0
Leveraging the Entire Care Team to ImproveCare Management and Data Capture Wayne Pan, MD, MBA Chief Medical Officer Pacifi...
3takeaways
1drawtheBIGpicture
2showmetheDATA
gowiththeFLOW3
1
vision
process
process
same page
teammates
goals   goals
metrics
outcomes
rewards
2
it’smorethanjustdata
it’salsoaboutwhomyour          DATAservingdata to
savvyconsumers
not current error prone  MPASTEEno comparator
unadulterated
michaelvandurenmdmbasutterhealth
variationreduction
3
intheflowoflife
zen: one with the universe
the   new         way of doing things...  ...feels just like the   old   way
user-centereddesign
theSCCIPAstory
? who whatwherewhen why how
Who is         ?
Individual Practice Association        Medical Group of      Santa Clara County
Individual Practice Association        Medical Group of      Santa Clara County
SCCIPA
largest IPA in Santa Clara County
Santa Clara Countysize 1,304.01 sqmiles pop 1,781,642 (2010)medianincome $74,335
THEApr 21,2012    Price 75 FB C                                     REDITSVIEW FROM THE VALLEY        EUROPE              ...
5 PCP 80 Specialists                                           173 PCP                                           343 Speci...
urban/                    suburban                                             ruralSCCIPA founded in 1986 physician-owned...
25,000commercialACO
40,000commercialHMO
5,000MedicareHMO
nooriginal Medicare,    Medi-Cal, CHIP, uninsured
= managementservicesorganization  medicalmanagement  casemanagement  networkmanagement  providercontracting  qualityimprov...
partialrisk
managingDOFR
DivisionOfF inancialResponsibility
outpatientservices
inpatientservices
capitatepcps
specialistspaidffs
performancebonus
IHAP4P&HCC
IPAcitizenship
roughroad
roughroad 4x4   healthcare
4processes x4dimensionaldata
4processes
communication
collaboration
Case           ManagersPatients              PCPs           Specialists     coordination
anticipation
4dimensionaldata
financial
administrative
clinical
retrospective   retrospective
reactivecare
$$$$$$
+   behavioral
predictive
proactivecare
provideactionabledata
@pointofcare
@home
thecareteam
thecarecontinuum
peopleprocessesplatform
peopleprocessesplatform
peopleprocesseshospitalistsavailable 24/7evaluation of patients for possible redirection to SNFaggressive use of observati...
peopleprocesseshospitalistsavailable 24/7evaluation of patients for possible redirection to SNFaggressive use of observati...
peopleprocessesSNFistsongoing evaluation of patients to reduce   rehospitalizationnotification of PCP of admission/discharg...
peopleprocessesonsite case managersdaily review of patients based on Milliman guidelinesactively involved with discharge p...
peopleprocessescomplex case managerswarm hand-off between onsite and ccmuse of clinical and non-clinical staff to assist  ...
peopleprocessesutilization review staffall authorizations/referrals reviewed using Milliman guidelinesworking closely with...
people:physicians/staffprimary care physiciansspecialistsancillary providerscommunity pharmacists
people:physicians/staffprimary care physiciansspecialistsancillary providerscommunity pharmacistsfront office staff
people:plan staffcase managersdisease managersmember outreachbenefit design
peopleprocessesplatform     communicate      collaborate      coordinate       anticipate
peopleprocessesplatformcommon web-based communication platformfacilitates administrative functionsrules-based management o...
peopleprocessesplatformcommon web-based communication platformfacilitates administrative functionsrules-based management o...
peopleprocessesplatformcommon web-based communication platformfacilitates administrative functionsrules-based management o...
designphilosophy
“put hottriggers inthe path ofmotivatedpeople”BJ Fogg, PhDDirector, Persuasive Technology LabStanford University
Are incentives aligned properly?How can I increase their motivation?
Have I made it easy for people to act?How can I make it even simpler?
Are people being triggered at the mostappropriate time and in their workflow (path)?
putting it all together: how does it work?
QualityAccess Express Management            TM
patient
patient          front desk staff
patient          analog to digital           front desk staff              converter
AMERICAN HEALTH PLAN                                       112                     MARY SMITH        1/1/2011             ...
QualityAccess Express                                                            TM                                       ...
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
ACCESSEXPRESS                      Q          New Eligibility Response   New Message (3)          AMERICAN HEALTH PLAN
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)                      SMITH...
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)                      SMITH...
