the business case for p4p
DESCRIPTION
The Business Case for P4P. Douglas Allen MD., MMM. Chief Medical Officer Greater Newport Physicians IPA. What P4P Incentivises. Changes Directly Inventivised. Information systems to house clinical data Disease Registry Creation - PowerPoint PPT PresentationTRANSCRIPT
The Business Case for The Business Case for P4PP4P
Douglas Allen MD., MMM.Douglas Allen MD., MMM.Chief Medical OfficerChief Medical Officer
Greater Newport Physicians IPAGreater Newport Physicians IPA
What P4P IncentivisesWhat P4P Incentivises
Changes Directly Changes Directly InventivisedInventivised
Information systems to house clinical Information systems to house clinical datadata
Disease Registry CreationDisease Registry CreationClinical Quality Reports and Physician Clinical Quality Reports and Physician
reminders (retrospective)reminders (retrospective)Point of Care Physician RemindersPoint of Care Physician Reminders Improved Access, Physician Improved Access, Physician
Communication and Specialty CareCommunication and Specialty Care
Changes Indirectly InventivisedChanges Indirectly Inventivised
Alternative uses of a Data Alternative uses of a Data Warehouse: Understanding Cost Warehouse: Understanding Cost TrendsTrends
Using Data to Reach out to Members. Using Data to Reach out to Members. Education and/or Marketing Education and/or Marketing
EMR Development – Most Effective EMR Development – Most Effective Strategy to Decrease Errors and Strategy to Decrease Errors and Improve Efficiency/EffectivenessImprove Efficiency/Effectiveness
Changes Indirectly InventivisedChanges Indirectly Inventivised
Innovative Patient Engagement Innovative Patient Engagement Strategies, to Further Improve Strategies, to Further Improve Disease Control. Disease Control.
Innovative Scheduling Strategies. Innovative Scheduling Strategies. Possibly Doing Away with Scheduling Possibly Doing Away with Scheduling Altogether.Altogether.
Innovative Patient Communication Innovative Patient Communication Strategies. Online Consults, Email Strategies. Online Consults, Email etc.etc.
The Ideal StateThe Ideal State Patient Centered Health Care. Patient Patient Centered Health Care. Patient
Efficiently Interacts with all Members of Efficiently Interacts with all Members of the Health Care Team. Contextually the Health Care Team. Contextually Sensitive Educational Tools, Sent to the Sensitive Educational Tools, Sent to the Patient Through Medium of Their Choosing.Patient Through Medium of Their Choosing.
Information Available at the Physician’s Information Available at the Physician’s Fingertips, Including Insurance Guidelines, Fingertips, Including Insurance Guidelines, Guidelines for DM, Preventive Care and Guidelines for DM, Preventive Care and New Technologies.New Technologies.
Full Relational Database at Group Level, to Full Relational Database at Group Level, to used for both QI and Cost Control.used for both QI and Cost Control.
Ideal State (Cont.)Ideal State (Cont.) Point of care support for Physicians, Point of care support for Physicians,
Including Drug-drug Interactions, Including Drug-drug Interactions, Medication Compliance, Labs etc..Medication Compliance, Labs etc..
Physician Offices have Re-designed Work Physician Offices have Re-designed Work Flow to Flex to Individual patient Needs, Flow to Flex to Individual patient Needs, Including use of Educational Aids, Planned Including use of Educational Aids, Planned Visit Tools, Group Visits etc.Visit Tools, Group Visits etc.
Health Care Providers have Access to Health Care Providers have Access to Health Related Patient Activity Regardless Health Related Patient Activity Regardless of Location Within the Community.of Location Within the Community.
Progress Toward the IdealProgress Toward the Ideal Relay Health, Individual Medical Group (e.g. Relay Health, Individual Medical Group (e.g.
Bristol Park) and other Strategies to Improve Bristol Park) and other Strategies to Improve Patient Communication. Patient Communication.
Numerous Vendor Strategies to Improve Numerous Vendor Strategies to Improve Physician Point of Care Support. Quest, Access Physician Point of Care Support. Quest, Access Express, Physicians Web Link, Physician Express, Physicians Web Link, Physician Associates etc.Associates etc.
Numerous Groups Building Clinical Data Numerous Groups Building Clinical Data Warehouses or Relying on Vendors to Jumpstart Warehouses or Relying on Vendors to Jumpstart Their Efforts.Their Efforts.
BCCP Experiments, Demonstrating Applicability BCCP Experiments, Demonstrating Applicability and Effectiveness of Office Re-design in the and Effectiveness of Office Re-design in the California Market Place.California Market Place.
Progress (cont.)Progress (cont.) RHIO Concept put forth by David Brailer. RHIO Concept put forth by David Brailer.
Would Allow All Health Care Providers to Would Allow All Health Care Providers to Know about Health Related Activity for Know about Health Related Activity for Every Patient Regardless of Location.Every Patient Regardless of Location.
