The Evolution of Clinical Quality Programs

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By Drew Borland — Manager, Architecture and Research

A quality program (or Clinical Quality Improvement program) is a collection of healthcare quality measures/metrics grouped together and applied for a meaningful purpose, to evaluate and/or incentivize an entity to improve clinical and/or financial outcomes. These entities are typically providers, provider groups (IPAs, PHOs, ACOs), and payers.  The main purpose of a healthcare quality program is to assess performance as it relates to controlling costs, and to create an environment that incentivizes participants to adhere to the quality standards.

Over the past few years, healthcare professionals have gone from marginally understanding these quality programs, to now barely being able to keep up with them. Incentive-based payer-driven quality programs are quickly becoming the modern day ‘tax code’ for the healthcare industry.  Keeping that in mind, this Wellcentive Blog post will focus on identifying the overarching trends among the quality programs and shed some light on where you can expect them to be in the coming years. Continue reading →

Physician Engagement Series: Maintenance of Certification

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By Dr. Paul D. Taylor, Wellcentive co-founder and CMIO

In this final Wellcentive Blog post in the Physician Engagement Series, I will describe not only how Maintenance of Certification (MOC) programs can help your providers get engaged with Responsible Population Health Management (PHM) and Clinical Quality Improvement (CQI), but also how any work already being done in these areas can apply to MOC. In other posts in this series, I have covered a variety of other initiatives that can also engage your physicians, including Pay for Performance (P4P or PFP), Patient Centered Medical Home (PCMH), the Physician Quality Reporting System (PQRS), Accountable Care, Meaningful Use, Public Reporting, and Local Programs.

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The Relationship Between HIE and Population Health Management

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By Jordan Lento, Senior Project Manager

The last blog post in our series on Health Care Data and Interfacing addressed the data management aspects of Population Health Management (PHM). This week, I’m tackling PHM from a different angle – understanding the relationships between healthcare organizations and Health Information Exchanges (HIE), and how HIEs connect fragmented Health Information Technology (HIT) systems within a community. While the words “fragmented” and “relationship” in the same sentence may not typically bode well, don’t worry – it’s not all doom and gloom! Continue reading →

Physician Engagement Series: Local Programs

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In this Wellcentive Blog series, I have covered a variety of programs and initiatives that can engage your physicians in Responsible Population Health Management (PHM) and Clinical Quality Improvement (CQI), including Pay for Performance (P4P or PFP), Patient Centered Medical Home (PCMH), the Physician Quality Reporting System (PQRS), Accountable Care, Meaningful Use, and Public Reporting programs. In this post, I will discuss some Local Programs that my own office and PHO have participated with or initiated as examples of other types of programs that can engage physicians with PHM and CQI. Continue reading →

Data Management for Population Health

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By Kirk Elder, Chief Technology Officer

As we have seen from other Wellcentive Blog posts, community interfacing and data aggregation are critical for Responsible Population Health Management (PHM).  However, after your PHM program is initially implemented, ongoing management and maintenance of your overall data strategy becomes even more critical.  If you do not “govern” your data landscape, you will not be running an efficient and effective population health program, and the return from your investment can be reduced if stability is not gained and maintained.  In fact, your investment could be lost completely if data governance mistakes escalate into serious data management problems. Continue reading →

Physician Engagement Series: Public Reporting

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By Dr. Paul D. Taylor, Wellcentive co-founder and Chief Medical Information Officer

In this Wellcentive Blog post, I’m going to talk about another program you can use to help get your physicians engaged in Responsible Population Health Management (PHM) and Clinical Quality Improvement (CQI). The programs I’ve covered in the series so far, Pay for Performance (P4P or PFP), Patient Centered Medical Home (PCMH), the Physician Quality Reporting System (PQRS), Accountable Care, and Meaningful Use, all have a little more carrot than Public Reporting, which really is both carrot and stick. Continue reading →

Community Interfacing Strategies for Population Health Management

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By Mason Beard, V.P. of Product Strategy

Earlier this month in the Wellcentive Blog, Phillip Burgher talked about health care data aggregation and normalization and how important these tasks are for ensuring you have an accurate, up-to-date, and complete data set for Population Health Management (PHM) work. This week, I am going to spend some time talking about community-wide interfaces and how they help collect the data you need to implement and manage a successful PHM program. Continue reading →

Physician Engagement Series: Meaningful Use

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For those loyal followers of The Wellcentive Blog, you know that one central theme of my posts is that physicians must be proactively engaged with Clinical Quality Improvement (CQI) programs in order to successfully improve clinical outcomes and reduce costs. In this blog series, I am covering several programs that provide a framework to help physicians organize and prioritize this work and to reward them for their participation and success. So far, I’ve covered Pay for Performance (P4P or PFP), Patient Centered Medical Home (PCMH), the Physician Quality Reporting System (PQRS), and Accountable Care, and this time I’ll discuss how Meaningful Use is yet another tool in the physician engagement shed. Continue reading →

Data Aggregation and Normalization for Population Health Management

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By Phillip Burgher, Director of Integration Services

Responsible population health management (PHM) depends on having a comprehensive view of a patient’s overall health; data accuracy relies heavily on data aggregation and normalization. However, in today’s healthcare world, the bits and pieces that comprise a patient’s chart are spread out across entire communities and beyond.

For example, a patient’s demographic information might be in the practice management system (PMS), whereas the information about the encounter is entered into an Electronic Health Record (EHR). To complicate matters, there is no guarantee the two pieces of software talk to each other, reference the same patient identifiers (IDs), use the same coding systems, or even come from the same vendor.  Additionally, clinical quality measures (CQM) are based on both administrative and clinical data. Clearly, PHM solutions have their work cut out for them in aggregating and normalizing this disparate data. Continue reading →

Physician Engagement Series: Accountable Care

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In this Wellcentive Blog series, I am covering different programs that reward physicians for improving clinical outcomes and cutting costs, which generally requires proactive physician engagement with a Responsible Population Health Management program. So far, we’ve covered Pay for Performance (PFP or P4P), Patient Centered Medical Home (PCMH), and Physician Quality Reporting (PQRS) programs, and in this post I’ll spend a little time talking about how Accountable Care can help engage your physicians with this important work. Continue reading →

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