VALUE INDEX SCORE WHAT IS IT AND HOW IS WELLMARK USING THE VIS TO MEASURE QUALITY? TOM NEWTON Vice President, Network Engagement PRESENTED BY

Transcription

1 VALUE INDEX SCORE WHAT IS IT AND HOW IS WELLMARK USING THE VIS TO MEASURE QUALITY? PRESENTED BY TOM NEWTON Vice President, Network Engagement 1

2 WHAT IS THE VIS? HOW IS WELLMARK USING THE VIS? CONNECTING CLAIMS AND CLINICAL DATA WHAT IS THE VIS? LESSONS LEARNED 2

3 DEVELOPMENT PRINCIPLES Meaningful to Wellmark customers and members Population, not disease centric Outcome-based Claims-based Measures are risk adjusted Influenced by provider intervention Supported by external evidence of the measures Use valid building blocks reasonably free from upcoding Transparency Supportive of the Triple Aim s principles: Health, Cost, and Experience 3

4 MEASURING QUALITY VALUE INDEX SCORE (VIS) SM Developed for Wellmark by 3M Health Information Systems, the VIS is a single score that quantifies the quality of care like a Consumer Reports for health care value. Applies to all patients, regardless of health status Measures Domains of quality Quality Score 4

5 VIS DOMAINS AND MEASURES Primary and Secondary Prevention Chronic and Follow-up Care Population Health Status* Continuity of Care Tertiary Prevention Breast cancer screening Risk-adjusted percent difference in potentially preventable readmissions Percent difference of attributed members who acquire chronic conditions, risk-adjusted Percent of attributed members who are non-users, not riskadjusted Risk-adjusted percent difference in potentially preventable admissions Colorectal screening Percent of attributed members with hospital discharge with provider office visit equal to or less than 30 days post-discharge Percent difference of attributed members with chronic conditions that increase in severity, risk-adjusted Percent of attributed members with PCP visit, not risk-adjusted Risk-adjusted percent difference in potentially preventable emergency department visits Percent of attributed members birth to 15 months who had the recommended number of wellchild visits with a PCP Percent of attributed members with chronic disease (clinical risk categories 50, 60, 70) with 3 or more provider visits Percent of attributed members with continuity of care, riskadjusted Percent of attributed members 3 6 years of age who had the recommended number of well-child visits with a PCP *To be added at a future date. 5

6 WHAT IS THE VIS? HOW IS WELLMARK USING THE VIS? CONNECTING CLAIMS AND CLINICAL DATA LESSONS LEARNED HOW IS WELLMARK USING THE VIS? 6

7 2015 WELLMARK ACO COVERAGE 13 2, ,433 $2.3B ACOs PCPs Cost/Quality Members Total Cost of Care 7

8 WHAT IS THE VIS? HOW IS WELLMARK USING THE VIS? HOW TO INFLUENCE PERFORMANCE? LESSONS LEARNED HOW TO INFLUENCE PERFORMANCE? 8

9 AVAILABLE RESOURCES The VIS PCP Summary Report includes VIS targets and scores for each PCP at the measure, domain and aggregate level. The Completion Rate Report provides the ACO PCP completion rate for each measure. The report also includes the current network mean (average). The Care Management Gap Report identifies gaps in patient care and members who are at risk based on a change in risk. The Patient Profile Report provides detailed information on each attributed member such as frequently used diagnosis codes; and professional, inpatient, outpatient and pharmacy history. The Inpatient Notification Report lists inpatient admissions notifications received by Wellmark for attributed members each week. 9

10 BREAST CANCER SCREENING 10

11 COLORECTAL CANCER SCREENING 11

12 POTENTIALLY PREVENTABLE ADMISSIONS 12

13 POTENTIALLY PREVENTABLE VISITS 13

14 CHRONIC CARE VISITS Confidential and Proprietary Wellmark Blue Cross and Blue Shield. 14

15 WHAT IS THE VIS? HOW IS WELLMARK USING THE VIS? LESSONS LEARNED HOW TO INFLUENCE PERFORMANCE? LESSONS LEARNED 15

16 WHAT HAVE WE LEARNED? PCPs can influence the individual measures and overall VIS. Claims information is just a piece of what is necessary PCPs must augment with clinical data! Variability in VIS scores exist across Wellmark s network and within practices and ACOs. Transparency is a great motivator. Physician leadership is critical to success. There is still work to be done in fine tuning the VIS PCPs have given us great feedback. Wellmark s customers appreciate the value of a single composite score and they are asking for transparency. 16

17 17 THANK YOU! Tom Newton Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association. Confidential and Proprietary Wellmark Blue Cross and Blue Shield.