provider engagement <ul><li>wayne pan md </li></ul><ul><li>preedar oreggio md </li></ul>
agenda <ul><li>why? </li></ul><ul><li>how? </li></ul><ul><li>getting their attention </li></ul><ul><li>who to involve? </l...
why? <ul><li>can you effectively manage a Medicare risk adjustment program without provider engagement? </li></ul><ul><li>...
why? <ul><li>can you effectively manage a Medicare risk adjustment program without provider engagement? </li></ul><ul><li>...
how? <ul><li>set clear expectations </li></ul><ul><li>establish mutual goals </li></ul><ul><li>data, data, data </li></ul>...
incentive programs <ul><li>nothing is free </li></ul><ul><li>fee-for-service model - pay for services performed </li></ul>...
incentive programs <ul><li>capitation model </li></ul><ul><ul><li>annual HCC bonus based on </li></ul></ul><ul><ul><ul><li...
who? <ul><li>which physicians:  PCPs vs specialists vs hospitalists? </li></ul><ul><li>office staff </li></ul><ul><li>memb...
when? <ul><li>timing is everything </li></ul><ul><li>cms data reporting schedule: sweeps </li></ul>
what's @ risk? <ul><li>under reporting </li></ul><ul><li>under documentation (over reporting) </li></ul>
follow up <ul><li>close the loop </li></ul><ul><li>how is provider efficacy communicated? </li></ul><ul><li>progress repor...
bench marks <ul><li>compare to last year </li></ul><ul><li>% chronic hcc's rolled-over </li></ul><ul><li>% patients with a...
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RISE Provider Engagement for HCC Risk Score Management

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RISE Provider Engagement for HCC Risk Score Management

  1. 1. provider engagement <ul><li>wayne pan md </li></ul><ul><li>preedar oreggio md </li></ul>
  2. 2. agenda <ul><li>why? </li></ul><ul><li>how? </li></ul><ul><li>getting their attention </li></ul><ul><li>who to involve? </li></ul><ul><li>when to start? </li></ul><ul><li>what's at risk? </li></ul><ul><li>follow up </li></ul><ul><li>q&a </li></ul>
  3. 3. why? <ul><li>can you effectively manage a Medicare risk adjustment program without provider engagement? </li></ul><ul><li>yes, but it involves building a network of providers who can review and document the work that providers are doing - redundant and expensive </li></ul>
  4. 4. why? <ul><li>can you effectively manage a Medicare risk adjustment program without provider engagement? </li></ul><ul><li>no , because provider documentation is the foundation of risk adjustment and provider engagement is essential </li></ul>
  5. 5. how? <ul><li>set clear expectations </li></ul><ul><li>establish mutual goals </li></ul><ul><li>data, data, data </li></ul><ul><ul><li>timely </li></ul></ul><ul><ul><li>quantifiable </li></ul></ul><ul><ul><li>changeable </li></ul></ul><ul><li>education </li></ul>
  6. 6. incentive programs <ul><li>nothing is free </li></ul><ul><li>fee-for-service model - pay for services performed </li></ul><ul><ul><li>annual refresh examination and documentation </li></ul></ul><ul><ul><li>providing charts for documentation auditing </li></ul></ul>
  7. 7. incentive programs <ul><li>capitation model </li></ul><ul><ul><li>annual HCC bonus based on </li></ul></ul><ul><ul><ul><li>benchmarks for process </li></ul></ul></ul><ul><ul><ul><li>benchmarks for risk scores </li></ul></ul></ul>
  8. 8. who? <ul><li>which physicians: PCPs vs specialists vs hospitalists? </li></ul><ul><li>office staff </li></ul><ul><li>member services </li></ul><ul><li>nurse case managers </li></ul>
  9. 9. when? <ul><li>timing is everything </li></ul><ul><li>cms data reporting schedule: sweeps </li></ul>
  10. 10. what's @ risk? <ul><li>under reporting </li></ul><ul><li>under documentation (over reporting) </li></ul>
  11. 11. follow up <ul><li>close the loop </li></ul><ul><li>how is provider efficacy communicated? </li></ul><ul><li>progress reports (static) </li></ul><ul><li>provider dashboards (&quot;real-time&quot;) </li></ul><ul><li>how well is your program working: benchmarks? </li></ul>
  12. 12. bench marks <ul><li>compare to last year </li></ul><ul><li>% chronic hcc's rolled-over </li></ul><ul><li>% patients with annual hcc refresh visit </li></ul><ul><li>% of algorithm identified &quot;suspect&quot; codes captured </li></ul><ul><li>is there a true hcc benchmark? </li></ul>
  13. 13. ?
  14. 14. thank you
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