CAPG StarQuest Presentation 1 Mar11
Transcript of CAPG StarQuest Presentation 1 Mar11
Wayne Pan, MD, MBAHealth Access Solutions
CMS “5 STAR” Rating System
How to effectivelymanage the
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-secure
• Web-based
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?
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
The approach• Involvement of multiple stakeholders
• Primary care physicians
• Specialty physicians
• Ancillary professionals
• Office staff
• Patient
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
• Level 3: electronic, patient- and provider-centric process
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
Level 1• Asynchronous data exchange
• Resource-intensive
• Not scalable
• Still with positive ROI, if done well
• Need provider buy-in
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
Level 2• Two audiences
• Office staff
• Providers
• Create a team-based approach to achieving goals
• Provide simple-to-use tools
Level 2• Office staff portal
• Provides communication link
• Reactive approach: when patient shows up in the office
• Proactive approach: when providing patient outreach
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
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
Level 2• Office staff portal: proactive approach
• Data entry by provider office staff
• Automated IVR outbound appointment reminder calls
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
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
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
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
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
The demo
Scenario 1 - Reactive
Sample workflowPatient arrives
at office
1
Sample workflowPatient arrives
at office
1Office staff
checks patient in
2
Sample workflowPatient arrives
at office
1Office staff
checks patient in
2Office staff
checks eligibility
3
Sample workflowPatient arrives
at office
1Office staff
checks patient in
2Office staff
checks eligibility
3Pop-up member
questionnaire
4
Sample workflowPatient arrives
at office
1Office staff
checks patient in
2Office staff
checks eligibility
3
Collect questionnaire,
give patient info
5
Pop-up member
questionnaire
4
Sample workflowPatient arrives
at office
1Office staff
checks patient in
2Office staff
checks eligibility
3
Collect questionnaire,
give patient info
5
Office staffputs reminder(s) on patient chart
6
Pop-up member
questionnaire
4
Sample workflowPatient arrives
at office
1Office staff
checks patient in
2Office staff
checks eligibility
3
Collect questionnaire,
give patient info
5
Office staffputs reminder(s) on patient chart
6Physician sees
patient with reminder(s)
7
Pop-up member
questionnaire
4
Sample workflowPatient arrives
at office
1Office staff
checks patient in
2Office staff
checks eligibility
3
Collect questionnaire,
give patient info
5
Office staffputs reminder(s) on patient chart
6Physician sees
patient with reminder(s)
7
Patient receives appropriate care
8
Pop-up member
questionnaire
4
Sample workflowPatient arrives
at office
1Office staff
checks patient in
2Office staff
checks eligibility
3
Collect questionnaire,
give patient info
5
Office staffputs reminder(s) on patient chart
6Physician sees
patient with reminder(s)
7
Patient receives appropriate care
8P4P/HCC/5STAR metrics achieved
for this patient
9
Pop-up member
questionnaire
4
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
Check eligibility
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
MEDICARE PATIENT
CLOSE x
QUESTIONNAIREHCC
Pop-upmessage
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
MEDICARE PATIENT
CLOSE x
QUESTIONNAIREHCC
Click toprint
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
MEDICARE PATIENT
CLOSE x
QUESTIONNAIREHCC Click to
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
Click onmeasures
MARY SMITH1234567890
x
x
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
Medicare Dashboard
MammographyColorectal Cancer ScreeningCardio CareDiabetes CareHypertensionGlaucomaChronic Meds MonitoringFlu VaccinePneumo VaccineBone Density TestingRheumatologic MedicationSpirometry for COPDUrine leakage counselingFalls counselingExercise counselingAppointment easePhysical/emotional health
25FEB111MAR1125FEB1125FEB111MAR1115FEB111MAR118FEB111MAR1125FEB118FEB111MAR111MAR111MAR111MAR111MAR111MAR11
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DOC MeasureComplete?
Scenario 2 - Proactive
Sample workflowOffice staff
opens dashboard
1
Sample workflowOffice staff
opens dashboard
1Prints list of
patients needing care
2
Sample workflowOffice staff
opens dashboard
1Prints list of
patients needing care
2Outreach to patients on
list
3
Sample workflowOffice staff
opens dashboard
1Prints list of
patients needing care
2Office staff
checks eligibility and prints
questionnaire
4Outreach to patients on
list
3
Sample workflowOffice staff
opens dashboard
1Prints list of
patients needing care
2
Collect questionnaire,
give patient info
5
Office staffchecks eligibility
and prints questionnaire
4Outreach to patients on
list
3
Sample workflowOffice staff
opens dashboard
1Prints list of
patients needing care
2
Office staffputs reminder(s) on patient chart
6
Collect questionnaire,
give patient info
5
Office staffchecks eligibility
and prints questionnaire
4Outreach to patients on
list
3
Sample workflowOffice staff
opens dashboard
1Prints list of
patients needing care
2
Office staffputs reminder(s) on patient chart
6Physician sees
patient with reminder(s)
7
Collect questionnaire,
give patient info
5
Office staffchecks eligibility
and prints questionnaire
4Outreach to patients on
list
3
Sample workflowOffice staff
opens dashboard
1Prints list of
patients needing care
2
Office staffputs reminder(s) on patient chart
6Physician sees
patient with reminder(s)
7
Patient receives appropriate care
8
Collect questionnaire,
give patient info
5
Office staffchecks eligibility
and prints questionnaire
4Outreach to patients on
list
3
Sample workflowOffice staff
opens dashboard
1Prints list of
patients needing care
2
Office staffputs reminder(s) on patient chart
6Physician sees
patient with reminder(s)
7
Patient receives appropriate care
8P4P/HCC/5STAR metrics achieved
for this patient
9
Collect questionnaire,
give patient info
5
Office staffchecks eligibility
and prints questionnaire
4Outreach to patients on
list
3
Click onmeasure
MARY SMITH
SANDRA SMITH
ANDREW SMITH
PAULA SMITH
Click onpatient
MARY SMITH
SANDRA SMITH
ANDREW SMITH
PAULA SMITH
MARY SMITH1234567890
Click todownload
MARY SMITH
SANDRA SMITH
ANDREW SMITH
PAULA SMITH
SMITH ANDREW SMITH MARYSMITH PAULASMITH SANDRA
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SMITH ANDREW SMITH MARYSMITH PAULASMITH SANDRA
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SMITH ANDREW SMITH MARYSMITH PAULASMITH SANDRA
MFFF
MARY SMITH
SMITH, MARY8/15/1945F123 MAIN STREETSANTA CLARA, CA 950514085551212SCCIPAROBERT NORMAN, MD
1/1/2000
1234567890
Quality MeasuresCMS 5 STAR
MAMMOGRAPHY, CRC, CARDIO CARE, DIABETES CARE, HYPERTENSION GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
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Betty
Charles
David
Edward
Frank
Georgette
Henry
Illana
Jackie
Kelly
Lori
Mary
Nancy
Octavia
Paul
Quincy
Robert
Samantha
Tom
Smith
Smith
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Discussion
Thank you
Wayne Pan, MD, MBAHealth Access Solutions
CMS “5 STAR” Rating System
How to effectivelymanage the