5 keys to medicare expansion approval
DESCRIPTION
For those healthcare insurers seeking approval of your government programs for expansion and compliance.TRANSCRIPT
- 1. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 P R O V I D I N G P O W E R F U L S O L U T I O N S
2. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Lock Smiths Robert Smith Account Manager, West Region [email protected] Linda Borths Director of Sales [email protected] John Weis President & Co-Founder [email protected] Darren Huff Account Manager, East Region [email protected] 3. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 What Well Cover Today The CMS Process Know Your Deficiencies Market Providers Call The Lock Smith HSD Automation 4. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Key #1 ~ The Key Keeper Understanding CMS Process 5. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Minimum number of providers Must contract with sufficient numbers of each provider specialty type Must contract with sufficient number of each HSD facility type Maximum Travel Time & Distance to Providers/Facilities 90% of beneficiaries have access to at least one provider/facility Contracted providers are not limited to the boundaries of the county or counties as long as the provider is within the time & distance requirements. ADEQUACY Methodology KEYNOTE Contracted providers are not limited to the boundaries of the county or counties as long as the provider is within the time & distance requirements. 6. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 What Happens to Your HSD Tables 7. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 2014 PROVIDER T/D Requirements Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) 001 General Practice 002 Family Practice 003 Internal Medicine 004 Geriatrics 005 Primary Care - Physician 006 Primary Care - Nurse S03 Primary Care 10 5 15 10 30 20 40 30 70 60 007 Allergy and Immunology 30 15 45 30 80 60 90 75 125 110 008 Cardiology 20 10 30 20 50 35 75 60 95 85 010 Chiropractor 30 15 45 30 80 60 90 75 125 110 011 Dermatology 20 10 45 30 60 45 75 60 110 100 012 Endocrinology 30 15 60 40 100 75 110 90 145 130 013 ENT/Otolaryngology 30 15 45 30 80 60 90 75 125 110 014 Gastroenterology 20 10 45 30 60 45 75 60 110 100 015 General Surgery 20 10 30 20 50 35 75 60 95 85 016 Gynecology, OB/GYN 30 15 45 30 80 60 90 75 125 110 017 Infectious Diseases 30 15 60 40 100 75 110 90 145 130 018 Nephrology 30 15 45 30 80 60 90 75 125 110 019 Neurology 20 10 45 30 60 45 75 60 110 100 020 Neurosurgery 30 15 60 40 100 75 110 90 145 130 021 Oncology - Medical, Surgical 20 10 45 30 60 45 75 60 110 100 022 Oncology - Radiation/Radiation Oncology30 15 60 40 100 75 110 90 145 130 023 Ophthalmology 20 10 30 20 50 35 75 60 95 85 025 Orthopedic Surgery 20 10 30 20 50 35 75 60 95 85 026 Physiatry, Rehabilitative Medicine30 15 45 30 80 60 90 75 125 110 027 Plastic Surgery 30 15 60 40 100 75 110 90 145 130 028 Podiatry 20 10 45 30 60 45 75 60 110 100 029 Psychiatry 20 10 45 30 60 45 75 60 110 100 030 Pulmonology 20 10 45 30 60 45 75 60 110 100 031 Rheumatology 30 15 60 40 100 75 110 90 145 130 033 Urology 20 10 45 30 60 45 75 60 110 100 034 Vascular Surgery 30 15 60 40 100 75 110 90 145 130 035 Cardiothoracic Surgery 30 15 60 40 100 75 110 90 145 130 2014 Provider Time and Distance Requirements Metro Micro Rural Specialty Geographic Type CEACLarge Metro CMS Code 8. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 2014 FACILITY T/D Requirements Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) 040 Acute Inpatient Hospitals 12.2 20 10 12.2 45 30 12.2 80 60 12.2 75 60 12.2 110 100 041 Cardiac Surgery Program NA 30 15 NA 60 40 NA 160 120 NA 145 120 NA 155 140 042 Cardiac CatheterizationServices NA 30 15 NA 60 40 NA 160 120 NA 145 120 NA 155 140 043 CriticalCare Services Intensive Care Units (ICU) NA 20 10 NA 45 30 NA 160 120 NA 145 120 NA 155 140 044 Outpatient Dialysis NA 20 10 NA 45 30 NA 65 50 NA 55 50 NA 100 90 045 SurgicalServices (Outpatient or ASC) NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 046 SkilledNursingFacilities NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 95 85 047 Diagnostic Radiology NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 048 Mammography NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 049 PhysicalTherapy NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 050 OccupationalTherapy NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 051 SpeechTherapy NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 052 Inpatient Psychiatric Facility Services NA 30 15 NA 70 45 NA 100 75 NA 90 75 NA 155 140 054 Orthotics andProsthetics NA 30 15 NA 45 30 NA 160 120 NA 145 120 NA 155 140 055 Home Health NA NA NA NA NA 056 Durable MedicalEquipment NA NA NA NA NA 057 Outpatient Infusion/Chemotherapy NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 061 Heart Transplant Program NA NA NA NA NA 062 Heart/LungTransplant NA NA NA NA NA 064 Kidney Transplant Program NA NA NA NA NA 065 Liver Transplant Program NA NA NA NA NA 066 LungTransplant Program NA NA NA NA NA 067 Pancreas Transplant Program NA NA NA NA NA 2014 Provider Time and Distance Requirements Specialty Geographic Type Micro Rural CEACLarge Metro Metro CMS Code 9. