PBAM: Clinical Viewpoint

1

• PBAM Clinical Viewpoint

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Agenda

• Pneumovax Policies
• - Vaccination Rate
• - Outcomes
• HEDIS and PBAM
• PBAM Awards
• Impact on HEDIS Measures (12 mos.)

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Pay for Performance

• For years we talked about the need to change
  emphasis and culture in order to improve
  healthcare outcomes.
• The time for change is now..
• A good plan executed today is better than a
  perfect plan executed at some indefinite point in
  the future.--- General George Patton Jr

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Rapid Performance Improvement

• Sep 06 Pneumovax Campaign set vaccination
  targets in Jan 07, Jun 07 and Jan 08 (impact less
  than desired)
• Feb 07 5 rewards for MTFs that reach targets
  (performance improved, less than desired)
• Sep 07 50 and 100 rewards for MTFs that meet
  targets

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Pneumovax Vaccination Rate
Jan 08 34,962 vaccinations of 58,627 eligible
60 vaccinated
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Measuring Pneumovax Outcomes
Bacterial Pneumonia Admission Rates per 100,000
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Current PBAM Awards for HEDIS Measures

• For each measure
• MTF 90th percentile 5 per screening
• 50th percentile MTF lt 90th Percentile 2.50
  per screening
• MTF lt 50th percentile 0 per screening

SECURITY CLASSIFICATION HERE
Date-Time-Group
Name/Office Symbol/(703) XXX-XXX (DSN XXX) /
email address
8
Current PBAM Awards
2.50 each person
5 each person
0
SECURITY CLASSIFICATION HERE
Date-Time-Group
Name/Office Symbol/(703) XXX-XXX (DSN XXX) /
email address
9
Percent of Eligible Population with Colo-Rectal
Exam
Source Command Management System as of 01/17/07
for data thru Sept 2007. Reflects current 2006
commercial benchmarks (effective with April 2007
data).
10
HEDIS Changes in FY07
Statistically significant change at p lt .05
Source Population Health Portal
QA data, protected under 10 USC 1102.
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Proposed HEDIS Reward SchemeMTF Award
Calculation
2. Snapshot is taken of MTF Action list which is
larger than the HEDIS list of patients
1. MTF surpasses 50th percentile threshold
3. Total Award is based upon each individual on
the Action List that is compliant with measure
50th percentile
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Challenges

• AHLTA unique data (Wellness Reminders, direct
  entries to Problem List) not currently
  incorporated into MHS Population Health Portal
• AHLTA data not easily accessible from Clinical
  Data Mart (CDM) with some concerns about CDM data
  completeness
• Specific network data unavailable (eg. HgBA1c and
  LDL values for DM patients)
• ERMC network data not captured in current data
  systems, only available through manually entered
  AHLTA Wellness Reminder data

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Recommendations

• Consistently high asthma measure performance
• Continue to track, drop as PBAM measure
• Performing least well on 3 HEDIS DM measures
• Add chlamydia screening (AD only) and F/U
  appointment post- BH admission
• Enhance colorectal cancer screening (3 stool
  guaiacs/year insensitive and poorly executed)

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Conclusions

• Financial rewards are aligned with
  strategically-focused and clinically relevant
  objectives.
• Rewarding good clinical practices has shown to
  increase MTFs compliance rates.
• Initiatives will have improved health outcomes
• A healthier beneficiary population
• Cost savings resulting from early detection and
  improved health management

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Next Steps .

• Consider negative financial incentives for long
  standing measures.
• Increase PBAM initiatives and funding targeted at
  improving clinical outcomes.
• MHS must resolve data issue
• Integrity of PCM assignment information
• AHLTA data included in PopHealth Portal
• An effective Clinical Data Mart
• Increase in clinical (VAP, CLABSI, NSQIP),
  business and operational outcomes

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Food for Thought Where is our emphasis?
2007 PBAM Payouts
Workload Payouts

Dollars, in Millions
EBM Payouts

What are we waiting for? - Journal of Health
Affairs, Jan/Feb issue (London School of Hygiene
and Tropical Medicine) Preventable deaths before
age 75 in 19 industrialized countries in
2002-2003 compared to 5 years earlier. US 19th
out of 19 in 2002-2003, with 109 deaths per 100K,
down from 15th place in 1997-1998.