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Learn How to Improve Your CMS 5-Star Quality Rating

The CMS Five-Star Quality Rating System was created to help members compare healthcare providers. It is a balanced scorecard approach to consider the process-based performance as well as the customer service considerations experienced by each CMS plan’s members. In compliance with the Affordable Care Act (ACA), CMS providers have been tasked with reducing reimbursements by 14% nationwide beginning in 2017.

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What if?

So much of what we do in healthcare is about the “what if’s”—the educated guess, or even better, the SWAG. Facts we know to be true today prove to be unfounded tomorrow. More and more data becomes available on a daily basis as we improve technical proficiencies to disseminate the pieces and parts of how and why the human body works. It is a never-ending circle of evaluation and discovery.

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Could It Really Be That Easy?

We have a client who has his motto, “Make it easy, make it awesome”. This motto is clearly posted in every one of his urgent care clinics, visible to staff and patients alike. The first time I saw it, my immediate thought was, “Yeah, right.” I work in the field of health IT. Given the complexities of Meaningful Use, Accountable Care, patient privacy, population management, and patient qualities initiatives, do you seriously think anything is going to be easy? And I can’t even fathom awesome.

I have always preferred the phrase, “If it doesn’t challenge you, it doesn’t change you,” and was having a difficult time reconciling the two seemingly divergent positions in my mind. Is it even reasonable to expect a health IT system, with the constant challenge of disparate data integration issues, lack of standard terminology, and competing government agendas to be “easy”?

If it were easy, everyone would already be doing it, right? Shouldn’t we be constantly innovating, challenging our users to push the envelope, to think outside the box?

After spending time with our client and watching his team work, it hit me. Maybe, I was missing the point. Maybe, we spend too much time pushing the envelope and we forget what the vast majority of our users really want. They want an easy way to answer the simple questions. They want the “who,” “what,” “when,” and “why” of healthcare.

It starts off innocently. We are asked by a user to build a simple metric to define a patient population based on specific criteria, but then we become our own worst enemy. What about this data exception? Wouldn’t it be cool if we could show this? But department “X” only wants to see things in a certain format. Can we build an interface for them in case they need access too?

All are questions that we could answer, but everything can quickly spiral out of control. One question, leads to another and we are suddenly complicating a simple question into a complicated algorithm that only a PhD statistician can decipher.

By accepting this self-imposed “challenge” to push the envelope we have taken the simple request, and quickly turned it into a 23-page requirement document and five-screen dashboard that needs a training tutorial and help desk backup to navigate. We still didn’t answer the simple question.

What if we turned the tables and started off answering the easy questions first? What if we empower our users to answer their own simple questions? What would health IT look like if we challenged ourselves to create an easy data framework of who, what, when, and why and then put it in the hands of our clients? Chances are the results would be pretty awesome.

Building Your BI Roadmap

This week we hosted our healthcare webinar educating our audience on how to build their BI roadmap. We believe creating a BI roadmap provides the framework for how business intelligence and analytics can be applied to specific challenges faced in the healthcare industry. As healthcare entities develop their long–term corporate vision, they are challenged with seeking avenues for continuous improvements to meet their patients’ needs as well as ensuring compliance with evolving government mandates and payment reform models. Building your BI roadmap can be broken down into the following steps:
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How We Helped an Urgent Care Succeed in 4 Steps

Learn how our healthcare application, Resultz™, helped an Urgent Care center with better operational effectiveness and higher patient satisfaction. “This is truly innovative and one step ahead. The color coding makes it simple and informative enough to allow for immediate corrective action.” – Dr. Piper Moore, Center Manager at MEDcare Urgent Care.

1.  Created a more positive patient experience
By implementing real-time monitoring of exit surveys, we facilitated an Urgent Care center in tracking patient satisfaction with their physician, length of the visit, level of customer service they received, and how likely they are to recommend the center. With this information the clinic is continually able to evaluate areas of improvement and implement necessary changes to exceed patient expectations beyond the medical norm.

2.  Promoted team collaboration and communication
Our application promoted a collaborative learning environment for physicians to engage in peer learning, sharing valuable insights and helping each team member excel. Individuals are able to establish best practices and transform their personal weaknesses into strengths. The Urgent Care center was able to implement a reward system to recognize employees that exceed expectations.

3.  Streamlined scheduling process
We created a simplified scheduling system for shift schedules for physicians to balance their personal and work life. Medical Officers are able to monitor the number of hours that team members are scheduled and unnecessary overtime.

4.  Tracked success
The bottom line – through identifying and understanding best key performance indicators, they now know how to utilize and apply them effectively. By evaluating personal and peer performance and understanding strengths and weaknesses, physicians and clinic operators were able to focus on areas of improvement, establish best practices, thus improving patient outcomes and satisfaction, as well as overall operations of the Urgent Care Center.

Learn more about Resultz™ at http://panderasystems.com/clients/case-study/resultz/ and how it elevated performance of employees, physicians, and patient satisfaction increased.