2013 10 utilizing member engagement to improve cahps scores

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The Accountable Care Act means more access to healthcare for more people. But to pay for that access it also means margins for healthcare companies are going to be squeezed. But this does not necessarily imply doom for healthcare companies. The law actually encourages healthcare businesses to build better business models – and is willing to pay for it. By retooling your market approach, and the operations that run your business, you can actually improve your margins and your customer’s happiness at the same time you are helping to create a better and more efficient healthcare ecosystem.

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  • Healthcare Effectiveness Data and Information Set (HEDIS)
  • Brokers, employer groups, unions, states, and other purchasing groups now “compare the ratings” before making multi-year commitments to health care providers and health plans. Consequently, one performance misstep for a health plan (for example, a mediocre asthma care score), even if it doesn’t jeopardize accreditation, can produce a lower ranking for a health plan than its competitor. This can quickly mean the loss of significant business from a keen-eyed purchaser.
  • The Business Model Canvas (designed by Alexander Osterwalder) is a strategic management template for developing new or documenting existing business models through a visual language. The design is to align business activities that produce value by illustrating potential trade-offs. This method helps describe, design, challenge, invent, and pivot your business model. You can find out more about it here.
  • modelH is a business model canvas designed specifically for healthcare. Expanding on Osterwalder’s Business Model Canvas, modelH integrates aspects of Michael Porter’s definition of shared value, measured as the patient health outcome achieved per healthcare dollar spent. It is designed to incorporate the 3 domains of the healthcare “ecosystem”: care consumption, care delivery, and care financing. These domains are actually interdependent points of interaction along a value chain of healthcare. To impact one point, you really impact them all. modelH also accounts for the four key stakeholders across the healthcare value chain: patients, providers, payers, and purveyors.
  • Each healthcare organization’s journey to improve the member/patient experience (and resultant CAHPS scores is unique). It is a mistaken hope that you can just apply a discreet, tactical approach to revenue optimization. This is merely applying write processes and checklist and it will come across as insincere to you member/patient - and you will suffer for out in the customer satisfaction surveys. You also need to focus on the culture of your organization.
  • Improving processes that impact multiple member segments are likely to generate a larger return on investment (ROI) than initiatives targeted at specific population segments.Targeting specific populations with mailings, telephone and other forms of outreach can be effective ways to improve scores in specific, low-scoring cohortsapproach and model accounts for the size of cohorts and their relative distance to the next star level to prioritize improvement opportunities and maximize the plan’s star rating.Examples include: focusing patient education on large membership cohorts or steering patients in particular geographies toward specific medical facilitiesAssesses ongoing performance and highlights correlations across cohorts that should help develop process improvements with the broadest impact.This includes reviewing complaint patterns across medical groups and identifying a process shortcoming or systemic customer service failures particular to a providerYou may want to see how your performance has changed over time by comparing the 2012 survey results to those of previous years
  • Incenting providers through contract clauses and shared-risk payment model is a powerful tool to improve your own quality ratings. identifies under and over-performing cohorts (e.g., medical groups) that can be used as a fact-base to inform provider engagement and contracting decisions across the network.This could entail creating financial incentives for specific, poorly performing providers or creating profit sharing goals with a medical group based on quality ratings created from published provider report cards
  • Each healthcare organization’s journey to improve the member/patient experience (and resultant CAHPS scores is unique). It is a mistaken hope that you can just apply a discreet, tactical approach to revenue optimization. This is merely applying write processes and checklist and it will come across as insincere to you member/patient - and you will suffer for out in the customer satisfaction surveys. You also need to focus on the culture of your organization.
