best practices for data analysis 16 jan12
DESCRIPTION
Presentation given at the Breakthrough Strategies to Boost HEDIS Scores & Quality Management meeting, Key West, January 16, 2012.TRANSCRIPT
![Page 1: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/1.jpg)
Best Practices for Data Analysis
Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012
A Chasing Logic Case Study
Wayne Pan, MD, MBAChief Medical OfficerPacific Partners Management Services, Inc.
![Page 2: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/2.jpg)
Best Practices for Data Analysis
Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012
A Chasing Logic Case Study?
Wayne Pan, MD, MBAChief Medical OfficerPacific Partners Management Services, Inc.
![Page 3: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/3.jpg)
to recap....Breaking Down the Silos for Risk Adjustment, HEDIS & Care Management:
From Streamlining Charts to Capturing & Sharing the Right Data
A Complementary Duo - Risk Adjustment and HEDIS: How to Ensure a Plan is Effectively Accomplishing Objectives for Both
Practical Steps to Improve the Integrity, Quality & Timeliness of Data & Supplemental Data
How Star Rating Measures Correlate with Overall HEDIS Quality
The State of Health Care Quality – Plans, Providers and Consumers in the New World
of Star Ratings and Exchanges
A Two-Part Discussion on EffectiveQuality Improvement Partnerships
A Collaborated Effort: Plans & Providers Working to Improve Clinical Outcomes
Provider Education & Incentives: Creating Tools & Toolkits for Providers
That They Will Use
![Page 4: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/4.jpg)
we cannot continue to keep quality,risk adjustment/stratification,
cost-effectiveness,medical management,
network management, andmember engagement in
separate silos
![Page 5: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/5.jpg)
that’s because....
![Page 6: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/6.jpg)
![Page 7: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/7.jpg)
they’re all related!
![Page 8: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/8.jpg)
with the common denominator....
![Page 9: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/9.jpg)
the patient.
![Page 10: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/10.jpg)
some learnings from California’s IHA P4P....
![Page 11: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/11.jpg)
theory: combine the variousplans’ quality P4P bonus programs into a single coherent program for physicians
![Page 12: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/12.jpg)
results: very modest gains in quality outcomes despite more than half a billion dollars in P4P bonuses paid out, since 2004
![Page 13: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/13.jpg)
what happened?
![Page 14: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/14.jpg)
not enough money set asidequality not linked to efficiencyproviders always have sicker, less compliant patients
![Page 15: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/15.jpg)
the P4P program didn’t change provider or patient behavior
![Page 16: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/16.jpg)
the plans didn’t save any money
![Page 17: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/17.jpg)
IHAP4P
sponsored by
![Page 18: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/18.jpg)
two ideas....
![Page 19: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/19.jpg)
![Page 20: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/20.jpg)
combine quality & efficiency....
![Page 21: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/21.jpg)
![Page 22: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/22.jpg)
TwoȱStrategicȱP4PȱGoalsȱforȱ2011Ȭ2015
Goalȱ#1:ȱȱBendȱtheȱcostȱtrendȱTargets:ȱȱ•Totalȱcostȱbelowȱriskȱadjusted,ȱgeographyȱadjustedȱ
average•TotalȱCostȱtrendȱbelowȱConsumerȱPriceȱIndexȱ+1
Goalȱ#2:ȱȱAchieveȱmeaningfulȱqualityȱ improvementsȱinȱclinicalȱcareȱandȱpatientȱ
experience,ȱandȱincreaseȱmeaningfulȱuseȱofȱ healthȱIT
4Copyrightȱ©
2011ȱIntegratedȱHealthcareȱAssociation.ȱAllȱrightsȱreserved.
![Page 23: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/23.jpg)
![Page 24: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/24.jpg)
be patient-centered....
![Page 25: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/25.jpg)
why does that matter?
![Page 26: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/26.jpg)
insanity: doing the
same thing over and over
and expecting
different results
![Page 27: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/27.jpg)
get out of our rut?
![Page 28: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/28.jpg)
4x4 healthcare
![Page 29: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/29.jpg)
4processes
![Page 30: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/30.jpg)
communication
![Page 31: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/31.jpg)
collaboration
![Page 32: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/32.jpg)
coordination
PCPs
Specialists
Patients
CaseManagers
![Page 33: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/33.jpg)
anticipation
![Page 34: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/34.jpg)
4dimensionaldata
![Page 35: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/35.jpg)
financial
![Page 36: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/36.jpg)
administrative
![Page 37: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/37.jpg)
clinical
![Page 38: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/38.jpg)
retrospectiveretrospective
![Page 39: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/39.jpg)
reactivecare
![Page 40: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/40.jpg)
$$$$$$
![Page 41: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/41.jpg)
behavioral+
![Page 42: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/42.jpg)
predictive
![Page 43: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/43.jpg)
prediction can lead to....
