New Beacon Scorecard

Beacon Scorecard 2015

The new Beacon Scorecard was released May 1st. In addition to completely redesigning our previous dashboard, there are some important new features and metrics we would like to bring to your attention:
QUAC scores – QUAC is our unique overall population health metric and remains intact displayed with its components broken down. Of note, please check the focus period in the table under the # of attributed lives… and this metric can also be seen in your profile in our directory.
Under the “This Quarter” row which shows your current scores you will see:
Last Quarter: your score on the last report date
Beacon Average: the average score in Beacon
You vs. Beacon: how you compare to the Beacon average. Please note that context is important. For instance, Quality is a metric where higher scores vs. Beacon average are desirable… whereas, higher than average costs are less desirable for Admits and Cost.
Your Percentile: where you rank compared to your peers 1-100 (100 percentile is top)
Your Points: Each category Q, U, A, C is worth a maximum of 25 points. The U and A categories are broken down to 12.5 points each. All of the metrics except for Quality are given points via the following equation: Your Percentile X # max points. Quality points are generated by this equation: This Quarter X 25
For example if you score in the 70th percentile (70%) on Re-admissions, your points for that category would be 0.7 x 12.5 = 8.75 points.
QUAC TOTAL SCORE = summation of all the “Your Points” category in the row
YOUR QUAC Rank is given and n is listed. N= # qualifying docs with >50 lives
QM Completion and QM Performance are as they were previously. This data can be seen on the Beacon – Health Endeavors dashboard.
Risk Adjusted Non-PCP touches per attributed life – this is a new metric we have added starting May 2015. We risk adjust your patient panel and come up with a # of provider visits (excluding yours) that the average patient in your panel is generating. Then this is compared to the Beacon average to see where you are in relation to others in the Network.
Beacon Engagement Index – this is a metric we are using for Kinship (along with EMR and PCMH). Kinship is responsible for the K in the QUACK score which is a part of your shared savings distribution. You are awarded engagement points by doing various activities such as attending meetings, events, downloading the app, reading newsletters, etc. We then divide the range (low to high score) by 4 and break it into quartiles (1=top quartile).
Domestic Utilization is a composite metric:
50% “Provider”: this is outpatient office referrals
50% “Facility”: this is for in-network facilities. At this time, we are using CHS in-patient admits.
Your Score and the Beacon Average are shown in the box on the right. The average of your scores is brought to your “This Quarter” score under U in the QUAC scoring.
BCBS / United-Oxford / Aetna:
Here you will find your attributed lives per contract and progress with your gaps in care through the date range under the heading. Your provider relations representative will be regularly providing you with this data, but if there is any question you can always reach out for further clarification.
Please contact your Provider Relations representative if you have any questions about your data. If you have any general questions, comments or suggestions regarding how we can further improve these Scorecards, please let us know

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Health Affairs Blog: Health Information Technology: Where We Stand and Where We Need to Go

Health Information Technology: Where We Stand And Where We Need To Go

Posted By Karen DeSalvo On April 24, 2015

Editor’s note: Below, Karen DeSalvo, MD, MPH, MSc, the National Coordinator for Health Information Technology, discusses her view of the health information technology landscape. She outlines an agenda for her office that includes incentivizing interoperability, “standardizing standards,” and establishing shared expectations and actions around data security and privacy. This post is based on Dr. DeSalvo’s presentation at the Health Information and Management Systems Society 2015 annual conference last week.

I am optimistic about the bright future we have to leverage health information technology to enable better health for everyone in this country.

One year ago, we called upon the health IT community to move beyond adoption and focus on interoperability, on unlocking the data, so it can be put to the many important uses demanded by consumers, doctors, hospitals, payers, and others who are part of the learning health system.

ONC spent the year listening to the health IT community to understand the challenges and opportunities and developing strategic roadmaps to guide our way. Our goal was to evolve to be best able to lead where appropriate, and partner wherever possible, as we all shift the national strategic focus towards interoperability. I hope you all have felt that shift.

