Maximizing Your Medicare Star Ratings

Transcription

1 Maximizing Your Medicare Star Ratings Adrianne Wagner, MHSA, FACHE Quality and Health Plan Strategy Manager The Everett Clinic, Everett, WA Bernadette Loftus, MD Associate Executive Director The Permanente Medical Group Executive Medical Director The Mid Atlantic Permanente Medical Group

2 Adrianne Wagner, MHSA, FACHE An Everett Clinic Perspective 2

3 About The Everett Clinic Largest independent medical group in the Pacific Northwest Nine locations throughout Snohomish County Fourth largest private employer in county 1,700 employees 500 providers 300,000 patients 900,000 annual visits More than 40 medical specialties 3-time Fortune Top 100 Best Workplace 3

4 5 Star and TEC Awarded to Medicare Advantage health plans 50+ measures Quality of care Member experience with the health plan Drug plan Selected clinically relevant measures to estimate a 5 Star Rating based on TEC s Medicare-Eligible Patient Population 4

5 Our Why Right thing to do for patients Owning clinical quality components Influencing health plan performance ratings Becoming attractive network partners Being rewarded for the thing we do best- leveraging performance to build a sustainable model 5

6 Strategy with Health Plans Partner with high performing health plans (higher Star ratings) that are aligned with our goals and have staying power Strengthen data integration and predictive modeling to improve population management Share risk with plans who are willing to delegate Complex Case Management Disease Management Utilization Management Claims (future state) 6

7 Working together with Health Plans Star Snapshot Bi-directional data exchange Identifying/Addressing Gaps Coordinating Clinical Efforts Star Snapshot Practice: The Everett Clinic TAX Identification Number: Report Period: Jan 2014 August BY Avg. Star Score 2016BY Avg. Star Score - Aug Measure Measure ID Weight Eligible 2016BY Star Snapshot Compliant PassRate 2016BY 2016BY MeasureStar 2016BY MeasureStar 2017 BY Access to Primary Care AAP % 5 4 Adult BMI Assessment ABA % 1 2 Breast Cancer Screening BCS % 4 3 Cardiovascular Care Cholesterol Screening CMC_LDLTEST % 5 1 Colorectal Cancer Screening COL % 2 2 Diabetes Care Blood Sugar Controlled CDC2_HBAPOOR % 1 1 Diabetes Care Cholesterol Controlled CDC2_LDL % 1 1 Diabetes Care Cholesterol Screening CDC2_LDLTEST % 5 1 Diabetes Care Eye Exam CDC2_EYE % 5 2 Diabetes Care Kidney Disease Monitoring CDC2_NPH % 5 4 Diabetes Treatment DTM % 4 5 High Risk Medication HRM % 3 4 Medication Adherence for Cholesterol (Statins) ADH_STATINS % 5 5 Medication Adherence for Diabetes Medications ADH_DIAB % 5 5 Medication Adherence for Hypertension (RAS antagonists) ADH_ACE % 5 5 Osteoporosis Management in Women who had a Fracture OMW % 3 2 Plan All Cause Readmissions PCR % 4 3 Rheumatoid Arthritis Management ART % Courtesy of Humana Insurance Company

8 8 Accountability

9 9 Calculating Internal 5 Star Rating

10 Targeting Measures Twelve measures selected each year Includes key 5 Star measures and other value-based contract measures Targeted reports created for all levels of accountability Primary Care Overall Primary Care Location Provider 10

11 Reporting Measures Internal calculation published monthly Gaps in performance shared regularly with leadership Monthly huddles with sites to review performance and areas of opportunity 11

12 Engaging provider teams Medical assistants print Daily EvEN Better each day to find today s patients who have outstanding HMDM needs Standardizing outreach by using smart registries (EvEN Better) and tools built into the EMR 5 Star Council formed to get feedback and create front-line conduit of information about Quality initiatives Building leader standard work to support physician/medical assistant teams 12

13 13 Creating Tools for the Front Line

14 5 Star as a Quality Framework Expand tools to entire population Standardize quality measures used for commercial valuebased contracts Use front-line workflows to advance all quality measures/initiatives Quantify a quality performance aggregate and use for clinic goal-setting and measurement 14

15 Bernadette Loftus, MD A Permanente Medical Group Perspective 15

16 Kaiser Permanente Today KP Medicare plans hold 7 of the top 10 spots in the NCQA national rankings 2014, and all are rated 5 Stars 16

17 17 Physician, Know Thy Stuff

18 The Toolbox Quality Structure Integrated Pharmacy EMR, including strategic use of AVS Medical Assistant Workflows Smart rooming tools as a vital sign Registries Quality Is Everyone s Job every specialty/every visit 18

19 Non-Encounter Based Tools For Patient Engagement Health education departments Targeted mailings re: survey measures Outreach via phone, snail mail, Web site tools 19

20 It s Constitutional Prevention/wellness in the Permanente DNA Data is king, and it is shared liberally and transparently Built-in CME, and it is built around strategic priorities Same approach across all lines of business, and line of business not obvious to front-line clinicians 20

21 King Data MONTHLY SNAPSHOT OF SPECIALTY CARE ACCESS - November 2012 ALL ALT CAR DRM END ENT GI ID NEP NEU ONC OPH ORT PAI PHY PLS POD PUL RHE SPS SUR URO VAS SLP-MD BALT 80% 83% 17% 86% 76% 84% 75% 85% 95% 80% 94% 92% 78% 86% 84% 33% 79% 85% DCSM 83% 80% 96% 34% 68% 91% 75% 84% 93% 87% 91% 81% 93% 86% 93% 95% 92% 83% 92% 55% 89% 87% 82% NOVA 98% 60% 95% 93% 84% 89% 82% 86% 90% 88% 89% 92% 89% 87% 85% 81% 92% 95% 92% 85% 89% 66% 90% 89% REGION Weekly 88% 72% Specialty 93% 62% Access 77% 88% Report 79% 84% 91% 89% 88% 87% 91% 87% 88% 89% 90% 87% 91% 73% 88% 80% 84% 89% 21 Reporting Period: 11/11/ /08/2012 Spec SA Facility Desc AUDIOLOGY ALL ALL Week Desc New Demand (Referrals Entered) Referrals Closed Member NOT Seen Referrals Closed Member Seen Backlog Calculations # of Referrals Open at End of Report Period 10 Day Through put Backlog Weekly Through put Backlog in Weeks ITS and ITB Calculations Number of Visits in ITB and ITS Calc Initiated to Booked (Days) Initiated to Seen (Days) % Seen Within 10 Days 11/11/ /17/ % 11/18/ /24/ % 11/25/ /1/ % 12/2/ /8/ % ALL 4 Week %

22 In the final analysis, it s about culture Essentially no monetary incentives for this work Rather, it s a series or behavioral norms and performance expectations Performance does indeed get managed Everyone gets to choose their bliss 22

23 23 Conversation

24 Plan-Do-Check-Act Approach Plan-Do-Check-Act Approach Transparency Population Management Comparing Culture 24