This document summarizes key factors for successful reporting in pay-for-performance healthcare programs. It discusses the growing push for pay-for-performance under the Affordable Care Act and in Medicaid programs. Successful reporting requires clearly defined processes, preparation and validation of reports, flexibility to adapt to changing requirements, using data to drive decision-making, and aligning organizational strategy with reporting needs. Reporting is important to demonstrate achievement of quality goals and access incentive payments.
Health Reform & the Delivery System: A New Medley of Payment & IncentivesNASHP HealthPolicy
This document discusses opportunities and challenges for states in implementing provisions of the Affordable Care Act that aim to improve healthcare quality and efficiency. It outlines several key areas of reform including: data collection and performance measurement; public reporting of cost and quality; payment reform through value-based purchasing; consumer engagement; and provider engagement. For each area, it identifies state challenges such as lack of standardized measures and federal-state misalignment, as well opportunities created by the ACA such as incentives for care coordination and grants for delivery system transformation. Overall, the document argues that the ACA provides momentum to build on current state quality and efficiency efforts while addressing challenges around scarce resources and pressure to adopt mandatory reforms.
Maximizing Performance Incentives Through Star RatingsCitiusTech
The main aim of this document is to provide a high level understanding of the Star rating quality program of CMS and it’s impact on plans (at contract level) offered by the payers which are in Medicare Advantage line of business
It describes the various measure categories and their weightages, domains and sources required by CMS to assess quality of care and patient experience.
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
This document provides an overview of HealthLandscape, which is a tool created by the American Academy of Family Physicians to help with data-driven healthcare decision making through geographic information systems (GIS) mapping. The presentation discusses HealthLandscape's history and capabilities, provides a brief introduction to GIS, and outlines several free online HealthLandscape mapping tools that can be used to visualize health outcomes, social determinants of health, and healthcare workforce data. It also describes how HealthLandscape can work with organizations to create custom maps and analyses to support advocacy efforts and other projects.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
PYA Monitors Topics on Healthcare Radar at AlaHAPYA, P.C.
PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:
ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?
This document summarizes updates to the Strong Start funding opportunity. Key points include: the application deadline was extended to August 9th, 2012; optional letters of intent are no longer required; applicants can propose testing multiple models but individual sites can only administer one; and applicants must commit to collecting gestational age and birthweight data for the intervention and baseline periods to help with evaluation.
Health Reform & the Delivery System: A New Medley of Payment & IncentivesNASHP HealthPolicy
This document discusses opportunities and challenges for states in implementing provisions of the Affordable Care Act that aim to improve healthcare quality and efficiency. It outlines several key areas of reform including: data collection and performance measurement; public reporting of cost and quality; payment reform through value-based purchasing; consumer engagement; and provider engagement. For each area, it identifies state challenges such as lack of standardized measures and federal-state misalignment, as well opportunities created by the ACA such as incentives for care coordination and grants for delivery system transformation. Overall, the document argues that the ACA provides momentum to build on current state quality and efficiency efforts while addressing challenges around scarce resources and pressure to adopt mandatory reforms.
Maximizing Performance Incentives Through Star RatingsCitiusTech
The main aim of this document is to provide a high level understanding of the Star rating quality program of CMS and it’s impact on plans (at contract level) offered by the payers which are in Medicare Advantage line of business
It describes the various measure categories and their weightages, domains and sources required by CMS to assess quality of care and patient experience.
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
This document provides an overview of HealthLandscape, which is a tool created by the American Academy of Family Physicians to help with data-driven healthcare decision making through geographic information systems (GIS) mapping. The presentation discusses HealthLandscape's history and capabilities, provides a brief introduction to GIS, and outlines several free online HealthLandscape mapping tools that can be used to visualize health outcomes, social determinants of health, and healthcare workforce data. It also describes how HealthLandscape can work with organizations to create custom maps and analyses to support advocacy efforts and other projects.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
PYA Monitors Topics on Healthcare Radar at AlaHAPYA, P.C.
PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:
ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?
This document summarizes updates to the Strong Start funding opportunity. Key points include: the application deadline was extended to August 9th, 2012; optional letters of intent are no longer required; applicants can propose testing multiple models but individual sites can only administer one; and applicants must commit to collecting gestational age and birthweight data for the intervention and baseline periods to help with evaluation.
CMS Medicare Advantage 2021 Star Ratings: An AnalysisCitiusTech
This report is intended for business, consulting, and technology audience who are actively engaged, or impacted, with the functioning of Medicare Advantage Star ratings, to help them align their star improvement initiatives to the market trends.
This document discusses applications of big data and data analytics in healthcare. It provides two case studies: 1) a rural clinically integrated network in Kansas that uses data analytics to identify at-risk patients and reduce costs, and 2) an analysis of billing data for a Department of Justice investigation. The document also outlines other healthcare data analytics projects and discusses growing demand for data analytics expertise and the potential for analytics to improve healthcare outcomes and reduce costs.
PYA Principal J. Michael Keegan, MD, recently presented “Pacing Volume-to-Value Transition” and “The ROI of Avoiding Antibiotic Overuse” at the AlaHA Annual Meeting, June 8-11, 2016. The presentation focused on the importance of antibiotic stewardship programs (ASP) for population health. The presentation explained:
Why the Centers for Medicare & Medicaid Services is proposing a requirement that hospitals implement ASPs to stem the rise of resistant bacteria.
Why PYA is invested in offering hospitals a proven program for improving patient safety while saving costs.
What constitutes a successful ASP.
CMS’ Hospital Readmission Reduction Program: What does it mean for your hospi...PYA, P.C.
The document summarizes information presented at an Alabama Hospital Association meeting about the CMS Hospital Readmission Reduction Program. It discusses rising healthcare costs, the shift from fee-for-service to value-based reimbursement, and new programs linking hospital payment to quality metrics like readmission rates. Hospitals face reductions of up to 3% of Medicare reimbursement payments if they have excess readmissions for conditions like heart attacks, heart failure and pneumonia. The presentation provides Alabama-specific data on the financial impacts of readmission adjustments and new billing codes for transitional care management.