Listening To Our Partners

While developing the new strategic focus and plans, my team and I have also worked with and listened to our federal partners and with the states.

I personally had the chance to host or participate in nearly two dozen listening sessions across the country. In those sessions I was able to hear from people on the front lines about what matters most to them. I became increasingly optimistic as I heard how committed people were to seeing that we would leverage health IT to the advancement of everyone’s health.

These listening sessions also reminded me that we would need to meet communities where they are. In Alabama, adoption is still being debated, and, like many communities in this nation, they have challenges like lack of broadband access for rural communities. In New Jersey, I heard that close proximity of major metropolitan areas from bordering states brought to light the issue of differing state privacy laws as a barrier to appropriate data flow.

In the Silicon Valley, the entrepreneurial community is moving past the notion of an electronic health record and is thinking about the next phase: person centered health records and the internet of things. In Minnesota, a history of collaboration showed me that when we let go of our own interests, communities move further when they work together instead of against each other, and we can put priorities like the public’s health at the top of the agenda.

We also had the opportunity to participate in a series of Robert Wood Johnson Foundation hosted listening sessions as part of their Data for Health initiative. Their convenings brought to the table community-based organizations and members whose voice is not as often heard in health IT policy and planning. What we heard was the importance of trust, data access, and how individuals and communities want to use data to improve overall health.

I also listened to my own experiences — as a doctor, as a daughter, and as a consumer. I thought of countless patients whom I have seen and those I continue to see when I am in clinic. Of visits where I did not have the information needed to make a decision that day, requiring patients to return and miss work, school, or other obligations. Of patients who want to engage and feel empowered but need not only data, but information, to help them level the playing field, to allow them to meaningfully engage.

Of being a caregiver for a mother dying of dementia and being frustrated at just how hard it was to get access to the information I needed to help her. And, as a public health advocate and official, needing information about my community to prioritize resources to help them address the broad determinants of health.

In the end, we have heard loudly and clearly that there is an intense pressure and impatience to continue the great progress we have made in digitizing the care experience and get to a place where every American has access to their electronic health information when and where it matters to them. ONC remains steady and unwavering in that vision.

What We’ve Accomplished

Indeed, that was the vision more than a decade ago when President Bush signed an executive order and asked David Brailer to stand up the Office of the National Coordinator for Health Information Technology. In 2009, Congress codified our role in the HITECH statute, and we carry out those responsibilities every day on behalf of the people of this country.

The flurry of work in the six years since HITECH passed brought significant advancement in the goals. The combined effort of the grant programs like the Regional Extension Centers, the ONC certification program and the Medicare and Medicaid EHR Incentive Programs – brought us to a tipping point. Today, we know adoption is strong. It is such an accomplishment from just six years ago.

This is an incredible achievement that results also from the hard work of those on the front lines. I know this is hard work because of my own first-hand experience in selecting and implementing and using electronic health records in the clinical environment — I know this is no easy task. It requires not only personal commitment but also organizational commitment, changes to workflow and culture.

Our nation’s success in adoption, and even the success we see in the increasingly widespread availability of exchange of health information, is just the beginning. To quote a member our advisory committee, the glass is indeed half full. But when you step back for perspective, it’s still a small glass. That means that we have much work to do to digitize the care experience across the entire care continuum, but also to see that we achieve true interoperability — not only exchange.

Planning For The Next Chapter

Our first step to guide all of our work in the next chapter was to lead the refresh our federal strategic direction on health IT. This was done with more than 35 partners ranging from CMS to FTC to VA/DoD and others. Why? Because the world has evolved since our last strategic plan was issued five years ago. We needed to take a moment to see that we were moving in a direction that was in synch with the marketplace and consumer expectation and to give certainty about our federal policies and approaches.

What became clear quickly was that we needed to develop a strategic approach that would leverage health IT including but beyond EHRs using levers beyond MU to bring not only better care but better health.

A key priority was to lay out a plan for how the public and private sector could work together to achieve interoperability. Systematically, with short term success but with an eye on a clear glide path to the future vision of a learning health system — one where data, shared with appropriate consent, can inform continuous improvement in health care and health in real time.

