Understanding BUMED s Performance Based Budget PBB A Clinical Quality Perspective

1. Understanding BUMED�s Performance Based Budget (PBB) �A Clinical Quality Perspective CDR Annette M. Von Thun Head, Evidence-Based Programs (BUMED M3) May 6, 2008

2. 2 Outline & Objectives Review the basic principles of the PBB Discuss the relative contributions of the Evidence-Based Health Care (EBHC) and Public Health components Discuss where the EBHC data originates & is displayed PHN PHN Dashboard Review PBB Resources/Reports

3. 3 PBB Context: Escalating Medical Costs

4. 4 PBB: Timeline 2003 � MHS Business Plans introduced. 2004 � Prospective Payment System (PPS) designed to incentivize productivity within the Direct Care System. 2005 - PPS implemented and began to influence the Service�s funding based on workload measures (RVUs, RWPs and Mental Health Bed Days). 2006 � Expansion of PPS to use performance-based planning, financing and management for ALL Defense Health Plan (DHP) funding. 2007 � Navy Medicine conceptualizes Navy Performance Based Budgeting (PBB) as an expansion of PPS. 2008 � Navy Medicine begins to implement PBB.

5. 5 PBB: Purpose Pay for Performance model to ensure quality and appropriate utilization of resources Properly aligns authority, accountability and financial responsibility. Provides the appropriate tools and information to enable leaders to achieve business plan performance goals. Will result in programmatic adjustments to future annual budgets Provides financial incentive for achieving uniform level of excellence with respect to quality measures across Navy Medicine. Will allow Navy Medicine to re-allocate resources to those commands who are excelling in the provision of healthcare.

6. 6 Calculates each individual quality metric at the Parent MTF Level. Provides a weighted score based on 4 categories that corresponds to financial recompense Applies to CONUS Facilities Only Composition of PBB

7. 7 Prospective Payment System (PPS) is based upon productivity (compared with base year) Outpatient Care (RVUs) Inpatient Care (RWPs) Mental Health Bed Days Is driven substantially by HA/TMA Composition of PBB

8. 8 An MTF�s funding can be impacted up to 25% as a consequence of the PBB quality metrics. Each metric may adjust up/down a maximum percentage based from the planned budget: Measure Max Adjustment EBHC ( + 10%) IMR ( + 5%) Inpatient Bed Fill ( + 5%) Public Health ( + 5%) Composition of PBB

9. 9 Deployments taken into consideration Composition of PBB

10. 10 30% of budget categorized as �OTHER� Portion of budget unaffected by PPS & PBB Composition of PBB

11. 11 PBB: Significance Leadership, Comptroller and Care-giving Communities are jointly and keenly interested in the performance of these metrics, linking resources, performance and quality outcomes.

12. 12 Performance-Based Budget

13. 13 PBB: IMR Metric

14. 14 PBB: IMR Metric

15. 15 PBB: Bed Capacity

16. 16 PBB: Bed Capacity

17. 17 PBB: Public Health

18. 18 PBB: Public Health

19. 19 PBB: Public Health (draft)

20. 20 PBB: Public Health (draft)

21. 21 PBB: Public Health (draft)

22. 22 PBB: EBHC measures

23. 23 PBB: EBHC measures

24. 24 EBHC Impact 10% of budget now influenced by EBHC measures = BIG $$$$ Commanders now interested in Clinical Quality & Disease Mgmt Programs = TREMENDOUS opportunity Opportunity to GAIN or LOSE 10%

25. 25 EBHC Measures & PHN Where EBHC data comes from & Where else you can find this data�

26. 26 USAF tool created in 2000 Official name = MHS Population Health Portal Adapted for Tri-Service use Fall 2003 Incorporated into BUMED Business Plan FY04 Navy name = Population Health Navigator

