How to effectivelymanage theCMS “5 STAR” Rating System                     Wayne Pan, MD, MBA                   Health Acc...
Agenda• The basics• The approach• The roll-out• The demo• Q&A
The basics• Communication link among all  contracted providers • Easy to use • Integrated into the office workflow • HIPAA-s...
The basics• Dashboard of actionable items • Who needs something done? • What is it that they need? • When do I need to do ...
The basics• Dashboard also functions as: • Feedback on progress of to-do list • Compare my office progress with the   rest ...
The approach• Involvement of multiple stakeholders • Primary care physicians • Specialty physicians • Ancillary profession...
What does this mean?• Involvement of multiple stakeholders • Provider portal • Office staff portal • Patient portal
The roll-out• Stages of a program roll-out • Level 1: manual process • Level 2: electronic, provider-centric   process • L...
Level 1• Periodic production and distribution of  encounter/lab data in a paper-based  physician dashboard (quarterly)• Ma...
Level 1• Asynchronous data exchange• Resource-intensive• Not scalable• Still with positive ROI, if done well• Need provide...
Level 2• Use of electronic tools to push  information to providers and office staff • Goals • Patients needing contact/serv...
Level 2• Two audiences • Office staff • Providers• Create a team-based approach to  achieving goals• Provide simple-to-use ...
Level 2• Office staff portal • Provides communication link • Reactive approach: when patient   shows up in the office • Proa...
Level 2• Office staff portal: reactive approach • Incorporate into existing workflow   • Eligibility and patient co-pay     ...
Level 2• Office staff portal: proactive approach • Generates patient list to support office   staff outreach efforts • Office...
Level 2• Office staff portal: proactive approach • Data entry by provider office staff • Automated IVR outbound   appointmen...
Level 2a• Involving the provider through his/her  work environment/workflow • Paper-based • Integration with EMR• Provide e...
Level 2a• Physician portal: reactive approach • Dashboard driven data presentation • Fully integrated within physician wor...
Level 3• Involving the patient in addition to the  physician• Providing self-service patient portal• Pull - in addition to...
Level 3• Patient portal: proactive approach • Provide patients with their own clinical   data (engage with patients) • Rem...
Level 3• Patient portal: proactive approach • Reinforce provider messages regarding   preventive care (e.g., daily exercis...
The demo
Scenario 1 - Reactive
Sample workflow1    Patient     arrives    at office
Sample workflow1              2    Patient        Office staff     arrives         checks    at office        patient in
Sample workflow1              2                 3    Patient        Office staff       Office staff     arrives         check...
Sample workflow1              2                 3                  4    Patient        Office staff       Office staff       ...
Sample workflow1              2                 3                  4    Patient        Office staff       Office staff       ...
Sample workflow1              2                 3                  4    Patient        Office staff       Office staff       ...
Sample workflow1              2                 3                    4    Patient        Office staff       Office staff     ...
Sample workflow1              2                  3                    4    Patient        Office staff        Office staff   ...
Sample workflow1                       2                  3                    4      Patient               Office staff    ...
SMITH, MARY                   8/15/1945                   F                   123 MAIN STREET                   SANTA CLAR...
SMITH, MARY                   8/15/1945                   F                   123 MAIN STREET                   SANTA CLAR...
SMITH, MARY                   8/15/1945                   F                   123 MAIN STREET                   SANTA CLAR...
SMITH, MARY                   8/15/1945                   F                   123 MAIN STREET                   SANTA CLAR...
Pop-up                   SMITH, MARY                   8/15/1945                                                          ...
SMITH, MARY                   8/15/1945                   F                   123 MAIN STREET                   SANTA CLAR...
SMITH, MARY                   8/15/1945                   F                   123 MAIN STREET                   SANTA CLAR...
SMITH, MARY                   8/15/1945                   F                   123 MAIN STREET                   SANTA CLAR...
MARY SMITH1234567890
x    x
SMITH, MARY                                                    Medicare Dashboard                   8/15/1945             ...
Scenario 2 - Proactive
Sample workflow1    Office staff      opens    dashboard
Sample workflow1                 2    Office staff       Prints list of      opens             patients    dashboard        ...
Sample workflow1                 2                    3    Office staff       Prints list of       Outreach to      opens   ...
Sample workflow1                 2                    3                 4    Office staff       Prints list of       Outreac...
Sample workflow1                 2                    3                 4    Office staff       Prints list of       Outreac...