Wave of Advanced Access Pilots with and Wave of Advanced Access Pilots with and without Health Plan Supportwithout Health Plan Support
Groups using their own Data Warehouses Groups using their own Data Warehouses for Utilization Management, but Lack for Utilization Management, but Lack BenchmarkingBenchmarking
Clinical Data Repository by CAPG. A Clinical Data Repository by CAPG. A Benchmarking Solution.Benchmarking Solution.
Reminder of last year’s Pay-Reminder of last year’s Pay-out by health planout by health plan
Plan 1 $0.25Plan 1 $0.25
Plan 2 $0.78Plan 2 $0.78
Plan 3 $0.94Plan 3 $0.94
Plan 4 $1.30Plan 4 $1.30
Plan 5 $1.38Plan 5 $1.38
Plan 6 $1.89Plan 6 $1.89
Investment Cost LadderInvestment Cost Ladder
Dz Registry Through Vendor
Patient Negative lists
Patient Reminders
Internal Data Warehouse
Dr Financial Incentives
Real Time Decision Support
Dz Specific Case Management
Electronic Medical Record (Practitioner)
$
$$
$$$
$$$$Electronic Medical Record (Group)
GNP I.S. STRATEGYGNP I.S. STRATEGY
Challenge : to Weave Together Many Challenge : to Weave Together Many Applications and Solutions into a Applications and Solutions into a Single, Coherent, Overarching Single, Coherent, Overarching StrategyStrategy
PHYSICIAN
Internet
Internet
- Online Rx Requests- Online Prescribing
- E-Visits- E- Health Record
- Office Visit Requests
Relay Health
PHYSICIAN
Internet
Internet
PATIENT
- Online Rx Requests- Online Prescribing
- E-Visits- E- Health Record
- Office Visit Requests
- Generic Rx Pad Ordering
Relay Health
PHYSICIAN
Internet
Internet
SCRIPT IQ
PATIENT
- Online Rx Requests- Online Prescribing
- E-Visits- E- Health Record
- Office Visit Requests
- Generic Rx Pad Ordering
Relay Health
Access Express
PHYSICIAN
Internet
Internet
UM DEPARTMENT- Authorization Submission- Authorization Status
GNP
SCRIPT IQ
PATIENT
- Online Rx Requests- Online Prescribing
- E-Visits- E- Health Record
- Office Visit Requests
- Generic Rx Pad Ordering
Relay Health
Access Express
Access Express
PHYSICIAN
Internet
Internet
UM DEPARTMENT- Authorization Submission- Authorization Status
ELIGIBILITY- Eligibility Checking- Request to verify when not in system
GNP
SCRIPT IQ
PATIENT
- Online Rx Requests- Online Prescribing
- E-Visits- E- Health Record
- Office Visit Requests
- Generic Rx Pad Ordering
Relay Health
Access Express
Access Express
Access ExpressPHYSICIAN
Internet
Internet
UM DEPARTMENT- Authorization Submission- Authorization Status
ELIGIBILITY- Eligibility Checking- Request to verify when not in system
QUALITY IMPROVEMENT-HEDIS Patient Negatives
GNP
SCRIPT IQ
PATIENT
- Online Rx Requests- Online Prescribing
- E-Visits- E- Health Record
- Office Visit Requests
- Generic Rx Pad Ordering
Relay Health
Access Express
Access Express
Access Express
Web Pubilication
PHYSICIAN
Internet
Internet
UM DEPARTMENT- Authorization Submission- Authorization Status
ELIGIBILITY- Eligibility Checking- Request to verify when not in system
QUALITY IMPROVEMENT-HEDIS Patient Negatives
QUALITY IMPROVEMENT-HEDIS Performance Reports
GNP
SCRIPT IQ
PATIENT
- Online Rx Requests- Online Prescribing
- E-Visits- E- Health Record
- Office Visit Requests
- Generic Rx Pad Ordering
Relay Health
Access Express
Access Express
Access Express
Web Pubilication
MCNetCLAIMS
- Claims Submission- Claims Status
PHYSICIAN
Internet
Internet
UM DEPARTMENT- Authorization Submission- Authorization Status
ELIGIBILITY- Eligibility Checking- Request to verify when not in system
QUALITY IMPROVEMENT-HEDIS Patient Negatives
QUALITY IMPROVEMENT-HEDIS Performance Reports
GNP
SCRIPT IQ
PATIENT
- Online Rx Requests- Online Prescribing
- E-Visits- E- Health Record
- Office VisitRequests
- Generic Rx PadOrdering
Relay Health
Access Express
Access Express
Access Express
Web Pubilication
MCNetCLAIMS
- ClaimsSubmission- Claims Status
Physician Unilab Lab Results
Patient Physician Lab Ordering
PHYSICIAN
Internet
Internet
UM DEPARTMENT- AuthorizationSubmission- Authorization Status
ELIGIBILITY- Eligibility Checking- Request to verifywhen not in system
QUALITYIMPROVEMENT
-HEDIS Patient Negatives
QUALITY IMPROVEMENT-HEDIS PerformanceReports
GNP
SCRIPT IQ
PATIENT
UNILAB
Future StrategiesFuture Strategies
Online EMROnline EMRConnectivity with a RHIOConnectivity with a RHIOAdvanced AccessAdvanced Access