![Page 44: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/44.jpg)
proactivecare
![Page 45: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/45.jpg)
From: Dan Roam, “American Healthcare: a 4-napkin explanation”www.slideshare.net/danroam/healthcare-napkins-all
![Page 46: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/46.jpg)
one more thing....
![Page 47: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/47.jpg)
all providers are not the same
![Page 48: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/48.jpg)
use multiple communication channels and communicate consistently....
![Page 49: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/49.jpg)
case study: SCCIPA
![Page 50: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/50.jpg)
Santa Clara County1,304.01 sq. miles
1,781,642 (2010)$74,335
![Page 51: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/51.jpg)
5 PCP80 Specialists
57 PCP104 Specialists
173 PCP343 Specialists
11 PCP30 Specialists
SCCIPAfounded in 1986physician-owned, physician-governed800+ physicians - 240+ PCPs, 550+ specialistsall 9 hospitals - including a tertiary care center9 health plans (Commercial and Medicare Advantage)
![Page 52: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/52.jpg)
peopleprocessesplatform
![Page 53: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/53.jpg)
hospitalistsSNFistsonsite case managerscomplex case managersutilization review staff
people
![Page 54: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/54.jpg)
P4P/CMS 5 STAR dashboardincentive bonus based on qualityAscender for HCC processpaper quarterly physician workplanhospitalists perform HCC coding
processes
![Page 55: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/55.jpg)
common web-based communication platformfacilitates administrative functionsrules-based management of processesintuitive user-interfaceembed quality reminders into office/provider workflowprovider feedbackprovide actionable clinical data at point of careallow patients to access their own dataallow patients to provide feedback and enter their own data
platform
![Page 56: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/56.jpg)
results
![Page 57: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/57.jpg)
40.0
50.0
60.0
70.0
Inpatient Hospital Admissions Per 1000 Enrolled Patients (Commercial)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Admits per 1000 (Commercial)
![Page 58: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/58.jpg)
100.0
150.0
200.0
250.0
300.0
Bed Days Per 1000 Enrolled Population (Commercial)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Bed Days (Commercial)
![Page 59: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/59.jpg)
2.8
3.3
3.8
4.3Average Length of Stay (Commercial)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Average Length of Stay (Commercial)
![Page 60: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/60.jpg)
200.0
250.0
300.0
350.0
Inpatient Hospital Admissions Per 1000 Enrolled Population (Medicare)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Admits (Medicare)
![Page 61: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/61.jpg)
75010001250150017502000
Bed Days Per 1000 Enrolled Population (Medicare)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA Bed Days (Medicare)
![Page 62: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/62.jpg)
4.0
4.5
5.0
5.5Average Length of Stay (Medicare)
2011 Milliman Benchmark (Well Managed)2011 Milliman Benchmark (Moderately Managed)2011 Milliman Benchmark (Loosely Managed)SCCIPA ALOS(Medicare)
![Page 63: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/63.jpg)
![Page 64: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/64.jpg)
*
*
***
increase/same scores in 21 of 26 measures
![Page 65: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/65.jpg)
![Page 66: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/66.jpg)
no
![Page 67: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/67.jpg)
When you improve a little bit each day, eventually big things occur. Don’t look for big, quick improvement. Instead, seek small improvement one day at a time. That’s the only way it happens - and when it happens, it lasts.
John Wooden
![Page 68: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/68.jpg)
iteration
![Page 69: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/69.jpg)
Virtually nothing comes out right the first time.Failures, repeated failures, are finger posts on the road to achievement. The only time you don’t want to fail is the last time you try something. One fails forward toward success.
Charles F. Kettering
![Page 70: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/70.jpg)
don’t be afraid to FAIL....
![Page 71: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/71.jpg)
failfast
![Page 72: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/72.jpg)
![Page 73: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/73.jpg)
combine quality & efficiency.
![Page 74: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/74.jpg)
be patient-centered.
![Page 75: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/75.jpg)
use multiple communication channels and communicate consistently....
![Page 76: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/76.jpg)
![Page 77: Best practices for data analysis 16 jan12](https://reader034.vdocuments.us/reader034/viewer/2022052618/554b49fcb4c905cd2c8b5356/html5/thumbnails/77.jpg)
welcome tohealthcare2.0