  • Analyses of CAHPS data have shown that beneficiaries with certain characteristics tend to report systematically higher or lower scores, even when they are members of the same contract and therefore exposed to the same level of contract quality. Notably, older patients, healthier patients, less educated members and those with lower socio-economic status (SES) tend to give higher scores than younger, sicker and more educated members and those with higher SES.This gets adjusted but it is important to know and take advantage of.Source:  2012 Medicare Advantage CAHPS Results 
  • http://healthcareblog.pyapc.com/articles/quality-1/For AMI patients, fibronolytic therapy received within 30 minutes of arrival? “Check.”For pneumonia patients, blood cultures performed in the ED prior to initial antibiotic? “Check.”For surgical patients, prophylactic antibiotic received within one hour of incision? “Check.”Process measures are well defined and straightforward. But when you try to apply that same checklist methodology to H-CAHPS questions, compliance plays out in a very different way that doesn’t lend itself to a simple “check, complete, move-on” mentality.Did we (specifically, nurses and doctors) always explain things in a way that patients could understand? “I gave them the required information. I think they understood.”Did we always listen carefully to patients?  “I tried to listen … most of the time … I think.”Did we always do everything we could to help with pain?  “I told her to push her call light when she needed more pain medication.”
  • 2013 10 utilizing member engagement to improve cahps scores

    1. 1. Utilizing Member Engagement to Improve CAHPS Scores a presentation by Kevin Riley for the Opal 2013 ACOs Summit October 9, 2013 at 3:00 pm ET
    2. 2. Synopsis Webinar: Utilizing Member Engagement to Improve CAHPS Scores The Accountable Care Act means more access to healthcare for more people. But to pay for that access it also means margins for healthcare companies are going to be squeezed. But this does not necessarily imply doom for healthcare companies. The law actually encourages healthcare businesses to build better business models – and is willing to pay for it. By retooling your market approach, and the operations that run your business, you can actually improve your margins and your customer’s happiness at the same time you are helping to create a better and more efficient healthcare ecosystem. During this session you will learn: • How much is it worth to engage your customers (members)? • What are the consequences if you do not? • How to drive customer engagement into CAHPS information so you can maximize reimbursement.
    3. 3. Who am I?
    4. 4. Kevin Riley Principal at Kevin Riley & Associates | Health Model Innovation • former chief innovation officer of Florida Blue • founder and former president/CEO of GuideWell • founder of modelH.org • entrepreneur, health care executive, business model innovator Kevin started Kevin Riley & Associates | Health Model Innovation (modelH) in 2006 to help companies with the convergence of health care and the consumer. He founded and was CEO of a national health care retail company, played leadership roles for several national retail health start-ups, and served as the first Chief Innovation Officer of a major insurance plan. Kevin holds a Masters of Business in entrepreneurship and marketing from Rice University. follow me on @kevineriley, linkedin, slideshare
    5. 5. Why is this Necessary? Utilizing Member Engagement to Improve CAHPS Scores
    6. 6. What is the Consumer Assessment of Healthcare Providers and Systems (CAHPS)? CAHPS originally stood for the Consumer Assessment of Health Plans Study - but it has evolved beyond health plans to capture much more. Now it develops and supports the use of a comprehensive family of standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers, such as the communication skills of providers and the accessibility of services.
    7. 7. What does it mean to Providers/Systems? They get ranked by the NCQA, and the score is based on: • STARs Ratings Measures (90+ measures) • Consumer satisfaction surveys (Consumer Assessment of Health Providers and Systems survey, or CAHPS) • The base measures score is added to a consistency score - it takes good process and good manners. So …. • Compensation is linked to this score. • Higher ranked plans/providers get more money.
