4.1.5 How is Primary Care Performance Measured?

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Do curso por University of Minnesota

Healthcare Delivery Providers

127 classificações

University of Minnesota

Healthcare Delivery Providers

127 classificações

Curso 2 de 5 em Specialization Healthcare Marketplace

Welcome to the exciting world of Healthcare Delivery Providers! This second course in the Healthcare Marketplace Specialization will help you understand the various providers of healthcare across the U.S. delivery continuum. We will explore the unique value proposition of the various providers- from hospitals and clinics to physicians to community based providers. We will dissect this important value chain using various lenses such as- site of care delivery, people who provide the care and payers who pay for care. You will also learn about the challenges facing these providers and the innovations they are creating in order to help transform this important industry. I will use readings such as a case study and videos to make this learning more experiential for you, so that you can see and feel the world of healthcare delivery. I will also explain the various acronyms and specialized terms used in healthcare, so that you become more proficient and familiar with the language. Given the fact that Healthcare is one of the largest industries in the U.S. and growing at an rapid pace, it is critical that current and future leaders understand the internal and external drivers that are shaping this industry. Current and future leaders will need to constantly innovate in order to sustain this industry into the future- by creating value for the end customer and the entire population, as well as increasing engagement of the humans who work within this industry. Get ready to take a deep dive into the complex ocean that is U.S. healthcare delivery- and make sure your oxygen tank is securely fastened!

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PHYSICIANS: PRIMARY, SPECIALTY, NEWER SETTINGS & POPULATION HEALTH

In this module I will review the various types of physician practices and clinics. These include primary care physicians and specialty care physicians and their clinics. We will review how the various physicians are organized, how their performance is measured, how they get paid and also what challenges they face and what innovations they are leading. Welcome to the exciting world of physicians!

4.1.1 What are Primary Care Clinics?7:25

4.1.2 Primary Care: Services & Organization7:35

4.1.3 How is Primary Care Paid?6:09

4.1.4 What is a Medical Home?5:01

4.1.5 How is Primary Care Performance Measured?7:29

4.1.6 Primary Care: Challenges & Innovations8:07

Conheça os instrutores

Dr. Rahul Koranne
Faculty
Carlson School of Management, Department of Finance

This is the Healthcare Delivery Providers,

part of the Healthcare Marketplace Specialization.

This is module 4.1.5, Primary Care Performance Measurement.

Physician quality reporting system, Medicare shared savings

program, in this particular lecture, the learning outcomes are better

discussed how primary care performance is measured along these domains.

We are back to our familiar diagram of the quadruple aim and again, just like for

all of the other delivery providers, primary care physicians and

primary care clinics are also measured according to these four domains.

So, here's the schematic that we have seen for the hospitals and

post acute care providers.

So very similarly for primary care clinics and physicians there are many

many different types of [INAUDIBLE] and systems that measurement happens in.

So here's, let's take one example of physician quality reporting system

through Medicare would have various different measures like diabetes,

smoking, depression, medications, immunizations.

All of those would then flow to Medicare federal government and then be reported

onto a transparent, public facing website called Physician Compare,

where hopefully the patients will go and then be able to visualize those metrics.

And then close the loop and

make a judgment about how their primary care practice or physician is.

And if the quality is not good, they have the option of switching.

So again, it's a way to be very transparent in all of these metrics

to the end user or the end customer.

Dig into some of these systems.

The first one, which is a governmental system from CMS or

Medicare is called the Physician Quality Reporting System, it has

quality measures that can either be directly abstracted from claims.

So a claim is a bill that is sent to through Medicare and

Medicare can pull some of the quality reporting directly through that.

Or there are some metrics that need to be specially uploaded

electronically into the federal government.

This could be done directly by the clinic practice or they outsource it

to a third party that does this for many many clinics and groups.

The payment is then modified up or down

based upon the reporting of these metrics to Medicare or the Federal government.

Other way of quality measurement for

primary care is through the Accountable Care Organizations, so for example,

a Medicare ACO is the Medicare Shared Savings Program, MSSP,

and it has a long list of screening and ambulatory service,

sensitive conditions that it measures measures for all of the ACOs, and recall

that the way that the ACOs get paid is that the first gate is the quality gate.

So you need to measure the quality and then hit the target and

exceed the quality measures first, before you can get to the next gate of cost.

So if you reduce the cost, you get a share in those value creations.

System linked to the electronic health record is called the meaningful use,

it is slowly being phased out as of this year.

However, it was in place for the last several years and it came in stages.

So they were increasing metrics for primary care and

specialty care physicians, which had incentive payments related to quality and

safety communications.

And also, is the electronic health record communicating and

connecting with, for example, pharmacies, other sites of care and with the patient?

So again, came in stages and

there were dollar incentives on hitting those targets.

Another measurement system for primary care for the commercial insurance

payers is called the Healthcare Effectiveness Data and Information Set.

It is used by over 90% of the private insurance payers in the US.

And there are numerous quality measures,

such as screening, immunizations, medication management, and

then many measures around outcomes and effectiveness of treatment.

Again, as you can see, the same primary care physician practice is being measured

by the government by the pair, by the ACO, by other regulatory bodies.

So as you can see, this can get a little confusing and

a whole infrastructure is needed to make sense of all of these measures.

Do a quiz.

The other domain of primary care

measurement is along patient experience metrics.

And again, here's our familiar CAHPS and there's a special to for

clinicians and groups in primary care called the clinician and

group consumer assessment and health care providers of systems.

And again these metrics are reported to the government and then posted and

part of the physician compare website.

So again, the questions are tailored to primary care practices and

a third party vendor collects the surveys by measuring and

surveying the patients, and then uploads those results to the Federal government,

which then uploads them onto this transparent website.

The metric of primary care measurement is the engagement of physicians and

staff, and as we have discussed before, there are increasing levels of physician

burnout in the US that is being actively looked at and worked on.

Also, typically it is measured through a survey methodology that is repeated

either every year or every other year.

Another way of measuring of the primary care clinic or

primary physician performance is obviously the financial metrics.

So how is the practice or the clinic is doing is it creating a margin,

are the physician's' productivity metrics being hit, is a physician supposed to see.

Number of patients in a month, but

was unable to see those, what were the reasons there?

Another metric might be Accountable Care Organization metrics, so

was there shared savings?

Did we hit all of the quality metrics?

And also a discussion around the brand.

So, that's a measure of stickiness to the patients of the community,

are the the patients happy and satisfied with the clinic?

Will they keep coming back or

are they switching to a different primary care clinic?

And there are many measures of customer retention in a particular

committee in a particular community that are being measured and

tracked by primary care clinics over time.

In summary primary care is measured also along the quadruple aim domains.

And there's the transparent Federal government website of Physician Compare

that transparently displays these results to the end customers,

hoping to make them more educated and more savvy as they choose these services.

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