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www.innovations.ahrq.gov/pqmp/implementation-qi/lessons.html
August 01, 2021 - measure be used to evaluate quality of care between multiple levels (i.e., state, health plan, and provider … determine measures can be appropriately used/aggregated at multiple levels (state, health plan, and provider … performance comparisons
How might relative performance be compared at each level, such as between different provider … For example, if improvement is likely to be more rapid at the provider-level, what are the implications … improvement) challenges and successes are identified at different levels (e.g., state, health plan, practice, provider
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-240-section-2-technical-specifications.pdf
February 21, 2020 - ≥85th percentile and an outpatient care visit whose parents were
surveyed and reported that their provider … is calculated as follows:
The percentage of eligible children whose parents reported that their provider … affirmative response to the question: “In the last 12 months,
Discussion did your child’s healthcare provider … care A Health Maintenance Exam (HME) or an Evaluation and Management (E&M)
visit with primary care provider
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www.innovations.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/amplify-impact-webinar.html
October 01, 2020 - Support provider-level improvement.
Improve quality of care. … Slide 19
Supporting Provider-Level Improvement
CHIPRA State strategies
Technical support
Learning … Provider surveys.
Interview agencies, advocacy groups, associations. … Weigh data usefulness, provider burden.
Improve data quality, connectedness. … Increase provider, family buy-in.
Elevate issues on policy agenda.
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/nyp-webinar-servati-demo-project.pdf
October 29, 2018 - WORDS
Please tell us in your own words about your experiences with the care and services from
your provider … What are the most important things that you look for in a healthcare provider and the
staff in his or … When you think about the things that are most important to you, how do your provider
and the staff in … Now we’d like to focus on any experiences in the last 3 months with your provider and
the staff in his … Please describe how you and your provider relate to and interact with each other.
30
The NYP Patient
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www.innovations.ahrq.gov/cahps/surveys-guidance/hp/about/child-survey-measures.html
June 01, 2017 - when discussing child’s care with providers
Preparing You and Your Child to Leave the Hospital
Q36 Provider … asked parent about child’s readiness to leave the hospital
Q37 Provider talked with parent about care … after leaving the hospital
Q41 Provider explained when child can resume regular activities
Q42 Provider … questions
Involving Teens in Their Care
Q45 Providers involved teen in discussions about care
Q46 Provider … asked teen about readiness to leave the hospital
Q47 Provider talked with teen about care after leaving
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www.innovations.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/communication/strategy6kculturalcompetence.html
March 01, 2020 - Building a Provider Network to Meet the Community’s Linguistic and Cultural Needs
6.K.2.c. … Building a provider network to meet the community's linguistic and cultural needs. … Building a Provider Network to Meet the Community's Linguistic and Cultural Needs
Once a plan has complete … CIGNA staff use a software system to search this information whenever a member requests a provider with … particular characteristics, thus facilitating a cultural and linguistic match between provider and patient
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www.innovations.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/nashp-webinar-slides.html
January 01, 2016 - Support provider-level improvement. … Slide 12
Supporting Provider-Level Improvement
Goals
Help providers interpret quality reports … Measures had to be reported directly from the provider organization's EHR. … organization
Participating provider organizations
Reported on 10 to 18 Child Core Set Measures. … Provider organizations supplemented annual reporting to PA to drive clinician-level change
Produced
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-234-technical-specs.pdf
December 01, 2015 - Provider Identification Identify dental providers using taxonomy-based codes linked
to provider
NPI … (National Provider Identifier). … For example, the
National Plan & Provider Enumeration System (NPPES)
registry may be used to identify … Outpatient Dental Care for Children
U18HS020516
Page 34
Submitted December 2015
Table AVS5-A: Provider
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-234-fullreport.pdf
June 17, 2014 - Otherwise,
taxonomy codes may be used to link to provider National Provider Identifier (NPI). … Provider NPIs from rendering and billing
provider fields were linked to relevant taxonomy codes from … during provider enrollment in a Medicaid
program or health plan; consistently included in provider … • Provider specialty – available by linking provider NPI with national or State databases via
taxonomy … provider specialty with complete accuracy.
