In our last webinar, titled: Streamlining Your Quality Processes, our very own Bruce Carver, Associate Vice President of Payer Services, addressed the challenges and strategies needed to ensure health plans were succeeding with quality management. The healthcare landscape, especially for payers, has changed. With the introduction of MACRA and now with nearly 500,000 physicians submitting data towards it, the shift towards value is in full swing. The promotion and adoption of value-based care and the importance of quality outcomes (from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare’s Star Ratings) has moved quality from a measurement system to an operational workflow. Payers now more than ever need to create a strong quality management program by establishing processes, leveraging data and establishing best practices to properly benchmark and track their progress.
Bruce outlined the common challenges health payers face when achieving a successful, streamlined quality management program. The challenges range from inaccessible, inaccurate data to inefficient processes and workflows. The bulk of these challenges can be alleviated with organizational processes and analytics which create checks and balances to ensure quality management programs are moving in the right direction.
Today, achieving high-quality outcomes requires an all-hands on deck, year-round effort. To work towards these programs, there are a few stepping stones that will enable health plans to implement effective processes of measurement. Here are some of the key components to quality improvement:
- Continuous, objective, and systematic process for monitoring and evaluating key indicators of care and service
- Identification of opportunities for improvement
- Development and implementation of interventions to address the identified opportunities
- Re-measurement to demonstrate effectiveness of program interventions
Data Democratization at the Heart of Health Datapalooza 2017
The 8th Annual Health Datapalooza conference in Washington D.C. brought together a variety of data advocates who focused on how to harness the power of big data and put it into the hands of the people who benefit from it most: patients and providers. As part of the two-day event, one of our clients – Ian Morris, Clinical Data Interoperability Project Manager for the State of Mississippi, Division of Medicaid – presented as part of a panel titled “Health Systems Reaching Out to Patients and Providers.” During his presentation, Morris shared Medicaid’s experience of modernizing their Medicaid infrastructure and empowering real-time data sharing across all of Mississippi. In addition, Morris outlined lessons learned around interoperability and the roadmap for Medicaid’s interoperability efforts in years to come.
After the conference came to an end, we connected with Morris to discuss his experience at the event and other key takeaways. Morris shares his highlights below.
1. As a first-time attendee and presenter at Health Datapalooza, what intrigued you most about the event?
It was refreshing to hear the patient perspective. A lot of the time when you attend conferences that focus on data and analytics, you don’t get the rich patient narrative. However, Health Datapalooza took the imperative to put democratization of health data at the heart of the event. Empowering the physician and patient to take control of the data is what we’re all striving for, and that’s where organizations like Medicaid fit into the narrative. You need to understand the value of data first, and that’s where we – people such as interoperability managers – come into play. We translate that value, and once it’s understood by the provider, it can be shared externally with the patient.
2. What was a best practice that you learned from your peers and what do you hope to see at next year’s conference?
There were many presentations at the event that delved into the importance of collaborating between multiple state systems (i.e. bridging the broader health and human services, mental health and advocacy groups together) all for the greater good – improving patient outcomes via better data sharing. Such intricate collaboration efforts made me think of the initiatives Medicaid plans to embark on in the future. If there is one take away, it’s that statewide collaboration is key to better data sharing practices. My hope for next year’s conference is to have more speaking panels that touch upon just this, especially as it relates to interoperability efforts overall.
3. Other post-conference highlights that you’d like to share?
Health Datapalooza was full of energetic and enthusiastic data leaders. From patient advocates, to vendors to hands-on project managers, conference attendees and speakers embraced each other’s lessons and shared challenges of their own. Serving as a microcosm of what we’re all striving for in healthcare, Health Datapalooza reminds us that the sharing and analysis of data has a purpose – and that is ultimately to improve patient outcomes.
To read more about how Mississippi Division of Medicaid became the first Medicaid Agency to exchange clinical data summaries with their providers, read their story here. To learn more about how to act on your data and ensure quality, cost-effective care for Medicaid beneficiaries, visit our Provider Access solution here.