27. 27 PHN compiles data from . . . M2 -Standard Inpatient Data Record (SIDR) -Standard Ambulatory Data Record (SADR) -Health Care Service Reports (HCSR) now known as TEDs (Tricare Encounter Data) Approximately 103 CHCS hosts downloaded individually -Lab, radiology (mmgm), pathology (paps) Pharmacy Data Transaction System (PDTS)- -MTFs, network, mail order Defense Eligibility Enrollment Registration System (DEERS) PHN data is pulled from a number of resources. M2 pulls MTF/direct care encounters (SIDRs and SADRs) along with Network care (HCSR). HCSR is now being called TED (Tricare Encounter Data). Every month special ad hocs are sent from each CHCS host to populate the clinical elements of PHN. Patient enrollment data is determined by DEERS. Since visits, pharm, lab and radiology tests are downloaded into the portal, we are able to get a complete picture of patient care and utilization regardless of where services were performed. Realize the importance of data accuracy. The data that is displayed is what�s entered into the various databases�.the data is only as good as your coding, end of day reports, etc. Data from PDTS (Pharmacy Data Transaction System) is pulled for pharmacy encounters to include MTF, Network, and Mail Order prescriptions. To gain specifics on what is considered a prescription refill, consult the module methodology. The data will be updated monthly but, because of where it is retrieved from, some of the (network) data is 2-3 months old when it appears on the web. You will see that much of the data is from your CHCS host�.this data is the most current. As for data coming from M2: SADR data is updated every week, SIDR data is updated every month; purchased care is usually behind several months because of delays in the billing and adjudication process; BUT� the data is downloaded to PHN at the end of every month. M2 -Standard Inpatient Data Record (SIDR) -Standard Ambulatory Data Record (SADR) -Health Care Service Reports (HCSR) now known as TEDs (Tricare Encounter Data) Approximately 103 CHCS hosts downloaded individually -Lab, radiology (mmgm), pathology (paps) Pharmacy Data Transaction System (PDTS)- -MTFs, network, mail order Defense Eligibility Enrollment Registration System (DEERS) PHN data is pulled from a number of resources. M2 pulls MTF/direct care encounters (SIDRs and SADRs) along with Network care (HCSR). HCSR is now being called TED (Tricare Encounter Data). Every month special ad hocs are sent from each CHCS host to populate the clinical elements of PHN. Patient enrollment data is determined by DEERS. Since visits, pharm, lab and radiology tests are downloaded into the portal, we are able to get a complete picture of patient care and utilization regardless of where services were performed. Realize the importance of data accuracy. The data that is displayed is what�s entered into the various databases�.the data is only as good as your coding, end of day reports, etc. Data from PDTS (Pharmacy Data Transaction System) is pulled for pharmacy encounters to include MTF, Network, and Mail Order prescriptions. To gain specifics on what is considered a prescription refill, consult the module methodology. The data will be updated monthly but, because of where it is retrieved from, some of the (network) data is 2-3 months old when it appears on the web. You will see that much of the data is from your CHCS host�.this data is the most current. As for data coming from M2: SADR data is updated every week, SIDR data is updated every month; purchased care is usually behind several months because of delays in the billing and adjudication process; BUT� the data is downloaded to PHN at the end of every month.

28. 28 PHN feeds data to . . . M2 -Standard Inpatient Data Record (SIDR) -Standard Ambulatory Data Record (SADR) -Health Care Service Reports (HCSR) now known as TEDs (Tricare Encounter Data) Approximately 103 CHCS hosts downloaded individually -Lab, radiology (mmgm), pathology (paps) Pharmacy Data Transaction System (PDTS)- -MTFs, network, mail order Defense Eligibility Enrollment Registration System (DEERS) PHN data is pulled from a number of resources. M2 pulls MTF/direct care encounters (SIDRs and SADRs) along with Network care (HCSR). HCSR is now being called TED (Tricare Encounter Data). Every month special ad hocs are sent from each CHCS host to populate the clinical elements of PHN. Patient enrollment data is determined by DEERS. Since visits, pharm, lab and radiology tests are downloaded into the portal, we are able to get a complete picture of patient care and utilization regardless of where services were performed. Realize the importance of data accuracy. The data that is displayed is what�s entered into the various databases�.the data is only as good as your coding, end of day reports, etc. Data from PDTS (Pharmacy Data Transaction System) is pulled for pharmacy encounters to include MTF, Network, and Mail Order prescriptions. To gain specifics on what is considered a prescription refill, consult the module methodology. The data will be updated monthly but, because of where it is retrieved from, some of the (network) data is 2-3 months old when it appears on the web. You will see that much of the data is from your CHCS host�.this data is the most current. As for data coming from M2: SADR data is updated every week, SIDR data is updated every month; purchased care is usually behind several months because of delays in the billing and adjudication process; BUT� the data is downloaded to PHN at the end of every month. M2 -Standard Inpatient Data Record (SIDR) -Standard Ambulatory Data Record (SADR) -Health Care Service Reports (HCSR) now known as TEDs (Tricare Encounter Data) Approximately 103 CHCS hosts downloaded individually -Lab, radiology (mmgm), pathology (paps) Pharmacy Data Transaction System (PDTS)- -MTFs, network, mail order Defense Eligibility Enrollment Registration System (DEERS) PHN data is pulled from a number of resources. M2 pulls MTF/direct care encounters (SIDRs and SADRs) along with Network care (HCSR). HCSR is now being called TED (Tricare Encounter Data). Every month special ad hocs are sent from each CHCS host to populate the clinical elements of PHN. Patient enrollment data is determined by DEERS. Since visits, pharm, lab and radiology tests are downloaded into the portal, we are able to get a complete picture of patient care and utilization regardless of where services were performed. Realize the importance of data accuracy. The data that is displayed is what�s entered into the various databases�.the data is only as good as your coding, end of day reports, etc. Data from PDTS (Pharmacy Data Transaction System) is pulled for pharmacy encounters to include MTF, Network, and Mail Order prescriptions. To gain specifics on what is considered a prescription refill, consult the module methodology. The data will be updated monthly but, because of where it is retrieved from, some of the (network) data is 2-3 months old when it appears on the web. You will see that much of the data is from your CHCS host�.this data is the most current. As for data coming from M2: SADR data is updated every week, SIDR data is updated every month; purchased care is usually behind several months because of delays in the billing and adjudication process; BUT� the data is downloaded to PHN at the end of every month.

