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Incentivizing and aligning providers 23 jul12 final
1. incentivizing and aligning providers
wayne pan, md, mba
chief medical officer
pacific partners management services, inc.
The RISE 2nd Annual Summit on Integrating Risk Adjustment and Quality Measures • Westlake Village, CA • July 23, 2012
2. ...standing
on the
shoulders
of giants
Sir Isaac Newton
89. patient
analog to digital
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90. AMERICAN HEALTH PLAN
112
MARY SMITH 1/1/2011
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91. Quality
Access Express
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Management
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92. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
93. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
AMERICAN HEALTH PLAN
94. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
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95. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
POP-UP
1234567890
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
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98. 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
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102. ACCESSEXPRESS
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SMITH, MARY
8/15/1945
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BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
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GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
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103. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
ENABLING
SMITH, MARY
8/15/1945
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FRONT OFFICE
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
STAFF
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
104. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
SMITH, MARY
8/15/1945
SIMPLE
1234567890
CARE PLAN
MAMMOGRAPHY, CRC, CARDIO CARE,
BLUE SHIELD OF CA
DIABETES CARE, HYPERTENSION,
GLAUCOMA, MED MONITOR, FLU VAC,
PNEUMO VAC, DEXA, OSTEOPOROSIS,
RHEUM, COPD
105. 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
106. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
107. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
108. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
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109. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
110. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
111. ACCESSEXPRESS
Q New Eligibility Response New Message (3)
129. When you improve a little bit
each day, eventually big things
occur. Don’t look for big, quick
improvement. Instead, seek
small improvement one day at a
time. That’s the only way it
happens - and when it happens,
it lasts.
John Wooden