creating clinical dashboards and incentive programs with

Proprietary & Confidential. Health Care Incentives Improvement Institute, Inc.

Creating Clinical Dashboards and

Incentive Programs with Impact

National P4P Summit Concurrent Session 1.3

March 23, 2011


Jessica DiLorenzo•Implementation Leader, Health Care Incentives Improvement Institute, Schenectady, NY

Eileen Hagan, MSN, APRN, BC•Director, Value-Driven Practice Solutions, American College of Cardiology, Washington, DC

Chad J. Brown, MPH•Program Implementation Leader, Southeast Region, Health Care Incentives Improvement Institute, Newtown, CT

2

Presenters


Session objectives

• To learn from a diverse set of examples in the field: – A large employer in PA encouraging small practices

using incentives to come up the performance assessment learning curve

– The American College of Cardiology leading a collaborative to build a practice recognition program that meets the needs of payers and providers

– BCBSTX using a national P4P framework with multiple assessment options to financially reward physicians who provide excellent care.

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Clinical dashboards and incentives

• Measure what matters: shift from provider centric measurement to patient centered quality measurement – Clinical data with mix of intermediate and outcome

measures; levels of achievement – Reduce cycle time between measurement,

reporting, improvement and re-measurement – Move up the glide path to include measuring

potentially avoidable complication rates • Provide meaningful incentives:

– Shift dollars to results

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How far we’ve come – 10-fold increase in 5 years

5


More options, more submissions

Data Source Count of Clinician Recognitions NCQA 23,485

Cinci FA4Q 282GE 279

HVMA 272IPRO Web Portal 235Medical Edge 126

NextGen 115CINA 55

NYCDOH 26ME‐PTE 3ABIM 0

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Clinicians pick their own pathway

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Automated option - NYCDOHScope • Adult Primary Care

Recognition Program - CAD- Hypertension- Diabetes - Population

Health measures

• Age 65 and under across all payers • NYC focus

Design • Use a NYCDOH “approved EMR”• Continuous quality improvement through ongoing quality measurement• Encourage payers to use the recognition as part of incentive program • Clinicians receive technical assistance for submission

Target Participants

• Top physician practice groups identified to participate in pilot program due EMR readiness

Financial Rewards

• Health plans use the program within their individual P4P programs

Recognition • National Health plans use the recognitions in their network distinction programs

• High-performing physicians will receive national BTE recognition

Timeline • Program launched 4Q2010• 28 recognitions to date

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Automated data submission - NYCDOH

EHR-Enabled Physicians

Aggregator

Quality measures

Quality measures (certified physicians only)

Feed

back

and

Qua

lity

Impr

ovem

ent

Patient dataQuality measures

Health Plans

TCN

Y P

rimar

y C

are

Rec

ogni

tion

Rew

ards

and

Rec

ogni

tion

(De-identified)

•Data aggregators or Practices

transmit the most recent aggregated

clinician‐level data for each

participating clinician to NYC

DOHMH

•Data transmitted to DOHMH is

verified prior to processing for

reporting to practices or BTE

•BTE reviews and makes Adult

Primary Care Recognition status

determinations.

•Physicians may also earn BTE

program recognition

(diabetes/hypertension).

•BTE will only send recognition

statuses of clinicians that meet the

recognition criteria to health plans

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Adult Primary Care Recognition Program

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PEBTF-BTE Excellence in Chronic Care Management Program• PEBTF is one of the largest payers of health care

services in PA, covering over 300,000 PA State employees, retirees and family members.– Approximately 85,000 members have a chronic

illness– Significant dollars spent annually on patients with

chronic conditions– Significant number of preventable hospitalizations

are incurred every year• Program designed to provide financial

incentives to support physicians that manage many PEBTF plan members that have one or more chronic illness

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Non automated option - PEBTFScope • Chronic programs

- Diabetes- Asthma- CHF- CAD- Hypertension- COPD

• Age 65 and under PEBTF members, non Medicare patients

• Statewide

Design • Focus on “top volume” physicians – All six chronic conditions (>50 members)• Continuous quality improvement through ongoing quality measurement• Tie incentives payout to overall score on a sliding scale• Incentives based on fixed/variable formula tied to overall reduction of potentially

avoidable complications

Target Participants

• Top physician practice groups identified to participate in pilot program due to volume of PEBTF members

Financial Rewards

• PEBTF is responsible for financially rewarding physician practices for delivering quality care based on fixed/variable incentives model

Recognition • PEBTF will recognize high-performing physicians through periodic communications to its members

• High-performing physicians will receive national BTE recognition

Timeline • Year 1 of pilot program launched January 2010 with financial payouts scheduled for Q3 2011

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Patient-mix adjusted overall scorecard

13

• Each practice is measured on domains relevant to their patient mix (e.g., cardiologists measured on CHF, CAD and Hypertension)

• Total score is weighted on the patient type that is most prevalent in that practice.


