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Hospital Value-Based Purchasing: Leveraging Analytics for HVBP Prospective Payments
 

Hospital Value-Based Purchasing: Leveraging Analytics for HVBP Prospective Payments

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  • - The healthcare industry as a whole is moving towards a more accountable, value-based payment models than the traditional volume-based modelMedicare intends to transform itself from a passive payer of claims to an active purchaser of quality health care for its beneficiariesThe HVBP is designed to be budget neutral so that the government’s total payments will be the same as they would have been without the Program
  • The hospital VBP program is a transition of the well-established Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) pay for reporting program to hospital-level pay for performance. HVBP will start payment to hospitals for their actual performance on quality measures rather than just on reporting as with the RHQDAPU, which was established in 2003 by the Medicare Modernization Act and initially provided a 0.4% payment differential for public reporting through the Hospital Compare website on 10 performance measures. The 2005 Deficit Reduction Act (DRA) increased the payment differential for public reporting to 2% and increased the number of measures to 21. Section 5001(b) of the DRA authorized the Centers for Medicare & Medicaid Services (CMS) to develop a Medicare Hospital VBP Plan for FY 2009 that did not materialize.The Hospital IQR program requires "sub-section (d)" hospitals to submit data for specific quality measures for health conditions common among people with Medicare, and which typically result in hospitalization. Eligible hospitals that do not participate in the Hospital IQR program will receive an annual market basket update with a 2.0 percentage point reduction(Q)What is the rationale behind the implementation of Value-Based Purchasing?The hospital value-based purchasing program continues a longstanding effort by CMS to forge a closer link between Medicare’s payment systems and improvement in health care quality, including the quality and safety of care in the inpatient hospital setting. In recent years, CMS has undertaken several initiatives, including demonstrations and quality reporting programs, to lay the foundation for rewarding health care providers and suppliers for the quality of care provided. This is achieved by tying a portion of Medicare payments to performance on quality measures. The transition of these initiatives to value-based purchasing is intended to transform Medicare from a passive payer of claims based on volume of care to an active purchaser of care based on the quality of services its beneficiaries receive. The hospital VBP program is one of multiple reforms that are dramatically changing how Medicare pays hospitals. Other changes include incentives for implementing electronic health records and additional payment adjustments based on hospitals’ rates of hospital-acquired conditions and readmissions.(Q) What is the basis for CMS’ authority to establish and implement this program?(A) The Deficit Reduction Act of 2005 instructed CMS to design a plan for the structure and implementation of a Value-Based Purchasing system. In accordance with that directive, CMS published a report to Congress on its plans for the VBP system in November 2007. Section 3001 of the Affordable Care Act requires CMS to implement a hospital value-based purchasing program that rewards hospitals for the quality of care provided as demonstrated by their performance or improvement on measures of care quality beginning in FFY2013. The VBP implementation isone step further than the current payment adjustment system that simply reduces payments to providers for failing to report on selected quality measures.

Hospital Value-Based Purchasing: Leveraging Analytics for HVBP Prospective Payments Hospital Value-Based Purchasing: Leveraging Analytics for HVBP Prospective Payments Presentation Transcript

  • This document is confidential and contains proprietary information, including trade secrets of CitiusTech. Neither the document nor any of the informationcontained in it may be reproduced or disclosed to any unauthorized person under any circumstances without the express written permission of CitiusTech.Leveraging Analytics Platform for HospitalValue Based Purchasing (HVBP)May 22, 2013Webinar
  • 2Webinar PresentersMartin SizemoreDirectorHealthcare StrategyPerficient, Inc.Harshad Patil,CPHIMS, AHIPCertifiedSr. ConsultantCitiusTech Inc.Martin Sizemore is Principal in Perficient’s national healthcare practice. Martin is ahealthcare strategist, senior consultant and a trusted advisor to Chief ExecutiveOfficers, COOs, CIOs and senior managers for healthcare organizations including bothpayers and providers.Martin is a specialist in clinical data warehousing, clinical data models and healthcarebusiness intelligence for improving operational efficiencies and clinical outcomes.Martin is a TOGAF certified Enterprise Architect with specialized skills in EnterpriseApplication Integration (EAI) and Service Oriented Architecture (SOA).Harshad Patil is part the Healthcare Informatics team at CitiusTech. He has extensiveexperience in technology consulting and development for clients worldwide, aroundhealthcare BI/analytics, clinical quality and performance management.Earlier, he was lead Business Analyst with Infosys working for a variety of customersin the payer and provider domains. He has a bachelors degree in BiomedicalEngineering.
