How Star Rating Measures Correlate with     Overall HEDIS Quality     Wayne Pan, MD, MBA            Chief Medical Officer  ...
RETIRED Measures
From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
? New Measures
From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
Average Stars of New Measures
From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
PART C Measures
HEDIS: Health Effectiveness Data and Information Set
HEDIS: Health Effectiveness Data and Information Set
HEDIS: Health Effectiveness Data and Information Set***       Only applies to plan enrollees 65+ years old
CAHPS: Consumer Assessment of Health Providers and Systems
HOS: Health Outcomes Survey
CMS DATA: Data Collected by CMS from Plans
PART D Measures
WEIGHTING
Outcomes 3xIntermediate Outcomes 3x Patient Experience 1.5x  Patient Access 1.5x       Process 1x
From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
?
a simpler way to manage yourP4P/CMS 5 Star qualityprogramwayne pan, md, mba
overview• who are the key players that need to be  involved in this process?• how can you engage the players in an effecti...
how are you going to coordinateall three stakeholders?             health             plans
need a bidirectional messagingplatform
need a cost-effective way tocommunicate with patients
need a way to consolidate allhealth plans into one platform
NOT
office manager’s view
Seniordoctor         patients
physician’s view
Seniordoctor         patients
doctor   patient
how can you affect change in the physician’s office?
payer-provider collaboration      is a team sport
patient
patient          front desk staff
analog to digital   converter
112                    MARY SMITH        1/1/2011                     1234567890                            $5.00         ...
how to engage your team inquality improvement efforts?
put hot triggers in the path ofmotivated people                             BJ Fogg, PhD      Director, Persuasive Technol...
TRIGGERS: Are people being triggered at themost appropriate time and in their workflow (path)?ABILITY: Have I made it easy ...
Introducing...  ACCESSEXPRESS                 Q
ACCESSEXPRESS                                                            Q    Click here to register     for a password or...
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
ACCESSEXPRESS                       Q      New Eligibility Response   New Message (3)          BLUE SHIELD OF CA
ACCESSEXPRESS                       Q          New Eligibility Response   New Message (3)                                T...
ACCESSEXPRESS                       Q      New Eligibility Response   New Message (3)          BLUE SHIELD OF CA
ACCESSEXPRESS                       Q      New Eligibility Response   New Message (3)          BLUE SHIELD OF CA
ACCESSEXPRESS                       Q      New Eligibility Response   New Message (3)          BLUE SHIELD OF CA
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)                      SMITH...
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)                      SMITH...
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)                           ...
ACCESSEXPRESS                Q                       New Eligibility Response   New Message (3)                      SMITH...
ACCESSEXPRESS                       Q      New Eligibility Response   New Message (3)          BLUE SHIELD OF CA
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
digital to analog converter module
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
ACCESSEXPRESS                Q       New Eligibility Response   New Message (3)                    N                    O ...
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
Description ofmeasure
Capability forphysician officeentry
Capability forphysician officeentry                   Y                  IT                  IL            AB
ACCESSEXPRESS                Q   New Eligibility Response   New Message (3)
how can you affect change in the physician’s office?
engage your team in quality   improvement efforts
“put hot triggers in the path of motivated people”    BJ Fogg, PhD    Director, Persuasive Technology Lab    Stanford Univ...
thankyouwpan@ppmsi.com
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
How star rating measures correlate with overall hedis quality (full) 16 jan12
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How star rating measures correlate with overall hedis quality (full) 16 jan12

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Presentation given at the Breakthrough Strategies to Boost HEDIS Scores & Quality Management meeting, Key West, January 16, 2012.

