Post on 13-Jan-2016
description
Monarch HealthCare Inc.Monarch HealthCare Inc.
Efficiency Collaborative Focus Group:Efficiency Collaborative Focus Group:
““Exploring Variation in the Frequency Exploring Variation in the Frequency of of
Emergency Department Visits Among Emergency Department Visits Among PCP Panels”PCP Panels”
Tuesday, May 13 – PediatriciansTuesday, May 13 – Pediatricians
California Quality California Quality CollaborativeCollaborative
The California Quality Collaborative (CQC) The California Quality Collaborative (CQC) is a healthcare improvement organization is a healthcare improvement organization dedicated to advancing the quality and dedicated to advancing the quality and efficiency of patient care in California.efficiency of patient care in California.
The CQC is supported by a state-wide The CQC is supported by a state-wide leadership alliance of healthcare leadership alliance of healthcare purchasers, providers and health plans, all purchasers, providers and health plans, all working toward a shared goal of working toward a shared goal of accelerating quality improvement in accelerating quality improvement in California.California.
Efficiency Collaborative GoalsEfficiency Collaborative Goals
Increase health care affordability Increase health care affordability through the reduction of unnecessary through the reduction of unnecessary variations in care. variations in care.
Promote reduction in the underuse, Promote reduction in the underuse, misuse and overuse of medical misuse and overuse of medical services, ensuring patients get the services, ensuring patients get the care they need, when they need it, care they need, when they need it, and in the correct setting.and in the correct setting.
ParticipantsParticipants
Six (6) Medical Groups across CaliforniaSix (6) Medical Groups across CaliforniaMonarch HeatlhCare Monarch HeatlhCare
Hill Physicians (Northern CA)Hill Physicians (Northern CA)
Mills Peninsula Medical Group (Northern CA)Mills Peninsula Medical Group (Northern CA)
Physicians Medical Group, Santa CruzPhysicians Medical Group, Santa Cruz
Torrance IPA (Southern CA)Torrance IPA (Southern CA)
Physicians Associates of San Gabriel ValleyPhysicians Associates of San Gabriel Valley
Efficiency Collaborative GoalEfficiency Collaborative Goal
““Reduce Emergency Department Reduce Emergency Department Utilization for Non-emergent Utilization for Non-emergent Conditions”Conditions”Monarch consistently performs poorly on Monarch consistently performs poorly on
this measure this measure Not the quality of care we expect for our Not the quality of care we expect for our
patientspatientsProfound financial implicationsProfound financial implicationsImprovement directly affects practicing Improvement directly affects practicing
physician reimbursementphysician reimbursement
Objectives of the Focus GroupObjectives of the Focus Group
1.1. Understand variation in ED Understand variation in ED Utilization among PCP panelsUtilization among PCP panels
2.2. Determine what is working and what Determine what is working and what is notis not
3.3. Learn preferred methods of Learn preferred methods of communication and define IPA/ PCP communication and define IPA/ PCP partnershippartnership
4.4. Share what Monarch is currently Share what Monarch is currently doing to help reduce inappropriate doing to help reduce inappropriate ED utilizationED utilization
ER Utilization Variance Among MHC ER Utilization Variance Among MHC PCPsPCPs
* Larger spread between actual vs. expected utilization indicates higher ER utilization;
Ranked among PCP invitees to this focus group (individual PCP or group)
Actual vs. Expected ER Utilization for Pediatrics SpecialtyAny Panel Size, All LOBs
0
100
200
300
400
500
600
700
Ven
dor2
16
Ven
dor2
20
Ven
dor2
25
Ven
dor2
26
Ven
dor1
98
Ven
dor2
31
Ven
dor2
02
Ven
dor1
94
Ven
dor1
86
Ven
dor1
87
Ven
dor2
04
Ven
dor2
05
Ven
dor2
38
Ven
dor2
08
Ven
dor2
40
Ven
dor2
42
Ven
dor2
43
Ven
dor2
44
Ven
dor1
90
Ven
dor2
48
Ven
dor2
11
Ven
dor1
92
Ven
dor2
49
Ven
dor2
56
Ven
dor2
59
Ven
dor2
57
Ven
dor2
12
Ven
dor2
13
Ven
dor2
61
Ven
dor2
70
Pan
el A
dju
sted
Per
Th
ou
san
d U
tiliz
atio
n
Expected Visits PTMPY Actual Visits
Actual=Expected
YOUR THOUGHTS?YOUR THOUGHTS?
What causes High Utilization of the What causes High Utilization of the ED for Non-emergent conditions?ED for Non-emergent conditions?
What can “low utilizing” PCPs do to What can “low utilizing” PCPs do to keep the utilization appropriate?keep the utilization appropriate?
What are the “high utilizing” PCPs What are the “high utilizing” PCPs doing or not doing that can doing or not doing that can contribute to higher rates?contribute to higher rates?
Monarch Healthcare PCP (Vendor)2006 ER Visits PTMPY and
Percentile Ranks*
5
1
4 3 6
2
25
50
75
100
125
150
175
200
225
250
275
0 10 20 30 40 50 60 70 80 90 100
Percentile Rank (% )*
20
06
ER
Ad
mit
s P
TM
PY
Sample Practitioner ER Utilization Sample Practitioner ER Utilization ReportReport
* Higher percentile ranks indicate higher ER utilization; Ranked among vendors (PCP or PCP Office) with at least 1,000
participating member months in 2006 Calendar Year
YOUR THOUGHTS?YOUR THOUGHTS?
Is this a useful report?Is this a useful report?
What can be done to make it more What can be done to make it more useful?useful?
What Monarch is DoingWhat Monarch is Doing
Ambulatory Case ManagementAmbulatory Case ManagementDisease ManagementDisease ManagementED Frequent Flyer ListsED Frequent Flyer ListsOutreach to Patients and PCP’sOutreach to Patients and PCP’s Information to PatientsInformation to Patients
Urgent Care LocationsUrgent Care LocationsDefining “Emergent Care”Defining “Emergent Care”
THANK YOUTHANK YOU
What we will do with the information What we will do with the information from tonight:from tonight:Create a user-friendly template to Create a user-friendly template to
present variance data to Monarch’s PCPspresent variance data to Monarch’s PCPsFormulate interventions and create Formulate interventions and create
support tools to reduce inappropriate ED support tools to reduce inappropriate ED utilization - revising systems where utilization - revising systems where necessary to improve the quality of care necessary to improve the quality of care our patients receiveour patients receive