AMERICAN HEALTH PLAN
AMERICAN HEALTH PLAN
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)      ENABLING             ...
ACCESSEXPRESS                       Q                    New Eligibility Response   New Message (3)                       ...
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)                      SMITH...
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)
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
Description ofmeasure
Capability forphysician officeentry
ACCESSEXPRESS                      Q             New Eligibility Response   New Message (3)                               ...
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)                           ...
ACCESSEXPRESS                Q       New Eligibility Response   New Message (3)                    N                    O ...
Capability forphysician officeentry                   Y                  IT                  IL            AB
medicationreconciliation
patient perspective
on average,there is a pharmacy    within 2.5 miles of every US resident           Source: National Association of Chain Dr...
Source: Gallop, November 28, 2011-December 1, 2011
get out of the rut?
from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
IPAhosspital      onsitedischarge       case planner      manager      hospitalist      patient discharge planning        ...
hospitalist                 Rx               patientdischarge   medicationplanning    reconciliation   thepatientjourney
hospitalist                                discharge                               instructions                           ...
Rx     discharge                                                instructions                                            fa...
failsafe
hosspitaldischarge                 IPA               onsite                           hospitalist    hospitalist     Rx   ...
hosspitaldischarge                 IPA               onsite                           hospitalist    hospitalist     Rx   ...
from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
brainstorm
hosspitaldischarge                 IPA               onsite                           hospitalist    hospitalist     Rx   ...
hosspitaldischarge                 IPA               onsite                           pharmacist     hospitalist     Rx   ...
“put hottriggers inthe path ofmotivatedpeople”BJ Fogg, PhDDirector, Persuasive Technology LabStanford University
Santa Clara County IPA (SCCIPA)Medication Reconciliation Pilot Project     How to find the medication list for patients usi...
Your   SCCIPA doctor wants to help you withyour medications, after you leave the hospital.                                ...
from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
what happened?
failfast
ourresults
80                                               Milliman - Loosely-Managed70                                            M...
275                                                Milliman - Loosely-Managed250225                                       ...
4.5 4.0                                                            Milliman - Loosely-Managed 3.5            Milliman - Mo...
400        Milliman - Loosely-Managed350        Milliman - Moderately-Managed300           Milliman - Well-Managed        ...
2,2002,000    Milliman - Loosely-Managed1,8001,600         Milliman - Moderately-Managed1,400                             ...
6.0 5.5         Milliman - Loosely-Managed 5.0         Milliman - Moderately-Managed 4.5                                  ...
managingACOpatientsinafee4serviceworld
challenge#1managingproviderbehavior
challenge#2managingpatientbehavior
challenge#3alignincentives
HMOworld
patientsassignedPCP
PCPmanagesreferrals
patientsstayinnetwork
ACOworld
patientsnotassigned
physiciansendspatient
notrestrictedtonetwork
whataboutquality?
whoisaccountable?
carecoordination?
oursolution
make the newway...
feel just like the oldway
1trackingauths> using the same auth system, have providers enter in  tracking auths for aco patients
keepspatientinnetwork
2providerselectiontool> when selecting “referred to” providers, these providers are  listed in descending order of quality...
promotesquality
promotesefficiency
promotessatisfaction
3rewardaccountability> referring physicians can be tracked to incentivize use of  provider network
4checkinbutton> allows for real-time patient tracking, provides opportunity  for care coodination efforts
automatedtracking
alertingcasemanager
nocheck-inby_________
requestimmediatehelp
5qualityreminders> @every encounter with the healthcare delivery system,  quality is reinforced
entireteamisaccountable
virtualpcmhmodel
air     trafffic     controlfor patients
ibelieve...
asknot...