  • 3Background The Affordable Care Act (ACA) establishes various programs to reward hospitalsfinancially for providing higher quality of care Once all of the quality programs and regulatory requirements are fullyimplemented beginning federal fiscal year 2017, the percentage of Medicare dollarspaid based on quality could be up to approximately 10% for a hospital The quality programs and regulatory requirements are: Pay for Reporting, HospitalAcquired Conditions Reporting, Meaningful Use Reporting, the ReadmissionsReduction Program, and the Hospital Value-Based Purchasing Program. The Hospital Value Based Purchasing Program (HVBP) was mandated by Section3001(a) of the ACA and became Section 1886(o) of the Social Security Act. CMSpublished a proposed rule for the Program in January 2011, published in the finalrule on May 6, 2011
  • 4AgendaPart 1: HVBP Overview Introduction and Timeline Measure CoveragePart 2: HVBP Calculation Performance Score and Incentive Calculations Achieving Continuous ImprovementPart 3: Live Demo – Health BI HVBP AppPart 4: Summary / Q&A
  • 5AgendaPart 1: HVBP Overview Introduction and Timeline Measure CoveragePart 2: HVBP Calculation Performance Score and Incentive Calculations Achieving Continuous ImprovementPart 3: Live Demo – Health BI HVBP AppPart 4: Summary / Q&A
  • 6Introduction to HVBP HVBP rewards acute-care hospitals with incentive payments for the quality ofcare they provide to Medicare patients The program uses the hospital quality data reporting infrastructure developedfor the Hospital Inpatient Quality Reporting (IQR) Program HVBP distributes payment to hospitals for their actual performance on qualitymeasures rather than just on reporting CMS funds the incentive by withholding a small part of regular fees under DRGpayment to Hospitals The HVBP incentive payments are based on the hospital scores on HVBPmeasures, which are updated annually.
  • 7How does HVBP work?Hospital CMSReportIQR measuresScore each measurefrom 0 to 10Calculate domainscoresCalculate TotalPerformance Scorefor the HospitalCalculate theincentive payment /penalty for the FYHospital receivesadjusted DRGpaymentsReviewscores, improveperformance• CMS calculates the scoresbased on the existing IQRreporting framework orclaims or the reportedHCAHPS results• No additional reporting isrequired• CMS publishes each hospital’sActual Percentage PaymentReport on My QualityNet atthe start of the relevant FYHospital submitscorrection andappeal, if needed
  • 8Timeline2013 2014 2015 2016 2017 ++1.00% 1.25% 1.5% 1.75% 2.00%DRG Payments Holdback % by Fiscal YearNANA20122011Reimbursementsadjustment beginVBPbeginsCMS announcesperformancestandardsYou arehere!!The reduction in DRG payments also provides opportunity for hospitals to earnincentives greater than the holdback!!* Fiscal year is from 1st Oct to 31st SepFinancial Impactof what you do today
  • 9Important Periods for Performance CalculationFiscal Year* Domain Baseline Period Performance Period2013Clinical Domain 1-Jul-09 to 31-Mar-10 1-Jul-11 to 31-Mar-12Patient Experience 1-Jul-09 to 31-Mar-10 1-Jul-11 to 31-Mar-122014Clinical Domain 1-Apr-10 to 31-Dec-10 1-Apr-12 to 31-Dec-12Patient Experience 1-Apr-10 to 31-Dec-10 1-Apr-12 to 31-Dec-12Outcome Domain 1-Jul-09 to 30-Jun-10 1-Jul-11 to 30-Jun-122015Clinical Domain 1-Jan-11 to 31-Dec-11 1-Jan-13 to 31-Dec-13Patient Experience 1-Jan-11 to 31-Dec-11 1-Jan-13 to 31-Dec-13OutcomeDomainMortality 1-Oct-10 to 30-Jun-11 1-Oct-12 to 30-Jun-12AHRQ 15-Oct-10 to 30-Jun-11 15-Oct-12 to 30-Jun-12CLABSI 1-Jan-11 to 31-Dec-11 1-Feb-13 to 31-Dec-13Efficiency 1-May-11 to 31-Dec-11 1-May-13 to 31-Dec-13* Fiscal year is from 1st Oct to 31st Sep
  • 10Growth of Domains for HVBP from FY 13 to FY 15FY 13 FY 14 FY 15ClinicalDomain(45%)PatientExperience(30%)OutcomeDomain(25%)ClinicalDomain(20%)PatientExperience(30%)OutcomeDomain(30%)Efficiency(20%)ClinicalDomain(70%)PatientExperience(30%)Clinical Measures – 12HCAHPS Measures – 8Clinical Measures – 13HCAHPS Measures – 8Outcome Measures – 3Clinical Measures – 12HCAHPS Measures – 8Outcome Measures – 5Efficiency Measure – 1Over the next few years, eligible hospitals need to build more complex capabilitiesaround outcome-based processes and clinical efficiency.
