Point of Care Tool to Manage Patient Populations

Cory Rayyes, R.N., MBAChief Operating OfficerSt. Joseph Hospital Affiliated Physicians

St. Joseph Hospital Affiliated Physicians

St. Joseph Heritage Healthcare

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Overview

St. Joseph Hospital Affiliated PhysiciansCalifornia based risk sharing IPAContracts

AetnaBlueCrossBlue ShieldCignaPacificare

Hospitals: St. Joseph Hospital & CHOC

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Overview

180 Primary Care Physicians500 Specialty Physicians80,000 Patients enrolled with our networkPCP Compensation

Capitation based on Age/SexReward program based on P4P parameters

Specialty Compensation80% of Network Capitation based20% FFS

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Process of Care

Traditional Acute/Episodic CarePopulation Based/Chronic CareNeed additional tools for the physicians to be able to switch from traditional care to a new chronic care model

Access to dataData needs to be timely and accurateNeed both claims based and chart based data

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Data Registry

SJHAP working with Intelligent Healthcare (IHC) developed a disease registry in 2002.Data sources

Claims Physician and HospitalPharmacy – Health Plan PBM’sLab Value data

Currently manual feeds monthlyMoving to live lab feeds in June

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Data Registry

Reasons for DevelopmentTrack populations of patientsImprove P4P scoresMeasure outcomes for network and individual physiciansImprove outcomes for our populationImprove gaps in care for patients with chronic conditions

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Pay for Performance Summary 2004 Measurement Year

MeasureIHC

NetworkSJHAP 2004

SJHAP 2003

75th % 2003

Asthma 5 72% 64% 74%Asthma 10 63% 59% 70%Asthma 18 71% 67% 73%Asthma Total 70% 69% 65% 71%Breast CA Screen 70% 74% 69% 72%Cervical CA Screen 72% 80% 76% 73%Cardiac LDL 76% 83% 76% 78%Cardiac LDL Value 9.0 25%Diabetes LDL 75%Diabetes LDL

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Enrollment

Open Panel

Satisfaction

Scores

Clinical Scores

Oct-04 Sep-04 Aug-04 Total $125,000 Total $125,000 Asthma Pap Mammo Child Imm

DM CV Total $500,000 Total Bonus

2119 2138 2108 6365 $3,344 10 35 45 $1,419 11 391 145 55 3 605 $23,194 $27,957 IM1625 1581 1538 4744 $2,493 10 30 40 $1,261 12 371 80 28 0 491 $18,824 $22,577 FP2023 2022 2047 6092 $3,201 10 35 45 $1,419 5 256 105 71 2 439 $16,830 $21,450 IM1818 1500 1315 4633 $2,434 10 25 35 $1,103 4 337 70 39 0 450 $17,252 $20,790 FP2060 2051 1980 6091 $3,200 10 15 25 $788 5 333 57 38 0 433 $16,600 $20,589 FP1533 1508 1536 4577 $2,405 10 35 45 $1,419 16 277 96 44 0 433 $16,600 $20,424 IM1978 1752 1673 5403 $2,839 10 35 45 $1,419 3 254 88 60 3 408 $15,642 $19,899 FP1731 1732 1606 5069 $2,663 10 35 45 $1,419 15 287 66 24 1 393 $15,067 $19,149 IM1959 1921 1950 5830 $3,063 10 40 50 $1,576 9 233 51 59 0 352 $13,495 $18,134 FP1039 1054 1071 3164 $1,662 0 40 40 $1,261 8 235 111 37 2 393 $15,067 $17,990 IM1342 1371 1370 4083 $2,145 10 40 50 $1,576 4 279 74 14 0 371 $14,223 $17,945 FP1678 1626 1617 4921 $2,586 10 30 40 $1,261 8 222 76 59 0 365 $13,993 $17,840 FP864 877 874 2615 $1,374 10 30 40 $1,261 5 231 92 40 2 370 $14,185 $16,820 IM919 958 912 2789 $1,465 10 35 45 $1,419 1 209 89 23 0 322 $12,345 $15,229 IM

1350 1380 1363 4093 $2,150 10 25 35 $1,103 7 189 68 45 3 312 $11,961 $15,215 FP1017 998 1036 3051 $1,603 0 55 55 $1,734 5 201 67 26 0 299 $11,463 $14,800 FP1562 1546 1554 4662 $2,449 10 30 40 $1,261 3 164 34 47 1 249 $9,546 $13,257 FP1093 1086 1091 3270 $1,718 10 45 55 $1,734 3 151 41 16 0 211 $8,089 $11,541 FP942 870 903 2715 $1,426 10 35 45 $1,419 1 175 18 12 0 206 $7,898 $10,743 FP

1283 1220 1184 3687 $1,937 10 25 35 $1,103 6 141 33 16 1 197 $7,553 $10,593 FP773 747 746 2266 $1,191 10 35 45 $1,419 1 150 38 15 1 205 $7,859 $10,468 IM444 462 473 1379 $725 0 45 45 $1,419 3 138 42 32 1 216 $8,281 $10,424 IM967 967 941 2875 $1,511 10 35 45 $1,419 9 138 29 14 0 190 $7,284 $10,213 FP803 792 810 2405 $1,264 0 55 55 $1,734 2 98 61 22 1 184 $7,054 $10,052 IM718 722 731 2171 $1,141 10 35 45 $1,419 3 116 55 13 0 187 $7,169 $9,728 IM980 978 942 2900 $1,524 10 45 55 $1,734 6 113 29 17 1 166 $6,364 $9,622 FP904 901 940 2745 $1,442 10 35 45 $1,419 2 119 39 15 1 176 $6,747 $9,608 FP856 888 882 2626 $1,380 10 25 35 $1,103 2 132 35 14 1 184 $7,054 $9,537 IM520 527 520 1567 $823 0 10 10 $315 3 160 38 12 2 215 $8,243 $9,381 FP700 684 644 2028 $1,066 10 20 30 $946 0 139 33 12 0 184 $7,054 $9,065 IM588 602 615 1805 $948 10 45 55 $1,734 3 105 35 19 1 163 $6,249 $8,931 IM872 899 885 2656 $1,395 10 35 45 $1,419 5 97 32 11 1 146 $5,597 $8,411 FP446 452 494 1392 $731 0 35 35 $1,103 0 109 39 0 23 0 171 $6,556 $8,391 IM920 934 945 2799 $1,471 10 25 35 $1,103 4 97 27 18 0 146 $5,597 $8,171 FP708 704 702 2114 $1,111 0 50 50 $1,576 7 95 19 11 1 133 $5,099 $7,786 IM647 614 605 1866 $980 10 20 30 $946 0 98 36 16 0 150 $5,751 $7,677 FP311 297 309 917 $482 10 55 65 $2,049 3 96 28 7 0 134 $5,137 $7,668 IM