Presentation Explores Many Contexts of Community BenefitPYA, P.C.
PYA Principal David McMillan gets to the bottom of the definition of community benefit in “Community Benefit: One Term, Many Contexts,” a presentation given at the 2013 AICPA Healthcare Industry Conference.
Driving Home Health Efficiency through Data AnalyticsCitiusTech
This whitepaper highlights how data analytics can help track key performance indicators to drive clinical, financial and operational efficiency to improve quality of home health in an efficient manner.
MACRA consolidates existing Medicare quality programs and establishes two pathways for physicians: MIPS and APMs. MIPS assesses performance in four categories (quality, cost, improvement activities, advancing care information) and adjusts payments up or down based on a composite score. It allows physicians to ease into reporting over multiple years. APMs provide an alternative for physicians meeting thresholds in qualifying models, exempting them from MIPS and providing bonus payments through 2024. MACRA aims to shift Medicare payments from volume to value over time through 2026.
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
The CMS Innovation Center hosted a webinar on Tuesday, June 10, 2014 from 12:00pm - 1:00pm EDT that focused on all components of the Round Two Model Test Award opportunity. The webinar also highlighted the requirements for submitting an application as well as considerations regarding the application review process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
COVID19: Impact & Mitigation Strategies for Payer Quality Improvement 2021CitiusTech
This white paper analyzes the impact of COVID-19 on payer quality improvement strategies and measures for 2020-2021. It finds that about 74% of quality measures will likely see negative impacts due to reduced outpatient visits, while 15% may improve due to lower utilization. The top negatively impacted domains are behavioral health, preventive care, and access. Future strategies discussed include integrating narrow networks, accounting for virtual care, and leveraging data science and interoperability.
This document discusses potential data sources for collecting baseline data before implementing a public health intervention program. It describes how baseline data is collected before a program begins to later compare outcomes. Sources discussed include birth certificates, CDC databases, state vital records, local health departments, hospitals, Medicaid programs, March of Dimes, and several CDC surveillance systems. The document provides examples of the type of baseline data that could be collected and considerations for selecting a data source.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
The 10th Annual Utah Health Services Research Conference: Data: What's available and how we are use it is changing. By: Danielle A. Lloyd, MPH - Premier
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
Presentation Zeroes in on Successful CIN PYA, P.C.
A 335-bed hospital in Florida sought to form a clinically integrated network (CIN) with its physicians to address strategic challenges. It formed a Clinical Integration Committee of physician leaders and gave them 9 months to gain commitment. The Committee educated physicians and formed workgroups to define the CIN. This led to physician summits that built consensus on a governance structure. A Physician Hospital Organization was then formally established with equal physician and hospital representation to govern the CIN within 9 months as planned.
MACRA consolidated several existing Medicare quality programs and introduced new payment models. It established two tracks for physician payment and quality programs starting in 2017 - MIPS and Advanced APMs. MIPS consolidated existing programs into four categories and allows physicians to gradually increase their participation over multiple years. Advanced APMs provide incentives for participation in alternative payment models and include models like Accountable Care Organizations. MACRA aims to reform Medicare payments to physicians and transition to value-based models.
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
The document summarizes the results of the 16th Annual Survey of Medicaid Directors conducted by Health Management Associates for the Kaiser Family Foundation. Some key findings from the survey include:
- Total Medicaid spending and enrollment growth has slowed in recent years for both expansion and non-expansion states.
- Nearly all states have implemented delivery system initiatives like patient-centered medical homes, and many have expanded these initiatives in recent years.
- States are focused on strategies to address the opioid epidemic and control pharmacy costs, particularly for specialty drugs. Most are also expanding community-based long-term services and supports.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
The Ubiz Mobile App Opportunity is gaining a lot of attention due to the industry numbers. Take a look at the Mobile trends. Look where the mobile industry is going.
Ubiz Mobile app and the BizBiz opportunity is right with the trends of Mobile Marketing. We are looking for Merchants and representatives to help get the Ubiz App out. Contact me for more details. http://zAPP.mobi
Cup shup discussion materials_coupondunia case study_feb2015Sidharth Singh
From Stable of CupShup, a pioneer of Paper Cup Advertising in India, the campaign for Coupondunia was done in Mumbai. Paper Cup Advertising is one of the most effective medium of advertising. The campaign was a success creating brand awareness among working professionals of Mumbai through Paper cup advertising.
CMS Medicare Advantage 2021 Star Ratings: An AnalysisCitiusTech
This report is intended for business, consulting, and technology audience who are actively engaged, or impacted, with the functioning of Medicare Advantage Star ratings, to help them align their star improvement initiatives to the market trends.
This document discusses applications of big data and data analytics in healthcare. It provides two case studies: 1) a rural clinically integrated network in Kansas that uses data analytics to identify at-risk patients and reduce costs, and 2) an analysis of billing data for a Department of Justice investigation. The document also outlines other healthcare data analytics projects and discusses growing demand for data analytics expertise and the potential for analytics to improve healthcare outcomes and reduce costs.
PYA Principal J. Michael Keegan, MD, recently presented “Pacing Volume-to-Value Transition” and “The ROI of Avoiding Antibiotic Overuse” at the AlaHA Annual Meeting, June 8-11, 2016. The presentation focused on the importance of antibiotic stewardship programs (ASP) for population health. The presentation explained:
Why the Centers for Medicare & Medicaid Services is proposing a requirement that hospitals implement ASPs to stem the rise of resistant bacteria.
Why PYA is invested in offering hospitals a proven program for improving patient safety while saving costs.
What constitutes a successful ASP.
CMS’ Hospital Readmission Reduction Program: What does it mean for your hospi...PYA, P.C.
