16. “Ask not what your
health plan can do
for you; ask what
you can do for your
health plan.”
17. partnership (noun) -ˌship
3: a relationship resembling a legal partnership and
usually involving close cooperation between
parties having specified and joint rights and
responsibilities
from: merriam-webster.com
23. • Provider programs - work with
providers to ensure nonduplicative efforts
• Member outreach - help providers with
things they can’t do well
• Clinical data - old data is worse than no
data
28. • Consistent communication plan -
providers do not like surprises
• Use multiple channels - providers are
unique, each has preferred method
• Embrace office staff - not everything
needs to go through the provider
62. 112
MARY SMITH 1/1/2011
1234567890
$5.00
$10.00
$25.00
analog to digital eligibility check
converter
63. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
64. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
BLUE SHIELD OF CA
65. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
66. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
76. 2011 Bonus Structure
PCPs: 2011 IHA P4P and HCC
CMS 5 STAR rating measures
Participation in patient satisfaction training (4 meetings)
Patient satisfaction scores (based on the CAHPS survey)
Responsiveness to PPMSI Med Management inquiries
77. 2011 Bonus Structure
Specialists: billing or SCCIPA unique patient volume
Overall achievement of SCCIPA in the CMS 5 STAR Rating Program
Participation in patient satisfaction training program (4 meetings)
Patient satisfaction scores (based on internal survey)
Use of Excelicare Clinical Hub
Responsiveness to PPMSI Medical Management inquiries (timeliness)
79. send patient reminders for annual visit
provide providers checklist
prompt front office staff HOS survey
full HCC review by hospitalists
48hr discharge follow-up
post-discharge office visit follow-up
post home health initiation follow-up
80. send patient reminders for annual visit
provide providers checklist
prompt front office staff HOS survey
full HCC review by hospitalists
48hr discharge follow-up
post-discharge office visit follow-up
post home health initiation follow-up
81. send patient reminders for annual visit
provide providers checklist
prompt front office staff HOS survey
full HCC review by hospitalists
48hr discharge follow-up
post-discharge office visit follow-up
post home health initiation follow-up
82. 5 dangerous ideas
• find ways to partner with your health
plans
• have a consistent, multi-faceted
communication strategy
• provide ample, data-driven feedback
• put money where your goals are
• focus on the whole patient