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Using Data to Improve Quality and Performance

Using Data to Improve Quality and Performance. CMS Personnel Jennifer Clark, RN, BSN. Objectives. Recognize the applicability of performance assessment data for quality improvement by CMS Recognize opportunities of partnering with stakeholders to improve performance and quality

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Using Data to Improve Quality and Performance

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  1. Using Data to Improve Quality and Performance CMS Personnel Jennifer Clark, RN, BSN

  2. Objectives • Recognize the applicability of performance assessment data for quality improvement by CMS • Recognize opportunities of partnering with stakeholders to improve performance and quality • Outline data that can be used for cost containment, improve member outcomes and satisfaction, and increased compliance

  3. Overview • Ramifications of low performance scores for for health plans and providers • Overall ratings were related to voluntary disenrollment rates • Decreased market credibility • Poor health outcomes • Ultimately cost implications

  4. Regional Utilization • Perspectives for RO consideration • Internal trends for pre audit • Regional trends for low composite percentile rank nationally

  5. Purpose • Purpose of using performance to improve quality: • Measurement and reporting performance data • Payment incentives • Quality Improvement initiatives • Consumer comparative shopping

  6. Trending for Pre-site Audit • Pre-site preparation for routine audit • Correlate performance scores with potential worksheet audit review findings, operational areas, and interdepartmental areas (Medicare Advantage Manual, Chapter 5)

  7. Regional Trends • Regional trends for lower or below composite percentile rank nationally • Internal collaboration with organizational components • Collaboration with other stakeholders • Regional Office Plan Managers • Quality Improvement Organizations • Accrediting Organizations. • State Agencies

  8. Internal component collaboration • Examples of references • CAHPS Improvement Guide • Medicare Advantage Chapter 5 • NCQA Bridge of Excellence Tools

  9. Example of CIG Responsibility Roster

  10. Example of Organization Response

  11. Example of collaborative alternatives • Collaborative efforts may be with all stakeholders • CMS • Quality Improvement Plans • State • Accrediting Organizations

  12. Example of collaborative alternatives

  13. Conclusion • Recap of objectives • Business & clinical outcomes • Appropriate care/cost containment • Services/Resource allocation • Customer Service/Consumer Satisfaction Cost containment will follow the quality of services

  14. Questions

  15. References Levitan, S.E.; Shaller, D; McInnes, K.; Joyce, Coltin, K.L.; and Cleary, P.D. (2003).The CAHPS Improvement Guide: Practical Strategies for Improving Guide.

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