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Network Adequacy OUTPUT (ACC) 10. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 A Quest Analytics Exclusive 2007 CMS Partnership Begins with Part D 2009 CMS Partnership Expands to Part C 2012 Medicare Standards Required for Dual Demonstration Projects 2012 CMS Integrates Server Version 2013 Network Adequacy at the Forefront of Qualifying and Monitoring Plans for the Exchanges *CMS Requirements Subject to Change Each CY 11. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 BUILT with VISION QUEST ANALYTICS SUITE The industry's only software solution that has continued to evolve to meet the changing demands of Network Adequacy. The Quest Analytics Suite fully integrates; Access, Disruption, Network Adequacy (Medicare and Custom), Address-level Geocoding and Hospital Quality Analysis into one easy to use suite. 12. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 ACCESS ANALYSIS Access Analysis I Access Comparison I Mapping ADEQUACY ANALYSIS Medicare Advantage I Medicaid I Dual Eligibles I Exchanges I Commercial GEOCODER & DATA STANDARDIZATION Address-Level Accuracy I Data Standardization I Zip Correction DISRUPTION ANALYSIS Transparency & Confidence I Provider Change Analysis QUALITY NETWORK ANALYSIS Hospital Quality I Tiered Networks QUEST ANALYTICS SUITE 13. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Key #2 ~ Verify the Lock Understanding Your Deficiencies 14. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 The Power of One NO need for County or SSA Code in data NO push pins and radius rings NO Google/MapQuest searches All you need is: ONE RECORD Per: Provider/Location/Specialty Field Requirements Name, Address, City, State, Zip, CMS Code, NPI. 15. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 2014 PROVIDER T/D Requirements Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) 001 General Practice 002 Family Practice 003 Internal Medicine 004 Geriatrics 005 Primary Care - Physician 006 Primary Care - Nurse S03 Primary Care 10 5 15 10 30 20 40 30 70 60 007 Allergy and Immunology 30 15 45 30 80 60 90 75 125 110 008 Cardiology 20 10 30 20 50 35 75 60 95 85 010 Chiropractor 30 15 45 30 80 60 90 75 125 110 011 Dermatology 20 10 45 30 60 45 75 60 110 100 012 Endocrinology 30 15 60 40 100 75 110 90 145 130 013 ENT/Otolaryngology 30 15 45 30 80 60 90 75 125 110 014 Gastroenterology 20 10 45 30 60 45 75 60 110 100 015 General Surgery 20 10 30 20 50 35 75 60 95 85 016 Gynecology, OB/GYN 30 15 45 30 80 60 90 75 125 110 017 Infectious Diseases 30 15 60 40 100 75 110 90 145 130 018 Nephrology 30 15 45 30 80 60 90 75 125 110 019 Neurology 20 10 45 30 60 45 75 60 110 100 020 Neurosurgery 30 15 60 40 100 75 110 90 145 130 021 Oncology - Medical, Surgical 20 10 45 30 60 45 75 60 110 100 022 Oncology - Radiation/Radiation Oncology30 15 60 40 100 75 110 90 145 130 023 Ophthalmology 20 10 30 20 50 35 75 60 95 85 025 Orthopedic Surgery 20 10 30 20 50 35 75 60 95 85 026 Physiatry, Rehabilitative Medicine30 15 45 30 80 60 90 75 125 110 027 Plastic Surgery 30 15 60 40 100 75 110 90 145 130 028 Podiatry 20 10 45 30 60 45 75 60 110 100 029 Psychiatry 20 10 45 30 60 45 75 60 110 100 030 Pulmonology 20 10 45 30 60 45 75 60 110 100 031 Rheumatology 30 15 60 40 100 75 110 90 145 130 033 Urology 20 10 45 30 60 45 75 60 110 100 034 Vascular Surgery 30 15 60 40 100 75 110 90 145 130 035 Cardiothoracic Surgery 30 15 60 40 100 75 110 90 145 130 2014 Provider Time and Distance Requirements Metro Micro Rural Specialty Geographic Type CEACLarge Metro CMS Code 16. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 2014 FACILITY T/D Requirements Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) 040 Acute Inpatient Hospitals 12.2 20 10 12.2 45 30 12.2 80 60 12.2 75 60 12.2 110 100 041 Cardiac Surgery Program NA 30 15 NA 60 40 NA 160 120 NA 145 120 NA 155 140 042 Cardiac CatheterizationServices NA 30 15 NA 60 40 NA 160 120 NA 145 120 NA 155 140 043 CriticalCare Services Intensive Care Units (ICU) NA 20 10 NA 45 30 NA 160 120 NA 145 120 NA 155 140 044 Outpatient Dialysis NA 20 10 NA 45 30 NA 65 50 NA 55 50 NA 100 90 045 SurgicalServices (Outpatient or ASC) NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 046 SkilledNursingFacilities NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 95 85 047 Diagnostic Radiology NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 048 Mammography NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 049 PhysicalTherapy NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 