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How star rating measures correlate with overall hedis quality (full) 16 jan12

  1. 1. How Star Rating Measures Correlate with Overall HEDIS Quality Wayne Pan, MD, MBA Chief Medical Officer Pacific Partners Management Services, Inc.Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012
  2. 2. RETIRED Measures
  3. 3. From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
  4. 4. ? New Measures
  5. 5. From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
  6. 6. Average Stars of New Measures
  7. 7. From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
  8. 8. PART C Measures
  9. 9. HEDIS: Health Effectiveness Data and Information Set
  10. 10. HEDIS: Health Effectiveness Data and Information Set
  11. 11. HEDIS: Health Effectiveness Data and Information Set*** Only applies to plan enrollees 65+ years old
  12. 12. CAHPS: Consumer Assessment of Health Providers and Systems
  13. 13. HOS: Health Outcomes Survey
  14. 14. CMS DATA: Data Collected by CMS from Plans
  15. 15. PART D Measures
  16. 16. WEIGHTING
  17. 17. Outcomes 3xIntermediate Outcomes 3x Patient Experience 1.5x Patient Access 1.5x Process 1x
  18. 18. From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
  19. 19. From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
  20. 20. From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
  21. 21. ?
  22. 22. a simpler way to manage yourP4P/CMS 5 Star qualityprogramwayne pan, md, mba
  23. 23. overview• who are the key players that need to be involved in this process?• how can you engage the players in an effective, systematic way?• how can you measure performance and provide feedback?• how can you engage patients?
  24. 24. how are you going to coordinateall three stakeholders? health plans
  25. 25. need a bidirectional messagingplatform
  26. 26. need a cost-effective way tocommunicate with patients
  27. 27. need a way to consolidate allhealth plans into one platform
  28. 28. NOT
  29. 29. office manager’s view
  30. 30. Seniordoctor patients
  31. 31. physician’s view
  32. 32. Seniordoctor patients
  33. 33. doctor patient
  34. 34. how can you affect change in the physician’s office?
  35. 35. payer-provider collaboration is a team sport
  36. 36. patient
  37. 37. patient front desk staff
  38. 38. analog to digital converter
  39. 39. 112 MARY SMITH 1/1/2011 1234567890 $5.00 $10.00 $25.00analog to digital eligibility check converter
  40. 40. how to engage your team inquality improvement efforts?
  41. 41. put hot triggers in the path ofmotivated people BJ Fogg, PhD Director, Persuasive Technology Lab Stanford University
  42. 42. TRIGGERS: Are people being triggered at themost appropriate time and in their workflow (path)?ABILITY: Have I made it easy for people to act?How can I make it even simpler?MOTIVATION: Are incentives alignedproperly? How can I increase their motivation?
  43. 43. Introducing... ACCESSEXPRESS Q
  44. 44. ACCESSEXPRESS Q Click here to register for a password or request more informationPowered by Access ExpressQ-v5.0.#.0.1 Build 2011.04.04.00
  45. 45. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  46. 46. ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
  47. 47. ACCESSEXPRESS Q New Eligibility Response New Message (3) TH PA BLUE SHIELD OF CA E TH IN
  48. 48. ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
  49. 49. ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
  50. 50. ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
  51. 51. ACCESSEXPRESS Q New Eligibility Response New Message (3) SMITH, MARY 8/15/1945 POP-UP 1234567890 MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
  52. 52. 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 CLICK HERE
  53. 53. ACCESSEXPRESS Q New Eligibility Response New Message (3) ER SMITH, MARY 8/15/1945 G 1234567890 IG MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, TR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD T O H
  54. 54. 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
  55. 55. ACCESSEXPRESS Q New Eligibility Response New Message (3) BLUE SHIELD OF CA
  56. 56. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  57. 57. digital to analog converter module
  58. 58. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  59. 59. ACCESSEXPRESS Q New Eligibility Response New Message (3) N O TI VA TI O M
  60. 60. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  61. 61. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  62. 62. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  63. 63. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  64. 64. Description ofmeasure
  65. 65. Capability forphysician officeentry
  66. 66. Capability forphysician officeentry Y IT IL AB
  67. 67. ACCESSEXPRESS Q New Eligibility Response New Message (3)
  68. 68. how can you affect change in the physician’s office?
  69. 69. engage your team in quality improvement efforts
  70. 70. “put hot triggers in the path of motivated people” BJ Fogg, PhD Director, Persuasive Technology Lab Stanford University
  71. 71. thankyouwpan@ppmsi.com

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