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/nashp-webinar-on-quality_measure-use.pdf
September 21, 2015 - demonstrating improvement
• Changed reimbursement to support improvements
13 13
Supporting Provider … ”
— North Carolina Practice Manager
14 14
Supporting Provider Improvement
• Lessons learned … organizations
reported measures annually to PA
• Measures had to be reported directly from the provider … organization
• Participating provider organizations
– Reported on 10 to 18 Child Core Set Measures … Improvement
Supporting Provider Improvement
Supporting Provider Improvement
Slide Number 15
Project
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www.innovations.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/index.html
March 01, 2023 - For some strategies, both health plans and provider groups have a role to play, even if one is more " … degree of influence a plan can exert depends in part on the structure of its relationship with its provider … Performance
Private Feedback on Provider Performance
Value-Based Payments
Return to Contents … Public Reporting on Provider Performance
Public reporting on provider performance can help patients … Private Feedback on Provider Performance
As a substitute or complement to public performance reports
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www.innovations.ahrq.gov/practiceimprovement/delivery-initiative/casalino/paper/idkeydsrapc.html
February 01, 2014 - Do hospital-employed physicians provider higher quality/lower cost care than physician-owned medical … What are the effects of capitation payment plus a bonus for quality on provider organization performance … To what extent do attempts to gain increased leverage affect the structure of provider organizations? … What are the effects of increased provider negotiating leverage on the quality and cost of health care … How large must a provider organization be for reliable measurement to be made of important measures of
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-235-section-2-tech-specs.pdf
September 21, 2018 - Identification Identify specialists using taxonomy codes linked to provider NPI
(National Provider … Examples include program enrollment files
and the National Plan & Provider Enumeration System [NPPES … See Table AVS4-A for National Uniform
Claim Committee provider taxonomy codes. … Table AVS4-A: Provider Taxonomy Codes
Specialty Subtype Taxonomy Code
Cardiology Interventional … Facility 06
Tribal 638 Free-standing Facility 07
Tribal 638 Provider-based Facility 08
Office 11
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/PCMH/creating-patient-centered-team-based-primary-care-white-paper.pdf
March 01, 2016 - We refer to this as the “coherence” of the provider team. … We refer to this as the “coherence” of a provider
team. … Build coherence among provider team members. … Improving patient-provider communication: a
call to action. … Build coherence among provider team members.
2.
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/item-sets/CG/administering_cg_narrative_items.pdf
June 01, 2021 - The next questions
ask you to describe the care you get from this provider in your own words. … What went well with this provider and their staff in the last 6 months? … What are the most important things that you look for in a healthcare
provider and their staff? … What went well with this provider and their staff in the last 6 months? … Q5: Please describe your interactions with this provider and how you got along.
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www.innovations.ahrq.gov/talkingquality/translate/compare/choose/compare-providers.html
January 01, 2023 - Project
Resources
About TalkingQuality
Comparing Health Plan and Provider … A provider with a much higher score than average could still be doing quite poorly and one with a much … Page originally created November 2013
Internet Citation: Comparing Health Plan and Provider
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/item-sets/elicitation/cahps-infographic-v7.pdf
June 01, 2021 - richness to this picture by asking patients
to describe their experiences:
1 What do you look for in a provider … 2 How does your provider measure up?
3 What has gone well?
4 What hasn’t gone well? … 5 How do you and your provider get along?
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www.innovations.ahrq.gov/talkingquality/measures/setting/hospitals/databases.html
January 01, 2023 - access two hospital quality databases: Healthcare Cost and Utilization Project (HCUP) and Medicare Provider … Medicare Provider Analysis and Review (MEDPAR)
This data file, available from the Centers for Medicare … Learn more at:
Medicare Provider Analysis and Review (MEDPAR) File: https://www.cms.gov/Research-Statistics-Data-and-Systems
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0242-technicalspecs.pdf
February 04, 2020 - Additional outpatient visit where weight was addressed
A visit with a health care provider within the … which weight
was addressed could occur in various settings: with a primary care or mental
health provider … physical activity
• Anticipatory guidance for physical activity
OR
Visit includes documentation that provider … care A Health Maintenance Exam (HME) or an Evaluation and Management
(E&M) visit with primary care provider
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www.innovations.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/qde-mmd-webinar-slides.html
January 01, 2016 - to track QI efforts
Accurate reports require accurate documentation
Slide 13
Supporting Provider … Based on a standardized process, five other provider organizations reported measures annually to PA. … Measures had to be reported directly from the provider organization's EHR. … Project Outcomes
PA paid $935,000 in incentive payments, ranging from $65,000 to $260,000 per provider … organization
Participating provider organizations
Reported on 10 to 18 Child Core Set Measures