Presentation given at the Breakthrough Strategies to Boost HEDIS Scores & Quality Management meeting, Key West, January 16, 2012.

1. Best Practices for Data Analysis
A Chasing Logic Case Study
Wayne Pan, MD, MBA
Chief Medical Officer
Pacific Partners Management Services, Inc.
Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012

2. Best Practices for Data Analysis
A Chasing Logic Case Study?
Wayne Pan, MD, MBA
Chief Medical Officer
Pacific Partners Management Services, Inc.
Breakthrough Strategies to Boost HEDIS Scores & Quality Management • The Reach Resort, Key West • January 16, 2012

3. to recap....
Breaking Down the Silos for Risk Adjustment, HEDIS & Care Management:
From Streamlining Charts to Capturing & Sharing the Right Data
A Complementary Duo - Risk Adjustment and HEDIS: How to Ensure a Plan is
Effectively Accomplishing Objectives for Both
Practical Steps to Improve the Integrity, Quality & Timeliness of Data & Supplemental Data
How Star Rating Measures Correlate with Overall HEDIS Quality
The State of Health Care Quality – Plans, Providers and
Consumers in the New World
of Star Ratings and Exchanges
A Two-Part Discussion on Effective
Quality Improvement Partnerships
A Collaborated Effort: Plans & Providers Working
to Improve Clinical Outcomes
Provider Education & Incentives:
Creating Tools & Toolkits for Providers
That They Will Use

4. we cannot continue to keep quality,
risk adjustment/stratification,
cost-effectiveness,
medical management,
network management, and
member engagement in
separate silos

5. that’s because....

7. they’re all related!

8. with the common denominator....

9. the patient.

10. some learnings from California’s IHA P4P....

11. theory: combine the various
plans’ quality P4P bonus
programs into a single coherent
program for physicians

12. results: very modest gains in
quality outcomes despite more
than half a billion dollars in P4P
bonuses paid out, since 2004

13. what happened?

14. not enough money set aside
quality not linked to efficiency
providers always have sicker,
less compliant patients

15. the P4P program didn’t change
provider or patient behavior

16. the plans didn’t save any money

17. sponsored by
IHA
P4P

18. two ideas....

20. combine quality & efficiency....

22. Two Strategic P4P Goals for 2011 2015
Goal #1: Bend the cost trend
Targets:
•Total cost below risk adjusted, geography adjusted
average
•Total Cost trend below Consumer Price Index +1
Goal #2: Achieve meaningful quality
improvements in clinical care and patient
experience, and increase meaningful use of
health IT
Copyright © 2011 Integrated Healthcare Association. All rights reserved. 4

24. be patient-centered....

25. why does that matter?

26. insanity:
doing the
same
thing over
and over
and
expecting
different
results

27. get out of our rut?

28. 4x4 healthcare

29. 4processes

30. communication

31. collaboration

32. Case
Managers
Patients PCPs
Specialists
coordination

33. anticipation

34. 4
dimensional
data

35. financial

36. administrative

37. clinical

38. retrospective
retrospective

39. reactivecare

40. $$$$$$

41. + behavioral

42. predictive

43. prediction can lead to....

44. proactivecare

45. From: Dan Roam, “American Healthcare: a 4-napkin explanation”
www.slideshare.net/danroam/healthcare-napkins-all

46. one more thing....

47. all providers are not the same

48. use multiple communication
channels and communicate
consistently....

49. case study: SCCIPA

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

51. 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)

52. peopleprocessesplatform

53. people
hospitalists
SNFists
onsite case managers
complex case managers
utilization review staff

54. processes
P4P/CMS 5 STAR dashboard
incentive bonus based on quality
Ascender for HCC process
paper quarterly physician workplan
hospitalists perform HCC coding

55. platform
common web-based communication platform
facilitates administrative functions
rules-based management of processes
intuitive user-interface
embed quality reminders into office/provider workflow
provider feedback
provide actionable clinical data at point of care
allow patients to access their own data
allow patients to provide feedback and enter their own data

56. results

57. Inpatient
Hospital
Admissions
Per
1000
Enrolled
Patients
(Commercial)
70.0
60.0
50.0
40.0
2011
Milliman
Benchmark
(Well
Managed)
2011
Milliman
Benchmark
(Moderately
Managed)
2011
Milliman
Benchmark
(Loosely
Managed)
SCCIPA
A dmits
per
1000
(Commercial)

58. Bed
Days
Per
1000
Enrolled
Population
(Commercial)
300.0
250.0
200.0
150.0
100.0
2011
Milliman
Benchmark
(Well
Managed)
2011
Milliman
Benchmark
(Moderately
Managed)
2011
Milliman
Benchmark
(Loosely
Managed)
SCCIPA
Bed
Days
(Commercial)

59. Average
Length
of
Stay
(Commercial)
4.3
3.8
3.3
2.8
2011
Milliman
Benchmark
(Well
Managed)
2011
Milliman
Benchmark
(Moderately
Managed)
2011
Milliman
Benchmark
(Loosely
Managed)
SCCIPA
A verage
L ength
of
Stay
(Commercial)

60. Inpatient
Hospital
Admissions
Per
1000
Enrolled
Population
(Medicare)
350.0
300.0
250.0
200.0
2011
Milliman
Benchmark
(Well
Managed)
2011
Milliman
Benchmark
(Moderately
Managed)
2011
Milliman
Benchmark
(Loosely
Managed)
SCCIPA
A dmits
(Medicare)

61. Bed
Days
Per
1000
Enrolled
Population
(Medicare)
2000
1750
1500
1250
1000
750
2011
Milliman
Benchmark
(Well
Managed)
2011
Milliman
Benchmark
(Moderately
Managed)
2011
Milliman
Benchmark
(Loosely
Managed)
SCCIPA
Bed
Days
(Medicare)

62. Average
Length
of
Stay
(Medicare)
5.5
5.0
4.5
4.0
2011
Milliman
Benchmark
(Well
Managed)
2011
Milliman
Benchmark
(Moderately
Managed)
2011
Milliman
Benchmark
(Loosely
Managed)
SCCIPA
A LOS(Medicare)

64. *
*
*
*
*
increase/same scores in 21 of 26 measures

66. no

67. When you improve a little bit
each day, eventually big things
occur. Don’t look for big, quick
improvement. Instead, seek
small improvement one day at a
time. That’s the only way it
happens - and when it happens,
it lasts.
John Wooden

68. iteration

69. Virtually nothing comes
out right the first time.
Failures, repeated
failures, are finger posts
on the road to
achievement. The only
time you don’t want to
fail is the last time you try
something. One fails
forward toward success.
Charles F. Kettering

70. don’t be afraid to FAIL....

71. failfast

73. combine quality & efficiency.

74. be patient-centered.

75. use multiple communication
channels and communicate
consistently....

77. welcome to
healthcare2.0

78. Thank you!
wpan@ppmsi.com
WWW.SNOOPY.COM