what are some business questions related to the patient careflow journey
Contents
6.A. Overview of Strategies
Appendix 6a. Crosswalk of Patient Feel Domains and Survey Measures
Appendix 6b. How Wellness Plans Tin Drive Improvements at the Medical Grouping Level
References
half-dozen.A. Overview of Strategies
The steps you lot take to appraise patient experience with care in your system and explore what is driving those experiences will enable the quality improvement team to identify opportunities to ameliorate and establish goals. As discussed in Section 4 of this Guide, the next pace in the quality comeback process is to place possible strategies. Your squad may accept several ideas for improvement strategies based on its evaluations of care delivery processes and input from stakeholders. To supplement and help to organize those ideas, this department presents selected strategies for improving the experiences of patients and enrollees as measured by the CAHPS surveys.
The strategies are intended to address the various topics covered by CAHPS surveys of ambulatory intendance, with an emphasis on the three cadre survey domains of access to health care, advice, coordination of care, and client service. Tabular array 6-1 lists xvi strategies you could consider and the survey topics they address. Appendix 6a provides a crosswalk of these topics and the measures derived from different CAHPS surveys (all of which are variations on the CAHPS Health Plan Survey or the CAHPS Clinician & Grouping Survey).
These strategies represent a range of possible solutions. Some are easy and inexpensive to implement, while others are more logistically complex and require a significant investment of money, fourth dimension, and other resources. If your team wants to pursue a more intensive strategy, information technology can aid to "outset pocket-size" past breaking down the strategy into smaller components and tackling 1 component at a time. As well, some strategies may allow you to see results right away, while others may require time to make a measurable departure; your team will demand to work with the organization's leaders to decide which approach would be best.
Finally, it is of import to note that these strategies are directed at dissimilar audiences. Some strategies are aimed at physician practices and medical groups because they address aspects of care that happen in the doctor's function, such as admission to care (east.g., scheduling appointments and receiving timely care and information), communication betwixt providers and patients, interactions with part staff, shared decision making, and self-management back up. Other strategies address experiences within the domain of health plans, such as fellow member services, information to manage health care and costs, and wellness promotion and education. For some strategies, both health plans and provider groups accept a function to play, even if 1 is more "responsible" than the other for an aspect of patient experience. Health plans, for example, tin can equip providers with the skills, tools, and information systems they can utilize to improve their communication with patients. Health plans can also play a very of import role in motivating medical groups, practices, and individual physicians to improve patient experience. Appendix 6b discusses three means in which health plans can harness reporting and purchasing strategies to focus attending on the experience of care.
Tabular array 6-ane. Improvement Strategies Organized by Topic
| Strategy | Access to Care & Information | Communication with Patients | Coordination of Care | Client Service | Health Promotion/Education |
|---|---|---|---|---|---|
| Open Access Scheduling for Routine and Urgent Engagement (6.A) | Ten | ||||
| OpenNotes (vi.C) | 10 | X | X | ||
| Internet Access for Health Data and Advice (half-dozen.D) | X | 10 | |||
| Rapid Referral Programs (6.East) | X | X | |||
| On-Demand Advice, Diagnosis, and Treatment for Minor Health Weather (half-dozen.F) | Ten | X | |||
| Training To Advance Physicians' Communications Skills (half dozen.Thou) | Ten | X | 10 | ||
| Tools To Help Patients Communicate Their Needs (6.H) | X | X | |||
| Shared Controlling (vi.I) | X | X | |||
| Support Groups and Self-Intendance (6.J) | X | ||||
| Cultivating Cultural Competence (6.K) | X | ||||
| Planned Visits (half-dozen.50) | Ten | X | 10 | ||
| Group Visits (6.M) | 10 | X | Ten | ||
| Toll Transparency (6.North) | X | ||||
| Service Recovery Programs (6.P) | X | ||||
| Standards for Customer Service (half dozen.Q) | X | ||||
| Reminder Systems for Immunization and Preventive Services (half-dozen.R) | X | X | X |
What You Can Learn Well-nigh Each Strategy
The descriptions of each strategy are intended to provide enough information to determine whether the strategy is pertinent and claim farther investigation by your team. Specifically, each description covers the following:
- The problem addressed past the strategy (i.e., its connection to the patient'southward or enrollee'due south feel with health care services).
- An overview of the strategy.
- Benefits of the strategy.
- How the strategy can exist implemented.
- Challenges of the strategy.
- Examples.
- Available resources for more information, including journal manufactures, websites, and books.
Render to Contents
Appendix 6a. Crosswalk of Patient Experience Domains and Survey Measures
The tables below listing composite measures derived from the standard items in each survey, i.e., the items included by every user of that specific survey. Many other topics, including some of the domains in the left column, are covered past supplemental items that users tin choose to add to their surveys. The tables do not include the global rating measures.
