Data and Measurement Review: Regional Feedback Reports
Q&A with BestDoctors Specialty Data Pilot
Kim Brown, Rocky Mountain Health Plans
Best Doctors Analytics
Carol Schlageck, Primary Care Partners
Part 1: CPCI Q12 Regional Feedback and Synthesis Reports
• CPC At a Glance
• Q10 Medicare FFS Expenditures for All Attributed Beneficiaries in Region, by Category of Service
• Hospital Admissions for Any Cause
• Hospital Admissions for Ambulatory Care-Sensitive Conditions
• Outpatient ED Visits
• 30-Day Unplanned Hospital Readmits
CPC At a Glance
REGIONAL SYNTHESIS REPORT: Risk-Adjusted Expenditures, Q4 – Q12
6
Source: CMS Q11 Regional Feedback Report.
$650
$700
$750
$800
$850
$900
$950
Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12
AR CO NJ NY OH/N KY OK OR National
REGIONAL SYNTHESIS REPORT: Hospital Admissions Rate, Q4 – Q12
8
Source: CMS Q11 Regional Feedback Report.
200
220
240
260
280
300
320
340
360
Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12
AR CO NJ NY OH/N KY OK OR National
REGIONAL SYNTHESIS REPORT: Outpatient ED Visits Rate, Q4-Q12
200
250
300
350
400
450
500
550
600
Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12
AR CO NJ NY OH/N KY OK OR National
11
446 64%
2,614
339,248
29
2.7 million
$791 $805
550,221
90%
82%
40%
3.5%
3.7%
7.2%
7.4%
69 48%
500
49,777 453,194
$725 $735
7.3% 2.3%
39%
10.8%
9
39,682
89%
90%
6.1%
12
Part 2: Q&A with Best Doctors
This material was prepared by TMF Health Quality Institute under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Any statements expressed by the individual and resources cited in this publication are not an opinion of, nor endorsement by, TMF or CMS.
Stratus Use Case Overview
Best Doctors Analytics
Jeremy Boyer - Director of Analytics
Rob Pitney - Director of Reporting
April 29th, 2016
Agenda
• Use Case Overview – Populations with Multiple Chronic Conditions and High PMPM
– Causes for Increased ER/1,000 Rates
– View Members with IP Stays
• Find Use Case Documentation in Stratus
Use Case Overview
Analyze The Population With Multiple Chronic Conditions And High PMPM
• Go to the Welcome tab • Click the Populations button • Go to the Pop Metrics tab • Click the Chronic Disease button • Use the mouse to draw a box around 3+ chronic diseases • Go to the Continuity tab • Click the Medical PMPM button • Use the mouse to draw a box around members having PMPM $1,000+ • Go to the Registry tab • Identify the patients • Go to the KPI tab • Click the Coordination of Care button to review their coordination of care
Use Case Overview
Analyze The Population With Multiple Chronic Conditions And High PMPM - Screenshot
Use Case Overview
Analyze The Population With Multiple Chronic Conditions And High PMPM - Take your analysis a step further!
• Compare Providers based upon their Admits per 1,000 and ER
per 1,000 • Go to the Welcome tab • Click the Providers button • Go to the Prov Compare tab • Click the ER per 1,000 button and analyze the providers • Click the Admits per 1,000 button and analyze the providers
Use Case Overview
Analyze The Population With Multiple Chronic Conditions And High PMPM - Take your analysis a step further! Screenshot
Use Case Overview
What Is Accounting For Higher IP/1,000 Rate Over the Past Year? • Important for developing better care strategies or identifying areas for reducing
costs, • Go to the Welcome tab • Click the Utilization button • Go to the Med Cost Drill tab • From the Service Category dropdown, click on the categories Inpatient and
Inpatient Visits • Hold down the Ctrl button on your keyboard to make multiple selections
• Analyze the results on the Med Cost Drill tab by Body System, Level 2 Diagnostic Category, or Facility • Are certain body systems, diagnoses, or facilities standing out for their
utilization? • Can alternative procedures be performed to reduce costs and improve
outcomes? • Can patients receive the same treatment at a lower cost facility?