Sample workflow1                 2                    3                 4    Office staff       Prints list of       Outreac...
Sample workflow1                 2                    3                    4    Office staff       Prints list of       Outr...
Sample workflow1                 2                    3                    4    Office staff       Prints list of       Outr...
Sample workflow1                       2                    3                    4    Office staff             Prints list o...
Click onmeasure
ANDREW SMITHMARY SMITHPAULA SMITHSANDRA SMITH
ANDREW SMITHMARY SMITHPAULA SMITHSANDRA SMITH      Click on       patient
MARY SMITH1234567890
ANDREW SMITHMARY SMITHPAULA SMITHSANDRA SMITH                Click to              download
SMITH ANDREW   MSMITH MARY     FSMITH PAULA    FSMITH SANDRA   F
SMITH ANDREW   MSMITH MARY     FSMITH PAULA    FSMITH SANDRA   F
SMITH ANDREW   MSMITH MARY     FSMITH PAULA    FSMITH SANDRA   F
MARY SMITH
SMITH, MARY                   8/15/1945                   F                   123 MAIN STREET                   SANTA CLAR...
Alice       SmithBetty       SmithCharles     SmithDavid       SmithEdward      SmithFrank       SmithGeorgette   SmithHen...
Discussion
Thank you
How to effectivelymanage theCMS “5 STAR” Rating System        Wayne Pan, MD, MBA       Health Access Solutions         wpa...
CAPG StarQuest Presentation 1 Mar11
CAPG StarQuest Presentation 1 Mar11
CAPG StarQuest Presentation 1 Mar11
CAPG StarQuest Presentation 1 Mar11
CAPG StarQuest Presentation 1 Mar11
CAPG StarQuest Presentation 1 Mar11
CAPG StarQuest Presentation 1 Mar11
CAPG StarQuest Presentation 1 Mar11
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CAPG StarQuest Presentation 1 Mar11

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CAPG StarQuest Presentation 1 Mar11

  1. 1. How to effectivelymanage theCMS “5 STAR” Rating System Wayne Pan, MD, MBA Health Access Solutions
  2. 2. Agenda• The basics• The approach• The roll-out• The demo• Q&A
  3. 3. The basics• Communication link among all contracted providers • Easy to use • Integrated into the office workflow • HIPAA-secure • Web-based
  4. 4. The basics• Dashboard of actionable items • Who needs something done? • What is it that they need? • When do I need to do it? • Why do I need to do it? • How can my office reach them?
  5. 5. The basics• Dashboard also functions as: • Feedback on progress of to-do list • Compare my office progress with the rest of my peers • Link to office data entry portal • Display of bonus achieved thus far
  6. 6. The approach• Involvement of multiple stakeholders • Primary care physicians • Specialty physicians • Ancillary professionals • Office staff • Patient
  7. 7. What does this mean?• Involvement of multiple stakeholders • Provider portal • Office staff portal • Patient portal
  8. 8. The roll-out• Stages of a program roll-out • Level 1: manual process • Level 2: electronic, provider-centric process • Level 3: electronic, patient- and provider-centric process
  9. 9. Level 1• Periodic production and distribution of encounter/lab data in a paper-based physician dashboard (quarterly)• Manual collection of provider-based data• Manual entry of provider data into tracking database• Letters to patients to remind them of missing items
  10. 10. Level 1• Asynchronous data exchange• Resource-intensive• Not scalable• Still with positive ROI, if done well• Need provider buy-in
  11. 11. Level 2• Use of electronic tools to push information to providers and office staff • Goals • Patients needing contact/services• Provide near-realtime feedback regarding progress towards goals• Tying bonus to achieving goals
  12. 12. Level 2• Two audiences • Office staff • Providers• Create a team-based approach to achieving goals• Provide simple-to-use tools
  13. 13. Level 2• Office staff portal • Provides communication link • Reactive approach: when patient shows up in the office • Proactive approach: when providing patient outreach
  14. 14. Level 2• Office staff portal: reactive approach • Incorporate into existing workflow • Eligibility and patient co-pay information • Pop-up messaging for missing items in provider quality workplan • Use of portal traceable through auditing
  15. 15. Level 2• Office staff portal: proactive approach • Generates patient list to support office staff outreach efforts • Office staff to call patients to schedule appointments for missing items • MSO member services staff could assist smaller offices to do outreach calls
