Se ha denunciado esta presentación.
Utilizing Member Engagement to
Improve CAHPS Scores
a presentation by Kevin Riley
for the Opal 2013 ACOs Summit
October 9,...
Synopsis
Webinar: Utilizing Member Engagement to Improve CAHPS Scores
The Accountable Care Act means more access to health...
Who am I?
Kevin Riley
Principal at Kevin Riley & Associates | Health Model Innovation
• former chief innovation officer of Florida B...
Why is this Necessary?
Utilizing Member Engagement to Improve CAHPS Scores
What is the Consumer Assessment of Healthcare
Providers and Systems (CAHPS)?
CAHPS originally stood for the Consumer Asses...
What does it mean to Providers/Systems?
They get ranked by the NCQA, and the score is based on:
• STARs Ratings Measures (...
It is part of something much larger
Data Source Domains
% Total Stars
Ratings
HEDIS Part C: Domains I&II ~31%
PDE Data Par...
Lets focus on CAHPS
Consumer satisfaction measures what patients reported
about the experiences of their care in a survey,...
How much is all this worth?
Why is all this important?
Think of it as your business model at risk:
• ACA requires that plans sold through exchanges in...
What does it look like for Plans?
Health Plan
Composite Measures
National
2012
Getting Needed Care 3.57
Getting Care Quick...
What does it look like for Providers?
Source: CAHPS Clinician & Group Surveys and Instructions
What will this eventually look like?
Source: Why Not the Best? http://www.whynotthebest.org
A Framework for Discussion
Utilizing Member Engagement to Improve CAHPS Scores
modelH is a business model canvas designed
specifically for healthcare companies and acts as a
strategic management templa...
The modelH method aligns business activities
that produce value by illustrating potential trade-
offs, and helps
describe,...
modelH is about producing value though
profitable and sustainable business models made
by creating and/or realigning the a...
The healthcare business model canvas (modelH)
A Path Forward
Utilizing Member Engagement to Improve CAHPS Scores
What is patient/member engagement?
Customer engagement, or experience (CX), is the
aggregation of all of the engagements a...
Health coverage engagement loop
Resolved?
Prospect Acquisition Product Education Issue ResolutionMember Engagement
Care Ma...
How to approach member engagement
• Segments
• Regions
• Ability to influence
• Ability to excel
Identify the “best”
custo...
Don’t forget about provider engagement
Prevention & WellnessRewards & Incentives
Resolved?
Health care engagement loop
Patient Need Diagnosis Communicate Solutio...
Some Final Thoughts
Utilizing Member Engagement to Improve CAHPS Scores
Not all customers are the same
Adapted from Winning at Retail: Developing a Sustained Model for Retail Success
It takes a consumer culture
Adapted from Why Not the Best? http://www.whynotthebest.org
Questions
Kevin Riley & Associates
Business Model Innovation for Healthcare
kevin@healthmodelinnovation.com
www.healthmode...
Próxima SlideShare
Cargando en…5
×

2013 10 utilizing member engagement to improve cahps scores

537 visualizaciones

Publicado el

The Accountable Care Act means more access to healthcare for more people. But to pay for that access it also means margins for healthcare companies are going to be squeezed. But this does not necessarily imply doom for healthcare companies. The law actually encourages healthcare businesses to build better business models – and is willing to pay for it. By retooling your market approach, and the operations that run your business, you can actually improve your margins and your customer’s happiness at the same time you are helping to create a better and more efficient healthcare ecosystem.

