What questions do you have about your clinic’s performance? And what would you do with the answers?
For Beth Harvey, MD, FAAP of South Sound Pediatric Associates in Olympia, a few questions came to mind as she examined a quarterly data report Molina provided to the clinic since they joined the Pediatric Transforming Clinical Practices Initiative (P-TCPI). She’s using the answers to improve the clinic’s performance on specific goals related to Healthcare Effectiveness Data and Information Set (HEDIS) measures.
Molina provides clinics enrolled in P-TCPI quarterly reports that show how a clinic is performing on HEDIS measures along with run charts that track improvement. Three of these measures link directly to value based payment for Apple Health in 2017.
Look at your patient panel
For South Sound Pediatric Associates, a look at the data from Molina indicated the need to resolve discrepancies in their patient panel before they could identify areas for improvement. It required a time investment to look at the clinic’s panel – patient by patient – to determine who they were really serving.
“We found that to really make sure your quality metrics are accurate you need to know if your denominator is accurate,” says Dr. Harvey. “And you don’t know that unless you dig in to the panel.” As a result of the discrepancies, the clinic’s internal metrics were saying one thing, while the MCO metrics were saying another. Even if practices are not notified when patients are added to their panel, those patients still affect a clinic’s performance on HEDIS measures.
Effect on payment
A few of the discrepancies could be chalked up to coding errors, but much of the discrepancy was due to the patient panel being inaccurate. As the state moves toward value-based payment, those discrepancies will affect the clinic’s payment, so it is worth the effort to resolve any differences and ensure accuracy going forward.
“Now that our internal data is accurate we have a very smooth workflow,” says Dr. Harvey. “We have a protocol when people move.” The clinic has implemented processes to keep their information up to date, and in doing so to improve their percentage of well checks. Some routine ways to keep information accurate:
- Update records as part of your process for reaching out with reminders of well checks.
- Keep tabs on patients under 2 years old, and when they come in for their well checks schedule the next visit.
- Teens will need to come in over the summer for immunizations or sports physicals, so start calling them now to remind them. In just over a year, well visits for patients 12-21 years have gone up by 6% at Dr. Harvey’s clinic.
- Use a spreadsheet to calculate how big your panel should be for each provider in the practice and communicate that information to MCOs.
South Sound Pediatric Associates is also tracking emergency department and urgent care utilization, and is working to improve their Combo 10 immunization rates. In less than a year they have been able to bring ED utilization down by a third. A closer look at the immunization data showed that their rates on flu vaccine were bringing the whole number down. Now that they know where to target their efforts, they expect to see continued improvement.