Optimizing Triple Aim Performance via Incentives, Transparency, and Best Practice Implementation

Transcription

1 Optimizing Triple Aim Performance via Incentives, Transparency, and Best Practice Implementation Mary Barton Durfee, MD Executive Vice President & Chief Medical Officer Richard Duffy, MBA Vice President of Quality and Performance Improvement

2 2012 Strategic Considerations Reimbursement Entry into Pioneer ACO Payment models shifting towards value-based payments Poised for Growth 2010 merger with large health system Large practices being considered for integration Reimbursement models shifting Organization is poised for growth

3 Governing Board Advance Report prior to accountability Achievable individual provider level goals Support mechanisms to assist with improvement Consistent leadership support Dashboard drivers should be clear Prioritize team member collaboration Expectations clarified Dashboard will be a key tool

4 Dashboard Timeline Board Advance Dashboard Development Dashboard V1 Dashboard V Guiding principles developed during board advance is the starting point

5 Why is this important? Volume Value

6 Competing on results requires that results be measured and made widely available. Only by measuring and holding every system participant accountable for results will performance of the health care system ever be improved Michael E. Porter, Ph.D. Harvard Business School

7 Would you like to jump? Volume Value

8 Or build a bridge? Value Volume Volume Value

9 Provider Dashboard View the User Guide View the Dashboard Guide Physican Name 2015 Practice Name You Division IHA Previous Year Current Year Date Generated: Measure Score Rating Performance Trend Num Den View Patients Kept Appointments Weekday Outside of 8am- 5pm or Weekend View Plan in Hand should be generated within 2 hours of check-in 98.% View Care Provider Explanation of problem/condition The provider dashboard is helping us build the bridge 8.3% Friendliness and courtesy of care provider 10.4% 95.1% 84.7% 95.9% 87.6% Breast Cancer Screening 83.1% View OB/GYN Gaps In Care 61.8% View

10 Measure Individual Accountability To the Triple Aim Provider Dashboard View the User Guide View the Dashboard Guide Physicain Name 2015 Q4: 10/1/ /31/2015 Practice Name You Division IHA Date Generated: Previous Year Current Year Score Rating Performance Trend Num Den View Patients Tool Kept Appointments Weekday Outside of 8am View 5pm or Weekend Plan in Hand should be generated within 2 hours 99.% View of check-in Care Provider Explanation of 6.1% 87.5% 81.4% problem/condition Friendliness and courtesy of care 3.8% 89.4% 85.6% provider Provider Dashboard Blinded metric 9.4% View Blinded metric 40.2% View The provider dashboard is a tool to drive individual accountability to the Triple Aim

11 Okay, I get it, we need a provider dashboard where do I start?

12 Study the approaches used by other organizations

13 Study Assess cultural fit Determine approach The approach used should be based on an assessment of the cultural fit

14 Now figure out what metrics you want to use

15 Values Commitment Advocacy Respect Efficiency Service Triple Aim and organizational values were the foundations for metric selection

16 Environmental factors Payer incentive programs HEDIS changes Organizational Priorities Developed annually Providers vote to help prioritize Environmental factors and organizational priorities also influenced metric selection

17 Don t Dictate Collaborate Buy-in Collaborative process increases buy-in

18 Will collaboration give you 100% buy-in? No 100% Collaborative process doesn t result in 100% buy-in

19 How many metrics?

20 Too many metrics = Provider frustration

21 Not enough metrics = Lack of sufficient impact

22 We think the right number is about

23 What is the right number of metrics for a provider dashboard? 1) 5 2) 10 3) 15 4) 20 5) It depends on the specialty

24 We think the right number is about

25 # of metrics 12 # of Dashboard Metrics By Division Family Medicine Internal Medicine Pediatrics Obstetrics / Gyn Metrics are under development to bring the number closer to 10 for each division

26 What is the metric development process?

27 Quality metric roll-out process Develop Specification Approval by Clinical Quality Improvement Committee Produce performance data

28 Report Only Measure Valid Metric? No End Yes Set Goal Compensated Metric Desired Improvement Achieved? No Yes No Change

29 Why report only initially? Validate Driving the right behaviors Develop Buy-in Educating providers Preventing unintended consequences Providing lead time Identifying support resources Report only provides opportunity to validate and develop buy-in