  • 11Measures for FY14Clinical Measures1. AMI-7a Fibrinolytic Therapy Received within 30 Minutes ofHospital Arrival2. AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival3. HF-1 Discharge Instructions4. PN-3b Blood Cultures Performed in the ED Prior to InitialAntibiotic Received in Hospital5. PN-6 Initial Antibiotic Selection for CAP in ImmunocompetentPatient6. SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Priorto Surgical Incision7. SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients8. SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 HoursAfter Surgery9. SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m.Postoperative Serum Glucose10. SCIP–Inf–9 Postoperative Urinary Catheter Removal onPostoperative Day 1 or 2.11. SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to ArrivalThat Received a Beta Blocker During the Perioperative Period12. SCIP-VTE-1 Surgery Patients with Recommended VenousThromboembolism Prophylaxis Ordered13. SCIP-VTE-2 Surgery Patients Who Received Appropriate VenousThromboembolism Prophylaxis within 24 Hours1. Nurse Communication2. Doctor Communication3. Hospital Staff Responsiveness4. Pain Management5. Medicine Communication6. Hospital Cleanliness andQuietness7. Discharge Information8. Overall Hospital RatingPatient Experience1. MORT-30-AMI Acute MyocardialInfarction (AMI) 30-day mortalityrate2. MORT-30-HF Heart Failure (HF) 30-day mortality rate3. MORT-30-PN Pneumonia (PN) 30-daymortality rateOutcome Measures
  • 12Measures for FY15Clinical Measures1. AMI-7a Fibrinolytic Therapy Received within 30 Minutes ofHospital Arrival2. AMI-8 Primary PCI Received within 90 Minutes of HospitalArrival3. HF-1 Discharge Instructions4. PN-3b Blood Cultures Performed in the ED Prior to InitialAntibiotic Received in Hospital5. PN-6 Initial Antibiotic Selection for CAP inImmunocompetent Patient6. SCIP-Inf-1 Prophylactic Antibiotic Received within One HourPrior to Surgical Incision7. SCIP-Inf-2 Prophylactic Antibiotic Selection for SurgicalPatients8. SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24Hours After Surgery9. SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m.Postoperative Serum Glucose10. SCIP–Inf–9 Postoperative Urinary Catheter Removal onPostoperative Day 1 or 2.11. SCIP-Card-2 Surgery Patients on a Beta Blocker Prior toArrival That Received a Beta Blocker During thePerioperative Period12. SCIP-VTE-2 Surgery Patients Who Received AppropriateVenous Thromboembolism Prophylaxis within 24 Hours1. Nurse Communication2. Doctor Communication3. Hospital Staff Responsiveness4. Pain Management5. Medicine Communication6. Hospital Cleanliness and Quietness7. Discharge Information8. Overall Hospital RatingPatient Experience1. AHRQ (PSI-90) Patient Safety for SelectedIndicators (composite)2. CLABSI Central Line-AssociatedBloodstream Infection3. MORT-30-AMI Acute Myocardial Infarction(AMI) 30-day mortality rate4. MORT-30-HF Heart Failure (HF) 30-daymortality rate5. MORT-30-PN Pneumonia (PN) 30-daymortality rateOutcome Measures1. MSPB-1 Medicare Spending Per BeneficiaryEfficiency Measures
  • 13 Applies to subsection (d) hospital found inSection 1886(d)(1)(B) of Social Security Act Applies to acute care hospitals in the 50 statesand the District of Columbia Clinical Process of Care Domain score requiresat least 10 cases for each of at least 4applicable measures during the PerformancePeriod Patient Experience of Care Domain scorerequires at least 100 completed HCAHPSsurveys during the Performance Period Outcome 30-Day Mortality requires at least10 cases and 2 measures during PerformancePeriodEligible and Excluded Hospitals Hospitals subject to payment reductionsunder Hospital IQR Hospitals and hospital units excluded fromthe Inpatient Prospective Payment System(IPPS) Hospitals cited for deficiencies during theperformance period that pose immediatejeopardy to the health or safety of patients Hospitals without the minimum number ofcases, measures, or surveys Hospitals that are paid under Section 1814(b)(3) and have received an exemption fromthe Secretary of HHS Teaching and Children’s HospitalsEligible Hospitals Excluded HospitalsHVBP is mandatory for all eligible hospitals; not reporting the data will attract thefinancial penalty by CMS