Pilot practices’ progress to date

• 5 practices completed an optional baseline data submission in 2010

– Each practice ran reports to identify eligible patients, manually extracted patient data and completed template worksheets

• Feedback from baseline assessments shared with practices to inform quality improvement efforts

– Practices report BTE feedback prompted comprehensive review of care protocols (around both BTE and non- BTE measures)

• All participating practices currently undergoing data collection for Year 1 incentives – submissions due March 31

“The initial screening that we did last year really opened our eyes to some major issues we were missing with certain disease processes. We were completely missing out on doing PFT's for our COPD and Asthma patients. We had the means to do these procedures in the office, we were just not doing it. Once we shared this information with all of our providers and staff, the amount of PFT's we did every week doubled. ”

- Baughman Family Medicine Harrisburg, PA

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Building a Program to Assess and Recognize Quality in

Cardiovascular Practice

Eileen Hagan, MSN, APRN, BCAmerican College of Cardiology

March 24, 2011

15

Describe the collaborative process of building a practice assessment and recognition programReview the program content and scoring methodologyDiscuss the value proposition and the interest so far

Today’s Objectives

16

Background

U.S. healthcare system evolving from one based on volume to one based on value

Practices need a mechanism to demonstrate their commitment to quality improvement and achievement of quality thresholds

To allow the profession rather than external forces to influence the process, the ACC developed and piloted a practice‐level performance assessment and recognition program

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Purpose

Standardize the methodology for how cardiology practices are assessed and recognized

Provide a platform for practices to evaluate themselves against a comprehensive measure set to support the delivery of CV care that achieves the six national quality aims identified by the IOM:

safe, timely, effective, efficient, equitable, and patient‐centered

(STEEEP)

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Domains

Clinical:Measure sets developed by the ACC with the AHA and the AMA to improve rates of providing evidence‐based care, reduce variations in care, and improve patient outcomes: HTN, CAD, HF, AF/AFLStructural: Metrics to evaluate practice‐level systems that promote STEEEP careProfessional: Metrics to identify individual achievement & maintenance of professional credentials; commitment to professionalism at the practice‐level is believed to have positive effects on STEEEP care

19

Partners

BTE ensures the objective third party administration and manages the performance assessment and audit processes

CECity.com provides the technology required to set up, host and support on‐line data collection

ACC assembles and convenes steering committees and advisory panels to oversee all phases of program development, implementation, and evaluation

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Methods

22 practices participated in pilot

Metrics: Practice performance was assessed using 10 structural metrics13 professional metrics24 clinical measures

Measurement period: 12 consecutive months (Jan 1‐Dec 31, 2009)

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Eligible Patients

≥18 years on 1st day of measurement period

Any, some, or all of the following diagnoses :Hypertension (HTN)

Coronary Artery Disease (CAD)

Heart Failure (HF)

Atrial Fibrillation (AF) and/or A‐flutter (A‐FL)

At least two eligible outpatient encounters within measurement period.

22

Sampling and Reporting Requirements

Minimum number of patients per measure set per practice based on number of physicians in the practiceInformed by strategies used in established and credible physician performance assessment programsSample included consecutive eligible patients with an eligible encounter on the last day of the measurement period, working backward until the minimum reporting requirement for each measure set was met

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Pilot Results

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http://files.abstractsonline.com/CTRL/21/B/D80/40B/AD2/4AE/8BC/2F2/1AC/F98/BAA/4F/g6306_1.JPG

Value Statement

The program provides an:

unbiased, transparent, comprehensive, self‐reported, all‐payer assessment of a

practice’s performance against national benchmarksto better and more consistently understand how we practice as a profession

allowing us to demonstrate and quantify value

while implementing practice improvements that facilitate efficient workflows and drive effective patient care

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Value Proposition

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Quality in Cardiology Practice

With its partners, ACC has developed two practice‐ level solutions for assessing, improving, and

quantifying quality in cardiovascular practice:

•

Cardiology Practice Improvement PathwayProvides a platform for continuous quality improvement

•

Cardiology Practice RecognitionPublicly reported practice achievement of quality thresholds established by the ACC

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Practice‐level performance improvement program housed on cardiosource.org

Approved by ABIM for Part IV MOCApply QI methods: FOCUS & PDSAPractices can choose to apply for recognition by

submitting their data to IPRO, BTE’s performance assessment organization, for evaluation against established thresholds.

