dollars and sense - spectramedix ebooks/dollars … · dollars and sense leveraging hedis and mips...
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Dollars and Sense
Leveraging HEDIS and MIPS Measures to Optimize
Performance for Your Network
October 18, 2018
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2
Chris Bethell
VP, Marketing and Client Relations, SpectraMedix
Raj Lakhanpal, MD
CEO SpectraMedix
TODAY’S PRESENTERS
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1. Objectives | About Us
2. Measures Overview
3. Moving the Dial on Performance
AGENDA
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OBJECTIVES
Understand how expanded measures
calculations can help health plans like
yours:
1. Get a better view of care across your
population
2. Drive more timely interventions
3. Direct focused improvement efforts
on high cost/high return areas of care
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About SpectraMedix
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MISSION
Help payers and providers thrive in the VBP world.
We do this by providing a powerful platform that delivers
advanced data management, analytics, and populations
profiling—across clinical, operational, financial, quality,
and socioeconomic domains.
MEASURES CALCULATION,
REPORTING & ANALYTICS
POPULATION LEVEL RISK MODELING & PROFILING
MASTER DATA MANAGEMENT, EMPI
The SpectraMedix
Platform
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• A seasoned team of clinicians, informaticists, and
technologists with deep healthcare expertise
• Well established with a highly secure platform to
address the diverse performance improvement
requirements across the VBP ecosystem
• Supporting the diverse needs and requirements
within the payer and provider domains across
Medicaid, Medicare, and commercial markets
WHO WE ARE
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THE SPECTRAMEDIX PLATFORM™
• End-to-end enterprise data management.
• Field-validated in NY Medicaid transformation.
• Serving provider environments across the US.
• Agile data acquisition and normalization system.
• Powerful measures authoring, calculation,
and reporting.
• Advanced functionality for a wide span of
performance improvement and populations health
management efforts.
• HIPAA-compliant Microsoft Azure environment.
• Drives applications across numerous payer and
provider domains.
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© SpectraMedix, 2009-2018. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
MEASURES
OVERVIEW
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HEDIS MEASURES
HEDIS measures are the gold standard
• HEDIS reported for 184M patients
• CMS covers 75M patients
• Employer based/private covers 100M+ patients
HEDIS measures:
• Help define quality
• Help ascertain the quality of care providers and health
plans provide to members
• Are used by CMS
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DEMYSTIFYING MIPS
• Calculated monthly from clinical data
• Drill down to a deeper clinical level
• Some MIPS measures are HEDIS measures
• MIPS can provide timely insights for earlier
interventions
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ACCELERATING PERFORMANCE IMPROVEMENT
• HEDIS “proxy” measures and other measures can be
utilized to get more timely results to:
o Provide a 360 degree view of healthcare status
o Gain provider network performance insights around
quality and cost
o Close Gaps in Care
• Clinical disciplines that can impact performance
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© SpectraMedix, 2009-2018. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
MOVING THE DIAL ON
PERFORMANCE
Three Use Cases
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USE CASE ONEEXPANDING CLINICAL INSIGHTS
Look at whole landscape
• Understand things in full clinical context to
help direct my initiatives
• Enact initiatives I would be unable to
otherwise
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USE CASE TWOTHE VALUE OF TIMELINESS
FLU VACCINATIONS
• HEDIS will not help identify those that need flu
vaccinations
• Need proxy or MIPS measures that enable timely
interventions that impact quality and cost
• Compare/contrast with chronic disease?
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USE CASE THREETARGETING SPECIALTY CARE AREAS
• Determine what areas in the care environment can
provide a bigger care improvement impact
• Need broader set of measures and more timely
access to a more diverse set of data to truly
intervene
• Help prioritize intervention efforts
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Improving these HEDIS domain outcomes with clinical data/MIPS measures
• Effectiveness of Careo Ex., Controlling HBP
• Access/Availability of Careo Ex., Adult Access to Preventive/Ambulatory Services
• Experience of Care• Utilization and Risk-Adjusted Utilization
o Ex., Mental Health Utilizationo Ex., Plan All Cause Readmission
• Health Plan Descriptive Information• Measures Collected Using E-Clinical Data Systems
o Ex., Unhealthy Alcohol Use Screening & Follow-up
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MEASURES AND VBP
Payers increasingly rely on measures to build VBP models and contracts.
Goals:
• Boosting patient & provider engagement• QI – preventive health screening, patient
satisfaction and follow up • Outcome & cost
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THANK YOU
For more information visit spectramedix.com.
You’re doing great work!
Or contact Nathan Brown directly:
609-336-7733 Ext. 308 / [email protected]