H
ave you ever wondered how other providers improve member outcomes? And ultimately get rewarded
with higher payments through the Care Based Incentive (CBI) program? The following is a compilation of
the Alliance “Top 10 List” of CBI Best Practices. These were based on responses received from providers,
Alliance staff, surveys and observations of care delivery with demonstrated exceptional member outcomes.
Countdown for the Top 10 CBI Best Practices!
And the #1 Best Practice is...
#1
Leverage the electronic medical record to program templates or trigger alerts for CBI measures—
“Make it easy to do the right thing.”
Active use of the Provider Portal!
#10
Refer members to the Alliance Care Management resources.
Ways to do this:
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Improve asthma management through the Healthy Breathing for Life program.
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Perform outreach with Health Programs staff to prevent ED visits.
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Partner with Case Management for coordination of care and oversight.
For example:
●●
For the Diabetes measures, Diabetes Hba1C, nephropathy and LDL were the top performing measures. Utilize the member lists
to check on individuals that require screening on a monthly basis (or more frequently).
●●
Electronic referrals increased by 54% and electronic claims (EDI) submission increased by 4%.
●●
Work with Alliance staff (Quality Improvement and Provider Services) to review outliers.
Connect Provider and Member incentives when promoting the CBI program to staff.
Provider and member incentives were purposefully aligned to support each other. For example:
●●
Diabetes measure: For the provider incentive, points are awarded as a Quality of Care Measure and an additional FFS payment
is given when all diabetes screenings are completed. For members, a gift card is given once all diabetes screenings are completed.
●●
Asthma Action Plan:
FFS payment for providers and a gift card raffle to members.
●●
Body Mass Index (BMI): For the provider incentive, points are given as a Quality of Care Measure and an FFS payment for a
Healthy Weight for Life
referral. Members are given a gift for a reduced BMI.
Use of generic prescriptions is still a top performer!
#3
Incorporate a team-based care concept of daily clinic “huddles” to review preventive
screenings that are due.
Proactively align clinic strategic goals and quality measures with CBI measures.
Consider Coleman Dramatic Performance Improvement (DPI) tactics. For example:
●●
Allow walk-in appointments to prevent ED visits.
●●
Visually display a dashboard to monitor performance.
●●
Continually coach staff through scripting and feedback.
Provide extensive training to staff (in partnership with the Quality Improvement and Provider Services
departments) on measures and performance.
#6
#7
#8
#9
#4
Identify a “champion” to primarily focus on the measures, perform outreach and follow up
with every member.
#5
#2
DECEMBER 2013
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