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The Bridges to Excellence Cardiology Practice Recognition is awarded to those cardiology

practices that achieve performance thresholds for recognition established jointly by the ACC

and BTE.

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ACC/BTE Cardiology Practice Recognition Payment Model Trajectory

EMR / REG

ISTRYINTEG

RATIO

NEFFICIEN

CY MEA

SURES

BETTER DIFFEREN

TIATIO

NMORE

DATA

Today, we

are here…

Incentives

for BTE

Recognition

Performance‐

Based Contracting:

Fee ScheduleDifferentials,

Bonus Payments

Shared

SavingsPrograms

Bundled

Payments

our future is

there

31


Blue Cross Blue Shield of Texas: A BTE Licensee

Chad Brown, MPH, MBAImplementation Leader www.hci3.org

http://www.hci3.org/

Proprietary & Confidential. Health Care Incentives Improvement Institute, Inc. 33

Why Bridges to Excellence?• Enhances HCSC’s wellness vision and

focus• Integrates well with critical disease

management focus (i.e., diabetes, cardiac)

• Links all constituents to improving patient condition

PhysiciansMembersEmployersHealth Plan

• Integrates and blends financial recognition with wellness and disease management


Program Goals

• Financially reward physicians who provide excellent care to member with diabetes and cardiac disease

• Improve patient outcomes and quality of life• Reduce the economic burden of caring for members with

diabetes and cardiac disease• Link into other established Blue Care Connection medical and

dental programs that interact directly with members to improve their health and disease condition


Program Model

Two Step process - Achieve Recognition, then automatically are included in the BCBSTX program

Obtain Bridges to Excellence recognized provider list from Bridges to Excellence

Identify Blue Cross and Blue Shield of Texas diabetes members that see Bridges to Excellence recognized physicians (Blue Card & FEP members are excluded from these programs)

BCBSTX sends communications to physiciansPhysician returns the information for review and claims

approvalPhysician bills claim

BCBSTX pays the BTE incentive to physician

A Bridges to Excellence recognized physician can be incentivized $100 per Blue Cross and Blue Shield of Texas selected patient, per physician, per year


Member Identification Criteria

• Must be a Blue Cross and Blue Shield of Texas PPO/POS or HMO member (Blue Card & FEP members are excluded)

• Must have a Texas address• Must by 5 years of age or older• Specific diagnosis codes• Must have at least one inpatient claim or one ambulatory

claim• COB claims are not considered• Medicare eligible members are excluded


Texas Current Program Information As of January, 2011

Diabetes– 331 recognized physicians in Texas– 12,526 patients have participated since the program

started

Cardiac – Program started June, 2010– 115 recognized physicians in Texas– 951 patients have participated since the program

started

38

Bridges to Excellence Diabetes Success (report not final)

The program has experienced a 733% increase in BTE recognized physicians since year end 2008

39 as of Dec, 2008 to 325 in Dec, 2010

0

50

100

150

200

250

300

350

YE 2008 YE 2009 YE 2010

ROI for 7 months shows project savings of $2.5M


BTE Diabetes - Program Effectiveness Integrating Care and Incentives

Incentives

$580,000 paid in incentives to BTE-

recognized physicians

Integrating CareIntegrating Care

BCC Program Referrals

806

July – Dec 2009

BCC Program Referrals

3,148

CY 2010 Inception toDec 2010


Expansion of BTE Programs

• Implement in Oklahoma and New Mexico in July, 2011

• Will evaluate for new BTE programs to implement in 2012 in all 3 plans if appropriate


BTE Contact Information

Blue Cross and Blue Shield of TexasJill Brooks, [email protected]

Bridges To ExcellenceChad [email protected]

mailto:[email protected]

mailto:[email protected]


For contact information:www.HCI3.orgwww.bridgestoexcellence.orgwww.prometheuspayment.org

creating clinical dashboards and incentive programs with

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