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

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Incentivizing and aligning providers 23 jul12 final

  1. 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. 2. ...standing on the shoulders of giants Sir Isaac Newton
  3. 3. QUESTION
  4. 4. 100%ACHIEVING
  5. 5. WHY NOT?
  6. 6. PROBLEM
  7. 7. insanity: doing the samething over and over andexpecting different results
  8. 8. Let’s take astep back... from: http://step-dad.blogspot.com/2010/04/step-back.html
  9. 9. humanbehavior
  10. 10. somebasics
  11. 11. humannature
  12. 12. humannaturelazy
  13. 13. humannaturesocial
  14. 14. humannaturecreaturesofhabit
  15. 15. human lazy socialnature habitnotgood@change
  16. 16. human lazy socialnature habitsocialnorms
  17. 17. human lazy socialnature habitstatusquo
  18. 18. human lazy socialnature habitsocialnorms
  19. 19. doctornature
  20. 20. doctornaturecompetitive
  21. 21. doctornatureindependent
  22. 22. doctornaturecurious
  23. 23. doctor competitivenature independent curiousformsilos
  24. 24. doctor competitivenature independent curiousnotgood@cooperation
  25. 25. doctor competitivenature independent curiousnotgood@collaboration
  26. 26. doctor competitivenature independent curiouscurious
  27. 27. doctor competitivenature independent curiouscompetitive
  28. 28. doctor competitivenature independent curiouscompetence
  29. 29. doctor competitivenature independent curiousmastery
  30. 30. leverageour nature
  31. 31. leverageour nature4 behaviorchange
  32. 32. assumptions aboutimprovingquality andaffordability
  33. 33. assumptions aboutimprovingquality andaffordabilityclinicians care about bothwant to improve bothwant feedback on both
  34. 34. michaelvandurenmdmbasutterhealth
  35. 35. PREFERRED NON-PREFERRED variation reduction Drug Utilization PatternDrug ADrug BDrug CDrug D
  36. 36. prescribing preferreddrug increases
  37. 37. prescribing preferreddrug increases average drug cost drops
  38. 38. prescribing preferred drug increases average drug cost dropssavings over baseline accumulate
  39. 39. prescribing preferreddrug increases
  40. 40. prescribing preferreddrug increases average drug cost drops
  41. 41. prescribing preferred drug increases average drug cost dropsno adverse effect on quality
  42. 42. prescribing preferred drug increases average drug cost dropsno adverse effect on quality savings begin to accrue
  43. 43. how did thathappen?
  44. 44. motivation1.0
  45. 45. motivation2.0
  46. 46. motivation3.0
  47. 47. MOTIVATIONLearning & Challenging Incentives & Punishment intrinsic extrinsic
  48. 48. MOTIVATIONLearning & Challenging Incentives & Punishment intrinsic extrinsic
  49. 49. VLearning & Challenging Incentives & Punishment intrinsic extrinsic
  50. 50. reframe
  51. 51. easy
  52. 52. easyaccessible
  53. 53. easyaccessibledesign for failure
  54. 54. easyaccessibledesign for failureachievement
  55. 55. easyaccessibledesign for failureachievementfeedback
  56. 56. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
  57. 57. it’smorethanjustdata
  58. 58. it’salsoaboutwhomyour DATAservingdata to
  59. 59. savvyconsumers
  60. 60. not current error prone MPASTEEno comparator
  61. 61. unadulterated
  62. 62. nonjudgemental
  63. 63. showmetheDATA
  64. 64. “put hottriggers inthe path ofmotivatedpeople”BJ Fogg, PhDDirector, Persuasive Technology LabStanford University
  65. 65. Are incentives aligned properly?How can I increase their motivation?
  66. 66. Have I made it easy for people to act?How can I make it even simpler?
  67. 67. Are people being triggered at the mostappropriate time and in their workflow (path)?
  68. 68. putting it all together: how does it work?
  69. 69. patient
  70. 70. patient front desk staff
  71. 71. patient analog to digital front desk staff converter
  72. 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. 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. 74. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  75. 75. ACCESSEXPRESS Q New Eligibility Response New Message (3) AMERICAN HEALTH PLAN
  76. 76. ACCESSEXPRESS Q New Eligibility Response New Message (3) TH PA AMERICAN HEALTH PLAN E TH IN
  77. 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. 78. digital to analog converter module
  79. 79. x x x x x x x xdigital to analog converter module
  80. 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. 81. AMREICAN HEALTH PLAN
  82. 82. AMREICAN HEALTH PLAN
  83. 83. AMREICAN HEALTH PLAN
  84. 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. 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. 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. 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. 88. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  89. 89. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  90. 90. ACCESSEXPRESS Q New Eligibility Response New Message (3) N O TI VA TI O M
  91. 91. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  92. 92. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  93. 93. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  94. 94. Description ofmeasure
  95. 95. Capability forphysician officeentry
  96. 96. Capability forphysician officeentry Y IT IL AB
  97. 97. ourresults@SCCIPA
  98. 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. 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. 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. 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. 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. 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. 104. * * * * *increase/same scores in 21 of 26 measures
  105. 105. anessentialaspect ofcreativity isnot beingafraid tofail- edwin land
  106. 106. failfast
  107. 107. no
  108. 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. 109. iterate
  110. 110. a journey of a thousand miles, begins with a single step - Lao-Tzu
  111. 111. don’t beafraid totake theplunge
  112. 112. Thank you! wpan@ppmsi.com slideshare.net/bonedoc97WWW.SNOOPY.COM

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