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Dollars and Sense

Leveraging HEDIS and MIPS Measures to Optimize

Performance for Your Network

October 18, 2018

2

Chris Bethell

VP, Marketing and Client Relations, SpectraMedix

Raj Lakhanpal, MD

CEO SpectraMedix

TODAY’S PRESENTERS

1. Objectives | About Us

2. Measures Overview

3. Moving the Dial on Performance

AGENDA

OBJECTIVES

Understand how expanded measures

calculations can help health plans like

yours:

1. Get a better view of care across your

population

2. Drive more timely interventions

3. Direct focused improvement efforts

on high cost/high return areas of care

About SpectraMedix

MISSION

Help payers and providers thrive in the VBP world.

We do this by providing a powerful platform that delivers

advanced data management, analytics, and populations

profiling—across clinical, operational, financial, quality,

and socioeconomic domains.

MEASURES CALCULATION,

REPORTING & ANALYTICS

POPULATION LEVEL RISK MODELING & PROFILING

MASTER DATA MANAGEMENT, EMPI

The SpectraMedix

Platform

• A seasoned team of clinicians, informaticists, and

technologists with deep healthcare expertise

• Well established with a highly secure platform to

address the diverse performance improvement

requirements across the VBP ecosystem

• Supporting the diverse needs and requirements

within the payer and provider domains across

Medicaid, Medicare, and commercial markets

WHO WE ARE

THE SPECTRAMEDIX PLATFORM™

• End-to-end enterprise data management.

• Field-validated in NY Medicaid transformation.

• Serving provider environments across the US.

• Agile data acquisition and normalization system.

• Powerful measures authoring, calculation,

and reporting.

• Advanced functionality for a wide span of

performance improvement and populations health

management efforts.

• HIPAA-compliant Microsoft Azure environment.

• Drives applications across numerous payer and

provider domains.

© SpectraMedix, 2009-2018. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.

MEASURES

OVERVIEW

PAGE 11

HEDIS MEASURES

HEDIS measures are the gold standard

• HEDIS reported for 184M patients

• CMS covers 75M patients

• Employer based/private covers 100M+ patients

HEDIS measures:

• Help define quality

• Help ascertain the quality of care providers and health

plans provide to members

• Are used by CMS

PAGE 12

DEMYSTIFYING MIPS

• Calculated monthly from clinical data

• Drill down to a deeper clinical level

• Some MIPS measures are HEDIS measures

• MIPS can provide timely insights for earlier

interventions

PAGE 13

ACCELERATING PERFORMANCE IMPROVEMENT

• HEDIS “proxy” measures and other measures can be

utilized to get more timely results to:

o Provide a 360 degree view of healthcare status

o Gain provider network performance insights around

quality and cost

o Close Gaps in Care

• Clinical disciplines that can impact performance

© SpectraMedix, 2009-2018. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.

MOVING THE DIAL ON

PERFORMANCE

Three Use Cases

PAGE 15

USE CASE ONEEXPANDING CLINICAL INSIGHTS

Look at whole landscape

• Understand things in full clinical context to

help direct my initiatives

• Enact initiatives I would be unable to

otherwise

PAGE 16

USE CASE TWOTHE VALUE OF TIMELINESS

FLU VACCINATIONS

• HEDIS will not help identify those that need flu

vaccinations

• Need proxy or MIPS measures that enable timely

interventions that impact quality and cost

• Compare/contrast with chronic disease?

PAGE 17

USE CASE THREETARGETING SPECIALTY CARE AREAS

• Determine what areas in the care environment can

provide a bigger care improvement impact

• Need broader set of measures and more timely

access to a more diverse set of data to truly

intervene

• Help prioritize intervention efforts

PAGE 18

Improving these HEDIS domain outcomes with clinical data/MIPS measures

• Effectiveness of Careo Ex., Controlling HBP

• Access/Availability of Careo Ex., Adult Access to Preventive/Ambulatory Services

• Experience of Care• Utilization and Risk-Adjusted Utilization

o Ex., Mental Health Utilizationo Ex., Plan All Cause Readmission

• Health Plan Descriptive Information• Measures Collected Using E-Clinical Data Systems

o Ex., Unhealthy Alcohol Use Screening & Follow-up

PAGE 19

MEASURES AND VBP

Payers increasingly rely on measures to build VBP models and contracts.

Goals:

• Boosting patient & provider engagement• QI – preventive health screening, patient

satisfaction and follow up • Outcome & cost

THANK YOU

For more information visit spectramedix.com.

You’re doing great work!

Or contact Nathan Brown directly:

609-336-7733 Ext. 308 / nathan.brown@spectramedix.com