30 How often do the metrics change? It depends Ongoing evaluation to determine Add / Delete Metrics Change Specifications Change goals The objective is to balance stability and flexibility

31 What does it look like? What are some key features?

32 Provider Dashboard View the User Guide View the Dashboard Guide Practice Name You Division Key Feature User guides Physican Name 2015 IHA Previous Year Current Year Date Generated: Measure Score Rating Performance Trend Num Den View Patients Kept Appointments Weekday Outside of 8am- 5pm or Weekend Plan in Hand should be generated within 2 hours of check-in Care Provider Explanation of problem/condition Measure Name Friendliness and courtesy of care provider View Current Score 98.% 634 Click 647 Viewthrough 10.4% 95.1% 84.7% 8.3% Key Feature Breast Cancer Screening 83.1% Click through to specification Red Yellow Green Performance Trend Performance relative to: Division IHA overall Numerator 95.9% 87.6% Denominator OB/GYN Gaps In Care 61.8% Key Feature to patient level detail 1571 View View Shows relative performance, performance trends and has drill-down capabilities

33 Building & maintaining a provider dashboard is hard work / resource intensive

34 Resource Intensity IT Organize data Build queries Validate metrics Physician Leadership Develop metrics Validate metrics Seek input Follow up on questions / concerns Administrative Leadership Develop metrics Validate metrics Follow up on questions / concerns Significant time commitment by IT, physician leadership & administrative leadership

35 Transparency

36 Transparency Demonstrates what is possible Fosters competition Identifies variability Fosters competition by identifying variability and demonstrating what is possible

37 Transparency journey Health Plan Quality Data Patient Satisfaction Dashboard V1 Dashboard V ed to all PCPs ed to all PCPs Blinded at a later date Not transparent.pdf for each provider Full transparency but requires effort to view Transparency has been an ongoing journey

38 Now that you have seen how the dashboard was built you may be wondering Is the dashboard driving performance improvement?

39 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA Quality Composite Score One Commercial Health Plan Physician Organization Adult Preventative Measures Composite Score One Commercial Health Plan Pediatric Preventative Measures Composite Score One Commercial Health Plan 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA Physician Organization 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA Physician Organization Provider dashboard is contributing to high quality performance

40 Yes & No High Perceived Degree of Influence Low Low High Amount of Improvement In general, falling into two quadrants

41 High Patient Plan Appt. Outside 9-5 Breast Cancer Screening OB/GYN Gaps in Care Perceived Degree of Influence Low High risk patient Seeing PCP within 7 days Of discharge Well child visits Childhood Imms In general, falling into two quadrants PCS ER Low High Amount of Improvement

42 I can t control that! We can t control what patients do or don t do But. We can influence it

43 Is the degree of influence real or perceived?

44 Provider writes preventative service order Patient calls to get an appointment Patient gets preventative service completed Patient goes to ER Is there really a significant difference in the degree of influence?

45 Metric story #1

46 OB/GYN Gaps in Care Metric Components Cervical Cancer Screening Colorectal Cancer Screening HIV Screening LDL Screening Bone Density Screening

47 # of gaps closed OB/GYN Gaps in Care Metric # of Gaps Closed ,475 more gaps closed in

48 Keys to success Health maintenance Template review at every visit Medical assistant standard rooming protocol Physician leadership advocacy

49 Metric story #2

50 % Primary Care Sensitive Emergency Room Visits Up from 45.4% to 46.2% Q Q1

51 Metric issues Lack of provider belief in ability to influence Data from one hospital only Changing metric to risk adjusted ER/1000

52 e-visit Booking appointments Urgent care call ahead Support is being provide to improve access

53 On call physician active involvement in triage Patient education material developed Support is being provided to improve triage and patient education

54 How is this impacting provider compensation?

55 Compensation Distribution Example Internal Medicine Division 2014 Compensation outcome is a function of performance and FTE status

56 Provides insight into how improved performance would impact compensation

57 What s next?

58 Specialist dashboards with a common structure Health of a population Patient Experience of Care Specialty based quality metrics Patient Centered Medical Home Neighborhood capabilities CG CAHPS questions Access Communication Per Capita Cost ED visits and IP admissions for specific conditions

59 Lessons learned summary Be Consistent with organizational values & culture Focused on the Triple Aim Transparent Stable but not static

60 Questions & Answers