29. 29 Strengths Provides both corporate level (HEDIS�) metrics and drills to patient/provider/clinic level Provides data on patient care regardless of where care provided: throughout entire MHS inpatient & outpatient care network & MTF care Can be displayed in Excel� for easy use of data. FREE and readily available

30. 30 Compares to other clinics/MTFs Contrast own clinic/MTF over time Displays denominators, values, and benchmarks Navy averages HEDIS� 50th percentile HEDIS� 90th percentile The PHN dashboard displays clinical performance and denominator values in aggregate form to the child DMIS level, allows the comparison between clinics, MTFs, Navy averages, and HEDIS benchmarks, without requiring passwords or accounts.The PHN dashboard displays clinical performance and denominator values in aggregate form to the child DMIS level, allows the comparison between clinics, MTFs, Navy averages, and HEDIS benchmarks, without requiring passwords or accounts.

31. 31 Dashboard Details No accounts/ passwords required CAC-enabled Updated monthly once PHN refreshed Also available via PHC and NMO webpages https://dataquality.med.navy.mil/reconcile/pophealth The PHN dashboard displays clinical performance and denominator values in aggregate form to the child DMIS level, allows the comparison between clinics, MTFs, Navy averages, and HEDIS benchmarks, without requiring passwords or accounts.The PHN dashboard displays clinical performance and denominator values in aggregate form to the child DMIS level, allows the comparison between clinics, MTFs, Navy averages, and HEDIS benchmarks, without requiring passwords or accounts.

32. 32 This is the opening slide showing total enrollment. You can go to the lower left and select a metricThis is the opening slide showing total enrollment. You can go to the lower left and select a metric

33. 33 This is HbA1c across Navy Medicine for the 30 Parent DMISs. The HEDIS� goals and Navy Medicine average are shown. This is HbA1c across Navy Medicine for the 30 Parent DMISs. The HEDIS� goals and Navy Medicine average are shown.

34. 34 This slide displays drilldown for the MTF to the Child DMIS level.This slide displays drilldown for the MTF to the Child DMIS level.

35. 35 With a click of a button (or two!) allows for the denominators to be shown concomitantly in the gold bars.With a click of a button (or two!) allows for the denominators to be shown concomitantly in the gold bars.

36. 36

37. 37 Important links on the Navy Environmental Health Center (NEHC) web page in support of the Population Health Navigator program. Important links on the Navy Environmental Health Center (NEHC) web page in support of the Population Health Navigator program.

38. 38 PBB Reports/Resources https://nmo.med.navy.mil/pbb/ http://navymedicine.med.navy.mil/pbb/

39. 39

41. 41 PBB: EBHC Adjustments

42. 42 Performance-Based Budget

43. 43 Performance-Based Budget

44. 44 Performance-Based Budget

45. 45 Performance-Based Budget

46. 46 EBHC Changes

47. 47

48. 48

49. 49

50. 50 Future Directions Performance-Based Budget Addition of 2 EBHC measures Incorporate EBHC measures into PPS? ORYX measures? (doubtful) Disease Mgmt Policy New (HEDIS/non-HEDIS) measures Tobacco cessation Population Health Navigator Daily data refresh? CDM data input Graphing capability? �Active� enrollment? PHN Dashboard Display all 7+ measures, update benchmarks� ETA???

51. 51 Web Site & POC https://NMO.med.navy.mil/PBB