The country asked for a plan to get to interoperability and that learning health system. We delivered one. I am optimistic that we have hit the mark with the interoperability plan. From the broad feedback we received, we heard agreement that this plan is the right path forward. I am not surprised by this feedback because as we did this work over the last year we listened and sought practical solutions that would work in the real world.

Getting To Interoperability

To get to interoperability as quickly and safely as possible we need to build upon the current infrastructure and to pursue three critical pathways:

  1. First, we need to standardize standards, including APIs, and implementation standards.
  2. Second, we need to have clarity about the trust environment — what are the shared expectations and actions around data security and privacy?
  3. And third, we need to incentivize—in a durable and sustainable way—interoperability and the appropriate uses of electronic health information — all with the goal to advance health care and health.

And now we must act on our roadmap, our plan. For the ONC’s part, we put out our first deliverable which was our Interoperability Standards Advisory. Clear expectations about what standards we should all use.

To define the trust environment, we are working with states on one of their top priorities: harmonizing privacy policy and regulations, and we have been working on defining the rules of the road for governance and how to hold people accountable to them.

We also released a report on information blocking last week that gives a clear definition of blocking and recommends actions in hand, gaps in authorities where we look forward to working with Congress on solutions.

We are committed to leveraging not only Meaningful Use, but also CMS payment rules, the Department of Defense in their acquisition of health IT and other federal program incentives to incentivize the use of those standards and that trust environment.

We intend to use all of the most impactful and appropriate tools in our toolbox and have called on the private sector and states to do the same. Congress is our partner; I am excited to see their interest in making sure that health data is available for consumers, and our doctors, when and where it matters most.

I am optimistic because I am seeing collaboration like never before from the private sector — look at the Argonauts—the coalition of technologists and developers who are collaborating in an unprecedented fashion—who are accelerating the maturation of FHIR, to see that we have a safe, but highly usable new technology that stands to transform the health IT ecosystem.

The Ultimate Goals: Better Care And Better Health

Interoperability is a priority but is really only a means to an end. What we are moving towards is a world in which health IT and interoperability enables better care and better health. This is a community goal, and this is clearly our goal at HHS. Secretary Burwell has embraced the importance of health IT and interoperability as central to delivery system reform and one of her top priorities.

HHS and the Administration have laid out a framework to get to better care, smarter spending and healthier people—this delivery system reform initiative that I have the honor to co-lead on her behalf—is leveraging the three pillars of changing the way we pay for care, deliver care, and make information available to inform care and health.

We know for a fact that unless we have the health information technology, including interoperability right, we will not bring payment reform or better care models like the medical home to scale.

As we act on this vision, we have an ongoing cadence of work ahead. We will need an unprecedented amount of cooperation, collaboration, and transparency to see that there is the best public private partnership possible. We will build upon our strong foundation, using the tools and technologies in hand, systematically but with urgency. I am optimistic that together, we can reach our vision — that we are within reach of every American having access to their electronic health information when and where it matters most to them.

Blue Cross Blue Shield Freestanding Patient Centered Care Measures

The Beacon Health Partners, CHS, Blue Cross Blue Shield Shared Savings Program Contract has been completed for attribution for our Blue Cross Medicare Population. This new program is referred to as the Freestanding Patient Centered Care (FPCC) Program. The Gap in Care report has been sent to Beacon Physician offices quarterly from the Beacon CareNation Department.  This may have happened prior to your association.  It involves a list of patients that have missing claims (i.e. tests, screenings, medication refills, etc.). The goal is to see these patients – or refer them when appropriate – to have these tests/screenings completed.  When the event is billed, the patient Gap will close and your list will grow smaller. Here are some additional measures, specifically targeted to the Medicare population. These measures include:

  1. Adult BMI Assessment
  2. Functional Status Assessment
  3. Pain Screening
  4. Diabetes Care-Blood Sugar Controlled
  5. Medication Review
  6. Controlling Blood Pressure