  • 14Useful ResourcesHospital Inpatient Quality Reporting Program How to Participate• https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1138900291659 Measures Comparison tables –Calendar Year 2013 Discharges:• https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1138900298473 FY2013 HVBP Payment Adjustment Factors ( Under Download section)• http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/ Each Hospital’s Value Based Purchasing – Value Based Percentage Payment Summary Report andthe supporting explanatory documents• https://www.qualitynet.org./
  • 15AgendaPart 1: HVBP Overview Introduction and Timeline Measure CoveragePart 2: HVBP Calculation Performance Score and Incentive Calculations Achieving Continuous ImprovementPart 3: Live Demo – Health BI HVBP AppPart 4: Summary / Q&A
  • 16Threshold and Benchmark Hospitals are scored for each measure according to a 10-point scale defined between themeasure’s achievement threshold and a benchmark. Achievement threshold is the minimum level of performance to be considered for incentivepayment. The achievement thresholds are set at the 50th percentile of on a given measureduring the baseline period. Benchmark is the highest levels of performance among hospitals during the baseline period.The benchmarks are the mean of the top decile of overall hospital scoresTotal Performance Score0 10050NumberofHospitalsThreshold (50th Percentile)Benchmark(Mean of top decile)40 95
  • 17Achievement, Improvement & Total Performance Scores The achievement score is based on how a hospital’s current performance compares to theperformance of all other hospitals during the baseline period. The improvement score is based on how a hospital’s current performance compares to itsprior performance during the baseline periodTimeMy Hospital’s currentperformancecompared to AllHospitals’ BaselinePeriod PerformanceMy Hospital’s currentperformancecompared to MyHospital’s BaselinePeriod PerformanceMeMeMeAll
  • 18Score Calculation: Total PerformanceAchievement Score Methodology Improvement Score Methodology• Hospital will earn 0 to 10 points on where itsperformance for the measure falls relative tothe Threshold and the Benchmark• Formula is [9 * ((Hospital’s performanceperiod score - Threshold) / (Benchmark -Threshold))] + 0.5• All achievement points will be rounded tothe nearest whole number• Hospital will earn 0 to 9 points on how muchits performance during performance periodimproves relative to performance in baselineperiod• Formula is [10 * ((Hospital performanceperiod score - Hospital baseline periodscore) / (Benchmark – hospital baselineperiod score))] - 0.5• All improvement points will be rounded tothe nearest whole numberTotal Performance Score = Weighted sum of All the domain scores for that FYFor FY 14:TPS = 45%(Clinical Score) + 30%(Patient Experience Score) + 25%(Outcome Score)For FY 15:TPS = 20%(Clinical Score) + 30%(Patient Experience Score) + 30%(Outcome Score) + 20%(EfficiencyScore)
  • 19Sample calculations for FY 14 for Hospital ABC for AMI-7a50% 100%70% 80%60% 90%Benchmark 99%79%Achievement Range69%Achievement Threshold  65%0 2 3 4 5 6 7 8 911 2 3 4 5 6 7 8 9Improvement Range010Threshold = 65%Benchmark = 99%Baseline Score = 69%Performance Score = 79%Ach. Score = 4Imp. Score = 3= 45% of 40 + 30% of 84 + 25% of 50= 45% of (52/130 * 100) + 30% of (64 + 20) + 25% of (15/30 * 100)= 55.7* Assuming Clinical score for each measure = 4,Patient Experience score for each measure =8and Consistency Points = 20Outcome score for each measure = 5
  • 20Translating TPS into the VBP IncentiveEstimate each hospital’s total annual base operating DRG paymentamount using Medicare inpatient claims data from MedPAR filesCalculate the total annual estimated base operating DRGpayment amount reduction across all eligible hospitalsCalculate the linear exchange function slopeCalculate each hospital’s incentive percentage (a.k.a.per cent of base operating DRG earned back)Compute the net percentage change in thehospital’s base operating DRG paymentCompute the value-based multiplier123456$ $ $Calculate Net change inbase DRG7