Table vi-2. Domains and Blended Measures in Electric current Versions of the CAHPS Clinician & Group Survey (as of Winter 2017)
| Domains for Patient Feel | Clinician & Group Survey 3.0 | CAHPS Surveys for Accountable Care Organizations (ACOs)*,** | CAHPS for Medico Quality Reporting Organization (PQRS) Survey** |
|---|---|---|---|
| Access to care | Getting Timely Appointments, Care, and Information | Getting Timely Appointments, Intendance, and Data (nine & 12) Between Visit Communication (12) | Getting Timely Appointments, Intendance, and Information Between Visit Advice |
| Communication | How Well Providers Communicate with Patients | How Well Providers Communicate (9 & 12) | How Well Providers Communicate |
| Part Staff | Helpful, Courteous, and Respectful Office Staff | Courteous and Helpful Function Staff (9 & 12) | Courteous and Helpful Function Staff |
| Coordination of care | Providers' Use of Information to Coordinate Patient Care | Care Coordination (12) | Care Coordination |
| Self-direction | Talking with You About Taking Care of Your Ain Health (from the Patient-Centered Medical Home Detail Set) | Helping You Take Medications as Directed (12) | Helping You lot Accept Medications as Directed |
| Shared decision making | (not included) | Shared Decision Making (9 & 12) | Shared Decision Making |
| Wellness promotion and teaching | (not included) | Wellness Promotion and Education (nine & 12) | Health Promotion and Education |
| Access to specialists | (not included) | Access to Specialists (9 & 12) | Access to Specialists |
| Toll of care | (not included) | Stewardship of Patient Resources (9 & 12) | Stewardship of Patient Resources |
*In 2016, CMS accepted results for two versions of the ACO Survey: ACO-9 and ACO-12.
**Health Condition/Functional Status is non included as a composite measure for the purposes of this table because the questions are non asking nigh the patient's experience with care.
Table six-3. Domains and Measures in Current Versions of the CAHPS Health Plan Survey (as of Winter 2017)
| Domains for Enrollee Experience | Health Plan Survey v.0 | Medicare Reward CAHPS Survey | Qualified Wellness Plans (QHP) Enrollee Survey |
|---|---|---|---|
| Access to intendance | Getting Needed Intendance Getting Care Quickly | Getting Needed Intendance Getting Appointments and Care Quickly | Getting Needed Care Getting Care Quickly |
| Communication | How Well Doctors Communicate | Doctors Who Communicate Well | How Well Doctors Communicate |
| Client service | Wellness Plan Client Service | Health Programme Data and Client Service | Wellness Program Client Service |
| Coordination of care | (non included) | Care Coordination | How Well Doctors Coordinate Care and Proceed Patients Informed |
| Cultural Competence | (non included) | (non included) | Getting Information in a Needed Language or Format |
| Admission to Information | (not included) | (not included) | Getting Information about the Health Plan and Cost of Intendance |
| Costs | (not included) | (not included) | Enrollee Feel with Costs |
Return to Contents
Appendix 6b. How Health Plans Can Drive Improvements at the Medical Group Level
Many of the measures in the CAHPS ambulatory surveys address bug outside of the direct command of wellness plans, considering the locus of the care or service lies at the medical group or practice level. Withal, health plans can exert some influence on medical groups and individual physicians, encouraging and motivating them to better the patient'southward experience in the doctor's office. The degree of influence a plan can exert depends in part on the structure of its relationship with its provider network. Wellness plans that own md practices and/or employ physicians, and those that have an exclusive relationship with their contracted providers, tend to have more than influence than those that business relationship for simply a small share of a medical grouping'due south patients.
This section outlines a few ways in which wellness plans can encourage medical groups and doc practices to take steps to improve patient feel:
- Public Reporting on Provider Performance
- Private Feedback on Provider Functioning
- Value-Based Payments
Return to Contents
6b.ane. Public Reporting on Provider Performance
Public reporting on provider performance tin can assist patients make more informed choices about which health systems, hospitals, medical groups, and individual physicians all-time meet their needs. In addition, making such data publicly available encourages providers to engage in quality improvement activities in areas where their performance lags.1-five
Public Reporting Can Stimulate Comeback
Since initiating public reporting of patient survey scores and patient comments nearly physicians, the University of Utah Health Care has seen a significant increase in physician communication scores, from the 35th percentile in 2010 to the 90th percentile in 2014. Public reporting has too led to a doubling of website traffic.*
*Source: Embracing Transparency: Valuing Patients As Informed Consumers. Feb 2013.