Best Practices for Providers Looking to Improve the Quality of Care
In all areas of healthcare, organizations are looking for innovative ways to reduce costs and improve quality. According to a new study published in Health Affairs, MACRA could reduce CMS physician services spending from $35 billion to $106 billion. MACRA is also leading the way towards quality healthcare by creating incentives and penalties for providers who leverage the program to improve quality and efficiency of care. For providers to succeed under MACRA, they must work collaboratively with payers to meet the quality objectives defined by CMS.
In order to qualify for incentives and avoid penalties under MACRA, providers have the option to choose from two payment models: MIPS and APMs. Under MIPs, providers’ performance on quality, EHR use and practice improvements will be measured this year to determine the incentives or penalties they will receive in 2019. CMS is expected to notify physicians who are eligible for the program by the end of the month. APMs give incentive payments to providers that offer high-quality and cost-efficient care and can apply to a specific clinical condition, a care episode or population.
This week, our blog shares three steps providers can take to help ensure they are successfully meeting the requirements under these programs:
- Ensure Access to the Correct Tools - In a recent blog post, John Hansel, vice president of provider solutions, notes, “CMS’ quality reporting is complicated. There are numerous requirements that providers need to meet – from patient satisfaction to Electronic Health Record reporting – which can be difficult to manage. To ensure healthcare organizations are on track with these measurements, they need to have the right tools and insights in place to meet CMS’ various measures.” As providers look to improve quality and find success with the ever-evolving quality measures, they must ensure they have the correct tools in place to find success in improving patient care.
- Work with Payers to Break Down Data Silos - Although there has been some improvement in breaking down data silos, data preparation still accounts for nearly 80% of the work included in acquiring and preparing data. This can prevent the health system from getting a holistic look at the total patient record. To steer away from these data silos, providers need to leverage their relationship with payers, who typically are the only entity that have the data required to create a holistic patient record. Payers can provide access to crucial information, including the care received when the patient goes out of network. Overall, the shift to VBC requires that payers and providers work together in this aspect.
- Adopt Technologies Aimed at Improving Quality Measures - To truly succeed in improving the quality of care for the patient, providers must adopt technologies that serve as a basis for their collaboration efforts with payers. These programs must be able to successfully measure and monitor quality measures and create data driven conversations so payers and providers are aware of how to best improve quality for their populations. MedeAnalytics’ quality management solution offer insights that enable health plans to fully understand performance on quality measures and ultimately improve quality care for members.
At the end of the day, providers should be aiming for one goal: to improve patient care. To successfully provide patients with the best care possible, providers must work with the right tools, successfully leverage payer data and adopt technologies that serve as a place for collaboration with payer partners.
For more on how your organization can best improve the quality of care for your members, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To find out how MedeAnalytics can act as a strategic partner in this journey, learn about our quality management solution here.
Lessons Learned: A look back at the 21st Annual Compliance Institute
At this year’s 21st Annual Compliance Institute, compliance executives gathered to share insights and practical advice on common compliance challenges – from auditing and monitoring to privacy and security risks. Our partners from UT Southwestern (UTSW) Medical Center were selected to present their abstract, “Designing a Successful Analytics-Based Hospital Compliance Program and Securing Cross-Department Endorsement.” During their session, UTSW’s Kate Conklin, Chief Compliance Officer and Trissi Gray, Assistant Director of health system compliance, shared their knowledge on how automation, sophisticated algorithms and analytics played key roles in improving compliance within their organization.
At the conclusion of the conference, we connected with Conklin who shared her experience at the event, including trends and notable takeaways. Below you’ll find her feedback:
1. Were there any notable trends that you were surprised to see?
The most notable trend I found during the conference was a consistent message about the role compliance plays in establishing a culture for higher and more reliable performance across the organization. I was pleased to hear that this was a common theme amongst the keynotes and speakers that challenged Compliance Officers and other leaders to partner with the C-Suite to promote a foundational culture of compliance. I gained excellent insight into different methods for translating data into useful dashboards designed to educate the organization’s executive team.