  • 21Sample HVPB Incentive Calculation: FY14 vs. FY15Step Description FY14 FY151 Base DRG amount for the hospital $1 Billion $1.1 Billion2 Total annual estimated base operating DRG paymentamount reduction across all eligible hospitals*Sum [Base Operating DRG Payment Amount] × 1.25%$1 Billion $1.2 Billion3 Linear Exchange Function Slope*Sum of DRG payment reduction amount for all hospitals) /(Sum of DRG payment amount for each hospital x thathospital’s TPS/100)$1b/$500m= 2$1.2b/$600m= 24 VBP Incentive PercentageApplicable percent Reduction for Program Year × Hospital’sTPS/100 × Linear Exchange Function Slope0.0125 X 55.7% X 2= 1.39%0.015 X 45% X 2= 1.35%5 Net % change for hospital’s base DRG payment for eachdischargeHospital’s Value-based Incentive Payment Percentage –Applicable percent Payment Reduction1.39 – 1.25= 0.14%1.35 – 1.5= -0.15%6 Hospital’s Value-Based MultiplierNet % change for Hospitals based DRG payment x Estimatebase DRG amount1 + 0.14%= 1.00141 – 0.15%= 0.9985Net Change in Base DRG ($1b) $1.4m -$1.65m(Multiplier x Base DRG)-Base DRG7
  • 22AgendaPart 1: HVBP Overview Introduction and Timeline Measure CoveragePart 2: HVBP Calculation Performance Score and Incentive Calculations Achieving Continuous ImprovementPart 3: Live Demo – Health BI HVBP AppPart 4: Summary / Q&A
  • 23HVBP: Financial Impact on Non-Performing HospitalsLowPerformanceScoreLoss of market share tocompetitorsNon-performing hospitalsstand to lose money to theirregional competitors whoare performing wellMired in the non-performance quicksandThe benchmark and thresholdrise each year, making it moredifficult each year to break evenDirect impact on bottom-lineThe penalties directly impact hospital’sbottom-lines and its ability to take onnew efficiency or safety initiatives
  • 24Computeperiodic measure-wise performancescoresIdentifyImprovementareas usingmeasure /domain scoresTrackContinuousImprovementContinuous ImprovementPredictIncentives- Leverage EHR investments by coupling it with analytics solutions to calculate currentperformance rates periodically- Identify at-risk, inefficient and wasteful areas; take corrective actions- Use analytics to predict your future incentives / penalties today
  • 25AgendaPart 1: HVBP Overview Introduction and Timeline Measure CoveragePart 2: HVBP Calculation Performance Score and Incentive Calculations Achieving Continuous ImprovementPart 3: Live Demo – Health BI HVBP AppPart 4: Summary / Q&A
  • 26Health BI: OverviewOthersEMR PMS/RCM Lab Pharmacy RIS/PACS Comprehensive list of Apps for healthcareBI / analytics – acrosshospitals, physician practices, ACOs andHIEs BI-Clinical Rules Engine to addressbusiness critical needs – includingHVBP, ACO analytics, population healthanalytics, re-admission and utilizationmanagement 600+ pre-built measures acrossregulatory initiatives -PQRS, JCAHO/JCI, NCQA HEDIS, PCMH Deployment options available on bothon-premise and cloud-baseddeployment modelsServing over 1,200 provider sites – mostwidely deployed 3rd party ONC-ATCB 2011-12 certified BI/Analytics platform
  • 27Health BI HVBP App: DemoLive Demo
  • 28Health BI: HEDISStatusABA Adult BMI Assessment PASSWCCWeight Assessment and Counseling for Nutrition and Physical Activity forChildren/Adolescents PASSCIS Childhood Immunization Status PASSIMA Immunizations for Adolescents PASSHPV Human Papillomavirus Vaccine for Female Adolescents PASSLSC Lead Screening in Children PASSBCS Breast Cancer Screening PASSCCS Cervical Cancer Screening PASSCOL Colorectal Cancer Screening PASSCHL Chlamydia Screening in Women PASSGSO Glaucoma Screening in Older Adults PASSCOA Care for Older Adults PASSCWP Appropriate Testing for Children With Pharyngitis PASSURI Appropriate Treatment for Children With Upper Respiratory Infection PASSAAB Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis PASSSPR Use of Spirometry Testing in the Assessment and Diagnosis of COPD PASSPCE Pharmacotherapy Management of COPD Exacerbation PASSASM Use of Appropriate Medications for People With Asthma PASSMMA Medication Management for People With