2013 10 utilizing member engagement to improve cahps scores

Editor's Notes

• #8: Healthcare Effectiveness Data and Information Set (HEDIS)
• #12: Brokers, employer groups, unions, states, and other purchasing groups now “compare the ratings” before making multi-year commitments to health care providers and health plans. Consequently, one performance misstep for a health plan (for example, a mediocre asthma care score), even if it doesn’t jeopardize accreditation, can produce a lower ranking for a health plan than its competitor. This can quickly mean the loss of significant business from a keen-eyed purchaser.
• #17: The Business Model Canvas (designed by Alexander Osterwalder) is a strategic management template for developing new or documenting existing business models through a visual language. The design is to align business activities that produce value by illustrating potential trade-offs. This method helps describe, design, challenge, invent, and pivot your business model. You can find out more about it here.
• #18: modelH is a business model canvas designed specifically for healthcare. Expanding on Osterwalder’s Business Model Canvas, modelH integrates aspects of Michael Porter’s definition of shared value, measured as the patient health outcome achieved per healthcare dollar spent. It is designed to incorporate the 3 domains of the healthcare “ecosystem”: care consumption, care delivery, and care financing. These domains are actually interdependent points of interaction along a value chain of healthcare. To impact one point, you really impact them all. modelH also accounts for the four key stakeholders across the healthcare value chain: patients, providers, payers, and purveyors.
• #22: Each healthcare organization’s journey to improve the member/patient experience (and resultant CAHPS scores is unique). It is a mistaken hope that you can just apply a discreet, tactical approach to revenue optimization. This is merely applying write processes and checklist and it will come across as insincere to you member/patient - and you will suffer for out in the customer satisfaction surveys. You also need to focus on the culture of your organization.
• #24: Improving processes that impact multiple member segments are likely to generate a larger return on investment (ROI) than initiatives targeted at specific population segments.Targeting specific populations with mailings, telephone and other forms of outreach can be effective ways to improve scores in specific, low-scoring cohortsapproach and model accounts for the size of cohorts and their relative distance to the next star level to prioritize improvement opportunities and maximize the plan’s star rating.Examples include: focusing patient education on large membership cohorts or steering patients in particular geographies toward specific medical facilitiesAssesses ongoing performance and highlights correlations across cohorts that should help develop process improvements with the broadest impact.This includes reviewing complaint patterns across medical groups and identifying a process shortcoming or systemic customer service failures particular to a providerYou may want to see how your performance has changed over time by comparing the 2012 survey results to those of previous years
• #26: Incenting providers through contract clauses and shared-risk payment model is a powerful tool to improve your own quality ratings. identifies under and over-performing cohorts (e.g., medical groups) that can be used as a fact-base to inform provider engagement and contracting decisions across the network.This could entail creating financial incentives for specific, poorly performing providers or creating profit sharing goals with a medical group based on quality ratings created from published provider report cards
• #27: Each healthcare organization’s journey to improve the member/patient experience (and resultant CAHPS scores is unique). It is a mistaken hope that you can just apply a discreet, tactical approach to revenue optimization. This is merely applying write processes and checklist and it will come across as insincere to you member/patient - and you will suffer for out in the customer satisfaction surveys. You also need to focus on the culture of your organization.
• #28: Analyses of CAHPS data have shown that beneficiaries with certain characteristics tend to report systematically higher or lower scores, even when they are members of the same contract and therefore exposed to the same level of contract quality. Notably, older patients, healthier patients, less educated members and those with lower socio-economic status (SES) tend to give higher scores than younger, sicker and more educated members and those with higher SES.This gets adjusted but it is important to know and take advantage of.Source:  2012 Medicare Advantage CAHPS Results 
• #29: http://healthcareblog.pyapc.com/articles/quality-1/For AMI patients, fibronolytic therapy received within 30 minutes of arrival? “Check.”For pneumonia patients, blood cultures performed in the ED prior to initial antibiotic? “Check.”For surgical patients, prophylactic antibiotic received within one hour of incision? “Check.”Process measures are well defined and straightforward. But when you try to apply that same checklist methodology to H-CAHPS questions, compliance plays out in a very different way that doesn’t lend itself to a simple “check, complete, move-on” mentality.Did we (specifically, nurses and doctors) always explain things in a way that patients could understand? “I gave them the required information. I think they understood.”Did we always listen carefully to patients?  “I tried to listen … most of the time … I think.”Did we always do everything we could to help with pain?  “I told her to push her call light when she needed more pain medication.”