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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
SCCIPAA Pacific Partners Medical Group