Asthma PASSAMR Asthma Medication Ratio PASSCMC Cholesterol Management for Patients With Cardiovascular Conditions PASSCBP Controlling High Blood Pressure PASSPBH Persistence of Beta-Blocker Treatment After a Heart Attack PASSCDC Comprehensive Diabetes Care PASSART Disease-Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis PASSOMW Osteoporosis Management in Women Who Had a Fracture PASSLBP Use of Imaging Studies for Low Back Pain PASSAMM Antidepressant Medication Management PASSADD Follow-Up Care for Children Prescribed ADHD Medication PASSFUH Follow-Up After Hospitalization for Mental Illness PASSSSDDiabetes Screening for People With Schizophrenia of Bipolar Disorder Who Are UsingAntipsychotic Medications PASSSMD Diabetes Monitoring for People With Diabetes and Schizophrenia PASSSMC Cardiovascular Monitoring for People With Cardiovascular Diseases and Schizophrenia PASSSAA Adherence to Antipsychotic Medications for Individuals With Schizophrenia PASSMPM Annual Monitoring for Patients on Persistent Medications PASSMEASUREStatusMRP Medication Reconciliation Post-Discharge PASSDDE Potentially Harmful Drug-Disease Interactions in the Elderly PASSDAE Use of High-Risk Medications in the Elderly PASSAAP Adults’ Access to Preventive/Ambulatory Health Services PASSCAP Children and Adolescents’ Access to Primary Care Practitioners PASSADV Annual Dental Visit PASSIET Initiation and Engagement of Alcohol and Other Drug Dependence PASSPPC Prenatal and Postpartum Care PASSFPC Frequency of Ongoing Prenatal Care PASSW15 Well-Child Visits in the First 15 Months of Life PASSW34 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life PASSAWC Adolescent Well-Care Visits PASSFSP Frequency of Selected Procedures PASSAMB Ambulatory Care PASSIPU Inpatient Utilization—General Hospital/Acute Care PASSIAD Identification of Alcohol and Other Drug Services PASSMPT Mental Health Utilization PASSABX Antibiotic Utilization PASSPCR Plan All-Cause Readmissions PASSRDI Relative Resource Use for People With Diabetes PASSRAS Relative Resource Use for People With Asthma PASSRCA Relative Resource Use for People With Cardiovascular Conditions PASSRHY Relative Resource Use for People With Hypertension PASSRCO Relative Resource Use for People With COPD PASSENP Enrollment by Product Line PASSEBS Enrollment by State PASSLDM Language Diversity of Membership PASSRDM Race/Ethnicity Diversity of Membership PASSWOP Weeks of Pregnancy at Time of Enrollment PASSTLM Total Membership PASSCPA CAHPS 5.0H Adult Survey Layout PASSCPC CAHPS 5.0H Child Survey Layout PASSCCC Children With Chronic Conditions Layout PASSMEASURE
  • 29AgendaPart 1: HVBP Overview Introduction and Timeline Measure CoveragePart 2: HVBP Calculation Performance Score and Incentive Calculations Achieving Continuous ImprovementPart 3: Live Demo – Health BI HVBP AppPart 4: Summary / Q&A
  • 30Summary The best performing hospitals win the $ share of poor performing hospitals - (e.g. for FY’13TREASURE VALLEY HOSPITAL earned 83% more & AUBURN COMMUNITY HOSPITAL earned 90%less than usual MS-DRG payment) The incentives / penalties depend not only on your performance, but all the hospitals in thecountry; the achievement thresholds and benchmarks may rise every year Health BI provides analytics capabilities to help hospitals track their current scores vis-à-visthresholds and benchmarks, identify improvement areas and thus maximize future incentives bycontinuous improvement. Health BI provides What-If capabilities around calculating incentives / penalties; a user canmodify performance / domain scores and see its financial impact Being HEDIS 2013 certified gives Health BI a distinct edge; large hospitals could attractivelyposition their health plans to local employers
  • Business Contacts: Martin SizemoreDirector, Healthcare Strategy, Perficient Inc.Dennis SwarupVice President, BI Practice, CitiusTech Inc.U: www.citiustech.comE: Dennis.Swarup@Citiustech.comQ&AContact us to learn moreabout how our Health BI / BI-Clinical solution can helpyour ACO quality reportingand analytics requirements.U: www.perficient.comE: Martin.Sizemore@perficient.com
  • 32Thank You