  16. 16. Level 2• Office staff portal: proactive approach • Data entry by provider office staff • Automated IVR outbound appointment reminder calls
  17. 17. Level 2a• Involving the provider through his/her work environment/workflow • Paper-based • Integration with EMR• Provide electronic tools to help provider track his/her progress towards goals
  18. 18. Level 2a• Physician portal: reactive approach • Dashboard driven data presentation • Fully integrated within physician work portal (e.g., EHR) • Auto creation of necessary referral auths based on missing items • Auto generation of patient clinical information sheets
  19. 19. Level 3• Involving the patient in addition to the physician• Providing self-service patient portal• Pull - in addition to the push from the provider end
  20. 20. Level 3• Patient portal: proactive approach • Provide patients with their own clinical data (engage with patients) • Remind patients of preventive care items that still need to be completed
  21. 21. Level 3• Patient portal: proactive approach • Reinforce provider messages regarding preventive care (e.g., daily exercise, smoking cessation, need for DXA, etc.) • Survey patients routinely after physician office visits
  22. 22. The demo
  23. 23. Scenario 1 - Reactive
  24. 24. Sample workflow1 Patient arrives at office
  25. 25. Sample workflow1 2 Patient Office staff arrives checks at office patient in
  26. 26. Sample workflow1 2 3 Patient Office staff Office staff arrives checks checks at office patient in eligibility
  27. 27. Sample workflow1 2 3 4 Patient Office staff Office staff Pop-up arrives checks checks member at office patient in eligibility questionnaire
  28. 28. Sample workflow1 2 3 4 Patient Office staff Office staff Pop-up arrives checks checks member at office patient in eligibility questionnaire 5 Collect questionnaire, give patient info
  29. 29. Sample workflow1 2 3 4 Patient Office staff Office staff Pop-up arrives checks checks member at office patient in eligibility questionnaire 5 Collect questionnaire, give patient info 6 Office staff puts reminder(s) on patient chart
  30. 30. Sample workflow1 2 3 4 Patient Office staff Office staff Pop-up arrives checks checks member at office patient in eligibility questionnaire 5 Collect questionnaire, give patient info 7 6 Physician sees Office staff patient with puts reminder(s) reminder(s) on patient chart
  31. 31. Sample workflow1 2 3 4 Patient Office staff Office staff Pop-up arrives checks checks member at office patient in eligibility questionnaire 5 Collect questionnaire, give patient info 8 7 6 Physician sees Office staff Patient receives patient with puts reminder(s) appropriate care reminder(s) on patient chart
  32. 32. Sample workflow1 2 3 4 Patient Office staff Office staff Pop-up arrives checks checks member at office patient in eligibility questionnaire 5 Collect questionnaire, give patient info9 8 7 6 P4P/HCC/5STAR Physician sees Office staff metrics achieved Patient receives patient with puts reminder(s) for this patient appropriate care reminder(s) on patient chart
  33. 33. SMITH, MARY 8/15/1945 F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 SCCIPA ROBERT NORMAN, MD 1/1/2000 Check eligibility 1234567890Quality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  34. 34. SMITH, MARY 8/15/1945 F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 SCCIPA ROBERT NORMAN, MD 1/1/2000 1234567890Quality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  35. 35. SMITH, MARY 8/15/1945 F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 SCCIPA ROBERT NORMAN, MD 1/1/2000 1234567890Quality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  36. 36. SMITH, MARY 8/15/1945 F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 SCCIPA ROBERT NORMAN, MD 1/1/2000 1234567890Quality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  37. 37. Pop-up SMITH, MARY 8/15/1945 message F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 CLOSE x SCCIPA ROBERT NORMAN, MD 1/1/2000 MEDICARE PATIENT 1234567890 QUESTIONNAIRE HCCQuality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  38. 38. SMITH, MARY 8/15/1945 F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 CLOSE x SCCIPA ROBERT NORMAN, MD 1/1/2000 MEDICARE PATIENT 1234567890 QUESTIONNAIRE Click to HCC printQuality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  39. 39. SMITH, MARY 8/15/1945 F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 CLOSE x SCCIPA ROBERT NORMAN, MD 1/1/2000 MEDICARE PATIENT 1234567890 QUESTIONNAIRE HCC Click toQuality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION printCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  40. 40. SMITH, MARY 8/15/1945 F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 SCCIPA ROBERT NORMAN, MD 1/1/2000 1234567890 Click on measuresQuality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  41. 41. MARY SMITH1234567890