The document summarizes information presented at an Alabama Hospital Association meeting about the CMS Hospital Readmission Reduction Program. It discusses rising healthcare costs, the shift from fee-for-service to value-based reimbursement, and new programs linking hospital payment to quality metrics like readmission rates. Hospitals face reductions of up to 3% of Medicare reimbursement payments if they have excess readmissions for conditions like heart attacks, heart failure and pneumonia. The presentation provides Alabama-specific data on the financial impacts of readmission adjustments and new billing codes for transitional care management.
Presentation Explores Many Contexts of Community BenefitPYA, P.C.
PYA Principal David McMillan gets to the bottom of the definition of community benefit in “Community Benefit: One Term, Many Contexts,” a presentation given at the 2013 AICPA Healthcare Industry Conference.
Driving Home Health Efficiency through Data AnalyticsCitiusTech
This whitepaper highlights how data analytics can help track key performance indicators to drive clinical, financial and operational efficiency to improve quality of home health in an efficient manner.
MACRA consolidates existing Medicare quality programs and establishes two pathways for physicians: MIPS and APMs. MIPS assesses performance in four categories (quality, cost, improvement activities, advancing care information) and adjusts payments up or down based on a composite score. It allows physicians to ease into reporting over multiple years. APMs provide an alternative for physicians meeting thresholds in qualifying models, exempting them from MIPS and providing bonus payments through 2024. MACRA aims to shift Medicare payments from volume to value over time through 2026.
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
The CMS Innovation Center hosted a webinar on Tuesday, June 10, 2014 from 12:00pm - 1:00pm EDT that focused on all components of the Round Two Model Test Award opportunity. The webinar also highlighted the requirements for submitting an application as well as considerations regarding the application review process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
COVID19: Impact & Mitigation Strategies for Payer Quality Improvement 2021CitiusTech
This white paper analyzes the impact of COVID-19 on payer quality improvement strategies and measures for 2020-2021. It finds that about 74% of quality measures will likely see negative impacts due to reduced outpatient visits, while 15% may improve due to lower utilization. The top negatively impacted domains are behavioral health, preventive care, and access. Future strategies discussed include integrating narrow networks, accounting for virtual care, and leveraging data science and interoperability.
This document discusses potential data sources for collecting baseline data before implementing a public health intervention program. It describes how baseline data is collected before a program begins to later compare outcomes. Sources discussed include birth certificates, CDC databases, state vital records, local health departments, hospitals, Medicaid programs, March of Dimes, and several CDC surveillance systems. The document provides examples of the type of baseline data that could be collected and considerations for selecting a data source.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
The 10th Annual Utah Health Services Research Conference: Data: What's available and how we are use it is changing. By: Danielle A. Lloyd, MPH - Premier
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
Presentation Zeroes in on Successful CIN PYA, P.C.
A 335-bed hospital in Florida sought to form a clinically integrated network (CIN) with its physicians to address strategic challenges. It formed a Clinical Integration Committee of physician leaders and gave them 9 months to gain commitment. The Committee educated physicians and formed workgroups to define the CIN. This led to physician summits that built consensus on a governance structure. A Physician Hospital Organization was then formally established with equal physician and hospital representation to govern the CIN within 9 months as planned.
MACRA consolidated several existing Medicare quality programs and introduced new payment models. It established two tracks for physician payment and quality programs starting in 2017 - MIPS and Advanced APMs. MIPS consolidated existing programs into four categories and allows physicians to gradually increase their participation over multiple years. Advanced APMs provide incentives for participation in alternative payment models and include models like Accountable Care Organizations. MACRA aims to reform Medicare payments to physicians and transition to value-based models.
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
The document summarizes the results of the 16th Annual Survey of Medicaid Directors conducted by Health Management Associates for the Kaiser Family Foundation. Some key findings from the survey include:
- Total Medicaid spending and enrollment growth has slowed in recent years for both expansion and non-expansion states.
- Nearly all states have implemented delivery system initiatives like patient-centered medical homes, and many have expanded these initiatives in recent years.
- States are focused on strategies to address the opioid epidemic and control pharmacy costs, particularly for specialty drugs. Most are also expanding community-based long-term services and supports.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
The Ubiz Mobile App Opportunity is gaining a lot of attention due to the industry numbers. Take a look at the Mobile trends. Look where the mobile industry is going.
Ubiz Mobile app and the BizBiz opportunity is right with the trends of Mobile Marketing. We are looking for Merchants and representatives to help get the Ubiz App out. Contact me for more details. http://zAPP.mobi
Cup shup discussion materials_coupondunia case study_feb2015Sidharth Singh
From Stable of CupShup, a pioneer of Paper Cup Advertising in India, the campaign for Coupondunia was done in Mumbai. Paper Cup Advertising is one of the most effective medium of advertising. The campaign was a success creating brand awareness among working professionals of Mumbai through Paper cup advertising.
Report annual event Linking students and NGOs 8 Oct 2015Rosanne Anholt
The document summarizes a meeting that brought together students, researchers, practitioners, and policymakers working in sexual and reproductive health and rights. It discusses presentations given on various research projects, a keynote speech from UNFPA on international policymaking in SRHR, and a concluding discussion on linking research to policy and practice. Participants discussed taking an intersectional approach, challenges in implementation, involving donors, and the role of universities in societally-relevant research.
Behavioral Conformance of Artifact-Centric Process ModelsDirk Fahland
A talk help by Boudewijn van Dongen at the 14th International Conference on Business Information Systems (BIS 2011) in Poznan, Poland, June 2011. We present the problem of checking whether an artifact-centric process model conforms to process behavior observed in reality.
This talk was given by Dirk Fahland and Hajo A. Reijers at the BPM Roundtable at TU Eindhoven in July 2011. We presented first insights into how people model and the modeling outcome.
The circulatory system is formed by blood vessels, the heart, and blood. It carries nutrients and oxygen from the lungs to tissues throughout the body, and carries carbon dioxide from the tissues back to the lungs. Arteries carry oxygenated blood away from the heart to the body, while veins return deoxygenated blood back to the heart. The heart pumps blood through this network of vessels to deliver nutrients and oxygen and remove waste from all parts of the body.
