Quality & Service Recognition Program A PPO Incentive Program for Quality Richard S. Chung, MD SVP, Health Services Division BCBS of Hawaii (Hawaii Medical.

Slides:

Advertisements

Similar presentations

Medi-Cal Managed Care Pay-for-performance Programs Elaine Batchlor, MD, MPH L.A. Care Health Plan.

Advertisements

Making Payment Reforms Work for Patients and Families Lee Partridge Senior Health Policy Advisor National Partnership for Women and Families January 28,

Can Information Technology Transform Health Care? The RAND Study of Potential Costs and Benefits of Electronic Medical Record Systems Roger S. Taylor MD,

ACHIEVING VALUE IN HEALTHCARE: Some Experiential-based Observations ACHIEVING VALUE IN HEALTHCARE: Some Experiential-based Observations Kenneth W. Kizer,

Department of Vermont Health Access Vermont Blueprint for Health: Using APCD to Evaluate Health Care Reform Pat Jones, MS Blueprint Assistant Director.

The Value of Medication Therapy Management Services

4th Annual Investor Conference May 16, 2001 HEALTH PLANS DIVISION Panel Discussion: Contributing Value to Cost of Care.

SEHCB Educational and Training Conference Alere March 3, 2009 Columbus, OH.

Innovations: Using a Clinical Pharmacist as a Vehicle for Successful P4P Outcomes Lisa Meland, B.S., PharmD. Helen Pervanas, R.Ph. WellPoint-WellPoint.

Business Models for Health Information Technology: Towards a Conference White Paper James G. Anderson, Ph.D. Purdue University.

- Transformation - It is generally recognized that the current “system” for the delivery of healthcare in the United States is broken. “Fee for service”

Consumer Health Self-Care. Purposes of Self-Care Health Promotion Self-Diagnosis Home Medical Tests Self-Treatment of Chronic Diseases Organizations Self-Help.

BREAST AND CERVICAL CANCER CONTROL PROGRAM Emily Vance Nursing 250.

Saeed A. Khan MD, MBA, FACP © CureMD Healthcare ACOs and Requirements for Reporting Quality Measures © CureMD Healthcare Saeed A. Khan MD, MBA, FACP.

Renaissance Medical Management Company Overview A Pioneer Accountable Care Organization.

Missouri’s Primary Care and CMHC Health Home Initiative

Payment and Delivery Reform: Building a Bridge to the Future

VP Quarterly Report on Strategies Q1 Report – 2015/16 June 23, 2015 Vision: Healthy people, families and communities.

Memorial Hermann Healthcare System Clinical Integration & Disease Management Dan Wolterman April 15, 2010.

Preventive Health Care Use in Elderly Uterine Cancer Survivors Division of Health Policy and Management School of Public Health University of Minnesota.

Bangor Beacon Community Health Data Capture October 26, 2010 Barbara Sorondo, MD MBA.

The Business Case for Bidirectional Integrated Care: Mental Health and Substance Use Services in Primary Care Settings and Primary Care Services in Specialty.

Health Care Effectiveness Summer Quarterly Meeting July 19, 2011.

Value-Based Purchasing in NY Medicaid Deborah Bachrach, Esq. Medicaid Director Deputy Commissioner Office of Health Insurance Programs New York State Department.

Brown & Toland Medical Group National Pay for Performance Summit “Pay for Performance Pushes EMR Adoption” Stan Padilla, M.D. Vice-President, Medical Services.

Rewarding Performance: Three-Year Results from California's Statewide Pay-for-Performance Experiment Cheryl L. Damberg, PhD, Kristiana Raube, PhD, Stephanie.

The 2004 Healthcare Conference April 2004, Scarman House, University of Warwick David Mirkin & Joanne Alder.

Pay for Performance: Choosing Measures Linda K. Shelton AVP, Product Development PFP Boot Camp for Physicians and Physician Organizations February 2006.

The Value of Medication Therapy Management Services.

Performance Measurement Sets Dolores Yanagihara Program Development Manager IHA.

Jim Boswell, MBA – VP Physician Services / BMHCC and CEO / BMG Robert Vest, JD – COO / BMG.

11 Creating Value from EMR Investment Kevin Maben, MD, FAAP Associate Medical Information Officer Presbyterian Healthcare Services.

New Approaches to Disease Management Get Connected Knowledge Forum Larry G. Anderson MD MMC Physician-Hospital Organization June, 2005.

Washington State Medical Assistance Administration Disease Management Program Alice Lind, RN, MPH June 2004.

Title Slide Sub Title The Health Collaborative: Current Activities and Capabilities July 13, 2012 Greg Ebel, Executive Director Melissa Kennedy, Director.

THINC’S P4P PROJECT IN THE HUDSON VALLEY: QUALITY METRICS AND THE MEDICAL HOME Susan Stuard Executive Director, THINC.

SHIP: The Vision for the Future of Healthcare in Idaho Idaho Association of District Boards of Health Annual Meeting | Thursday, June 4, 2015 Ted Epperly,

Diabetes Mellitus Primary Care QI Project – Year III Mary Altier, RN, Bonnie Fiala-Bayser, Ph.D., William Cannon, MD, David Goldberg, MD, Jan Jandrisits,

- a Rewarding Results National Grant Pay for Performance: Driving Improvement through Provider Recognition & Reward MCOL Healthcare Web Summit Participating.

California Pay for Performance: Reporting First Year Results and The Business Case for IT Investment Lance Lang, MD Health Net, California November 18,

Page 1 External Quality Review Quarterly Meeting Monday, March 21, :00 p.m. –2:30 p.m. WELCOME!

Medicare Coordinated Care Demonstration May 13, 2003.

