Quality Improvement and Physician Behavior Change - PowerPoint PPT Presentation

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Quality Improvement and Physician Behavior Change

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  1. Quality Improvement and Physician Behavior Change djsslides

  2. Model for Health Care Improvement Deploy and Deliver Best Practices Design Best Practices Influence Physician Decision Making Improved Outcomes djsslides

  3. Academic Literature on Changing Physician Behavior • Education • Clinical Opinion Leaders • Administrative Mandates • Feedback • Incentives djsslides

  4. The Economics of Disease Management djsslides

  5. Sample Disease States With Rapid Vesus Eventual Economic Returns Disease Program Return on Investment Asthma Rapid Congestive Heart Failure Rapid Diabetes Eventual Hyperlipidemia Eventual Hypertension Eventual Low Back Pain Rapid Osteoporosis Eventual Pneumonia Rapid Depression Eventual Weight Reduction Eventual djsslides H:present/hmoprmce

  6. Basic And Advanced Return-On-Investment (ROI) Equations Basic ROI Equation Direct Costs of Program * + an Allocated Percentage of Overhead - Disease Episode Costs Preimplementation - Disease Episode Costs Postimplementation ROI = Advanced ROI Equation ROI = Direct Costs of Program + Allocated Overhead - (Disease Episode Costs Preimplementation - Disease Episode Costs Postimplementation) + (Benefit of Avoided Complications in Dollars + Benefits of Improved Clinical Outcomes in Dollars) + Additional Revenue of Increased Use of In-System Resources Attributed to the Disease Management Implementation * Costs associated with the specific program (e.g., disease-specific case managers, educational materials, and development costs). djsslides

  7. Contracting Models djsslides

  8. Outcomes-Based Contracting • Payments Should Align Reimbursement with the Implementation of Best Practices (Disease Management) • Financial Success is Tied to the Outcomes of a Defined Population djsslides

  9. Shared Objectives for Managed Care Organizations and Provider Systems Component Goal Access to All Sites and Providers Where Appropriate High Patient Satisfaction Across the Entire Experience Best Practice Approach Optimal Resource ($s) Use (more or less) 1.ACCESS 2. SERVICE 3. QUALITY 4. VALUE DISEASE MANAGEMENT djsslides

  10. PATIENTSComplex Registration, Non-Restricted Access Referral Requests by Protocol PHYSICIANSDocumentation Required Documentation for for Reimbursement Clinical Care OFFICE STAFFBilling, Paper Work Disease Mangement for Payers Support ADMINISTRATIVE 30% 5% COSTS Current System Versus Outcomes-Based Contracting Current System Outcomes-Based Contracting djsslides