Incentivizing and aligning providers 23 jul12 final
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Presentation given at the RISE 2nd Annual Summit on Integrating Risk Adjustment and Quality Measures, Westlake Village, CA, 23JUL12
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Incentivizing and aligning providers 23 jul12 final
- 1. incentivizing and aligning providers wayne pan, md, mba chief medical officer pacific partners management services, inc. The RISE 2nd Annual Summit on Integrating Risk Adjustment and Quality Measures • Westlake Village, CA • July 23, 2012
- 2. ...standing on the shoulders of giants Sir Isaac Newton
- 3. QUESTION
- 5. WHY NOT?
- 6. PROBLEM
- 11. insanity: doing the same thing over and over and expecting different results
- 13. Let’s take a step back... from: http://step-dad.blogspot.com/2010/04/step-back.html
- 14. humanbehavior
- 16. some basics
- 17. human nature
- 21. human lazy social nature habit notgood@ change
- 22. human lazy social nature habit socialnorms
- 24. human lazy social nature habit statusquo
- 25. human lazy social nature habit socialnorms
- 26. doctor nature
- 30. doctor competitive nature independent curious formsilos
- 31. doctor competitive nature independent curious notgood@ cooperation
- 32. doctor competitive nature independent curious notgood@ collaboration
- 33. doctor competitive nature independent curious curious
- 34. doctor competitive nature independent curious competitive
- 35. doctor competitive nature independent curious competence
- 36. doctor competitive nature independent curious mastery
- 40. assumptions about improving quality and affordability clinicians care about both want to improve both want feedback on both
- 42. PREFERRED NON-PREFERRED variation reduction Drug Utilization Pattern Drug A Drug B Drug C Drug D
- 44. prescribing preferred drug increases average drug cost drops
- 45. prescribing preferred drug increases average drug cost drops savings over baseline accumulate
- 47. prescribing preferred drug increases average drug cost drops
- 48. prescribing preferred drug increases average drug cost drops no adverse effect on quality
- 49. prescribing preferred drug increases average drug cost drops no adverse effect on quality savings begin to accrue
- 52. motivation1.0
- 53. motivation2.0
- 54. motivation3.0
- 55. MOTIVATION Learning & Challenging Incentives & Punishment intrinsic extrinsic
- 56. MOTIVATION Learning & Challenging Incentives & Punishment intrinsic extrinsic
- 57. V Learning & Challenging Incentives & Punishment intrinsic extrinsic
- 58. reframe
- 59. easy
- 60. easy accessible
- 64. from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)
- 67. it’s also about whom your DATA serving data to
- 68. savvy consumers
- 69. not current error prone MPASTEE no comparator
- 70. unadulterated
- 71. nonjudgemental
- 73. showme theDATA
- 74. “put hot triggers in the path of motivated people” BJ Fogg, PhD Director, Persuasive Technology Lab Stanford University
- 77. Are incentives aligned properly? How can I increase their motivation?
- 79. Have I made it easy for people to act? How can I make it even simpler?
- 81. Are people being triggered at the most appropriate time and in their workflow (path)?
- 86. putting it all together: how does it work?
- 87. patient
- 88. patient front desk staff
- 89. patient analog to digital front desk staff converter
- 90. AMERICAN HEALTH PLAN 112 MARY SMITH 1/1/2011 1234567890 $5.00 $10.00 $25.00 analog to digital analog to digital eligibility check converter converter
- 91. Quality Access Express TM Management Click here to register for a password or request more information Powered by Access ExpressQ-v5.0.#.0.1 Build 2011.04.04.00
- 92. ACCESSEXPRESS Q New Eligibility Response New Message (3)
- 93. ACCESSEXPRESS Q New Eligibility Response New Message (3) AMERICAN HEALTH PLAN
- 94. ACCESSEXPRESS Q New Eligibility Response New Message (3) TH PA AMERICAN HEALTH PLAN E TH IN
- 95. ACCESSEXPRESS Q New Eligibility Response New Message (3) SMITH, MARY 8/15/1945 POP-UP 1234567890 MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
- 96. digital to analog converter module
- 97. x x x x x x x x digital to analog converter module
- 98. 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 CLICK HERE
- 100. AMREICAN HEALTH PLAN
- 101. AMREICAN HEALTH PLAN
- 102. ACCESSEXPRESS Q New Eligibility Response New Message (3) ER SMITH, MARY 8/15/1945 G 1234567890 IG MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, TR GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD T O H
- 103. ACCESSEXPRESS Q New Eligibility Response New Message (3) ENABLING SMITH, MARY 8/15/1945 1234567890 FRONT OFFICE MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, STAFF GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
- 104. ACCESSEXPRESS Q New Eligibility Response New Message (3) SMITH, MARY 8/15/1945 SIMPLE 1234567890 CARE PLAN MAMMOGRAPHY, CRC, CARDIO CARE, BLUE SHIELD OF CA DIABETES CARE, HYPERTENSION, GLAUCOMA, MED MONITOR, FLU VAC, PNEUMO VAC, DEXA, OSTEOPOROSIS, RHEUM, COPD
- 105. 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
- 106. ACCESSEXPRESS Q New Eligibility Response New Message (3)
- 107. ACCESSEXPRESS Q New Eligibility Response New Message (3)
- 108. ACCESSEXPRESS Q New Eligibility Response New Message (3) N O TI VA TI O M
- 109. ACCESSEXPRESS Q New Eligibility Response New Message (3)
- 110. ACCESSEXPRESS Q New Eligibility Response New Message (3)
- 111. ACCESSEXPRESS Q New Eligibility Response New Message (3)
- 114. Capability for physician office entry Y IT IL AB
- 116. ourresults@SCCIPA
- 117. commercialadmits/1000 80 Milliman - Loosely-Managed 70 Milliman - Moderately-Managed 60 Milliman - Well-Managed 50 SCCIPA 40 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
- 118. commercialbeddays/1000 275 Milliman ’11 Loosely-Managed Milliman - Loosely-Managed 250 225 Milliman -’11 Moderately-Managed Milliman Moderately-Managed 200 SCCIPA SCCIPA 175 Milliman ’11 Well-Managed Milliman - Well-Managed 150 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
- 119. commercialalos 4.5 4.0 Milliman - Loosely-Managed 3.5 Milliman - Moderately-Managed SCCIPA 3.0 Milliman - Well-Managed 2.5 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
- 120. medicareadmits/1000 400 Milliman - Loosely-Managed 350 Milliman - Moderately-Managed 300 SCCIPA Milliman - Well-Managed 250 200 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
- 121. medicarebeddays/1000 2,200 2,000 Milliman - Loosely-Managed 1,800 1,600 Milliman - Moderately-Managed 1,400 SCCIPA 1,200 Milliman - Well-Managed 1,000 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
- 122. medicarealos 6.0 5.5 Milliman - Loosely-Managed 5.0 Milliman - Moderately-Managed 4.5 SCCIPA Milliman - Well-Managed 4.0 11 10 1 1 0 1 0 0 R1 N1 L1 L1 R1 N1 CT CT JU JU AP JA AP JA O O
- 124. * * * * * increase/same scores in 21 of 26 measures
- 125. an essential aspect of creativity is not being afraid to fail - edwin land
- 126. failfast
- 128. no
- 129. 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
- 130. iterate
- 131. a journey of a thousand miles, begins with a single step - Lao-Tzu
- 132. don’t be afraid to take the plunge
- 133. Thank you! wpan@ppmsi.com slideshare.net/bonedoc97 WWW.SNOOPY.COM