The document summarizes a student project that aimed to demonstrate a security flaw in Authenticated Network Time Protocol (NTP). The project involved setting up a virtual network with two machines, one functioning as an NTP client and the other as a server. By capturing network traffic with Wireshark, the students planned to conduct a man-in-the-middle attack to brute force the 32-bit authentication cookie and spoof the client into accepting the attacker as a legitimate NTP server. This would allow the attacker to feed the client false time information and potentially disrupt systems relying on accurate time synchronization.
Este documento describe los servicios y recursos disponibles en las bibliotecas de la Universitat de València. Ofrece lugares para estudiar, acceso a libros, revistas y recursos electrónicos, así como personas que pueden ayudar a los estudiantes a encontrar información. Los estudiantes pueden sacar libros en préstamo, usar ordenadores e impresoras, y acceder a Internet. Las bibliotecas ofrecen adaptaciones para personas con discapacidad.
DIFFERENT APPROACHES OF CONTENT ORGANIZATION IN SOCIAL SCIENCE Varshapadman
This document discusses the social science curriculum and principles of curriculum construction. It defines curriculum as the course of experiences given to learners in schools. The social science curriculum aims to develop understanding of human relations and society, impart knowledge, foster values, teach skills and tolerance, and develop citizenship. Principles for selecting content include being child-centered, objective-based, activity-focused, and preparing students for life. Approaches to organizing content discussed are the topic, spiral, and concentric approaches.
Failure investigations are tough rigorous challenges form the best in engineering. This course will teach delegates the range of thinking and subjects, which need to be considered in driving to find the real root cause of a failure.
U ovom tekstu možete pronaći savete za brže i lakše savladavanje nekog stranog jezika.
Osam saveta za učenje stranih jezika
1. Pronađite radio stanice i podkastove na jeziku koji želite da naučite - na internetu možete pronaći podkastove iz različitih oblasti. Zato, svoje slobodno vreme možete iskoristiti u slušanju podkastova iz oblasti koja vas interesuje.
2. Slušajte muziku - Pronađite muziku na stranom jeziku koji pokušavate da naučite, za svaku novu pesmu pronađite tekst i pratite ga dok slušate muziku.
3. Pratite zanimljive YouTube kanale - pronađite zanimljive YouTube kanale na tom jeziku, to je dobar način da spojite zabavu i učenje.
4. Gledajte filmove/serije - Pronađite zanimljive filmove/serije na jeziku koji pokušavate da naučite, poželjno je i da pronađete titlove na tom jeziku.
5. Dopisujte se sa ljudima kojima je to maternji jezik - Pronađite osobe čiji je maternji jezik onaj koji učite i dopisujte se sa njima.
6. Čitajte/pišite blog - Pronađite zanimljive blogove i sajtove na jeziku koji želite da naučite. Možete i napraviti blog na nekoj besplatnoj platformi gde ćete pisati na tom jeziku.
7. Posetite zemlju čiji jezik učite - Ukoliko ste u mogućnosti, otputujte i ostvarite direktan kontakt sa zemljom i narodom čiji jezik izučavate.
8. Upišite kurs stranih jezika - Ove prethodne stavke možete raditi u svoje slobodno vreme, međutim, za dobro savladavanje jezika je potrebno i formalno obrazovanje. Naša preporuka je Akademija Oxford koja ima svoja predstavništva u gotovo svim gradovima u Srbiji, gde možete naučiti 30+ stranih jezika.
http://jakasifra.blogspot.com/2015/12/saveti-za-ucenje-stranih-jezika.html
Introduction to Product strategy (Google Launchpad)Dhyana Scarano
This document discusses the importance of validating product ideas through user research. It emphasizes testing assumptions and hypotheses, rather than falling in love with ideas, by getting out and directly observing and questioning potential users. A process is outlined that involves creating hypotheses based on insights from user research, prototyping solutions to test against those hypotheses, and continuously refining through iterative research, testing and validation. Tools like business model canvases, user interviews and rapid prototyping are recommended to effectively engage in this process.
This document provides an overview of Synergetics' "Industry in Focus" series highlighting trends in the healthcare and life sciences industry and how Synergetics is positioned to help clients in this sector. It discusses the challenges facing third party administrators in healthcare, including balancing costs and provider reimbursement rates. It also identifies factors driving increasing healthcare costs and provides examples of ways Synergetics has helped healthcare clients improve efficiency and profitability through process improvements and technology optimization.
The Entity chosen was Baptist Healthcare South Florida for years 201.docxtodd701
The document outlines a course project that requires students to analyze the financial operations of a healthcare organization using three years of financial statements and metrics. It provides details on the expected case study format, including sections on background, issues identified, analysis using ratios, recommendations, implementation plan, monitoring methodology, and references. It also includes a sample analysis of Baptist Health South Florida that was done as part of the project, focusing on its statement of operations, balance sheet, statement of cash flows, and key financial ratios for 2017-2019.
Elevating Medical Management Services to Meet Member ExpectationsCognizant
Healthcare payer organizations can lower the cost of commoditized medical management functions via better and different processes, and invest the savings in member-centric care management services.
Evaluation is the set of processes and methods that managers and sta.docxtheodorelove43763
Evaluation is the set of processes and methods that managers and stakeholders use to determine whether the program is successful. Success is determined by multiple parameters such as financial viability of the program as well as the administrative and clinical impact of the program on the community’s or organization’s mission. Today’s programs are also expected to proactively address healthcare disparities and inequities in all levels of communities and demonstrate measureable reductions in inequities in diverse patient/client populations.
For this milestone, you will create an evaluation plan that will include the financial aspects of your proposed program as well as your evaluation methods. In your submission, be sure to include the following:
Proposed Program :to establish a department in IGM to facilitate holistic care of pediatric patients. This holistic care will require patients to be monitored before, during, and after a clinical procedure. The program will be flexible to ensure that each patient receives customized care at a subsidized fee.
Financial Aspects
o What specific resources would you suggest for use in your program? For example, what staffing and equipment suggestions would you make?
