5 dangerous ideas

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5 dangerous ideas

  1. 1. SCCIPA A Pacific Partners Medical Group5 dangerous ideas*Wayne Pan, MDSanta Clara County IPA
  2. 2. but first, some audience questions
  3. 3. PLEASE STAND IF:you are concerned about STAR ratings
  4. 4. PLEASE REMAIN STANDING IF: you are a provider
  5. 5. PLEASE REMAIN STANDING IF:you are part of a delegated group
  6. 6. PLEASE REMAIN STANDING IF:your group has a common EHR
  7. 7. PLEASE REMAIN STANDING IF:your common EHR is helping you with your STAR rating program
  8. 8. NOW, LOOK AROUND YOU
  9. 9. we ALL can learn from those left standing
  10. 10. it’s NOT about the EHR
  11. 11. it’s about people and processes
  12. 12. supported by the right technology
  13. 13. dialog (noun) ˈdī-ə-ˌlȯg, -ˌläg2a: a conversation between two or more persons
  14. 14. dangerous idea: # 1
  15. 15. “Ask not what yourhealth plan can do for you; ask whatyou can do for your health plan.”
  16. 16. partnership (noun) -ˌship3: a relationship resembling a legal partnership andusually involving close cooperation betweenparties having specified and joint rights andresponsibilitiesfrom: merriam-webster.com
  17. 17. Seniordoctor patients
  18. 18. Seniordoctor patients
  19. 19. doctor patientproviders clinically treat patients all the same
  20. 20. www.iha.org
  21. 21. www.iceforhealth.org
  22. 22. • Provider programs - work with providers to ensure nonduplicative efforts• Member outreach - help providers with things they can’t do well• Clinical data - old data is worse than no data
  23. 23. dangerous idea: # 2
  24. 24. • Consistent communication plan - providers do not like surprises• Use multiple channels - providers are unique, each has preferred method• Embrace office staff - not everything needs to go through the provider
  25. 25. dangerous idea: # 3
  26. 26. feedback
  27. 27. • Progress toward set goals• Performance comparison with peers• Customized help for improvement
  28. 28. iteration
  29. 29. dangerous idea: # 4
  30. 30. • Set aside money in advance• Clear performance targets• Transparent incentive program
  31. 31. dangerous idea: # 5
  32. 32. address the whole patient
  33. 33. • Link to annual HCC process• Link to all quality improvement programs• Use HCC risk scores to target outreach
  34. 34. it’s not just about STAR ratings
  35. 35. it’s really about patient care
  36. 36. too many of these
  37. 37. Santa Clara County 1,304.01 sq. miles 1,781,642 (2010) $74,335
  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)
  39. 39. full disclosure
  40. 40. SCCIPA GroupA Pacific Partners Medical
  41. 41. • Internal: • 2 RN’s - one CCM, one UM • 2 LVN’s - one CCM, one UM • 1 EMT • 1 clinical data analyst • 4 non-clinical• External: • 2 RN’s - onsite CM • 1 MSW - onsite @ SNFs • Hospitalist group (9 physicians) • 1 SNFist
  42. 42. 1how do we partner with health plans?
  43. 43. review & utilize health plan resources
  44. 44. provider training/education materials disease management programs patient-specific initiatives incentive programs quarterly sync-up meetings
  45. 45. 2require all physicians to use AccessExpress
  46. 46. our common communication platform
  47. 47. HIPAA-compliant secure communications eligibility resource electronic referral authorizations claims and authorization status
  48. 48. how do you make a platform helpful?
  49. 49. integration into the office workflow
  50. 50. how do you make a platform effective?
  51. 51. engage office staff
  52. 52. patient
  53. 53. patient front desk staff
  54. 54. analog to digital converter
  55. 55. 112 MARY SMITH 1/1/2011 1234567890 $5.00 $10.00 $25.00analog to digital eligibility check converter
  56. 56. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  57. 57. ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
  58. 58. 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
  59. 59. 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
  60. 60. digital to analog converter module
  61. 61. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  62. 62. 3used same communication platform for provider feedback
  63. 63. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  64. 64. 4physician bonus program based on achieving set targets
  65. 65. 2011 Bonus Structure PCPs: 2011 IHA P4P and HCC CMS 5 STAR rating measuresParticipation in patient satisfaction training (4 meetings)Patient satisfaction scores (based on the CAHPS survey)Responsiveness to PPMSI Med Management inquiries
  66. 66. 2011 Bonus Structure Specialists: billing or SCCIPA unique patient volumeOverall achievement of SCCIPA in the CMS 5 STAR Rating Program Participation in patient satisfaction training program (4 meetings) Patient satisfaction scores (based on internal survey) Use of Excelicare Clinical HubResponsiveness to PPMSI Medical Management inquiries (timeliness)
  67. 67. 5how do we focus on the whole patient?
  68. 68. send patient reminders for annual visit provide providers checklist prompt front office staff HOS survey full HCC review by hospitalists 48hr discharge follow-up post-discharge office visit follow-uppost home health initiation follow-up
  69. 69. send patient reminders for annual visit provide providers checklist prompt front office staff HOS survey full HCC review by hospitalists 48hr discharge follow-up post-discharge office visit follow-uppost home health initiation follow-up
  70. 70. send patient reminders for annual visit provide providers checklist prompt front office staff HOS survey full HCC review by hospitalists 48hr discharge follow-up post-discharge office visit follow-uppost home health initiation follow-up
  71. 71. 5 dangerous ideas• find ways to partner with your health plans• have a consistent, multi-faceted communication strategy• provide ample, data-driven feedback• put money where your goals are• focus on the whole patient
  72. 72. discussion
  73. 73. thankyou
  74. 74. SCCIPA A Pacific Partners Medical Groupwpan@ppmsi.com

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