How star rating measures correlate with overall hedis quality (full) 16 jan12
Transcript of How star rating measures correlate with overall hedis quality (full) 16 jan12
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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
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RETIRED Measures
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From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
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? New Measures
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From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
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Average Stars ofNew Measures
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From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011
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PART C Measures
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HEDIS: Health Effectiveness Data and Information Set
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HEDIS: Health Effectiveness Data and Information Set
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HEDIS: Health Effectiveness Data and Information Set
*
**
Only applies to plan enrollees 65+ years old
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CAHPS: Consumer Assessment of Health Providers and Systems
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HOS: Health Outcomes Survey
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CMS DATA: Data Collected by CMS from Plans
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PART D Measures
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WEIGHTING
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Outcomes 3x
Intermediate Outcomes 3x
Patient Experience 1.5x
Patient Access 1.5x
Process 1x
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From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
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From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
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From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)
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?
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a simpler way to manage your P4P/CMS 5 Star quality program
wayne pan, md, mba
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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?
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how are you going to coordinate all three stakeholders?
healthplans
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need a bidirectional messaging platform
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need a cost-effective way to communicate with patients
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need a way to consolidate all health plans into one platform
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NOT
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office manager’s view
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Senior
doctor
patients
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physician’s view
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Senior
doctor
patients
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doctor patient
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how can you affect changein the physician’s office?
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payer-provider collaborationis a team sport
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patient
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patient
front desk staff
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analog to digitalconverter
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analog to digitalconverter
eligibility check
MARY SMITH1234567890
1121/1/2011
$5.00$10.00$25.00
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how to engage your team in quality improvement efforts?
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put hot triggers in the path of
motivated peopleBJ Fogg, PhD
Director, Persuasive Technology LabStanford University
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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?
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Introducing...
ACCESSEXPRESSQ
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ACCESSEXPRESSQ
Click here to registerfor a password or
request more information
Powered by Access ExpressQ-v5.0.#.0.1 Build 2011.04.04.00
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
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BLUE SHIELD OF CA
IN THE PATH
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
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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,
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POP-UP
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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 CLICK HERE
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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
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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
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
BLUE SHIELD OF CA
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
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digital to analog converter module
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
MOTIVATIO
N
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
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Description ofmeasure
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Capability forphysician officeentry
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Capability forphysician officeentry
ABILITY
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ACCESSEXPRESSQ New Message (3)New Eligibility Response
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how can you affect changein the physician’s office?
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engage your team in quality improvement efforts
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“put hot triggers in the path of motivated people”
BJ Fogg, PhDDirector, Persuasive Technology LabStanford University
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