1. VHAN + Navvis Report Reviews August 7, 2017
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2. Agenda 11:00am - Introductions 11:15am – Metric Collection Updates
11:30am - Database Overview
11:45am – Reviewing Reports
Meeting Preparation Checklist
Communication Tips
Sample Report
Scenarios
1:45pm – Break
2:00pm – ED Toolkit
2:30pm - Questions/Discussion
Agenda

3. Metric Collection, Documentation and Reporting
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4. Metric Collection & Documentation
Metric Collection, Documentation and Reporting
Completed To Date VHAN + MAHN 81 practices (includes 20 new)
71 of 81 (88%) new and existing VHAN and MAHN practices now accurately reporting baseline measures on at least one incentive measure
66 of 81 (82%) new and existing VHAN and MAHN practices now accurately reporting baseline and monthly performance measures (see table below)
Baseline & Monthly
6/21
7/21
4 Measures 1 4
3 Measures 13
2 Measures 20 40
1 Measure 8 9
70% of VHAN and MAHN practices reporting monthly on at least 2 incentive measures

5. Metric Collection & Documentation
Database Data – VHAN + MAHN + Safety Net + BMG (~110)
7/21/17
At least 1 Baseline
At least 1 Monthly
91 practices (83%)
86 practices (78%)

6. Metric Collection & Documentation
Next Steps
Wrap up incentive measures selection/data collection for VHAN, MAHN and Safety Net
ED Follow Up Workflow – week of 8/21
Metric Definition sub-group has been established to work on the ED Reduction measure definition
Ongoing efforts regarding data sources (HIE, claims, ADT, etc.)
Database
Internal testing with July data load throughout August
Review with identified PTN/VHAN individuals
Data entry
Practice Reports
Measure Reports
Training practices – Early September for August data load
Telephonic/WebEx/Onsite

7. Database Demo
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8. Reviewing Reports
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9. Meeting Preparation Checklist:
What are the selected incentive measures?
Familiarity with Incentive Measure Definitions
Remind the practice what they’re measuring
Quality vs Utilization
TCPI vs MIPS
Standard vs Non-Standard
Inverse Measures
Measure Definitions Tool
Review the data prior to the meeting
Anticipate questions that may be asked and have an answer prepared
How was this measured?
What percentage do I need to be at to get my incentive payment?
What is my incentive payment?
Does this count all providers?
Can I use this measure for MIPS?
For poor performance, be prepared with suggestions for improvement
Create an action plan together
Follow-up and refer to the plan,
“Dr. _____, we were going to look at having your nurse take the BMI at triage for every patient and it looks like that has happened because the data shows improvement on this measure!”
“Dr. _____, we were going to look at having your nurse take the BMI at triage for every patient; I know it may take some time to implement this process, is there any way I can assist?”
Rely on your knowledge of practice activities to drive conversations
What PDSA’s have been started/completed
Other improvement activities?
What is the practice’s vision statement?

10. Communication Tips: Be a Communicator
Rather than just stating facts and giving numbers, tell a story!
If you’re sharing monthly measure data, your story is about performance
Look for trends
What may have happened in the month of August for numbers to drop?
Know what you really want to say
“If you can’t explain it simply, you don’t understand it well enough”
Be confident
Proper preparation will provide confidence
Goal vs Target
If you see the milestone, improvements, etc. as simply checking off a box, your audience will see it that way too
Target = getting to a number, then can stop. Goal = ongoing improvements for a broader achievement
“You” vs “We”

11. In your role, you are empowered as your practices view you as an “expert”. It’s okay to have uncomfortable conversations- just as a coach may often times need to do to ensure progress and performance improvement.
___________________________________________________________________________

12. Be Prepared for these reactions:
“Data is wrong”
Discuss how the data was obtained
Ask questions why the physician believes the data is wrong
Have the physician talk through examples why he/she believes it’s wrong
Take that feedback and let the physician know you will research his/her concerns
Follow-up quickly with an answer
Avoid “guessing” what the error might be. Instead, say:
We will look at the way the documentation is captured in the EMR and
flowing to the report
We will look at the timing of the data entry to the EMR vs what the
report is pulling
We will talk with the EMR vendor
“Too busy”
Ask questions:
Dr. ____, how can I support you to ensure we improve on our measures?
Are there tasks we can look at delegating or re-assigning?
Bring the conversation back to the value added:
TCPI prepares you for MIPS
How?
TCPI satisfies Quality Improvement Activity for MIPS
There is no risk to your practice in TCPI
TCPI = you are in a network – utilize resources available, share best practice workflows, etc.
To Agree or Disagree…?
Be understanding
Be supportive
Be positive
Be encouraging
But
Be the coach
Be empowered
Be comfortable in asking the practice to hold up their end of the deal too!

13. Practice Reports
Be aware of which measures should trend downward/upward. Generally, utilization is downward and quality is upward.

14. Presenting Reports - Scenarios
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15. Practice is Performing well Message to the Practice:
The ongoing teamwork of the entire medical staff is critical to the success of business operations and delivery of quality to patients.
Continue to explore, establish goals, and take actions on other meaningful quality activities
Continue monitoring metrics that show great performance to ensure that established processes continue to be followed by staff
Having a defined QI process sets the practice up for success for other quality programs
Medicine is continuously changing which means a need for constant improvement

16. Practice is Not Performing Well but is Motivated
Establish a Quality Improvement (QI) Team with Engaged Leadership
Document defined roles and responsibilities for each QI member
Document the QI Plan
Area(s) of Improvement?
What are the goals?
Baseline
Actionable Steps
Re-Measure
Performance?
Re-evaluate and Repeat

17. Practice Not Performing Well and Not Engaged
Support from Engaged Leadership is required for any major change initiative
How:
Re-visit the practice’s Mission and Vision
Focus on the message of “Improving Patient Care”
Encourage Physician(s) to lead the QI efforts and involved in decision making
Present role as new opportunity to deliver on the promise of improving patient care
Use Data to drive and guide improvement
Improvement efforts are a continuous process – does not have to be perfect at first
VHAN is there to support improvement efforts

18. Practice Skeptical of Accuracy of Data
Start with an understanding statement and use their name-
“Dr. Smith, let’s talk about why you think this data is not accurate and we can work through it”
Use gentle, soft voice, speak slowly and confidently when responding
Offer support in finding solution(s)

19. ED Toolkit
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20. Questions/Discussion
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