2. PATH to Health
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 90% of Medicare beneficiaries are NOT receiving recommended
COVERED preventative services
 Annual Physical and/or Wellness
 Helps uncover chronic conditions causing acute illness
 Helps to manage and educate on healthy behaviors for continued wellness
 Preventative Maintenance
 Screenings & Tests help catch health problems before they become chronic
 The Advantage of Medicare Advantage
 Must offer what traditional medicare offers plus an advantage
 Demand for Quality Healthcare
 CMS Guidelines in place for defining quality in healthcare
 HEDIS, HOS, CAHPS, Star Ratings
 Other programs like: CPCI, PCMH, PQRS, etc

3. 3
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Measure of Quality based on Several Items
 HEDIS: Healthcare Effectiveness Data and
Information Set
Preventative Measures
 Includes Part D
 CAHPS: Consumer Assessment of Healthcare
Providers and Systems
Random Survey Given Out to Medicare Eligibles
 HOS: Health Outcomes Survey
Random Survey Given out to Medicare Eligibles
STAR Ratings

4. 4
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Healthcare Effectiveness Data and Information Set
 Specific Preventative Measures
Mammograms
 Colorectal Screenings
 Controlling Blood Pressure
 Osteoporosis Management
 Rheumatoid Arthritis Management
 Readmissions
 Diabetic Measures
 Diabetic Eye Exam
 Diabetic Blood Sugar Control (triple weighted)
 Diabetic Kidney Function
 Special Needs Plan
Care of Older Adult Measures
HEDIS

5. 5
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Medication Adherence Measures
Gathered through pharmacy claims
 Triple Weighted Measures
 Sample and Pill Splitting are Detrimental
 Diabetes Treatment Adherence
Oral medications only
 Hypertension Medication Adherence
ACEi/ARB for Kidney protection
 Statin Medication Adherence
 Even if medication is on “$4 list”, run through insurance for tracking
Pharmacy Saver Program
 Make sure to discontinue medication if stopped for any reason
Part D Measures

6. 6
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Consumer Assessment of Healthcare Providers and Systems
Consumer Experience
Waiting room comfort and wait time
 Access to Care (appointments)
 Getting Needed Prescriptions
 Flu Vaccine
 Rating of Entire Healthcare Plan
 Care Coordination
Most are weighted 1 ½
Talk with patients about survey and ask for the high rating
CAHPS

7. 7
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Health Outcomes Survey
Talking with your patient
Does the physician have to ask these questions?
Physical Activity
Physical Health
 Mental Health
 Fall Risk
 Assessments can be built into EMR to document
 Again, talk with patients about survey, prompt conversation
Smart phrases to promote recall
HOS

8. 8
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Everything points to quality of care: HEDIS, Part D, CAHPS, HOS
 Supports Evidence Based Practice (preventative)
 Maintains Patient Autonomy
 Manages Chronic Co-Morbidities
 Increase Business Base
 Provides Community Awareness
 Ensures Future Benefits
 Population Health Management
 Patient Education
Why Quality?

9. Quality Healthcare Locally
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Quality Healthcare Team in Arkansas
Practice Performance Managers
 Practice Based-Support
 Monthly Reporting to Show Progress
Patient Care Opportunity Report (PCOR)
 Healthcare Quality Patient Assessment Forms
Healthcare Advocate
 Closes Gaps and Increase Risk Score
 Data Connection
Close gaps through data extraction electronically

10. Questions? Discussion?
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