How Star Rating Measures Correlate withOverall HEDIS Quality

Wayne Pan, MD, MBAChief Medical OfficerPacific Partners Management Services, Inc.

Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012

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 ofNew 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 3x

Intermediate 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 your P4P/CMS 5 Star quality program

wayne 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 effective, systematic way?

• how can you measure performance and provide feedback?

• how can you engage patients?

how are you going to coordinate all three stakeholders?

healthplans

need a bidirectional messaging platform

need a cost-effective way to communicate with patients

need a way to consolidate all health plans into one platform

NOT

office manager’s view

Senior

doctor

patients

physician’s view

Senior

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patients

doctor patient

how can you affect changein the physician’s office?

payer-provider collaborationis a team sport

patient

patient

front desk staff

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MARY SMITH1234567890

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how to engage your team in quality improvement efforts?

put hot triggers in the path of

motivated peopleBJ Fogg, PhD

Director, Persuasive Technology LabStanford University

TRIGGERS: Are people being triggered at the most 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 aligned properly? How can I increase their motivation?

Introducing...

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IN THE PATH

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BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

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SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD CLICK HERE

BLUE SHIELD OF CA

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD

HOT TRIGGER

BLUE SHIELD OF CA

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

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MOTIVATIO

N

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ACCESSEXPRESSQ New Message (3)New Eligibility Response

ACCESSEXPRESSQ New Message (3)New Eligibility Response

ACCESSEXPRESSQ New Message (3)New Eligibility Response

Description ofmeasure

Capability forphysician officeentry

Capability forphysician officeentry

ABILITY

ACCESSEXPRESSQ New Message (3)New Eligibility Response

how can you affect changein the physician’s office?

engage your team in quality improvement efforts

“put hot triggers in the path of motivated people”

BJ Fogg, PhDDirector, Persuasive Technology LabStanford University

thankyouwpan@ppmsi.com