culturalrevolution
thinkdifferent
3takeaways
1drawtheBIGpicture
2showmetheDATA
gowiththeFLOW3
HAVE FUN
welcome tohealthcare2.0
Thank you!  wpan@ppmsi.com  slideshare.net/bonedoc97WWW.SNOOPY.COM
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
Medicare risk revenue management 11 jun12 washington dc
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Medicare risk revenue management 11 jun12 washington dc

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Presentation given at the Medicare Risk Revenue Management - Best Practice Operation Strategies meeting in Washington, DC - June 11-12, 2012

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Transcript of "Medicare risk revenue management 11 jun12 washington dc"

  1. 1. Leveraging the Entire Care Team to ImproveCare Management and Data Capture Wayne Pan, MD, MBA Chief Medical Officer Pacific Partners Management Services, Inc. Medicare Risk Revenue Management - Best Practice Operation Strategies • Washington, DC • June 11, 2012
  2. 2. 3takeaways
  3. 3. 1drawtheBIGpicture
  4. 4. 2showmetheDATA
  5. 5. gowiththeFLOW3
  6. 6. 1
  7. 7. vision
  8. 8. process
  9. 9. process
  10. 10. same page
  11. 11. teammates
  12. 12. goals goals
  13. 13. metrics
  14. 14. outcomes
  15. 15. rewards
  16. 16. 2
  17. 17. it’smorethanjustdata
  18. 18. it’salsoaboutwhomyour DATAservingdata to
  19. 19. savvyconsumers
  20. 20. not current error prone MPASTEEno comparator
  21. 21. unadulterated
  22. 22. michaelvandurenmdmbasutterhealth
  23. 23. variationreduction
  24. 24. 3
  25. 25. intheflowoflife
  26. 26. zen: one with the universe
  27. 27. the new way of doing things... ...feels just like the old way
  28. 28. user-centereddesign
  29. 29. theSCCIPAstory
  30. 30. ? who whatwherewhen why how
  31. 31. Who is ?
  32. 32. Individual Practice Association Medical Group of Santa Clara County
  33. 33. Individual Practice Association Medical Group of Santa Clara County
  34. 34. SCCIPA
  35. 35. largest IPA in Santa Clara County
  36. 36. Santa Clara Countysize 1,304.01 sqmiles pop 1,781,642 (2010)medianincome $74,335
  37. 37. THEApr 21,2012 Price 75 FB C REDITSVIEW FROM THE VALLEY EUROPE ENGLAND RUSSIA ATLANTIC OCEAN NEW YORK CITY FLORIDA M DA EX NA ICCA CLEVELAND APPALACHIA O ILLINOIS the Mississippi River INFINITE LOOP SAND HILL ROAD
  38. 38. 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) Anthem Commercial ACO pilot (2011)
  39. 39. urban/ suburban ruralSCCIPA 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) Anthem Commercial ACO pilot (2011)
  40. 40. 25,000commercialACO
  41. 41. 40,000commercialHMO
  42. 42. 5,000MedicareHMO
  43. 43. nooriginal Medicare, Medi-Cal, CHIP, uninsured
  44. 44. = managementservicesorganization medicalmanagement casemanagement networkmanagement providercontracting qualityimprovement credentialing memberservices claims&encounterprocessing clinicaldataanalytics&reporting marketingoutreach grievance&appeals compliance&auditing ITservices finance&riskmanagement
  45. 45. partialrisk
  46. 46. managingDOFR
  47. 47. DivisionOfF inancialResponsibility
  48. 48. outpatientservices
  49. 49. inpatientservices
  50. 50. capitatepcps
  51. 51. specialistspaidffs
  52. 52. performancebonus
  53. 53. IHAP4P&HCC
  54. 54. IPAcitizenship
  55. 55. roughroad
  56. 56. roughroad 4x4 healthcare
  57. 57. 4processes x4dimensionaldata
  58. 58. 4processes
  59. 59. communication
  60. 60. collaboration
  61. 61. Case ManagersPatients PCPs Specialists coordination
  62. 62. anticipation
  63. 63. 4dimensionaldata
  64. 64. financial
  65. 65. administrative
  66. 66. clinical
  67. 67. retrospective retrospective
  68. 68. reactivecare
  69. 69. $$$$$$
  70. 70. + behavioral
  71. 71. predictive
  72. 72. proactivecare
  73. 73. provideactionabledata
  74. 74. @pointofcare
  75. 75. @home
  76. 76. thecareteam
  77. 77. thecarecontinuum
  78. 78. peopleprocessesplatform
  79. 79. peopleprocessesplatform
  80. 80. peopleprocesseshospitalistsavailable 24/7evaluation of patients for possible redirection to SNFaggressive use of observation statusannual coding/documentation training for risk adjustmentnotification of PCP of admission/dischargedischarge summary faxed to PCP
  81. 81. peopleprocesseshospitalistsavailable 24/7evaluation of patients for possible redirection to SNFaggressive use of observation statusannual coding/documentation training for risk adjustmentnotification of PCP of admission/dischargedischarge summary faxed to PCP