Working independently and in collaboration with other stakeholders (east.one thousand., big employers, local purchasing coalitions, authorities purchasers), health plans have been active in developing public "report cards" on provider performance—primarily on the web but sometimes in impress. These reports provide comparative information on the performance of hospitals and medical groups on various measures of quality, including but not limited to CAHPS survey measures. By making these reports bachelor, health plans encourage their members to pay attending to the quality of their providers and to select high-performing medical practices and physicians.6 Equally part of these programs, health plans can also publicly recognize high-performing providers in their network.
The following examples describe health plan efforts to piece of work with other stakeholders to develop and publicly report on patient experience with providers:
- The Wisconsin Collaborative for Healthcare Quality (WCHQ), a multi-stakeholder, voluntary consortium of Wisconsin wellness plans, wellness systems, medical groups, and hospitals, has been publicly reporting provider performance on quality measures since 2004. WCHQ's online Operation & Progress Report on clinics and medical groups shows scores for vi composite measures from the CAHPS Clinician & Group Survey: "Getting Timely Appointments, Care, and Information," "How Well Providers Communicate," "Helpful, Courteous, and Respectful Office Staff," "Follow Upward on Test Results," "Overall Provider Rating," and "Willingness to Recommend." For large medical groups, the results are cleaved downwards by specialty.7
- Massachusetts Wellness Quality Partners (MHQP) is a coalition of health plans, physicians, hospitals, purchasers, patient and public representatives, academics, and regime agencies that has worked to improve the quality of health care services in Massachusetts. Among other activities, MHQP collects and publicly reports on the performance of over 500 dr. practices on various quality metrics, including patient experience measures from MHQP's statewide Patient Experience Survey, which is based on the CAHPS Clinician & Grouping Survey.
Render to Contents
6b.ii. Private Feedback on Provider Performance
As a substitute or complement to public performance reports, health plans can likewise feed useful information to health care providers—including administrative leaders and staff—through individual reports that evaluate their performance on various aspects of quality, including patient experience. In some cases, health plans share private reports first, and then innovate public reports afterward providers become more comfortable with the assessment of quality and the methodology being used. Private reports ofttimes contain more detailed information than that available in public reports, thus helping providers to pinpoint more precisely those aspects of the patient feel that are in need of improvement. For case, private reports may include results for individual survey items also as summaries of patients' complaints and feedback, thus providing insights into common problems that need to be addressed.8
Individual reports also typically offer more detailed comparisons of individual provider and/or group performance to that of peers and other benchmarks, such equally local, regional or national norms and "best-in-grade" functioning. This comparative information not only encourages a sense of competition among providers to improve, but besides may stimulate conversations amidst doctors and other clinicians about ways to improve functioning on patient feel and other quality measures.
Examples of health plan initiatives to compile and disseminate private reports to network providers that include CAHPS or other patient feel survey measures include the following:
- In 2005, HealthPlus of Michigan (an independent health program) began privately reporting detailed operation data from the CAHPS Clinician & Group Survey to PCPs that direct primary intendance for enrollees in the plan's commercial HMO product. In combination with information on best practices, this feedback helped to stimulate steady improvement in both CG-CAHPS and CAHPS Health Plan Survey scores over a 7-year period through 2012.ix
- In addition to public reporting, Massachusetts Health Quality Partners distributes private reports to all medical practices that participate in the statewide Patient Feel Survey.
- In the public sector, the Centers for Medicare & Medicaid Services (CMS) provides each group practice participating in the CAHPS for PQRS Survey with survey results in an individualized, detailed report. These reports draw the content of the survey and include the group exercise's scores on both the summary measures and individual questions in the survey, comparison scores and, where applicable, trend data showing how a practice's results from the previous reporting period compare to results from the electric current one. CMS provides a similar feedback report to convey results from the CAHPS Survey for ACOs to those organizations participating in the Medicare Shared Savings and Pioneer Programs.
