International Business Environments and Operations 16th Global Edition test b...
How star rating measures correlate with overall hedis quality (full) 16 jan12
1. How Star Rating Measures Correlate with
Overall HEDIS Quality
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
24. a simpler way to manage your
P4P/CMS 5 Star quality
program
wayne pan, md, mba
25. overview
• who are the key players that need to be
involved in this process?
• how can you engage the players in an effective,
systematic way?
• how can you measure performance and
provide feedback?
• how can you engage patients?
26. how are you going to coordinate
all three stakeholders?
health
plans
41. 112
MARY SMITH 1/1/2011
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$5.00
$10.00
$25.00
analog to digital eligibility check
converter
42. how to engage your team in
quality improvement efforts?
43. put hot triggers
in the path of
motivated people
BJ Fogg, PhD
Director, Persuasive Technology Lab
Stanford University
44.
45. TRIGGERS: Are people being triggered at the
most appropriate time and in their workflow (path)?
ABILITY: Have I made it easy for people to act?
How can I make it even simpler?
MOTIVATION: Are incentives aligned
properly? How can I increase their motivation?
47. ACCESSEXPRESS
Q
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BLUE SHIELD OF CA
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BLUE SHIELD OF CA
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51. ACCESSEXPRESS
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BLUE SHIELD OF CA
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BLUE SHIELD OF CA
53. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA
54. ACCESSEXPRESS
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SMITH, MARY
8/15/1945
POP-UP
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MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
55. 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
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59. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
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SMITH, MARY
8/15/1945
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MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
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GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
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60. 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
61. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA
62. ACCESSEXPRESS
Q New Eligibility Response New Message (3)