    8. 8. It is part of something much larger Data Source Domains % Total Stars Ratings HEDIS Part C: Domains I&II ~31% PDE Data Part D: Domain IV ~20% CAHPS Part C: Domain I&III; Part D: Domain III ~18% HOS Part C: Domains I&II ~11% IRE Part C: Domain V; Part D: Domain I ~7% Phone Monitoring Part C: Domain V; Part D: Domain I ~6% CTM Part C: Domain IV ~2% CMS Audit Part C: Domain IV ~2% MBDS Part C: Domain IV ~2% MARx Part D: Domain I ~1% Total: 100.00%
    9. 9. Lets focus on CAHPS Consumer satisfaction measures what patients reported about the experiences of their care in a survey, including their experiences with doctors and services they had access to, and customer service. NCQA scores are on a scale of 1 to 5, from worst to best: • 5 means you are are in the top 10 percent compared with other plans in their category • 4 means you are above average • 3 means you are just plain old average • 2 means you are below average, and • 1 means you are are in the bottom10 percent compared with other plans in their category
    10. 10. How much is all this worth?
    11. 11. Why is all this important? Think of it as your business model at risk: • ACA requires that plans sold through exchanges in 2014 and beyond must be accredited • Member/patient satisfaction means you probably have a better Net Promoter Score which makes you stand out amongst your competition Think of this as your revenue at risk: • Buyers rely on health plan comparisons and ratings systems to inform their purchasing decisions • You will lose on reimbursement and this means your competitors can underprice you – starting a death spiral
    12. 12. What does it look like for Plans? Health Plan Composite Measures National 2012 Getting Needed Care 3.57 Getting Care Quickly 3.29 Doctors Who Communicate Well 3.72 Health Plan Customer Service 3.66 Care Coordination 3.61 Source: 2012 Medicare Advantage CAHPS Results
    13. 13. What does it look like for Providers? Source: CAHPS Clinician & Group Surveys and Instructions
    14. 14. What will this eventually look like? Source: Why Not the Best? http://www.whynotthebest.org
    15. 15. A Framework for Discussion Utilizing Member Engagement to Improve CAHPS Scores
    16. 16. modelH is a business model canvas designed specifically for healthcare companies and acts as a strategic management template for developing new or documenting existing business models through its visual language.
    17. 17. The modelH method aligns business activities that produce value by illustrating potential trade- offs, and helps describe, design, challenge, invent, and pivot a business model.
    18. 18. modelH is about producing value though profitable and sustainable business models made by creating and/or realigning the activity systems that improve patient experience, boost provider performance, and enable payer cost control.
    19. 19. The healthcare business model canvas (modelH)
    20. 20. A Path Forward Utilizing Member Engagement to Improve CAHPS Scores
    21. 21. What is patient/member engagement? Customer engagement, or experience (CX), is the aggregation of all of the engagements a prospect or customer has with your business model - whether they are recognized or not, and whether they are intentional or not. Experiences happen across the fundamental customer stages of awareness, discovery, attraction, interaction, purchase, use, cultivation and advocacy. Experiences are a key to retaining your Customers (Buyers and Users) and realizing a larger customer lifetime value.
    22. 22. Health coverage engagement loop Resolved? Prospect Acquisition Product Education Issue ResolutionMember Engagement Care Management Annual Renewals Prevention & Wellness Rewards & Incentives
    23. 23. How to approach member engagement • Segments • Regions • Ability to influence • Ability to excel Identify the “best” customer segments • Measures impacted • Ability to improve • Ability to excel Identify the “best” areas of focus • Value to the person • Value to you Rank the value • Set a target for improvement • Create a plan of attack Publish the list
    24. 24. Don’t forget about provider engagement
    25. 25. Prevention & WellnessRewards & Incentives Resolved? Health care engagement loop Patient Need Diagnosis Communicate SolutionProvider Engaged Care Management
    26. 26. Some Final Thoughts Utilizing Member Engagement to Improve CAHPS Scores
    27. 27. Not all customers are the same Adapted from Winning at Retail: Developing a Sustained Model for Retail Success
    28. 28. It takes a consumer culture Adapted from Why Not the Best? http://www.whynotthebest.org
    29. 29. Questions Kevin Riley & Associates Business Model Innovation for Healthcare kevin@healthmodelinnovation.com www.healthmodelinnovation.com

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