  • Sé el primero en comentar

2013 10 utilizing member engagement to improve cahps scores

  1. 1. Utilizing Member Engagement to Improve CAHPS Scores a presentation by Kevin Riley for the Opal 2013 ACOs Summit October 9, 2013 at 3:00 pm ET
  2. 2. Synopsis Webinar: Utilizing Member Engagement to Improve CAHPS Scores The Accountable Care Act means more access to healthcare for more people. But to pay for that access it also means margins for healthcare companies are going to be squeezed. But this does not necessarily imply doom for healthcare companies. The law actually encourages healthcare businesses to build better business models – and is willing to pay for it. By retooling your market approach, and the operations that run your business, you can actually improve your margins and your customer’s happiness at the same time you are helping to create a better and more efficient healthcare ecosystem. During this session you will learn: • How much is it worth to engage your customers (members)? • What are the consequences if you do not? • How to drive customer engagement into CAHPS information so you can maximize reimbursement.
  3. 3. Who am I?
  4. 4. Kevin Riley Principal at Kevin Riley & Associates | Health Model Innovation • former chief innovation officer of Florida Blue • founder and former president/CEO of GuideWell • founder of modelH.org • entrepreneur, health care executive, business model innovator Kevin started Kevin Riley & Associates | Health Model Innovation (modelH) in 2006 to help companies with the convergence of health care and the consumer. He founded and was CEO of a national health care retail company, played leadership roles for several national retail health start-ups, and served as the first Chief Innovation Officer of a major insurance plan. Kevin holds a Masters of Business in entrepreneurship and marketing from Rice University. follow me on @kevineriley, linkedin, slideshare
  5. 5. Why is this Necessary? Utilizing Member Engagement to Improve CAHPS Scores
  6. 6. What is the Consumer Assessment of Healthcare Providers and Systems (CAHPS)? CAHPS originally stood for the Consumer Assessment of Health Plans Study - but it has evolved beyond health plans to capture much more. Now it develops and supports the use of a comprehensive family of standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers, such as the communication skills of providers and the accessibility of services.
  7. 7. What does it mean to Providers/Systems? They get ranked by the NCQA, and the score is based on: • STARs Ratings Measures (90+ measures) • Consumer satisfaction surveys (Consumer Assessment of Health Providers and Systems survey, or CAHPS) • The base measures score is added to a consistency score - it takes good process and good manners. So …. • Compensation is linked to this score. • Higher ranked plans/providers get more money.
  8. 8. It is part of something much larger Data Source Domains % Total Stars Ratings HEDIS Part C: Domains I&II ~31% PDE Data Part D: Domain IV ~20% CAHPS Part C: Domain I&III; Part D: Domain III ~18% HOS Part C: Domains I&II ~11% IRE Part C: Domain V; Part D: Domain I ~7% Phone Monitoring Part C: Domain V; Part D: Domain I ~6% CTM Part C: Domain IV ~2% CMS Audit Part C: Domain IV ~2% MBDS Part C: Domain IV ~2% MARx Part D: Domain I ~1% Total: 100.00%
  9. 9. Lets focus on CAHPS Consumer satisfaction measures what patients reported about the experiences of their care in a survey, including their experiences with doctors and services they had access to, and customer service. NCQA scores are on a scale of 1 to 5, from worst to best: • 5 means you are are in the top 10 percent compared with other plans in their category • 4 means you are above average • 3 means you are just plain old average • 2 means you are below average, and • 1 means you are are in the bottom10 percent compared with other plans in their category
  10. 10. How much is all this worth?
  11. 11. Why is all this important? Think of it as your business model at risk: • ACA requires that plans sold through exchanges in 2014 and beyond must be accredited • Member/patient satisfaction means you probably have a better Net Promoter Score which makes you stand out amongst your competition Think of this as your revenue at risk: • Buyers rely on health plan comparisons and ratings systems to inform their purchasing decisions • You will lose on reimbursement and this means your competitors can underprice you – starting a death spiral
  12. 12. What does it look like for Plans? Health Plan Composite Measures National 2012 Getting Needed Care 3.57 Getting Care Quickly 3.29 Doctors Who Communicate Well 3.72 Health Plan Customer Service 3.66 Care Coordination 3.61 Source: 2012 Medicare Advantage CAHPS Results
  13. 13. What does it look like for Providers? Source: CAHPS Clinician & Group Surveys and Instructions
  14. 14. What will this eventually look like? Source: Why Not the Best? http://www.whynotthebest.org
  15. 15. A Framework for Discussion Utilizing Member Engagement to Improve CAHPS Scores
  16. 16. modelH is a business model canvas designed specifically for healthcare companies and acts as a strategic management template for developing new or documenting existing business models through its visual language.
  17. 17. The modelH method aligns business activities that produce value by illustrating potential trade- offs, and helps describe, design, challenge, invent, and pivot a business model.
  18. 18. modelH is about producing value though profitable and sustainable business models made by creating and/or realigning the activity systems that improve patient experience, boost provider performance, and enable payer cost control.
  19. 19. The healthcare business model canvas (modelH)
  20. 20. A Path Forward Utilizing Member Engagement to Improve CAHPS Scores
  21. 21. What is patient/member engagement? Customer engagement, or experience (CX), is the aggregation of all of the engagements a prospect or customer has with your business model - whether they are recognized or not, and whether they are intentional or not. Experiences happen across the fundamental customer stages of awareness, discovery, attraction, interaction, purchase, use, cultivation and advocacy. Experiences are a key to retaining your Customers (Buyers and Users) and realizing a larger customer lifetime value.
  22. 22. Health coverage engagement loop Resolved? Prospect Acquisition Product Education Issue ResolutionMember Engagement Care Management Annual Renewals Prevention & Wellness Rewards & Incentives
  23. 23. How to approach member engagement • Segments • Regions • Ability to influence • Ability to excel Identify the “best” customer segments • Measures impacted • Ability to improve • Ability to excel Identify the “best” areas of focus • Value to the person • Value to you Rank the value • Set a target for improvement • Create a plan of attack Publish the list
  24. 24. Don’t forget about provider engagement
  25. 25. Prevention & WellnessRewards & Incentives Resolved? Health care engagement loop Patient Need Diagnosis Communicate SolutionProvider Engaged Care Management
  26. 26. Some Final Thoughts Utilizing Member Engagement to Improve CAHPS Scores
  27. 27. Not all customers are the same Adapted from Winning at Retail: Developing a Sustained Model for Retail Success
  28. 28. It takes a consumer culture Adapted from Why Not the Best? http://www.whynotthebest.org
  29. 29. Questions Kevin Riley & Associates Business Model Innovation for Healthcare kevin@healthmodelinnovation.com www.healthmodelinnovation.com

×