Be sure to explain your rationale.
o What is the impact on the community’s or organization’s current budget? In other words, will the program fit into the existing budget, or willconcessions need to be made?
o What recommendations would you make for ensuring the program is financially sustainable? Are there measurable expense reductions for the community/organization that cover the costs of the program? Does the program create new sources of revenue for the community or organization to offset the costs of the program?
Evaluation
o What will you measure (such as benchmarks, patient outcomes, or other measurable data) in order to evaluate the effectiveness of the program implementation? Focus on both administrative and clinical measures. Include multiple levels of measurement, including the patients/clients served, populations of patients/clients served, and community environmental measures.
o What tools will you use to measure the effect of your program on reducing the incidence of healthcare disparities?
o How will these evaluation tools tell you whether the program is successful?
o To what extent will the program help ensure healthcare equity across diverse populations? Be sure to justify your reasoning.
Guidelines for Submission: Your paper for this milestone must be submitted as a 2- to 3-page Microsoft Word document with double spacing, 12-point Times New Roman font, one-inch margins, and proper APA formatting. Include at least three peer-reviewed, scholarly resources.
.
This document summarizes discussions from a series of panel discussions on the future of post-acute healthcare. Key concerns discussed include the need for better coordination and pathways between acute and post-acute care to reduce hospital readmissions, ensuring clinical staff in skilled nursing facilities have sufficient skills and training, understanding new models like Accountable Care Organizations, managing increased utilization of managed care plans with lower reimbursement rates, and navigating changes to state Medicaid systems. Potential solutions focus on developing partnerships across settings, sharing clinical information, participating in advocacy, and using technology and analytics to improve coordination and decision making.
The purpose of the strategic plan is to allow the selected healthc.docxoscars29
The purpose of the strategic plan is to allow the selected healthcare organization to understand their current strategic position, where they want to be in the future, and how they will achieve those goals. For this strategic plan, you will select an existing healthcare organization local to your community to conduct a strategic plan analysis on. The strategic plan should project 3 year’s worth of planning. Additionally, students should focus on identifying a target market (consumer or business in South Florida) whose needs are not currently being met, not being met satisfactorily or even recognized. Students also should think about competitive offerings, and how their offering will be communicated and delivered. The solution must be actionable or realistic.
The strategic plan will be completed in 3 phases, which will all culminate to create the final strategic plan. Please see course calendar in syllabus for the due dates of each phase.
Phase 1 (10 points): Cover page, introduction, M,V,V,G
The purpose of the strategic plan is to allow the selected healthcare organization to
understand their current strategic position, where they want to be in the future, and how
they will achieve those goals.
For this strategic plan, you will select an exis
ting
healthcare organization local to your community to conduct a strategic plan analysis on.
The strategic plan should project 3 year’s worth of planning.
Additionally, students
should focus on identifying a target market (consumer or business in South F
lorida)
whose needs are not currently being met, not being met satisfactorily or even
recognized. Students also should think about competitive offerings, and how their
offering will be communicated and delivered. The solution must be actionable or
realisti
c.
The strategic plan will be completed in 3 phases, which will all culminate to create the
final strategic plan.
Please see course calendar in
syllabus
for the
due dates of each
phase.
Phase 1
(10 points):
Cover page, introduction, M,V,V,G
The purpose of the strategic plan is to allow the selected healthcare organization to
understand their current strategic position, where they want to be in the future, and how
they will achieve those goals. For this strategic plan, you will select an existing
healthcare organization local to your community to conduct a strategic plan analysis on.
The strategic plan should project 3 year’s worth of planning. Additionally, students
should focus on identifying a target market (consumer or business in South Florida)
whose needs are not currently being met, not being met satisfactorily or even
recognized. Students also should think about competitive offerings, and how their
offering will be communicated and delivered. The solution must be actionable or
realistic.
The strategic plan will be completed in 3 phases, which will all culminate to create the
final strategic plan. Please see course calendar in syllabus for the d.
DeMarco and Associates and Pendulum HealthCare Corporation provide services to help organizations develop accountable care organizations (ACOs). They assist with infrastructure development, care coordination, and data analytics. Pendulum also designs, develops, and manages ACOs. An ACO aims to deliver coordinated, efficient care to a defined patient population through provider collaboration and accountability for costs and quality outcomes. Requirements include agreements between primary care physicians, specialists, and hospitals to be responsible for a minimum number of Medicare beneficiaries.
Melinda Hancock is Partner at Dixon Hughes Goodman and Chair Elect of HFMA for 2014-2015. She is responsible for developing new financial modeling products and services related to alternative payment models. Edward Stall has over 20 years of healthcare consulting experience providing strategic planning for healthcare clients. The presentation discusses the transition to alternative payment models like accountable care organizations and bundled payments requiring new forms of enterprise intelligence and analytics. It provides an overview of upcoming risk models and payment reforms, and the intelligence needs of organizations to succeed under new models.
ECO/561 Week 5 Assignment Rubric
Individual Assignment: Effectiveness of the Counter-Cyclical PoliciesPurpose of Assignment
This assignment addresses how both monetary and fiscal policies have been used during the so-called Great Recession, which began in December 2007 and ended in June 2009, to the present to moderate the business cycle. Resources Required
Tutorial help on Excel® and Word functions can be found on the Microsoft® Office website. There are also additional tutorials via the web offering support for Office products.Grading Guide
Content
Met
Partially Met
Not Met
Comments:
Selected an industry that suffered heavy losses during the Great Recession and produced an Excel® Workbook including the following data from December 2007 to the present:
· One dataset related to the U.S. housing industry such as housing starts, the FHFA housing price index, or another dataset of your choice related to the housing market.
· One dataset related to personal or household income or to personal or household saving.
· One dataset related to the labor market such as the unemployment rate, initial claims for unemployment insurance, or another dataset of your choice related to the U.S. labor force.
· One dataset related to production and business activity within the market or industry you choose to analyze.
15 points
Using data results analyzed the economic and sociological forces that drove the market equilibrium to unsustainable heights, commonly referred to as "bubbles," and the shocks that brought the markets back down.
