incentivizing and aligning providers 23 jul12 final

incentivizing and aligning providerswayne pan, md, mba

chief medical officerpacific partners management services, inc.

The RISE 2nd Annual Summit on Integrating Risk Adjustment and Quality Measures • Westlake Village, CA • July 23, 2012

...standingon the

shouldersof giants

Sir Isaac Newton

QUESTION

ACHIEVING100%

WHY NOT?

PROBLEM

insanity: doing the

same thing over and over

and expecting different

results

from: http://step-dad.blogspot.com/2010/04/step-back.html

Let’s take astep back...

humanbehavior

somebasics

humannature

humannaturelazy

humannaturesocial

humannaturecreaturesofhabit

humannaturenotgood@change

lazysocialhabit

humannaturesocialnorms

lazysocialhabit

humannaturestatusquo

lazysocialhabit

humannaturesocialnorms

lazysocialhabit

doctornature

doctornaturecompetitive

doctornatureindependent

doctornaturecurious

doctornatureformsilos

competitiveindependentcurious

doctornaturenotgood@cooperation

competitiveindependentcurious

doctornaturenotgood@collaboration

competitiveindependentcurious

doctornaturecurious

competitiveindependentcurious

doctornaturecompetitive

competitiveindependentcurious

doctornaturecompetence

competitiveindependentcurious

doctornaturemastery

competitiveindependentcurious

leverageour nature

leverageour nature4 behavior change

assumptions aboutimprovingquality andaffordability

clinicians care about bothwant to improve bothwant feedback on both

assumptions aboutimprovingquality andaffordability

michaelvandurenmdmba

sutterhealth

variationreduction

Drug Utilization PatternDrug ADrug BDrug CDrug D

PREFERRED

NON-PREFERRED

prescribing preferreddrug increases

prescribing preferreddrug increases

average drugcost drops

prescribing preferreddrug increases

average drugcost drops

savings over baseline

accumulate

prescribing preferreddrug increases

prescribing preferreddrug increases

average drugcost drops

prescribing preferreddrug increases

average drugcost drops

no adverse effect on

quality

prescribing preferreddrug increases

average drugcost drops

savings begin to accrue

no adverse effect on

quality

how did that happen?

motivation1.0

motivation2.0

motivation3.0

MOTIVATION

Learning & Challenging Incentives & Punishmentintrinsic extrinsic

MOTIVATION

Learning & Challenging Incentives & Punishmentintrinsic extrinsic

Learning & Challenging Incentives & Punishmentintrinsic extrinsicV

reframe

easy

easyaccessible

easyaccessibledesign for failure

easyaccessibledesign for failureachievement

easyaccessibledesign for failureachievementfeedback

from: Jeanne Liedtka and Tim Ogilvie, Designing for Growth (2011)

it’smorethanjust data

it’salsoaboutwhomyourserving data to

DAT

A

savvy consumers

not currenterror proneMPASTEE

no comparator

unadulterated

nonjudgemental

showmetheDATA

“put hot triggers in the path of motivated people”BJ Fogg, PhDDirector, Persuasive Technology LabStanford University

Are incentives aligned properly?How can I increase their motivation?

Have I made it easy for people to act?How can I make it even simpler?

Are people being triggered at the most appropriate time and in their workflow (path)?

putting it all together: how does it work?