050 OccupationalTherapy NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 051 SpeechTherapy NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 052 Inpatient Psychiatric Facility Services NA 30 15 NA 70 45 NA 100 75 NA 90 75 NA 155 140 054 Orthotics andProsthetics NA 30 15 NA 45 30 NA 160 120 NA 145 120 NA 155 140 055 Home Health NA NA NA NA NA 056 Durable MedicalEquipment NA NA NA NA NA 057 Outpatient Infusion/Chemotherapy NA 20 10 NA 45 30 NA 80 60 NA 75 60 NA 110 100 061 Heart Transplant Program NA NA NA NA NA 062 Heart/LungTransplant NA NA NA NA NA 064 Kidney Transplant Program NA NA NA NA NA 065 Liver Transplant Program NA NA NA NA NA 066 LungTransplant Program NA NA NA NA NA 067 Pancreas Transplant Program NA NA NA NA NA 2014 Provider Time and Distance Requirements Specialty Geographic Type Micro Rural CEACLarge Metro Metro CMS Code 17. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Network Adequacy OUTPUT (ACC) 18. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Network Adequacy OUTPUT (ACC) 19. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Key #3 ~ Make a Key Yourself Understanding Where To Find Your Keys 20. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 GAP ANALYSIS & MAPPING 21. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Market Possibilities 22. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Key #4 ~ Call The Locksmith Understanding How Fill the Deficiencies 23. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 About Narrow Networks UNDERSTANDING MARKET DRIVERS Filling Gaps I Service Area Expansion = Narrow Networks PREDICTING COSTS, REVENUES TIMELINES Budget Dollars I Resources I In-House or Contract NARROW NETWORK ANALYSIS SERVICE Identifies and Prioritizes Markets Ranked and Ordered Analysis for Use In: ~Tiered Networks ~Minimizing Exchange Exposure 24. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 A NEW MODEL EXPANDS Ranks providers across various specialties based on impact to members covered in each geographic area Focuses on minimum number of providers to meet criteria Highlights the importance of a single address Illustrates the impact a provider has across multiple counties Gives recruiters the ability to prioritize and create incentives for highly needed providers Provides insight to the impact an address has to fulfill multiple specialties 25. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 ANALYZING THE GAPS SCORECARD 26. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 REVIEWING THE DEFICIENCY 27. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 TRIED (but is it true?) 28. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 MEASURING IMPACT Very little or no impact, not worth the effort. Have an impact, but would not meet by their single location. Any single provider at one of these locations would provide access to 90% of membership. 29. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 VALIDATING THE IMPACT 30. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 MEASURING IMPACT across counties 31. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 MEASURING IMPACT across addresses 32. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 INCORPORATE UTILIZATION/COST/QUALITY 33. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Quality QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY QUANTITY NARROW NETWORK ANALYSIS NOT Its All About The Approval 34. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 The Master Key 35. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Automate Your HSD Tables 36. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 P R O V I D I N G P O W E R F U L S O L U T I O N S P R O V I D I N G P O W E R F U L S O L U T I O N S Market Opportunity and Return on Expansion Following the Money 37. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Revenue Stream 2014 HSD Reference File 2014 Reimbursement Rates 38. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Projected Return On Expansion 39. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Projected Return On Expansion 40. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Projected Return On Expansion 41. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Projected Return On Expansion 42. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Projected Return On Expansion 43. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Validating the Numbers 44. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 What is the Expansion Worth? 45. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 As We Depart 46. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2013 Well Be In Touch Robert Smith Account Manager, West Region [email protected] Linda Borths Director of Sales [email protected] John Weis President & Co-Founder [email protected] Darren Huff Account Manager, East Region [email protected]