10 points
Discussed specific changes in supply and demand within the markets and/or industries you chose to analyze.
10 points
Determined whether specialization of industry had any influence on the impact of the recession. 10 points
Examined prior government policies and legislation that might have exacerbated the impact of the shocks. Also, discuss government actions/regulations that might be undertaken, and/or have been undertaken, to moderate the effects of extreme economic fluctuations. 15 points
Evaluated the actions of the federal government (fiscal policy) and the Federal Reserve (monetary policy) to restore the economy and foster economic growth. Based your evaluation on information available at Internet sources such as, but not limited to, the Fed's The Economy Crisis and Response website as well as other appropriate sources found on the Internet and in the University Library. You did address the effectiveness of those counter-cyclical policies. 20 points
The analysis is a minimum of 1,050 words in length. 5 points
Total Available
Total Earned
85
#/85
Writing Guidelines
Met
Partially Met
Not Met
Comments:
The paper—including tables and graphs, headings, title page, and reference page—is consistent with APA formatting guidelines and meets course-level requirements. 10 points
Intellectual property is recognized with in-text citations and a reference page. 10 points
Paragraph and s ...
Hospitals and health systems are struggling to maximize the benefits of innovative technology to better manage uncompensated care and revenue integrity, suggests a HFMA/Navigant survey of 125 provider CFOs and revenue cycle management executives.
ACSG DIRECT TO EMPLOYER WHITE PAPER MARCH 15jackell
This document describes a population health management system that medical providers can access to manage healthcare for self-insured employers. It allows providers to take control of healthcare delivery and costs in their community. The system has been in place for over 12 years and has successfully reduced healthcare trends and costs for over 1 million members. It provides tools for providers to identify high-risk patients, implement treatment regimens, monitor compliance, and share in savings through gainsharing arrangements with employers. Medical providers who implement this turn-key system can diversify their payer mix and increase revenues.
ACSG DIRECT TO EMPLOYER WHITE PAPER MARCH 15jackell
This document describes a population health management system that medical providers can access to manage healthcare for self-insured employers. It allows providers to take on insurance-like roles without assuming insurance risk. The system utilizes over a decade of data on over 1 million members to analyze healthcare costs and outcomes. Medical providers are incentivized through gain-sharing agreements where they receive a portion of savings if healthcare budgets are kept lower than projected. The system aims to reduce costs through coordinated care, recruiting high quality/low cost providers, and promoting wellness. It has achieved healthcare cost reductions of up to 32% for some employers that have used the system.
The document discusses value-driven healthcare in Medicaid and outlines several strategies and initiatives to improve quality of care, including:
1) Using evidence-based practices and quality measurement, health IT, and partnerships to ensure safe, effective, timely and equitable care.
2) Promoting transparency of quality and price information to support value-based payment models.
3) Providing incentives for high-quality, high-value care through pay-for-performance programs and other initiatives.
4) Collaborating across states and with CMS to share best practices around quality improvement, health IT adoption, and value-based purchasing.
The document discusses the transition to value-based care models and accountable care organizations (ACOs). It outlines five core competencies needed for early success in an ACO program like the Medicare Shared Savings Program (MSSP): 1) physician-centered governance, 2) collection and reporting of quality metrics, 3) data analysis and spend identification, 4) developing a post-acute quality provider network, and 5) population management strategies. It provides examples from Methodist Health System's experience in an MSSP ACO.
Five Strategies for Easing the Burden of Clinical Quality MeasuresHealth Catalyst
Healthcare systems need to view regulatory measures in a different light. Rather than approaching them as required processes that burden the system, they should be viewed as quality improvement opportunities that lead to best practices. It helps to have a strategy to get there:
Prioritize measures that truly impact patient care
Have a line-of-sight to reimbursement
Understand measure alignment across programs
Involve the right people
Get involved in measure development upstream
The right tools also help, but a plan for success is advised for healthcare system administrators and clinicians who need to ease the reporting burden and take advantage of every measure in a positive way.
White Paper - Building Your ACO and Healthcare IT’s RoleNextGen Healthcare
The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.
Want to better understand what's driving value-based clinical and financial transformation? And, what you need to do to start planning for implementation?
This report is written for the Board of Directors of the Nazarene Community Health Clinic (NCHC). It outlines the importance and necessity of quality management as it pertains to the health care reform’s mandate that all Americans have access to quality, affordable health care.
- The document discusses updates from CMS on addressing administrative burden as part of the Quality Payment Program. Recent regulatory activities have aimed to reduce burden through changes to fee schedules, measure alignment, and telehealth coverage.
- CMS priorities include empowering patients, supporting state flexibility and local leadership, and improving the customer experience. The Innovation Center tests new payment and delivery models to improve quality and reduce costs.
- Under MACRA, clinicians can participate in the Merit-based Incentive Payment System or Advanced Alternative Payment Models. Technical assistance is available to help clinicians succeed under the Quality Payment Program.
Similar to The Importance of a Quality Reporting Process in a Pay-for-Performance Environment (20)
Administrative Burden: Legislative and Regulatory Advocacy to Improve Physici...
The Importance of a Quality Reporting Process in a Pay-for-Performance Environment
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2. By Mallory Johnson, Senior Consultant
The Importance Of A Quality Reporting Process In A Pay-For-Performance Environment
A push towards pay-
for-performance
The term “pay-for-
performance” (P4P)
has matured in
healthcare over the
last decade from concept to reality as healthcare policy creators, administrators, and clinical providers work
together to develop a more efficient, sustainable, and quality healthcare system focused on the patient. While
Medicare demonstration projects and Medicaid Waivers have been around for many years, more recently there is
a large focus on pay for performance incentive programs in healthcare transformation. These require providers to
be able to demonstrate successful achievement of defined process and clinical measures in order to earn shared
savings and/or incentive payments; both efforts made to change the way care is delivered across the care continuum and result in actual quality and cost
outcomes.