  82. 82. peopleprocessesSNFistsongoing evaluation of patients to reduce rehospitalizationnotification of PCP of admission/dischargedischarge summary faxed to PCP
  83. 83. peopleprocessesonsite case managersdaily review of patients based on Milliman guidelinesactively involved with discharge planningall discharge needs authorized/arranged prior to dischargepost-discharge follow-up on all patients with DME/HHC needs
  84. 84. peopleprocessescomplex case managerswarm hand-off between onsite and ccmuse of clinical and non-clinical staff to assist patient and family caregivers with care coordinationinsure follow-up with PCP/specialist within 2 weeks
  85. 85. peopleprocessesutilization review staffall authorizations/referrals reviewed using Milliman guidelinesworking closely with PCPs/specialists/ccm to facilitate care coordinationcompliance with regulatory guidelinesgenerate member/provider letters regarding medical necessity decisionsphysician performance and quality reportingidentification of potential quality issuescontinuous process improvement
  86. 86. people:physicians/staffprimary care physiciansspecialistsancillary providerscommunity pharmacists
  87. 87. people:physicians/staffprimary care physiciansspecialistsancillary providerscommunity pharmacistsfront office staff
  88. 88. people:plan staffcase managersdisease managersmember outreachbenefit design
  89. 89. peopleprocessesplatform communicate collaborate coordinate anticipate
  90. 90. peopleprocessesplatformcommon web-based communication platformfacilitates administrative functionsrules-based management of processesintuitive user-interfaceembed quality reminders into office/provider workflowprovider feedback
  91. 91. peopleprocessesplatformcommon 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 data
  92. 92. peopleprocessesplatformcommon 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/enter their own data
  93. 93. designphilosophy
  94. 94. “put hottriggers inthe path ofmotivatedpeople”BJ Fogg, PhDDirector, Persuasive Technology LabStanford University
  95. 95. Are incentives aligned properly?How can I increase their motivation?
  96. 96. Have I made it easy for people to act?How can I make it even simpler?
  97. 97. Are people being triggered at the mostappropriate time and in their workflow (path)?
  98. 98. putting it all together: how does it work?
  99. 99. QualityAccess Express Management TM
  100. 100. patient
  101. 101. patient front desk staff
  102. 102. patient analog to digital front desk staff converter
  103. 103. 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
  104. 104. 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
  105. 105. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  106. 106. ACCESSEXPRESS Q New Eligibility Response New Message (3) AMERICAN HEALTH PLAN
  107. 107. 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
  108. 108. 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
  109. 109. AMERICAN HEALTH PLAN
  110. 110. AMERICAN HEALTH PLAN
  111. 111. 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
  112. 112. 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
  113. 113. 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
  114. 114. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  115. 115. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  116. 116. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  117. 117. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  118. 118. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  119. 119. Description ofmeasure
  120. 120. Capability forphysician officeentry
  121. 121. ACCESSEXPRESS Q New Eligibility Response New Message (3) TH PA AMERICAN HEALTH PLAN E TH IN
  122. 122. 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
  123. 123. ACCESSEXPRESS Q New Eligibility Response New Message (3) N O TI VA TI O M
  124. 124. Capability forphysician officeentry Y IT IL AB
  125. 125. medicationreconciliation
  126. 126. patient perspective
  127. 127. on average,there is a pharmacy within 2.5 miles of every US resident Source: National Association of Chain Drug Stores
  128. 128. Source: Gallop, November 28, 2011-December 1, 2011
  129. 129. get out of the rut?