These measures are considered “enhanced” and closing these Gaps will be of great benefit in gaining “points” towards our Shared Savings. In order to close these Gaps, a CPT II code must be used when billing.  you will find a BCBS CPT Coding Cheat Sheet for all of the Blue Cross Blue Shield Gaps in Care. Additionally, we have provided a standardized Functional Status Assessment called the Katz Index, and a Pain Scale that can be used to document the completion of these measures. You do not have to use these tools if you have a mechanism built into your EMR that will record this data. Finally, you can access your reports on demand through the use of Availity – a tool typically used in the offices to check eligibility. If you already have Availity access, you can provide Beacon with your username and we can enhance your viewing rights to include these Blue Cross Gaps as well as other clinical information on your patient population. If you have any questions regarding these new measures or would like additional tools to assist in the process, please do not hesitate to contact the Beacon Health Partners CareNation Department at 516-570-3580.

The Keepage Conundrum

Why Domestic Utilization is So Important

Our mission is to accomplish the triple aim of healthcare while developing a culture to support and create increasing value for physician practices in our community. Through healthier patient and physician practices, Beacon’s ultimate goal is to achieve a healthier population.

That is our mission. But, what do we mean by developing a “culture to support and create increasing value for physician practices in our community”? Well, there are many ways in which we try to bring our physicians value. We do this with our managed care contracts in the form of enhanced rates tied to quality, shared savings opportunities, consultative services that improve office workflow, decreasing practice costs by brokering a host of strategic partnerships, educational opportunities through Beacon University… but, another way to bring value to Beacon physicians is by increasing our domestic utilization (DU). Improving domestic utilization is also known as increasing “keepage” (or decreasing leakage). Frankly, we have struggled in this area. We simply need to do better (Figure 1).

Figure 1. Domestic Utilization at Beacon. MSSP 2014 data.

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WHAT IS DOMESTIC UTILIZATION?

Domestic utilization (DU) is defined as the amount of healthcare utilization that occurs within Beacon. This includes referrals to Beacon physicians, and Beacon in-network hospitals and facilities. Our goal is to markedly improve our domestic utilization.

8 REASONS WHY IS DOMESTIC UTILIZATION IMPORTANT

  1. Beacon Community Growth- With more consistent use of Beacon providers and facilities, communication channels, data exchange and comfort all increase. Coming closer together or becoming a more tightly-knit community increases our chances of executing on all our initiatives.
  2. Beacon Physician Economics– increased use of Beacon providers drives the right volume and revenue to our members. When our population utilizes non-Beacon physicians, we, quite literally, miss out on millions of dollars. Our practices would be better off financially if more of the necessary utilization and associated healthcare spend was kept within the Beacon family.
  3. Beacon Partner Value- increasing the use of in-network facilities and hospitals not only improves the health of our partners, it can improve communication and transitions of care. This can lead to better, more efficient care that benefits our patients, our physicians and the entire organization. Also, the more value we create for our partners, the stronger and mutually beneficial our partner network becomes, and we are better positioned to engage in additional strategic partnerships.
  4. Recruiting Advantage- The attractiveness of “keeping it in the family” extends beyond our existing network. Just as many of our current providers would prefer more intra-Beacon referrals; potential new members would find high domestic utilization to be a very appealing feature of Beacon. This would help in our efforts to recruit and grow our network.
  5. Higher Quality- Beacon has high quality standards and outcomes. We are excelling on many quality measures and are actively closing clinical care gaps. Keeping patients within Beacon is likely to lead to even higher quality as we work together in a more coordinated fashion on shared quality initiatives.
  6. Population Health Outcomes- It is easier to manage patients in our population if the patients are kept within our network. Relationship building between Beacon physicians and in-network facilities will yield greater efficiency and improved outcomes. Additionally, higher DU results in enhanced interaction with Beacon CareNation and the rest of the Beacon support team.
  7. Shared Savings Bonus Growth- The better we manage our population, the more likely we are to realize greater savings, which may lead to higher shared savings bonuses for everyone. Moreover, non-Beacon providers and facilities are often more costly. So, in addition to adversely affecting our ability to manage our population, non-domestic utilization may have a higher per unit cost, which eats into a potential savings bonus.
  8. Improved Managed Care Contracts- Realizing higher quality, generating more savings within in a bigger, tighter knit network would send a powerful message to the managed care payors. Our success in this endeavor could allow us to achieve even bigger, better managed care contracts for everyone.