The most notable push towards P4P is seen in a number of implementation requirements and quality goals of the Affordable Care Act (ACA), which was
passed in 2010. Acknowledging the unsustainable cost of healthcare in the US, the ACA allows for a number of demonstration and pilot projects focused on
P4P as a conceptual model to assist in the challenging operationalization of policy goals and concepts related to provider reimbursement practices, quality of
services provided, health of the overall population, and reductions in overall spending. ACA demonstrations and pilot examples include the National Pilot
Program on Payment Bundling, Wellness Program Demonstration Project, Community Based Care Transitions Program for high risk Medicare Patients, and
many more. These incentive dollars are generally considered investment, or transitionary, funds that allow providers the ability to make incremental changes
in operational and clinical practices to support the transition from fee-for-services payments to value-based and capitated payments This shift in payment
structure rewards providers for meeting, all or in part, specified process and clinical outcomes rather than paying for services rendered. The intent is to
enhance the overall patient experience beginning with the physician encounter to improvements in individual health status.
Pay-for-Performance in Medicaid
Over the past decade CMS has worked with states to develop P4P demonstrations for the Medicaid population. One vehicle for this work has been the
Delivery System Reform Incentive Payment (DSRIP) programs seen in some states’ Section 1115 Medicaid Waivers. Individual states are charged with not only
developing program requirements for performance but also designing and implementing a robust reporting and monitoring system for participating
providers in order to draw down incentive funds. The two largest and most complex active DSRIP programs with relation to structure and inclusion of provider
types across the care continuum are found in Texas and New York. Each state has extensive clinical and process improvement performance expectations for
their providers. Both of these states have comparable expectations of providers despite different approaches to their
actual timing and processes of reporting (more information below), however New York’s program is groundbreaking in its statewide requirements to achieve
execution of 80% value based payment agreements between providers and Managed Care Organizations and regional level reporting of clinical outcomes.
Why is reporting so important?
The current DSRIP programs in Texas and New York are worth up to $11.1 billion all funds and $6.8 billion all funds for five years, respectively. Through these
programs, no funds will flow to the providers until they perform the required work to achieve all program requirements and can also successfully document
and report this achievement to the state and CMS. Reporting, and reporting well, is a critical factor for success in pay-for-performance programs et al, not just
DSRIP. P4P is not limited to DSRIP programs only, as it is now a requirement for Medicaid Managed Care, Medicare, and Commercial plans. Health plans are
required by states to report on dozens of quality outcomes each year for their members. In fact, in 2013, health plans in 34 states were required to report on
HEIDS (Healthcare Effectiveness Data Information Set) and CAHPS (Consumer Assessment of Healthcare Providers and Systems) measures for all commercial
and Medicaid plans for members in the state (NCQA.org). States require the reporting of these measures in anticipation that what is measured will be
improved upon over time, to provide consumers with better access to data about the quality of care they can receive, and in order to collect standard data for
public health officials to analyze regional differences in healthcare quality.
The quality outcomes required for reporting in DSRIP programs very much align with the quality reporting required by states. For example, 25 of the clinical
reporting and performance outcomes in the NY DSRIP Program are also required measures for Medicaid Plans in the 2015 Quality Assurance Reporting
Requirements. Just as health plans report on behalf of all members in their service area, the providers under NY DSRIP will report on, and be measured
against improvement, for Medicaid members within a region of the state. DSRIP programs allow providers and systems the time and incentive to learn how to
be successful for clinical outcome reporting, which will be critical to long-term success and sustainability within the healthcare industry. Systems and
geographic regions who leverage DSRIP to develop technology platformas and competencies to collect the right data, and use real-time data to make clinical
decisions, while reporting outcomes through health plans along the way will be able to increase total revenue available through improved quality scores and
shared savings from reductions in total cost.
3. Since its inception in 2008, the Triple Aim has moved to the forefront of healthcare professionals’ minds and integrated into operational strategy. Providers
need to be able to demonstrate that they can reduce total cost across a system while improving quality and patient satisfaction in parallel. This is a key lesson
for anyone participating in a DSRIP or other P4P program – now is the time to put boots on the ground and focus on improvements and reporting. This will
enable organizations to be more successful across all lines of business and allow the safety net providers to compete, creating opportunities for financial
sustainability in the long term.
The following table provides high-level information to show the similarities and differences in the development and execution of reporting practices in Texas
and New York DSRIP programs.
Key drivers to successful reporting in a pay-for-performance environment
1. Clearly defined processes, communication and accountability
Adapting to P4P requirements can be challenging, for organizations of all size and maturity levels. Without clearly defined processes and
accountability not only for reporting, but also performing against required milestones or outcomes, can lead to a number of problems.In working
with our clients we have observed a lack of structure for reporting generally leads to delays in collection of reporting requirements, creating a
downstream impact on being able to validate if reported results accurately represent performance, and ultimately increase the risk of scrutiny
from internal governance and oversight or auditing bodies of the program.The Community Care Collaborative (CCC) in Austin, Texas (a joint
venture between Seton Health System and Central Health to deliver integrated care to the safety net population in Travis County) has been very
proactive to ensure their success in reporting process metrics under the Texas DSRIP program. Some factors, but by no means all, that have
contributed to their success include:
• Putting one person in charge and making them accountable for reporting (reporting manager or champion). This person should be
considered a subject matter expert (SME) who understands the complexity of state and federal reporting requirements and can have
foresight into ensuring the design of the internal reporting process is in alignment. Additionally, this person must understand how
performance and reporting requirements link to incentive funds being received; based on the internal reporting process the SME should be
able to anticipate what funds an organization is eligible to earn during a performance period based on performance and quality of reporting.
• Maintaining frequent, clear communication with providers and the state. This is critical to prevent confusion regarding what should be
reported, or how reports should be created. Often reporting requirements change over time and these must be communicated clearly and
concisely in order to adapt reporting processes to stay compliant.
• Working closely with providers to develop clear expectations for reporting. The more clarity regarding expectations of reporting
(requirements, timing of report creation, performance windows, expected level of quality for reports, etc.) that is created up front and
throughout the program will result in less rework, high-quality reports, and long-term success.
