per  1000  Enrolled  Population  (Medicare)350.0300.0250.0200.0 2011  Milliman  Benchmark  (Well  Managed) 2011  Milliman  Benchmark  (Moderately  Managed) 2011  Milliman  Benchmark  (Loosely  Managed) SCCIPA  A dmits  (Medicare)
  57. 57. Bed  Days  Per  1000  Enrolled  Population  (Medicare)20001750150012501000 750 2011  Milliman  Benchmark  (Well  Managed) 2011  Milliman  Benchmark  (Moderately  Managed) 2011  Milliman  Benchmark  (Loosely  Managed) SCCIPA  Bed  Days  (Medicare)
  58. 58. Average  Length  of  Stay  (Medicare)5.55.04.54.0 2011  Milliman  Benchmark  (Well  Managed) 2011  Milliman  Benchmark  (Moderately  Managed) 2011  Milliman  Benchmark  (Loosely  Managed) SCCIPA  A LOS(Medicare)
  59. 59. * * * * *increase/same scores in 21 of 26 measures
  60. 60. no
  61. 61. When you improve a little biteach day, eventually big thingsoccur. Don’t look for big, quickimprovement. Instead, seeksmall improvement one day at atime. That’s the only way ithappens - and when it happens,it lasts. John Wooden
  62. 62. iteration
  63. 63. Virtually nothing comesout right the first time.Failures, repeatedfailures, are finger postson the road toachievement. The onlytime you don’t want tofail is the last time you trysomething. One failsforward toward success.Charles F. Kettering
  64. 64. don’t be afraid to FAIL....
  65. 65. failfast
  66. 66. combine quality & efficiency.
  67. 67. be patient-centered.
  68. 68. use multiple communicationchannels and communicateconsistently....
  69. 69. welcome tohealthcare2.0
  70. 70. Thank you! wpan@ppmsi.comWWW.SNOOPY.COM
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