These benefits are related and build upon each other (Figure 2).

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Figure 2. The Virtuous Cycle of Domestic Utilization

HOW ARE WE MEASURING DOMESTIC UTILIZATION?

We are using our population risk management tool, Crimson (CPRM) to comb through our Medicare claims data on an ongoing basis. Each expenditure is categorized as either domestic or non-domestic, according to the source of the claim. We have created a metric which we are now tracking for the organization as well as for individual physicians who are attributed lives in the MSSP. Our goal is to increase utilization within the Beacon network.

HOW ARE WE USING DOMESTIC UTILIZATION SCORES?

The domestic utilization scores are presented in the dashboard of physicians who have more than 50 attributed MSSP lives. DU makes up 50% of the overall utilization score in the QUAC metric (the other 50% is emergency room utilization). Higher DU leads to higher QUAC scores and higher QUAC scores lead to higher shared savings bonuses for the member. See our QUAC and Shared Savings Distribution videos.

WHAT IS NEXT AND HOW CAN YOU HELP?

Expect data driven feedback (tracking DU scores) and a greater organizational emphasis on increasing domestic utilization. We have also had some preliminary discussions with physicians to solicit feedback and participation in a DU Task Force to tackle this issue head on. If you wish to join us, please contact me at sprince@beaconaco.com.

The Beacon Remedy

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Beacon Health Partners has a remedy for what’s ailing health care.

The implementation of the Affordable Care Act and years of change in the healthcare industry have resulted in a trend toward hospital consolidation. Many private practice physicians have found it beneficial to become acquired by a hospital system, where they forgo independence to eliminate the burden of navigating a new and confusing atmosphere.

Some primary and specialty practices have held out against the wave of consolidation, preferring to remain independent. Yet, many of these practices report difficulties keeping up with the latest information technology, regulatory requirements, and administrative details. That’s where a strategic partner like Beacon comes in.

The most important question remains: How will changes in the healthcare industry ultimately affect patient care?

Beacon Health Partners seeks to reconcile to physicians the benefits of remaining independent while offering them much-needed support that serves the very purpose of the healthcare industry: providing high quality, cost effective patient care and ultimately realizing a healthier population.

Beacon Health Partners operates a three-pronged approach, focusing on creating healthier physician practices and healthier patient practices, in an effort to improve population health. By taking both pragmatic and innovative steps to accomplish its vision, Beacon brings a new and exciting solution to the realities of modern healthcare.

The benefits to participating doctors are manifold. In addition to shared savings opportunities and enhanced rates linked to quality efforts, Beacon offers its physicians group purchasing rates for medical supplies, consultative services for more efficient administration, including improved office workflow and experienced digital integration, free leadership training and special educational programs that enable them to deliver better care more efficiently while increasing their profitability.

There is a collaborative effort for patients in Beacon Health Partners between a patient’s current care providers and the Beacon care team to maximize health. This manifests by improving medication and preventive screening compliance, better communication across the continuum of care, easier access to their doctors, reduced out of pocket spending resulting from fewer encounters with the healthcare system, and better health education. A result of this attention leads to a significantly improved patient experience.

Through the creation of a robust collaborative network, the positive impact Beacon Health Partners has on the overall population is evidenced by an increase in quality care, fewer gaps in care for its entire population, and easier and more effective data sharing through a more complete infrastructure. The result is greater population oversight with fewer patients falling through the cracks. Under this model, the transition from disease-driven care to a focus on prevention and wellness has the potential to transform the way we live in a very real way.

Beacon Health Partners is excited to take the healthcare industry into a new realm, helping to heal a broken system so that doctors can do what they’re here to do: deliver the best possible care to their patients.