patient

patient

front desk staff

patient

front desk staffanalog to digitalconverter

analog to digitalconverter

eligibility check

MARY SMITH1234567890

1121/1/2011

$5.00$10.00$25.00

analog to digitalconverter

AMERICAN HEALTH PLAN

Click here to registerfor a password or

request more information

Powered by Access ExpressQ-v5.0.#.0.1 Build 2011.04.04.00

QualityManagementAccess ExpressTM

ACCESSEXPRESSQ New Message (3)New Eligibility Response

ACCESSEXPRESSQ New Message (3)New Eligibility Response

AMERICAN HEALTH PLAN

ACCESSEXPRESSQ New Message (3)New Eligibility Response

IN THE PATH

AMERICAN HEALTH PLAN

BLUE SHIELD OF CA

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD

POP-UP

digital to analog converter module

digital to analog converter module

x

xx

xxx

x

x

BLUE SHIELD OF CA

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD CLICK HERE

AMREICAN HEALTH PLAN

AMREICAN HEALTH PLAN

AMREICAN HEALTH PLAN

BLUE SHIELD OF CA

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD

HOT TRIGGER

BLUE SHIELD OF CA

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD

ENABLINGFRONT OFFICE

STAFF

BLUE SHIELD OF CA

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD

SIMPLECARE PLAN

BLUE SHIELD OF CA

ACCESSEXPRESSQ New Message (3)New Eligibility Response

BLUE SHIELD OF CA

SMITH, MARY

8/15/1945

1234567890

MAMMOGRAPHY, CRC, CARDIO CARE,DIABETES CARE, HYPERTENSION,

GLAUCOMA, MED MONITOR, FLU VAC,PNEUMO VAC, DEXA, OSTEOPOROSIS,

RHEUM, COPD

ACCESSEXPRESSQ New Message (3)New Eligibility Response

ACCESSEXPRESSQ New Message (3)New Eligibility Response

ACCESSEXPRESSQ New Message (3)New Eligibility Response

MOTIVATIO

N

ACCESSEXPRESSQ New Message (3)New Eligibility Response

ACCESSEXPRESSQ New Message (3)New Eligibility Response

ACCESSEXPRESSQ New Message (3)New Eligibility Response

Description ofmeasure

Capability forphysician officeentry

Capability forphysician officeentry

ABILITY

ourresults@SCCIPA

40

50

60

70

80

commercialadmits/1000

JAN10

APR10JU

L10

OCT10

JAN11

APR11JU

L11

OCT11

Milliman - Well-Managed

Milliman - Moderately-Managed

Milliman - Loosely-Managed

SCCIPA

commercialbeddays/1000

Milliman ’11 Well-Managed

Milliman ’11 Moderately-Managed

Milliman ’11 Loosely-Managed

SCCIPA

150

175

200

225

250

275

Milliman - Well-Managed

Milliman - Moderately-Managed

Milliman - Loosely-Managed

SCCIPA

JAN10

APR10JU

L10

OCT10

JAN11

APR11JU

L11

OCT11

commercialalos

2.5

3.0

3.5

4.0

4.5

Milliman - Well-Managed

Milliman - Moderately-Managed

Milliman - Loosely-Managed

SCCIPA

JAN10

APR10JU

L10

OCT10

JAN11

APR11JU

L11

OCT11

medicareadmits/1000

200

250

300

350

400

JAN10

APR10JU

L10

OCT10

JAN11

APR11JU

L11

OCT11

Milliman - Well-Managed

Milliman - Moderately-Managed

Milliman - Loosely-Managed

SCCIPA

1,000

1,200

1,400

1,600

1,800

2,000

2,200

medicarebeddays/1000

JAN10

APR10JU

L10

OCT10

JAN11

APR11JU

L11

OCT11

Milliman - Well-Managed

Milliman - Moderately-Managed

Milliman - Loosely-Managed

SCCIPA

4.0

4.5

5.0

5.5

6.0

medicarealos

JAN10

APR10JU

L10

OCT10

JAN11

APR11JU

L11

OCT11

Milliman - Well-Managed

Milliman - Moderately-Managed

Milliman - Loosely-Managed

SCCIPA

*

*

***

increase/same scores in 21 of 26 measures

anessentialaspect ofcreativity isnot beingafraid tofail- edwin land

failfast

no

When you improve a little bit each day, eventually big things occur. Don’t look for big, quick improvement. Instead, seek small improvement one day at a time. That’s the only way it happens - and when it happens, it lasts.

John Wooden

iterate

a journey of a thousand miles,begins with a single step

- Lao-Tzu

don’t beafraid totake the plunge

wpan@ppmsi.comslideshare.net/bonedoc97

Thank you!

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