2. What were your favorite parts of the event and what do you hope to see next year?
The keynote speakers were exceptional. I left the event feeling very inspired to elevate the importance of compliance and continue to advocate for automated analytics to lessen the burden. Next year, I hope to see more real-life examples from organizations that have faced significant challenges with a qui tam relator or non-compliance that resulted in serious penalty. I’m also looking forward to hearing topics that relate to leveraging data from hotline calls and other investigations to inform the institution about the work that is being done by the Office of Compliance. I believe this type of transparency is needed to encourage more reporting and strengthening of the organizational culture to ensure that their voice is heard and their concerns will be addressed.
3. Other post-conference takeaways that you’d like to share?
It’s always nice to network with your compliance peers. As compliance executives, we find ourselves in a unique situation, as we’re tasked to mitigate readmission, identify audit risk and find cost saving opportunities. However, when you hear so many compliance leaders share their best practices and tips, there’s a true sense of innovation and progress that empowers us all to continue leading the charge in improving our own compliance departments. In sum, it was one of the best conferences I have attended!
To read more about what Kate and Trissi discussed during their speaking session – such as manual vs. automated compliance monitoring and the importance of key stakeholder engagement – read highlights from their presentation, which were originally featured on the Compliance and Ethics blog. To learn more about how to act on your data and improve compliance, read about our revenue integrity solution.
How are you Tracking to Value-Based Care?
It’s no secret that today’s healthcare landscape is changing. As costs rise and reimbursement models change, healthcare organizations are continuing to track towards value instead of volume. With this transition comes the rising importance of quality, especially since payers and providers are now dependent on quality measures for reimbursement. According to CMS, these measures are meant to quantify healthcare processes, outcomes, patient perceptions and organizations’ structure associated with providing high-quality care. This journey requires a shift in mindset and new approaches to sharing information to enable quality improvements.
The first step in improving quality of care is the collaboration between payers and providers. Bruce Carver, associate vice president of payer services at MedeAnalytics, notes the importance of this collaboration in a recent interview with Becker’s Hospital Review, explaining that there are great opportunities between payers and providers, especially around data and best practices, to enhance value-based care, such as eliminating gaps in care and driving positive outcomes.
The second step is to use data as a guide to outline areas of opportunities. As payers and providers adopt technologies that enable value-based care, forward thinking organizations are collaborating on quality management programs that serve as the basis of their efforts. These programs must be designed to not only measure and monitor quality measures, but also lead data-driven conversations so payers and providers can collaboratively improve clinical outcomes for their patient populations. Through collaboration and the power of data, both payers and providers can leverage valuable information in the following ways:
- To measure and record an organization’s performance – Both payers and providers can benefit from understanding where their organization is succeeding in providing their members and patients with quality care. Among the many measures, HEDIS and CMS Star Ratings have the greatest impact as value-based care unfolds.
- To help avoid duplicative care – Today’s disconnected provider environment means that many providers operate in silos and do not have insight into care performed by other providers. Duplicative care is not only a waste of time for the patient, but it also negatively affects the healthcare organizations’ bottom line. By taking a holistic approach to a data strategy, organizations can better work together to avoid this.
- To better identify high-risk patients – Data, combined with population health tools and predictive analytics can identify high-risk patients immediately instead of waiting months for data to be generated. Identifying these types of patients early can allow organizations to step in to create personalized, automated interventions that lower healthcare costs and improve the overall health of the patient.
As healthcare industry continues to evolve, payers and providers must look toward a future defined by positive outcomes for their patient populations. The focus on quality and value will become more deeply ingrained. To meet these objectives, organizations must collaboratively design programs that enable them to meet or exceed quality measures and pay-for-performance expectations—today and for years to come.
To learn more about how to improve quality of care for your members in today’s changing healthcare ecosystem, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To learn how MedeAnalytics can help you on this journey, learn about our quality management solution here.