Community Care Physicians Quality of Care Initiatives 2006 Bridges to Excellence Bridges to Excellence Performance Improvement Projects Performance Improvement.

P4P and Group IT Investment Douglas Allen, MD., MMM. November 18, 2004.

Pay for Performance in BCBS Plans Nationally June 22, 2005 National Press Club Bruce E. Landon, M.D., M.B.A.

An Electronic Dashboard For Improving the Quality of Health Care and for Decreasing the Cost of health Care Stephen A. Kardos D.O.

EmblemHealth Medical Home High Value Network Project William Rollow, MD MPH PCPCC Presentation December 2, 2008.

Managed Care. In the broadest terms, Kongstvedt (1997) describes managed care as a system of healthcare delivery that tries to manage the cost of healthcare,

Maine Health Data Organization Board of Directors Retreat Barbara Sorondo, MD MBA Director EMMC Clinical Research Center June 5, 2014.

GERIATRIC EDUCATION SERIES Presented in partnership by Funded in part by a grant from the EJC Foundation.

HOUSTON METHODIST POPULATION HEALTH MANAGEMENT

The Role of Health Information Technology in Implementing Disease Management Programs Donald F. Wilson, MD Medical Director Quality Insights of Pennsylvania.

100 years of living science Implementing a Quality and Outcomes Framework in primary care: a UK perspective Dr Shamini Gnani November 2007, Mauritius.

© 2011 Blue Cross and Blue Shield of Minnesota. All rights reserved. PHYSICIAN QUALITY MEASUREMENT PROGRAM (PQM)

Financial Incentives: Pay for Performance (P4P) and the Effects with the Chronically Ill Patients David Conley, MSc Alberto Coustasse, MD, Dr. PH, MBA.

Promoting Health Information Technology Linda Magno Director, Medicare Demonstrations Group.

The Patient Centered Medical Home. Learning Objectives Identify the attributes of a patient centered medical home Describe some processes that facilitate.

Funded in part by a grant from the EJC Foundation Presented in partnership by GERIATRIC EDUCATION SERIES.

Wireless Access SSID: cwag2017

Longitudinal Evaluation of Physician Payment Reform and Team-Based Care on Chronic Disease Management and Prevention NAPCRG Annual Meeting, October 27,

Fundamental Payment Reform for Chronic Care

PHYSICIAN ALIGNMENT AND CARE MANAGEMENT LEADS TO VALUE BASED CARE

Tara Kiran1,2, Alex Kopp2, Rick Glazier1,2

Bending the Cost Curve A Case for Integration.

Enhanced Primary Care for Patients with Serious Mental Illness

Driving Quality Through Incentives in a Municipal Hospital System

Highmark QualityBLUE Pay for Performance Program

G:/CorpSvc/APowerpoint//SM/MANAGED_CARE_ONLINE_HEALTHWEBSUMMIT_1202

An Information and Point-Counterpoint Presentation By

Presentation transcript:

Quality & Service Recognition Program A PPO Incentive Program for Quality Richard S. Chung, MD SVP, Health Services Division BCBS of Hawaii (Hawaii Medical Service Association) June 22, 2005

Role of Incentives in Healthcare Management Low Risk Moderate Risk High Risk Acute Condition Chronic Disease Catastrophic Illness Primary Prevention Secondary Prevention Tertiary Prevention Health Promotion Preventive Care Self-Care Disease Management Care Management/Utilization Management Performance Management: QSR, EMR, E-Rx, EHR., etc.

PPO Program Design Issues

Design Issues Solution Patient Centric Analysis

I.Quality Indicators Maximum 40 points A. Clinical Measures (25) B. Member Rating (10) C. Board Certification ( 5) Patient Satisfaction Maximum 30 points Business Operations w/HMSA Maximum 15 points A. Hawaii Healthcare Information Network (HHIN) participation ( 5) B. Electronic Media Claims (EMC) participation ( 5) C. Lines of Business with HMSA ( 5) Practice Patterns Maximum 15 points A. Medical Utilization Report ( 5) B. Formulary Compliance Report (10) QSR Distribution of Points Practitioner Quality & Service Recognition Program

 Maximum Base Award = $16,000  1.5% -7.5% of the paid professional fees  For Scores <5%, Maximum award of $13,000  Minimum $100 for participation  Improvement Bonus Awards (20% of Ttl QSR Budget)  Clinical Measure (70+ measures)  Member Rating for Outcomes  Member Rating for Satisfaction  Rural Hospital Privileges/On-Call  Electronic Prescribing Technology  Generic Prescribing Rate Above the Mean  Overall, a maximum of $24,000 in Base & Bonus awards can be earned by an individual practitioner. Base & Bonus Monetary Awards Practitioner Quality & Service Recognition Program

Total Awards=$2,165,197$10,650,000 # of Participants=8552,243 Mean Award=$2,532$4,744 Median Award=$1,946$3,565 # of Min Awards=45177 ($150)($100) # of Max Awards=1440 $13,000) $16,000) Award Payment Summary Practitioner Quality & Service Recognition Program

PPO %

After PQSR program implementation, members were more likely to receive recommended care if they visited a QSR participating physician: MeasurePercent Greater Likelihood of Receiving Specified Care Breast Cancer Screening42 % Cervical Cancer Screening52 % Colorectal Cancer Screening13 % ACE Inhibitor Use in CHF51 % Diabetic Retinal Exam38 % Annual HbA1c16 % Use of Long Term Asthma Control Drugs -17 %* Compliance with Antihypertensives -1 %* Compliance with Lipid Lowering Drugs 7 %* MMR Vaccinations -6 %* VZV Vaccinations14 %* Complications Following Cataract Surgery51 %* *Result not statistically significant Individual Measure Logistic Regression Analysis Practitioner Quality & Service Recognition Program