Render to Contents
6b.3. Value-Based Payment
Health plan payments to providers can be a critical lever for creating incentives to providers to amend the patient experience. Many wellness plans take already implemented pay-for-performance (P4P) and other payment programs that financially reward the provision of "loftier-value" care—i.due east., intendance that is high quality, cost-effective, and person-centered. Such value-based payment programs typically tie payment to performance on a broad array of quality and price measures, including those that evaluate clinical processes, patient prophylactic, utilization of health care resource, structural elements of care, clinical outcomes (e.one thousand., readmissions, mortality, complications), and costs (eastward.thousand., total cost of care, cost per episode). By incorporating Clinician & Group Survey measures into these payment systems, health plans can create meaningful incentives for providers to improve the patient experience.x,eleven
For P4P and other value-based payment programs to be successful in stimulating improvement, wellness plans and providers must come up to a mutual agreement on the size and construction of the incentives, and not hesitate to tie a meaningful portion of payments to performance on a manageable number of measures.12-14
Examples of value-based payment programs that comprise patient experience measures include the following:
- Blue Cross Blue Shield of Massachusetts (BCBSMA) adult the Alternative Quality Contract (AQC) payment organisation, which pays providers a population-based, global budget combined with significant financial incentives tied to performance on a broad set of quality measures, including CAHPS measures. By its fourth year of performance, the AQC had led to cost savings of well-nigh x% while simultaneously improving quality performance, including patient feel scores. BCBSMA is now using AQC with its new wellness insurance products and so as to create meaning incentives for members to cull loftier-value providers and brand high-value care choices, which in turn has encouraged them to participate actively in discussions with health care providers most quality and value.fifteen
- The Integrated Healthcare Association (IHA), a multi-stakeholder grouping in California that includes health plans, administers a statewide P4P program in which participating commercial HMOs apply common measures to evaluate the performance of contracted dr. groups and pay bonuses tied to that performance. Measures evaluate both clinical processes and patient experience.
Return to Contents
References
1. Fung CH, Lim Y, Mattke S, et al. Systematic review: the evidence that publishing patient care operation information improves quality of care. Ann Intern Med 2008;148:111-23.
2. Lindenauer PK, Remus D, Roman S, et al. Public reporting and pay for operation in hospital quality improvement. Northward Engl J Med 2007;356:486-96.
3. Elliot MN, Cohea CW, Lehrman WG, et al. Accelerating comeback and narrowing gaps: trends in patients' experiences with hospital intendance reflected in HCAHPS public reporting. Health Serv Res 2015 Apr. [Epub alee of print]
4. Alexander JA, Maeng D, Casalino LP, et al. Use of care management practices in pocket-sized- and medium-sized md groups: do public reporting of physician quality and financial incentives matter? Health Serv Res 2013 48:376-97.
5. Lamb GC, Smith MA, Weeks WB, et al. Publicly reported quality-of-intendance measures influenced Wisconsin md groups to improve performance. Wellness Aff (Millwood) 2013 Mar;32(3):536-43.
6. Martino SC, Kanouse DE, Elliott MN, et al. A field experiment on the impact of physician-level operation information on consumers' choice of doc. Med Care 2012 Nov;l Suppl:S65-73.
7. The Wisconsin Collaborative for Healthcare Quality Functioning and Progress Report is accessible at http://www.wchq.org/reporting/.
8. Gerteis K, Harrison T, James CV, et al. Getting behind the numbers: agreement patients' assessments of managed intendance. New York: The Republic Fund; November 2000. Publication 428. Available at: http://world wide web.commonwealthfund.org/publications/fund-reports/2000/december/getting-backside-the-numbers--agreement-patients-assessments-of-managed-care.
9. Unpublished presentation by Clifford Rowley, Director of Member Service and Satisfaction, HealthPlus of Michigan, to the Michigan Patient Experience of Care Initiative, January sixteen, 2013.
10. Browne K, Roseman D, Shaller D, et al. Analysis & commentary. Measuring patient experience as a strategy for improving main care. Health Aff (Millwood) 2010 May;29(v):921.
11. Damberg CL, Sorbero ME, et al. ASPE Inquiry Report: Measuring Success in Wellness Care Value-Based Purchasing Programs. Summary and Recommendations. Available at http://aspe.hhs.gov/health/reports/2014/HealthCarePurchasing/rpt_vbp_summary.pdf.
12. Arcadia. Pay-for-Performance (P4P) Strategies for Health Plans and Provider Networks: Building Collaboration through Technology, Shared Value, and Trust. 2013. Accessible at http://content.arcadiasolutions.com/hs-fs/hub/358257/file-793806811-pdf/White_Paper_p4p.pdf.
13. Ryan AM, Damberg CL. What can the past of pay-for-functioning tell us virtually the future of Value-Based Purchasing in Medicare? Healthc (Amst) 2013 Jun;(1-two):42-9.
14. Kirschner G, Braspenning J, Jacobs JE, et al. Pattern choices made by target users for a pay-for-performance program in primary care: an action research approach. BMC Fam Pract 2012 Mar 27;thirteen:25.
15. More than data can be institute at Massachusetts Payment Reform Model: Results and Lessons and National Quality Strategy Webinar: Using Payment to Improve Health and Wellness Care Quality.
Render to Contents
Source: https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/index.html
0 Response to "what are some business questions related to the patient careflow journey"
Post a Comment