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Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
Incentivizing and aligning providers 23 jul12 final
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Incentivizing and aligning providers 23 jul12 final

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Presentation given at the RISE 2nd Annual Summit on Integrating Risk Adjustment and Quality Measures, Westlake Village, CA, 23JUL12

Presentation given at the RISE 2nd Annual Summit on Integrating Risk Adjustment and Quality Measures, Westlake Village, CA, 23JUL12

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  • 1. incentivizing and aligning providers wayne pan, md, mba chief medical officer pacific partners management services, inc.The RISE 2nd Annual Summit on Integrating Risk Adjustment and Quality Measures • Westlake Village, CA • July 23, 2012
  • 2. ...standing on the shoulders of giants Sir Isaac Newton
  • 3. QUESTION
  • 4. 100%ACHIEVING
  • 5. WHY NOT?
  • 6. PROBLEM
  • 7. insanity: doing the samething over and over andexpecting different results
  • 8. Let’s take astep back... from: http://step-dad.blogspot.com/2010/04/step-back.html
  • 9. humanbehavior
  • 10. somebasics
  • 11. humannature
  • 12. humannaturelazy
  • 13. humannaturesocial
  • 14. humannaturecreaturesofhabit
  • 15. human lazy socialnature habitnotgood@change
  • 16. human lazy socialnature habitsocialnorms
  • 17. human lazy socialnature habitstatusquo
  • 18. human lazy socialnature habitsocialnorms
  • 19. doctornature
  • 20. doctornaturecompetitive
  • 21. doctornatureindependent
  • 22. doctornaturecurious
  • 23. doctor competitivenature independent curiousformsilos
  • 24. doctor competitivenature independent curiousnotgood@cooperation
  • 25. doctor competitivenature independent curiousnotgood@collaboration
  • 26. doctor competitivenature independent curiouscurious
  • 27. doctor competitivenature independent curiouscompetitive
  • 28. doctor competitivenature independent curiouscompetence
  • 29. doctor competitivenature independent curiousmastery
  • 30. leverageour nature
  • 31. leverageour nature4 behaviorchange
  • 32. assumptions aboutimprovingquality andaffordability
  • 33. assumptions aboutimprovingquality andaffordabilityclinicians care about bothwant to improve bothwant feedback on both
  • 34. michaelvandurenmdmbasutterhealth
  • 35. PREFERRED NON-PREFERRED variation reduction Drug Utilization PatternDrug ADrug BDrug CDrug D
  • 36. prescribing preferreddrug increases
  • 37. prescribing preferreddrug increases average drug cost drops
  • 38. prescribing preferred drug increases average drug cost dropssavings over baseline accumulate
  • 39. prescribing preferreddrug increases
  • 40. prescribing preferreddrug increases average drug cost drops
  • 41. prescribing preferred drug increases average drug cost dropsno adverse effect on quality
  • 42. prescribing preferred drug increases average drug cost dropsno adverse effect on quality savings begin to accrue
  • 43. how did thathappen?
  • 44. motivation1.0
  • 45. motivation2.0
  • 46. motivation3.0
  • 47. MOTIVATIONLearning & Challenging Incentives & Punishment intrinsic extrinsic
  • 48. MOTIVATIONLearning & Challenging Incentives & Punishment intrinsic extrinsic
  • 49. VLearning & Challenging Incentives & Punishment intrinsic extrinsic
  • 50. reframe
  • 51. easy
  • 52. easyaccessible
  • 53. easyaccessibledesign for failure
  • 54. easyaccessibledesign for failureachievement
  • 55. easyaccessibledesign for failureachievementfeedback
  • 56. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
  • 57. it’smorethanjustdata
  • 58. it’salsoaboutwhomyour DATAservingdata to
  • 59. savvyconsumers
  • 60. not current error prone MPASTEEno comparator
  • 61. unadulterated
  • 62. nonjudgemental
  • 63. showmetheDATA
  • 64. “put hottriggers inthe path ofmotivatedpeople”BJ Fogg, PhDDirector, Persuasive Technology LabStanford University
  • 65. Are incentives aligned properly?How can I increase their motivation?