  130. 130. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
  131. 131. IPAhosspital onsitedischarge case planner manager hospitalist patient discharge planning thepatientjourney
  132. 132. hospitalist Rx patientdischarge medicationplanning reconciliation thepatientjourney
  133. 133. hospitalist discharge instructions patient outpatientdischarge medication physicianplanning reconciliation follow-up thepatientjourney
  134. 134. Rx discharge instructions family patient outpatientdischarge medication physician dischargeplanning reconciliation follow-up thepatientjourney
  135. 135. failsafe
  136. 136. hosspitaldischarge IPA onsite hospitalist hospitalist Rx discharge instructions case planner manager hospitalist Rx discharge instructions family patient patient patient patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
  137. 137. hosspitaldischarge IPA onsite hospitalist hospitalist Rx discharge instructions case planner manager hospitalist Rx discharge instructions family patient patient patient patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
  138. 138. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
  139. 139. brainstorm
  140. 140. hosspitaldischarge IPA onsite hospitalist hospitalist Rx discharge instructions case planner manager hospitalist Rx discharge instructions family patient patient patient patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
  141. 141. hosspitaldischarge IPA onsite pharmacist hospitalist Rx discharge instructions case planner manager hospitalist Rx discharge instructions family patient patient patient patient outpatient discharge medication physician discharge planning reconciliation follow-up thepatientjourney
  142. 142. “put hottriggers inthe path ofmotivatedpeople”BJ Fogg, PhDDirector, Persuasive Technology LabStanford University
  143. 143. Santa Clara County IPA (SCCIPA)Medication Reconciliation Pilot Project How to find the medication list for patients using AccessExpress1. Go to the PPMSI AccessExpress provider portal (http://ppmsi.com/accessexpress.html):2. Select Santa Clara County IPA:3. Enter USER NAME and PASSWORD, click on “SUBMIT”:
  144. 144. Your SCCIPA doctor wants to help you withyour medications, after you leave the hospital. Michael Lam, RPh pharmacist Samaritan Medical Center Pharmacy 2505 Samaritan Drive San Jose, CA (408) 356-7111Please visit the Samaritan Medical Center Pharmacy to pick upyour new prescriptions and have a pharmacist review yourmedications with you. SCCIPA A Pacific Partners Medical Group
  145. 145. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
  146. 146. what happened?
  147. 147. failfast
  148. 148. ourresults
  149. 149. 80 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> commercial admits/1000
  150. 150. 275 Milliman - Loosely-Managed250225 Milliman - Moderately-Managed200 SCCIPA175 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> commercial bed days/1000
  151. 151. 4.5 4.0 Milliman - Loosely-Managed 3.5 Milliman - Moderately-Managed SCCIPA 3.0 Milliman - Well-Managed 2.5 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O> commercial average length of stay
  152. 152. 400 Milliman - Loosely-Managed350 Milliman - Moderately-Managed300 Milliman - Well-Managed SCCIPA250200 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O> medicare admits/1000
  153. 153. 2,2002,000 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> medicare bed days/1000
  154. 154. 6.0 5.5 Milliman - Loosely-Managed 5.0 Milliman - Moderately-Managed 4.5 SCCIPA Milliman - Well-Managed 4.0 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O> medicare average length of stay
  155. 155. managingACOpatientsinafee4serviceworld
  156. 156. challenge#1managingproviderbehavior
  157. 157. challenge#2managingpatientbehavior
  158. 158. challenge#3alignincentives
  159. 159. HMOworld
  160. 160. patientsassignedPCP
  161. 161. PCPmanagesreferrals
  162. 162. patientsstayinnetwork
  163. 163. ACOworld
  164. 164. patientsnotassigned
  165. 165. physiciansendspatient
  166. 166. notrestrictedtonetwork
  167. 167. whataboutquality?
  168. 168. whoisaccountable?
  169. 169. carecoordination?
  170. 170. oursolution
  171. 171. make the newway...
  172. 172. feel just like the oldway
  173. 173. 1trackingauths> using the same auth system, have providers enter in tracking auths for aco patients
  174. 174. keepspatientinnetwork
  175. 175. 2providerselectiontool> when selecting “referred to” providers, these providers are listed in descending order of quality, efficiency, satisfaction
  176. 176. promotesquality
  177. 177. promotesefficiency
  178. 178. promotessatisfaction
  179. 179. 3rewardaccountability> referring physicians can be tracked to incentivize use of provider network
  180. 180. 4checkinbutton> allows for real-time patient tracking, provides opportunity for care coodination efforts
  181. 181. automatedtracking
  182. 182. alertingcasemanager
  183. 183. nocheck-inby_________
  184. 184. requestimmediatehelp
  185. 185. 5qualityreminders> @every encounter with the healthcare delivery system, quality is reinforced
  186. 186. entireteamisaccountable
  187. 187. virtualpcmhmodel
  188. 188. air trafffic controlfor patients
  189. 189. ibelieve...
  190. 190. asknot...
  191. 191. culturalrevolution
  192. 192. thinkdifferent
  193. 193. 3takeaways
  194. 194. 1drawtheBIGpicture
  195. 195. 2showmetheDATA
  196. 196. gowiththeFLOW3
  197. 197. HAVE FUN
  198. 198. welcome tohealthcare2.0
  199. 199. Thank you! wpan@ppmsi.com slideshare.net/bonedoc97WWW.SNOOPY.COM
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