1. SNP Alliance Stars Improvement Collaborative
Report to Fall Leadership Forum
October 29, 2010

2. Contents
The Process
SNP Stars Data
Opportunities
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3. Findings and Recommendations
SNPs are systematically disadvantaged in Stars rating system
Providers somewhat “flat footed”
There is neither silver bullet nor one-size-fits all solution
Recommendations
Policy engagement
Focusing the model of care on stars has promise
“Restless Innovation”, ie multiple concurrent pilots
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4. The Process

5. Collaborative Project Phases
Prioritization
Phase # 1:
Self Assessment Kickoff
Phase # 2:
Physician Survey Instrument & Report
Phase # 3:
Facilitated Meetings
Phase # 4:
Best Practices Sharing
Introduction & Project Overview
National Data
Competitive data
Analysis of opportunities
Self-Assessment Template
Data Analysis of Stars measures
One-on-one discussions with participants
Use of survey instrument
Physician perspective
Front line staff perspective
Identification of sample size and components
Optional Report on physician responses
Biweekly meetings to discuss key findings and progress on Key Stars Initiatives
Summary report and presentation at Fall Forum
Follow up telephone conferences
Report on findings at the Fall Forum from the Project
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6. Ingenix Consulting Engagements With SNP Plans
SNP Alliance Collaborative
5 Participating Plans
Membership breakdown
Plan 1: 1 contract; 100% Institutional
Plan 2: 1 contract; 100% Dual Eligible
Plan 3: 2 contracts
1 Dual Eligible Only contract, 100% SNP
1 Dual Eligible & Chronic contract, 100% SNP
Plan 4: 2 contracts
2 Dual Eligible contracts, 100% SNP
Plan 5: 4 contracts
3 Dual Eligible Only contracts, 8% SNP, 92% Non-SNP
1 Dual Eligible & Institutional contract, 96% SNP, 4% Non-SNP
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7. States Represented
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8. SNP Stars Data

9. 2010 Part C Summary Scores
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10. Membership Characteristics Impact Stars Scores
Educational Attainment
DSNP
Black
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11. Impact of Selected Other Variables on Part C Scores
NCQA Accreditation NS
For-Profit Status
-0.5
Growth NS
Commercial Plans NS
Medicare Market Share
0.04
All results show coefficients from IC regression analysis of 2010 stars summary score data linked with US Census and NCQA data
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12. Opportunities

13. What We Know: Network is Key Variable
Percent of variation in HEDIS scores explained by plan, providers, and other.
Easiest strategy is to terminate low performing docs
Sources:
Baker and Hopkins. “The contribution of health plans and provider organizations to variation in measured plan quality.” International Journal for Quality in Health Care. March 18, 2010, p 1-9.
Solomon, Zaslevsky and Landon. “Variation in patient-reported quality among health care organizations.” Health Care Financing Review. Summer, v 23, no. 4, p
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14. SNP Alliance Provider Survey: Providers Vary
Providers mixed in their ability to help vulnerable members navigate and access care: Flu shot results…
Providers vary in their awareness of the model of care
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15. What We Know: Care Management Matters
From a review of 57 QI interventions to control Blood Pressure:
“QI Strategies are associated with improved hypertension control. A focus on hypertension by someone in addition to the patient’s physician was associated with substantial improvement.”*
* Walsh, Judith, et al. “Quality Improvement Strategies for Hypertension Management: A Systematic Review.” Medical Care. July Vol 44 no 7, pp
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16. Resource Allocation Standard Patient Stratification Model
Distribution of Acuity
Dosage of Care Management
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17. SNP Challenges Are Well Understood….
Provider Engagement
Small panel size
Growth strategy
Burdensome population
Information overload
Member Engagement
Mobility, contact info
Psychosocial complexity
Medical complexity
Burden of mental illness
Linguistic, cultural issues
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18. We Know What We Want Model of care Provider Engagement
Inform provider of care opportunities
Effect change in provider behavior
Member Engagement
Track member for communication
Educate member on health conditions and benefits
Motivate
Mitigate barriers
Assist in navigation
Supplement providers
Complex case management, etc.
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19. Nobody Knows How to Get There
Great New Ideas
Embed outreach workers in community
Embed nurses in high volume practices
Create educational materials on Rx benefits for insertion in patient charts
Concierge services
The tried and true (on other populations)
Care opportunities reporting for providers
Patient reminders, outreach letters and calls
Contact point mapping, exploiting all contact opportunities
Evolving ideas
P4P
ACO
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20. QIPs Tend to Follow the Same Script….
Sample QIP: Not from SNP Alliance Member
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21. Culture Matters Results from QIP Self Assessment Questionnaire
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22. Conclusion: Restless Innovation
Multiple, concurrent pilots
Rigorously evaluated
Replicate the winners, scrap the losers
Collaboration has multiplier effect
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23. Contact Information
Eric E Cahow, Ph.D.
Stephen P Wood
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