  • 66. Have I made it easy for people to act?How can I make it even simpler?
  • 67. Are people being triggered at the mostappropriate time and in their workflow (path)?
  • 68. putting it all together: how does it work?
  • 69. patient
  • 70. patient front desk staff
  • 71. patient analog to digital front desk staff converter
  • 72. AMERICAN HEALTH PLAN 112 MARY SMITH 1/1/2011 1234567890 $5.00 $10.00 $25.00analog to digital analog to digital eligibility check converter converter
  • 73. QualityAccess Express TM Management Click here to register for a password or request more informationPowered by Access ExpressQ-v5.0.#.0.1 Build 2011.04.04.00
  • 74. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  • 75. ACCESSEXPRESS Q New Eligibility Response New Message (3) AMERICAN HEALTH PLAN
  • 76. ACCESSEXPRESS Q New Eligibility Response New Message (3) TH PA AMERICAN HEALTH PLAN E TH IN
  • 77. 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
  • 78. digital to analog converter module
  • 79. x x x x x x x xdigital to analog converter module
  • 80. 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
  • 81. AMREICAN HEALTH PLAN
  • 82. AMREICAN HEALTH PLAN
  • 83. AMREICAN HEALTH PLAN
  • 84. 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
  • 85. ACCESSEXPRESS Q New Eligibility Response New Message (3) ENABLING SMITH, MARY 8/15/1945 1234567890 FRONT OFFICE MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, STAFF GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  • 86. ACCESSEXPRESS Q New Eligibility Response New Message (3) SMITH, MARY 8/15/1945 SIMPLE 1234567890 CARE PLAN MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  • 87. 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
  • 88. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  • 89. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  • 90. ACCESSEXPRESS Q New Eligibility Response New Message (3) N O TI VA TI O M
  • 91. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  • 92. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  • 93. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  • 94. Description ofmeasure
  • 95. Capability forphysician officeentry
  • 96. Capability forphysician officeentry Y IT IL AB
  • 97. ourresults@SCCIPA
  • 98. commercialadmits/100080 Milliman - Loosely-Managed70 Milliman - Moderately-Managed60 Milliman - Well-Managed50 SCCIPA40 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
  • 99. commercialbeddays/1000275 Milliman ’11 Loosely-Managed Milliman - Loosely-Managed250225 Milliman -’11 Moderately-Managed Milliman Moderately-Managed200 SCCIPA SCCIPA175 Milliman ’11 Well-Managed Milliman - Well-Managed150 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
  • 100. commercialalos4.54.0 Milliman - Loosely-Managed3.5 Milliman - Moderately-Managed SCCIPA3.0 Milliman - Well-Managed2.5 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
  • 101. medicareadmits/1000400 Milliman - Loosely-Managed350 Milliman - Moderately-Managed300 SCCIPA Milliman - Well-Managed250200 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
  • 102. medicarebeddays/10002,2002,000 Milliman - Loosely-Managed1,8001,600 Milliman - Moderately-Managed1,400 SCCIPA1,200 Milliman - Well-Managed1,000 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
  • 103. medicarealos6.05.5 Milliman - Loosely-Managed5.0 Milliman - Moderately-Managed4.5 SCCIPA Milliman - Well-Managed4.0 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
  • 104. * * * * *increase/same scores in 21 of 26 measures
  • 105. anessentialaspect ofcreativity isnot beingafraid tofail- edwin land
  • 106. failfast
  • 107. no
  • 108. 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
  • 109. iterate
  • 110. a journey of a thousand miles, begins with a single step - Lao-Tzu
  • 111. don’t beafraid totake theplunge
  • 112. Thank you! wpan@ppmsi.com slideshare.net/bonedoc97WWW.SNOOPY.COM

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