  42. 42. x x
  43. 43. SMITH, MARY Medicare Dashboard 8/15/1945 Complete? DOC Measure F x 25FEB11 Mammography 123 MAIN STREET SANTA CLARA, CA 95051 x 1MAR11 Colorectal Cancer Screening 4085551212 x 25FEB11 Cardio Care SCCIPA x 25FEB11 Diabetes Care ROBERT NORMAN, MD x 1MAR11 Hypertension 1/1/2000 x 15FEB11 Glaucoma x 1MAR11 Chronic Meds Monitoring x 8FEB11 Flu Vaccine x 1MAR11 Pneumo Vaccine x 25FEB11 Bone Density Testing x 8FEB11 Rheumatologic Medication 1234567890 x 1MAR11 Spirometry for COPD x 1MAR11 Urine leakage counseling x 1MAR11 Falls counseling x 1MAR11 Exercise counseling x 1MAR11 Appointment ease x 1MAR11 Physical/emotional healthQuality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  44. 44. Scenario 2 - Proactive
  45. 45. Sample workflow1 Office staff opens dashboard
  46. 46. Sample workflow1 2 Office staff Prints list of opens patients dashboard needing care
  47. 47. Sample workflow1 2 3 Office staff Prints list of Outreach to opens patients patients on dashboard needing care list
  48. 48. Sample workflow1 2 3 4 Office staff Prints list of Outreach to Office staff checks eligibility opens patients patients on and prints dashboard needing care list questionnaire
  49. 49. Sample workflow1 2 3 4 Office staff Prints list of Outreach to Office staff checks eligibility opens patients patients on and prints dashboard needing care list questionnaire 5 Collect questionnaire, give patient info
  50. 50. Sample workflow1 2 3 4 Office staff Prints list of Outreach to Office staff checks eligibility opens patients patients on and prints dashboard needing care list questionnaire 5 Collect questionnaire, give patient info 6 Office staff puts reminder(s) on patient chart
  51. 51. Sample workflow1 2 3 4 Office staff Prints list of Outreach to Office staff checks eligibility opens patients patients on and prints dashboard needing care list questionnaire 5 Collect questionnaire, give patient info 7 6 Physician sees Office staff patient with puts reminder(s) reminder(s) on patient chart
  52. 52. Sample workflow1 2 3 4 Office staff Prints list of Outreach to Office staff checks eligibility opens patients patients on and prints dashboard needing care list questionnaire 5 Collect questionnaire, give patient info 8 7 6 Physician sees Office staff Patient receives patient with puts reminder(s) appropriate care reminder(s) on patient chart
  53. 53. Sample workflow1 2 3 4 Office staff Prints list of Outreach to Office staff checks eligibility opens patients patients on and prints dashboard needing care list questionnaire 5 Collect questionnaire, give patient info9 8 7 6 P4P/HCC/5STAR Physician sees Office staff metrics achieved Patient receives patient with puts reminder(s) for this patient appropriate care reminder(s) on patient chart
  54. 54. Click onmeasure
  55. 55. ANDREW SMITHMARY SMITHPAULA SMITHSANDRA SMITH
  56. 56. ANDREW SMITHMARY SMITHPAULA SMITHSANDRA SMITH Click on patient
  57. 57. MARY SMITH1234567890
  58. 58. ANDREW SMITHMARY SMITHPAULA SMITHSANDRA SMITH Click to download
  59. 59. SMITH ANDREW MSMITH MARY FSMITH PAULA FSMITH SANDRA F
  60. 60. SMITH ANDREW MSMITH MARY FSMITH PAULA FSMITH SANDRA F
  61. 61. SMITH ANDREW MSMITH MARY FSMITH PAULA FSMITH SANDRA F
  62. 62. MARY SMITH
  63. 63. SMITH, MARY 8/15/1945 F 123 MAIN STREET SANTA CLARA, CA 95051 4085551212 SCCIPA ROBERT NORMAN, MD 1/1/2000 1234567890Quality Measures MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSIONCMS 5 STAR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  64. 64. Alice SmithBetty SmithCharles SmithDavid SmithEdward SmithFrank SmithGeorgette SmithHenry SmithIllana SmithJackie SmithKelly SmithLori SmithMary SmithNancy SmithOctavia SmithPaul SmithQuincy SmithRobert SmithSamantha SmithTom Smith
  65. 65. Discussion
  66. 66. Thank you
  67. 67. How to effectivelymanage theCMS “5 STAR” Rating System Wayne Pan, MD, MBA Health Access Solutions wpan@hasinc.com 650.358.5820

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