Use Case Overview
What Is Accounting For Higher IP/1,000 Rate Over the Past Year? - Screenshot
Use Case Overview
What Is Accounting For Higher IP/1,000 Rate Over the Past Year? – Take your analysis a step further!
Identify the population demographics • Go to the Welcome tab • Click the Populations button • Go to the Pop Metrics tab • Click the Age/Gender button
• Are certain population demographics utilizing Inpatient services more than others?
• Select the age range of patients having the highest percentage of costs • Analyze their information in the Risk and Chronic Disease buttons
• Click on the Registry tab to identify the patients
Use Case Overview
What Is Accounting For Higher IP/1,000 Rate Over the Past Year? – Take your analysis a step further!
Identify the population demographics – Screenshot
Use Case Overview
View Members With IP Visits
• Go to the Welcome tab • Click the Utilization button • Go to the Med Cost Drill tab • From the Service Category dropdown menu, select Inpatient
Visits • If selecting multiple service categories, the results are
additive, thus saying Category A or Category B
Use Case Overview
View Members With IP Visits – Screenshot
Use Case Overview
View Members With IP Visits – Continued
• Only members with an inpatient stay are visible • Identify the top drivers for IP utilization (ex. Mental Illness) • Click on the diagnostic category • The population filters to only the patients having IP visits for
the diagnostic category
Use Case Overview
View Members With IP Visits – Screenshot
Find Use Case Documentation in Stratus
Use Case Documentation can be found by clicking here.
Open Q&A
PART 3: SPECIALTY DATA PILOT
Carol Schlageck, Primary Care Partners
Methodology
• Cohort for Pilot selected
• Data received Q8-Q11
– Specialty name
– Average monthly expenditures
Response to Pilot
• How did you use this data to help your patients, if at all?
• How can we improve this data? What more does your practice need for the data to be useful?
• Who in your practice reviewed and analyzed this data?
This material was prepared by TMF Health Quality Institute under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Any statements expressed by the individual and resources cited in this publication are not an opinion of, nor endorsement by, TMF or CMS.
Specialist Cost and Utilization Data Pilot
Primary Care Partners Carol Schlageck, Managing Associate
Specialist Cost and Utilization Data
• Specialist care has tremendous impact on the total cost of health care.
• As primary care providers, we must have access to this information to direct the most appropriate care for our patients.
• It also gives us a more comprehensive view of the patient’s overall health.
• Beginning with Q13, CMS will provide practice specific specialists cost and utilization data.
• During the pilot project, participants were encouraged to make recommendations regarding the data provided and the layout of the report.
• Suggestions were:
– Include CPT codes
– Full name of specialist instead of NPI
– Total of patients and visits by specialist instead of category.
– Elective or non-elective
• Although I have not seen the final version, the initial reports included the following data points.
Specialty
Average monthly expenditures on professonal
services
(per bene per month) NPIs ranked by:
For all attributed
patients
For attributed patients
that had a visit with the
given specialty
Total expenditures on
professonal services Total visits
Number of attributed
patients seen
Specialty overall $74.17 $133.70
Ophthamology $11.82 $21.32
1124019112 1275536138 1316150287
1275536138 1316150287 1548373343
1316150287 1861406274 1861406274
1457464257 1548373343 1770597189
1861406274 1457464257 1457464257
Orthopedic surgery $9.32 $16.80
1366478034 1124068291 1811989114
1639161979 1811989114 1780676114
1689666083 1689666083 1689666083
1780676114 1639161979 1275516486
1811989114 1780676114 1639161979
Anesthesiology $5.14 $9.26
1285776864 1740327014 1871553578
1366613440 1285776864 1699744367
1639134786 1366613440 1740327014
1699744367 1699744367 1346377355
1871553578 1871553578 1366613440
The data will likely include:
– Specialty
– Average monthly expenditures per beneficiary per month (all attributed patients)
– Average monthly expenditures per beneficiary per month (only those who were seen by a specialist)
– Total expenditures by specialists
– Total visits by specialist
– Number of attributed patients seen by specialist
Comments and Thoughts
Coming this Quarter. . . . .
CQM HIGHLIGHT’S:
• Measure Rationale
• Links to Clinical Guidelines
• Tools such as SDM
• Workflows to help guide improvement
• EMR tips/tricks
• Case Studies
Thank You!