• Implementing monthly and weekly reporting cycles to refine the practice of reporting. On the onset it may seem as if frequent meetings
will take away from the actual work that needs to be performed, but creating on-going accountability to monitor progress is key to adapting
program implementation efforts in real time based on what the data or status updates reflect. In these meetings, risks can be raised in a safe
environment and barriers can be removed to ensure goals are achieved.
These practices will set an organization up for success for process and clinical outcomes, but are not representative of the full strategy or reporting
reality. As the DSRIP program in New York begins to take flight, Preforming Provider Systems (PPS) (a collection of providers within a specific
geographic area working together to create an Integrated Delivery System) are looking to use data to implement change within, and across,
organizations as they begin to form an Integrated Delivery Systems (IDS). Reporting expectations for clinical outcomes require PPS to collect data
on attributed lives, improve their health outcomes, and report the improvement to the state each year.
4. Finger Lakes Preforming Provider System (FLPPS), a PPS consisting of hundreds of providers across 13 counties in upstate New York, is working
diligently to stand up the infrastructure, processes, and accountability to perform well in DSRIP reporting domains. They are going to leverage the
reporting capabilities of larger systems within the region, Rochester Regional Health and University of Rochester Medicine, in conjunction with
smaller health systems and community IPAs, to build a reporting infrastructure that will enable the PPS to collect clinical data from providers
across the care continuum, analyze data against state defined measure specifications, and implement specific improvement initiatives within
providers to drive change and produce clinical outcome transformation. If the PPS is able to achieve a 10% improvement in the difference between
their collective baseline and a state defined goal, they will successfully draw down payment for their performance. This is not an easy task, but with
the right vision, technology pipelines, and focused efforts it is an endeavor well worth pursing; success under Medicaid DSRIP reporting builds a
solid foundation in which the providers, individually and collectively, can build upon to improve their reporting practices for Medicare and
commercial requirements, enabling the opportunity for long-term sustainability.
2. Preparation and validation
The old saying goes, “Measure twice, cut once,” and the same theory applies in preparing reports in pay-for-performance programs. Organizations
that take the time to prepare and validate not only set themselves up for a higher success rate in having reporting documentation approved for
payment, but also find preparing for and passing future audits much easier than organizations with no formal preparation or validation process
for reporting. Some suggestions for organizations to consider to set themselves up for success in this area are:
• Develop a reporting manual that outlines roles and responsibilities of employees, data sources for milestones and metrics, outlines the
internal timeline and process as well as portrays any and all guidance produced by the program administration, i.e. CMS.
• Appoint a reporting manager, or SME, to oversee the reporting and validation process.
• Appoint a quality assurance officer to compare completed reports to internal and external reporting requirements and sign off when
reports meet expectations. This person should not be afraid to not approve a report the first time it is submitted; they should have high
expectations of others work.
• Approach each reporting period as a Plan Do Study Act (PDSA) cycle and continually adapt and improve your reporting process and
requirements based on lessons learned and newly released guidance.
3. Maintaining flexibility and anticipating the challenges
To continue the examination of success factors, flexibility is the key to preparedness. Organizations should be prepared for reporting and
performance expectations to adapt and change overtime as oversight agencies like CMS or departments of health understand more about what
they are looking for, witness best practices throughout the program and then place that requirement on all participants.Anticipating challenges,
such as delay in receiving guidance or submission templates from oversight agencies is critical. Successful organizations prepare and implement
internal reporting processes early on and are prepared to respond in an agile fashion when guidance is received late. The more you can anticipate
and plan for, the more successful reporting will be.
4. Use data to drive decision making
While reporting processes and expectations may appear to be arduous, proactive organizations look for the value in creating a reporting culture,
where data is used to drive decision making. Whether the data is quantitative or qualitative, process or clinical, information is powerful when
transforming an organization or system. Some organizations may choose to use daily huddles to analyze information, a tactic seen in Agile
approaches to project management. Others may develop homegrown dashboards to review internally and report information, and some
organizations are turning to online platforms. The method of data collection, storage, and analysis will differ based on an organizations need, size,
capabilities, and reporting requirements of a specific pay-for-performance program.Janet King, Director of the PMO at FLPPS is excited about the
data and information that will be available from partners within their PPS. According to her, “The role of reporting is multi-faceted, not only does
reporting from partners across the PPS [aggregated by the lead] allow documentation to be sent to New York state to draw down incentive funds,
but the information is also going to be a measurement barometer for how well the network is developing and doing.”FLPPS is one of many PPSs in
New York who are looking to an online solution to help collect, analyze, and store information specific to the reporting and performance
requirements of DSRIP.“While the online tool may be helpful, it won’t be a full solution at first,” notes Janet, “getting everyone to use the tool is
going to be a challenge, and our staff is going to have to be flexible with each provider’s vast level of sophistication, community based
organizations may have a tougher time utilizing the tool with limited IT infrastructure than a large health system.”Regardless of the approach to
organize data, successful organizations under P4P work diligently to create a culture of reporting where data is used to generate real-time change
in order to continually improve, perform, and be rewarded by earning incentive payments.
5. Alignment of organizational strategy and reporting requirements
In the end, providers will only achieve long-term sustainability if they can successfully align all aspects of their organizational strategy to the
collective reporting requirements of all-payer managed care organizations. Increasingly, the industry is witnessing more alignment and
standardization of requirements across MCOs, various P4P programs, and state Medicaid programs. Quality measures tied to reporting are
continually evaluated through a multi-stakeholder process to ensure they are staying up to date with changing clinical practices and retire
measures where all realistic improvement has been achieved. With measures being rotated and retired, successful organizations will look at their
data and other national reporting sets to focus transformational efforts where the most improvement is needed, while also doing everything
possible to plan for success in the next release of updated requirements. Successful strategic organizations will incorporate more than a focus on
just the outcomes; they will strive to utilize the best technological infrastructure, data analytics, population health tools, employee training,