Dollars and Sense - SpectraMedix eBooks/Dollars آ  Dollars and Sense Leveraging HEDIS and MIPS Measures

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  • Dollars and Sense

    Leveraging HEDIS and MIPS Measures to Optimize

    Performance for Your Network

    October 18, 2018

  • 2

    Chris Bethell

    VP, Marketing and Client Relations, SpectraMedix

    Raj Lakhanpal, MD

    CEO SpectraMedix

    TODAY’S PRESENTERS

  • 1. Objectives | About Us

    2. Measures Overview

    3. Moving the Dial on Performance

    AGENDA

  • OBJECTIVES

    Understand how expanded measures

    calculations can help health plans like

    yours:

    1. Get a better view of care across your

    population

    2. Drive more timely interventions

    3. Direct focused improvement efforts

    on high cost/high return areas of care

  • About SpectraMedix

  • MISSION

    Help payers and providers thrive in the VBP world.

    We do this by providing a powerful platform that delivers

    advanced data management, analytics, and populations

    profiling—across clinical, operational, financial, quality,

    and socioeconomic domains.

    MEASURES CALCULATION,

    REPORTING & ANALYTICS

    POPULATION LEVEL RISK MODELING & PROFILING

    MASTER DATA MANAGEMENT, EMPI

    The SpectraMedix

    Platform

  • • A seasoned team of clinicians, informaticists, and

    technologists with deep healthcare expertise

    • Well established with a highly secure platform to

    address the diverse performance improvement

    requirements across the VBP ecosystem

    • Supporting the diverse needs and requirements

    within the payer and provider domains across

    Medicaid, Medicare, and commercial markets

    WHO WE ARE

  • THE SPECTRAMEDIX PLATFORM™

    • End-to-end enterprise data management.

    • Field-validated in NY Medicaid transformation.

    • Serving provider environments across the US.

    • Agile data acquisition and normalization system.

    • Powerful measures authoring, calculation,

    and reporting.

    • Advanced functionality for a wide span of

    performance improvement and populations health

    management efforts.

    • HIPAA-compliant Microsoft Azure environment.

    • Drives applications across numerous payer and

    provider domains.

  • © SpectraMedix, 2009-2018. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.

    MEASURES

    OVERVIEW

  • PAGE 11

    HEDIS MEASURES

    HEDIS measures are the gold standard

    • HEDIS reported for 184M patients

    • CMS covers 75M patients

    • Employer based/private covers 100M+ patients

    HEDIS measures:

    • Help define quality

    • Help ascertain the quality of care providers and health

    plans provide to members

    • Are used by CMS

  • PAGE 12

    DEMYSTIFYING MIPS

    • Calculated monthly from clinical data

    • Drill down to a deeper clinical level

    • Some MIPS measures are HEDIS measures

    • MIPS can provide timely insights for earlier

    interventions

  • PAGE 13

    ACCELERATING PERFORMANCE IMPROVEMENT

    • HEDIS “proxy” measures and other measures can be

    utilized to get more timely results to:

    o Provide a 360 degree view of healthcare status

    o Gain provider network performance insights around

    quality and cost

    o Close Gaps in Care

    • Clinical disciplines that can impact performance

  • © SpectraMedix, 2009-2018. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.

    MOVING THE DIAL ON

    PERFORMANCE

    Three Use Cases

  • PAGE 15

    USE CASE ONE EXPANDING CLINICAL INSIGHTS

    Look at whole landscape

    • Understand things in full clinical context to

    help direct my initiatives

    • Enact initiatives I would be unable to

    otherwise

  • PAGE 16

    USE CASE TWO THE VALUE OF TIMELINESS

    FLU VACCINATIONS

    • HEDIS will not help identify those that need flu

    vaccinations

    • Need proxy or MIPS measures that enable timely

    interventions that impact quality and cost

    • Compare/contrast with chronic disease?

  • PAGE 17

    USE CASE THREE TARGETING SPECIALTY CARE AREAS

    • Determine what areas in the care environment can

    provide a bigger care improvement impact

    • Need broader set of measures and more timely

    access to a more diverse set of data to truly

    intervene

    • Help prioritize intervention efforts

  • PAGE 18

    Improving these HEDIS domain outcomes with clinical data/MIPS measures

    • Effectiveness of Care o Ex., Controlling HBP

    • Access/Availability of Care o Ex., Adult Access to Preventive/Ambulatory Services

    • Experience of Care • Utilization and Risk-Adjusted Utilization

    o Ex., Mental Health Utilization o Ex., Plan All Cause Readmission

    • Health Plan Descriptive Information • Measures Collected Using E-Clinical Data Systems

    o Ex., Unhealthy Alcohol Use Screening & Follow-up

  • PAGE 19

    MEASURES AND VBP

    Payers increasingly rely on measures to build VBP models and contracts.

    Goals:

    • Boosting patient & provider engagement • QI – preventive health screening, patient

    satisfaction and follow up • Outcome & cost

  • THANK YOU

    For more information visit spectramedix.com.

    You’re doing great work!

    Or contact Nathan Brown directly:

    609-336-7733 Ext. 308 / nathan.brown@spectramedix.com

    mailto:nathan.brown@spectramedix.com