Presentation given at the Breakthrough Strategies to Boost HEDIS Scores & Quality Management meeting, Key West, January 16, 2012.

1. How Star Rating Measures Correlate with
Overall HEDIS Quality
Wayne Pan, MD, MBA
Chief Medical Officer
Pacific Partners Management Services, Inc.
Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012

2. RETIRED Measures

3. From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011

4. ? New Measures

5. From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011

6. Average Stars of
New Measures

7. From: 2nd Update on Medicare Part C & D 2012 Plan Ratings, September 8, 2011

8. PART C Measures

9. HEDIS: Health Effectiveness Data and Information Set

10. HEDIS: Health Effectiveness Data and Information Set

11. HEDIS: Health Effectiveness Data and Information Set
*
*
*
Only applies to plan enrollees 65+ years old

12. CAHPS: Consumer Assessment of Health Providers and Systems

13. HOS: Health Outcomes Survey

14. CMS DATA: Data Collected by CMS from Plans

15. PART D Measures

18. WEIGHTING

19. Outcomes 3x
Intermediate Outcomes 3x
Patient Experience 1.5x
Patient Access 1.5x
Process 1x

20. From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)

21. From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)

22. From: Plan Ratings Memo, December 20, 2011 (planratingsmemo_122011.pdf)

23. ?

24. a simpler way to manage your
P4P/CMS 5 Star quality
program
wayne pan, md, mba

25. 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?

26. how are you going to coordinate
all three stakeholders?
health
plans

27. need a bidirectional messaging
platform

28. need a cost-effective way to
communicate with patients

29. need a way to consolidate all
health plans into one platform

30. NOT

31. office manager’s view

32. Senior
doctor
patients

33. physician’s view

34. Senior
doctor
patients

35. doctor patient

36. how can you affect change
in the physician’s office?

37. payer-provider collaboration
is a team sport

38. patient

39. patient
front desk staff

40. analog to digital
converter

41. 112
MARY SMITH 1/1/2011
1234567890
$5.00
$10.00
$25.00
analog to digital eligibility check
converter

42. how to engage your team in
quality improvement efforts?

43. put hot triggers
in the path of
motivated people
BJ Fogg, PhD
Director, Persuasive Technology Lab
Stanford University

45. 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?

46. Introducing...
ACCESSEXPRESS
Q

47. ACCESSEXPRESS
Q
Click here to register
for a password or
request more information
Powered by Access ExpressQ-v5.0.#.0.1 Build 2011.04.04.00

48. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

49. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA

50. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
TH
PA
BLUE SHIELD OF CA
E
TH
IN

51. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA

52. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA

53. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA

54. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
POP-UP
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD

55. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
CLICK HERE

59. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
ER
SMITH, MARY
8/15/1945
G
1234567890
IG
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
TR
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
T
O
H

60. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD

61. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA

62. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

63. digital to analog converter module

64. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

65. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
N
O
TI
VA
TI
O
M

66. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

68. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

69. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

70. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

71. Description of
measure

72. Capability for
physician office
entry

73. Capability for
physician office
entry
Y
IT
IL
AB

74. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

77. how can you affect change
in the physician’s office?

78. engage your team in quality
improvement efforts

79. “put hot triggers in the path of motivated people”
BJ Fogg, PhD
Director, Persuasive Technology Lab
Stanford University

81. thankyou
wpan@ppmsi.com