1. SCCIPA
A Pacific Partners Medical Group
5 dangerous ideas*
Wayne Pan, MD
Santa Clara County IPA

2. but first, some audience questions

3. PLEASE STAND IF:
you are concerned about STAR ratings

4. PLEASE REMAIN STANDING IF:
you are a provider

5. PLEASE REMAIN STANDING IF:
you are part of a delegated group

6. PLEASE REMAIN STANDING IF:
your group has a common EHR

7. PLEASE REMAIN STANDING IF:
your common EHR is helping you with
your STAR rating program

8. NOW, LOOK AROUND YOU

9. we ALL can learn from those left standing

10. it’s NOT about the EHR

11. it’s about people and processes

12. supported by the right technology

13. dialog (noun) ˈdī-ə-ˌlȯg, -ˌläg
2a: a conversation between two or more persons

15. dangerous idea: #
1

16. “Ask not what your
health plan can do
for you; ask what
you can do for your
health plan.”

17. partnership (noun) -ˌship
3: a relationship resembling a legal partnership and
usually involving close cooperation between
parties having specified and joint rights and
responsibilities
from: merriam-webster.com

18. Senior
doctor
patients

19. Senior
doctor
patients

20. doctor patient
providers clinically treat patients all the same

21. www.iha.org

22. www.iceforhealth.org

23. • Provider programs - work with
providers to ensure nonduplicative efforts
• Member outreach - help providers with
things they can’t do well
• Clinical data - old data is worse than no
data

24. dangerous idea: #
2

28. • Consistent communication plan -
providers do not like surprises
• Use multiple channels - providers are
unique, each has preferred method
• Embrace office staff - not everything
needs to go through the provider

29. dangerous idea: #
3

30. feedback

31. • Progress toward set goals
• Performance comparison with peers
• Customized help for improvement

32. iteration

33. dangerous idea: #
4

36. • Set aside money in advance
• Clear performance targets
• Transparent incentive program

37. dangerous idea: #
5

39. address the whole patient

40. • Link to annual HCC process
• Link to all quality improvement
programs
• Use HCC risk scores to target outreach

41. it’s not just about STAR ratings

42. it’s really about patient care

43. too many of these

44. Santa Clara County
1,304.01 sq. miles
1,781,642 (2010)
$74,335

45. 5 PCP
80 Specialists
173 PCP
343 Specialists
57 PCP
104 Specialists
11 PCP
30 Specialists
SCCIPA
founded in 1986
physician-owned, physician-governed
800+ physicians - 240+ PCPs, 550+ specialists
all 9 hospitals - including a tertiary care center
9 health plans (Commercial and Medicare Advantage)

46. full disclosure

47. SCCIPA Group
A Pacific Partners Medical

48. • Internal:
• 2 RN’s - one CCM, one UM
• 2 LVN’s - one CCM, one UM
• 1 EMT
• 1 clinical data analyst
• 4 non-clinical
• External:
• 2 RN’s - onsite CM
• 1 MSW - onsite @ SNFs
• Hospitalist group (9 physicians)
• 1 SNFist

49. 1
how do we partner with health plans?

50. review & utilize health plan resources

51. provider training/education materials
disease management programs
patient-specific initiatives
incentive programs
quarterly sync-up meetings

52. 2
require all physicians to use AccessExpress

53. our common communication platform

54. HIPAA-compliant secure communications
eligibility resource
electronic referral authorizations
claims and authorization status

55. how do you make a platform helpful?

56. integration into the office workflow

57. how do you make a platform effective?

58. engage office staff

59. patient

60. patient
front desk staff

61. analog to digital
converter

62. 112
MARY SMITH 1/1/2011
1234567890
$5.00
$10.00
$25.00
analog to digital eligibility check
converter

63. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

64. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA

65. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD

66. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD

70. digital to analog converter module

71. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

72. 3
used same communication platform
for provider feedback

73. ACCESSEXPRESS
Q New Eligibility Response New Message (3)

75. 4
physician bonus program based on
achieving set targets

76. 2011 Bonus Structure
PCPs: 2011 IHA P4P and HCC
CMS 5 STAR rating measures
Participation in patient satisfaction training (4 meetings)
Patient satisfaction scores (based on the CAHPS survey)
Responsiveness to PPMSI Med Management inquiries

77. 2011 Bonus Structure
Specialists: billing or SCCIPA unique patient volume
Overall achievement of SCCIPA in the CMS 5 STAR Rating Program
Participation in patient satisfaction training program (4 meetings)
Patient satisfaction scores (based on internal survey)
Use of Excelicare Clinical Hub
Responsiveness to PPMSI Medical Management inquiries (timeliness)

78. 5
how do we focus on the whole patient?

79. send patient reminders for annual visit
provide providers checklist
prompt front office staff HOS survey
full HCC review by hospitalists
48hr discharge follow-up
post-discharge office visit follow-up
post home health initiation follow-up

80. send patient reminders for annual visit
provide providers checklist
prompt front office staff HOS survey
full HCC review by hospitalists
48hr discharge follow-up
post-discharge office visit follow-up
post home health initiation follow-up

81. send patient reminders for annual visit
provide providers checklist
prompt front office staff HOS survey
full HCC review by hospitalists
48hr discharge follow-up
post-discharge office visit follow-up
post home health initiation follow-up

82. 5 dangerous ideas
• find ways to partner with your health
plans
• have a consistent, multi-faceted
communication strategy
• provide ample, data-driven feedback
• put money where your goals are
• focus on the whole patient

83. discussion

84. thankyou

85. SCCIPA
A Pacific Partners Medical Group
wpan@ppmsi.com