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Dollars and Sense
Leveraging HEDIS and MIPS Measures to Optimize
Performance for Your Network
October 18, 2018
2
Chris Bethell
VP, Marketing and Client Relations, SpectraMedix
Raj Lakhanpal, MD
CEO SpectraMedix
TODAY’S PRESENTERS
1. Objectives | About Us
2. Measures Overview
3. Moving the Dial on Performance
AGENDA
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
About SpectraMedix
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
• 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
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.
© SpectraMedix, 2009-2018. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
MEASURES
OVERVIEW
PAGE 11
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
PAGE 12
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
PAGE 13
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
© 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
PAGE 15
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
PAGE 16
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?
PAGE 17
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
PAGE 18
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
PAGE 19
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
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]