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How star rating measures correlate with overall hedis quality (full) 16 jan12
 

How star rating measures correlate with overall hedis quality (full) 16 jan12

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Presentation given at the Breakthrough Strategies to Boost HEDIS Scores & Quality Management meeting, Key West, January 16, 2012.

Presentation given at the Breakthrough Strategies to Boost HEDIS Scores & Quality Management meeting, Key West, January 16, 2012.

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    How star rating measures correlate with overall hedis quality (full) 16 jan12 How star rating measures correlate with overall hedis quality (full) 16 jan12 Presentation Transcript

    • How Star Rating Measures Correlate with Overall HEDIS Quality 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
    • 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 of New 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 3xIntermediate 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)
    • ?
    • a simpler way to manage yourP4P/CMS 5 Star qualityprogramwayne 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 coordinateall three stakeholders? health plans
    • need a bidirectional messagingplatform
    • need a cost-effective way tocommunicate with patients
    • need a way to consolidate allhealth plans into one platform
    • NOT
    • office manager’s view
    • Seniordoctor patients
    • physician’s view
    • Seniordoctor patients
    • doctor patient
    • how can you affect change in the physician’s office?
    • payer-provider collaboration is a team sport
    • 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
    • how to engage your team inquality improvement efforts?
    • put hot triggers in the path ofmotivated people BJ Fogg, PhD Director, Persuasive Technology Lab Stanford University
    • TRIGGERS: Are people being triggered at themost 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 alignedproperly? How can I increase their motivation?
    • Introducing... ACCESSEXPRESS Q
    • ACCESSEXPRESS Q Click here to register for a password or request more informationPowered by Access ExpressQ-v5.0.#.0.1 Build 2011.04.04.00
    • 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) TH PA BLUE SHIELD OF CA E TH IN
    • ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
    • ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
    • 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 POP-UP 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 CLICK HERE
    • ACCESSEXPRESS Q New Eligibility Response New Message (3) ER SMITH, MARY 8/15/1945 G 1234567890 IG MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, TR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD T O H
    • 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) BLUE SHIELD OF CA
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • digital to analog converter module
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • ACCESSEXPRESS Q New Eligibility Response New Message (3) N O TI VA TI O M
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • Description ofmeasure
    • Capability forphysician officeentry
    • Capability forphysician officeentry Y IT IL AB
    • ACCESSEXPRESS Q New Eligibility Response New Message (3)
    • how can you affect change in the physician’s office?
    • engage your team in quality improvement efforts
    • “put hot triggers in the path of motivated people” BJ Fogg, PhD Director, Persuasive Technology Lab Stanford University
    • thankyouwpan@ppmsi.com