5 dangerous ideas

5 dangerous ideas*Wayne Pan, MDSanta Clara County IPA

SCCIPAA Pacific Partners Medical Group

but first, some audience questions

you are concerned about STAR ratings

PLEASE STAND IF:

you are a provider

PLEASE REMAIN STANDING IF:

you are part of a delegated group

PLEASE REMAIN STANDING IF:

your group has a common EHR

PLEASE REMAIN STANDING IF:

your common EHR is helping you withyour STAR rating program

PLEASE REMAIN STANDING IF:

NOW, LOOK AROUND YOU

we ALL can learn from those left standing

it’s NOT about the EHR

it’s about people and processes

supported by the right technology

dialog (noun) \ˈdī-ə-ˌlȯg, -ˌläg\2a: a conversation between two or more persons

dangerous idea: #1

“Ask not what yourhealth plan can do

for you; ask whatyou can do for your

health plan.”

partnership (noun) \-ˌship\3: a relationship resembling a legal partnership and usually involving close cooperation between parties having specified and joint rights and responsibilities

from: merriam-webster.com

Senior

doctor

patients

Senior

doctor

patients

doctor patient

providers clinically treat patients all the same

www.iha.org

www.iceforhealth.org

• Provider programs - work with providers to ensure nonduplicative efforts

• Member outreach - help providers with things they can’t do well

• Clinical data - old data is worse than no data

dangerous idea: #2

• Consistent communication plan - providers do not like surprises

• Use multiple channels - providers are unique, each has preferred method

• Embrace office staff - not everything needs to go through the provider

dangerous idea: #3

feedback

• Progress toward set goals• Performance comparison with peers• Customized help for improvement

iteration

dangerous idea: #4

• Set aside money in advance• Clear performance targets• Transparent incentive program

dangerous idea: #5

address the whole patient

• Link to annual HCC process• Link to all quality improvement

programs• Use HCC risk scores to target outreach

it’s not just about STAR ratings

it’s really about patient care

too many of these

Santa Clara County1,304.01 sq. miles

1,781,642 (2010)$74,335

5 PCP80 Specialists

57 PCP104 Specialists

173 PCP343 Specialists

11 PCP30 Specialists

SCCIPAfounded in 1986physician-owned, physician-governed800+ physicians - 240+ PCPs, 550+ specialistsall 9 hospitals - including a tertiary care center9 health plans (Commercial and Medicare Advantage)

full disclosure

SCCIPAA Pacific Partners Medical Group

• Internal:• 2 RN’s - one CCM, one UM• 2 LVN’s - one CCM, one UM• 1 EMT• 1 clinical data analyst• 4 non-clinical

• External:• 2 RN’s - onsite CM• 1 MSW - onsite @ SNFs• Hospitalist group (9 physicians)• 1 SNFist

how do we partner with health plans?

1

review & utilize health plan resources

provider training/education materialsdisease management programs

patient-specific initiativesincentive programs

quarterly sync-up meetings

require all physicians to use AccessExpress

2

our common communication platform

HIPAA-compliant secure communicationseligibility resource

electronic referral authorizationsclaims and authorization status

how do you make a platform helpful?

integration into the office workflow

how do you make a platform effective?

engage office staff

patient

patient

front desk staff

analog to digitalconverter

analog to digitalconverter

eligibility check

MARY SMITH1234567890

1121/1/2011

$5.00$10.00$25.00

ACCESSEXPRESSQ New Message (3)New Eligibility Response

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

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

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

digital to analog converter module

ACCESSEXPRESSQ New Message (3)New Eligibility Response

3used same communication platform

for provider feedback

ACCESSEXPRESSQ New Message (3)New Eligibility Response

4physician bonus program based on

achieving set targets

2011 Bonus StructurePCPs: 2011 IHA P4P and HCCCMS 5 STAR rating measures

Participation in patient satisfaction training (4 meetings)Patient satisfaction scores (based on the CAHPS survey)Responsiveness to PPMSI Med Management inquiries

2011 Bonus StructureSpecialists: billing or SCCIPA unique patient volume

Overall achievement of SCCIPA in the CMS 5 STAR Rating ProgramParticipation in patient satisfaction training program (4 meetings)

Patient satisfaction scores (based on internal survey)Use of Excelicare Clinical Hub

Responsiveness to PPMSI Medical Management inquiries (timeliness)

5how do we focus on the whole patient?

send patient reminders for annual visitprovide providers checklist

prompt front office staff HOS surveyfull HCC review by hospitalists48hr discharge follow-up

post-discharge office visit follow-uppost home health initiation follow-up

send patient reminders for annual visitprovide providers checklist

prompt front office staff HOS surveyfull HCC review by hospitalists48hr discharge follow-up

post-discharge office visit follow-uppost home health initiation follow-up

send patient reminders for annual visitprovide providers checklist

prompt front office staff HOS surveyfull HCC review by hospitalists48hr discharge follow-up

post-discharge office visit follow-uppost home health initiation follow-up

• find ways to partner with your health plans

• have a consistent, multi-faceted communication strategy

• provide ample, data-driven feedback• put money where your goals are• focus on the whole patient

5 dangerous ideas

discussion

thankyou

[email protected]

SCCIPAA Pacific Partners Medical Group