Automating Provider Processes Tools and Strategies

Transcription

1 9/5/208 Automating Provider Processes Tools and Strategies Vicki Federico Director, Provider Relations and Provider Communications Cambia Company Profile Our Cause Serve as a catalyst to transform health care, creating a person-focused and economically sustainable system. A tax-paying nonprofit headquartered in the Pacific Northwest Over 20 companies and growing Health Plans Echo Health Ventures Human Services Platform 70+ million people touched nationwide Almost 5,000 employees in 30 states Business focus Nationally recognized: Top 00 Healthiest Workplaces Cambia Health Solutions, Inc.

2 9/5/208 Family of Regional Health Plans WA ID 6 health plans insuring 2.5 million people in four states NCQA Accredited A.M. Best A Rating 00-year history OR ~95K Medicare Advantage members UT Cambia Health Solutions, Inc. Key Levers to Risk Adjustment & Stars Success Provider Engagement Clinical Data Strategy Member Operational Excellence Chronic Disease Management & Behavioral Health Cambia Health Solutions, Inc. 2

3 9/5/208 Evolution of our Provider Engagement Model Cambia Health Solutions, Inc. The Challenge Aligning Risk Adjustment and Stars provider engagement initiatives to optimize patient quality and coding accuracy, while minimizing abrasion, resource burden, and duplication of efforts. $$ The Approach Data-Doctor-Patient in the same place at the same time Interactive tools and aligned incentives Bi-directional communication and feedback loop Proactive management of incoming, outgoing clinical data points Cambia Health Solutions, Inc. 3

4 9/5/208 Evolution of our Provider Engagement Model Cambia Health Solutions, Inc. Provider Engagement that drives Risk Adjustment and Stars Improvement??? Yes, there s an App for that Cambia Health Solutions, Inc. 4

5 9/5/208 Care Gap Management Application ( CGMA ) Cambia Health Solutions, Inc. Care Gap Management Application Members and their care gaps. Sortable and searchable Cambia Health Solutions, Inc. 5

6 9/5/208 Actionable Gap Filtering & Sharing Care Gap Management Application *QIP Incentive YTD $36,80 Gap Management All Providers Filters All Gap Types HMO & PPO All TINs Member All Gap Types Gaps 79 Member Roster Education Reports HCC LAST Part DNAME FIRST NAME DOB REGENCE ID GAPS HRM James John Med Rec Post Discharge Statin Use - Diabetes Smith Sam Adherence Georgie Quality Reichner McDaniel Adult BMI Assessment Xavier Blood Sugar Controlled Williams Blood Pressure Controlled Sally Breast Cancer Screening Rodgers George Colorectal Cancer Screening Diabetic Eye Exam Kidney Disease Monitoring Osteoporosis Management Plan All-Cause Readmissions Cambia Health Solutions, Inc. Actionable Gap Filtering & Sharing Care Gap Management Application *QIP Incentive YTD $36,80 Gap Management All Providers Filters Colorectal Cancer Screening HMO & PPO All TINs Gap Closure Progress Maximum Incentive Possible: $69,000 Maximum Estimated Incentive YTD: $36,80 Member Gaps 23 Member Roster Education Reports Colorectal Cancer Screening LAST NAME FIRST NAME DOB REGENCE ID GAPS Target Total Measure-eligible Members Total Non- Compliant Measure Star Rating Fredericsen George % Jones Ernest Smith Robert Gardner Alan Nordergren Soren Nelso Elmer Performance graph now shows only Colorectal Cancer Screening data TIN: Only members with Colorectal Cancer Screening gaps are shown Cambia Health Solutions, Inc. 6

7 9/5/208 Actionable Gap Filtering & Sharing Care Gap Management Application *QIP Incentive YTD $36,80 Gap Management All Providers Filters Share icon allows sharing of this filtered view with authorized users Colorectal Cancer Screening HMO & PPO All TINs Gap Closure Progress Maximum Incentive Possible: $69,000 Maximum Estimated Incentive YTD: $36,80 Member Gaps 23 Member Roster Education Reports Colorectal Cancer Screening LAST NAME FIRST NAME DOB REGENCE ID GAPS Target Total Measure-eligible Members Total Non- Compliant Measure Star Rating Fredericsen George % Jones Ernest Smith Robert Gardner Alan Nordergren Soren Nelso Elmer TIN: Cambia Health Solutions, Inc. Actionable, Engaging Close Gap Experience Close Gap GEORGIE REICHNER Member ID: Gap: Instruction: Colorectal Cancer Screening Need fecal occult blood test in 206, flexible sigmoidoscopy performed at least once during , or colonoscopy performed during Attach File Dates of Service Start Date End Date Select Reason Add a comment regarding the closure of this patient's gap. Save Cancel Cambia Health Solutions, Inc. 7

8 9/5/ Cambia Health Solutions, Inc. An Integrated Risk Adjustment and Stars Provider Engagement Strategy: Many Wins Rewarding improved clinical quality and complete coding drives provider engagement Real-time, accurate data allows providers to know how and who to intervene with to improve clinical outcomes and coding Bi-directional feedback loop improves efficiencies, revenue streams, projection accuracy Better outcomes and more efficient identification of care management needs leads to better member health Better outcomes and documentation leads to better Stars performance and more accurate HCC coding Better performance overall allows improved revenue for providers and health plan and lower premiums and/or expanded benefits for members Cambia Health Solutions, Inc. 8

9 9/5/208 Questions Cambia Health Solutions, Inc. Thank you! Cambia Health Solutions, Inc. 9