Feature Image
Brand New Table @ Annual Meeting Of the Minds
In more than 4 years they have only invited Keith to sit at
their table ONCE
-
Primary Source Documents
07_Assess_GBDP_Stars_18120304_Results_I
06_Literacy_Stars_15100803_Vocabulary_Acronyms V2018
-
Blogger Title
CMS Annual Stars Scores for Brand New Day H0838 – 2019
Embellishment by Keith E Torkelson, MS
Google Plus Information
External Quality Review of Brand New Day by Mentalation
Solutions Group (201812)
-
Acknowledgements
We would like to thank our Brand
New Day (BND) helpers: Jeff G, Derek C, Jessica R, and Sofia E for there
participation in this study. We
posthumously thank: Oswaldo E and Ali E.
All of our helpers except for Derek perform more work behind the scenes
than up front.
-
Dedication – Consumer &
Providers
We dedicate this paper to no more
less than five individual associated with Brand New Day. First would be our friend and plan member
Herbert HP. New would be BND associated
providers: Chester D Mojica MD (PCP), Rimal B Bera MD (BHD), and Martha G Gil
(Nurse). Last, we dedicate this paper
to BND's Constance “Connie” Snyder in corporate administration. Without the contributions of all these
people this paper (publication) would not be possible. “Hats Off” to all of them.
-
BND Member Herbert HP - B4 Crash and Burn
-
In Memory Of
For this term we would like to
remember our friends “Gravity” Dave (BND Member) and Mike Sisco because there
is a chance that both were inappropriately served. We place them in our Died Too Young category. Is it really better to burn out than fade
away?
[INSERT IMAGE OF BOTH]
-
BND Member "Gravity" Dave
"Sisco" Securing Permanent Supportive Housing
-
List – Tables/Matrices/Figures
List – Tables/Matrices/Figures
Figures – Partners
Acronyms – SuperList Link
Objective Results Up Front (ORUF)
-Figure – Brand New Day (CMS) – 2018 Stars Scores
-Figure – Brand New Day (CMS) – 2019 Stars Scores
Table – CMS Stars Related Acronyms & Vocabulary
Matrix – Stars Formula Discovery
Table - Q1Medicare’s Stars and Related Approach
Table - Guide to Medicare Star Ratings (Industry Standard)
Table - Some New Acronyms - Measure
Management
Figure – Self Advocacy with Corporate
Matrix – CMS Stars Quick Score Method – Provider Brand New
Day
Table - Business Process – Transformation (Parts 1 and 2)
Figure – Orientation Note by Rick
Mark Date 20120418-W:
Results – Matrix - Component Grades - Applying MHSA
Intelligence
Figure – BND Participation Letter
Matrix - Brand New Day Prescribed - Collaborative Personal
Recovery Plan (CPRP)
Matrix - Health Related Engagement (HRE) Summary
Table - Method – Star System Legend (Applied)
Table – Agencies Considered – Health Plans - Programs
Table - Decipher for MD Level Professionals
-
Promotions
Appendix - Matrix - BSA Virtue
Assessment – Applied to Brand New Day
Appendix - Table – Report Guide - Outline
Appendix - Table – Outline of Feature Item Consideration
Appendix - Table – Outline of Considerations (Elimination)
Appendix – Materials [HELD BACK]
-
Partners
-
Garden Grove Corporate Offices
Ali E disappeared here - only one sighting since
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Acronyms – SuperList Link - Friday, December 7, 2018
Acronyms and Terminology Associated with CMS Annual Stars
Scores Report for Brand New Day H0838
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20181207-F: Abstract – Executive
Summary
We here are Mentalation Solutions
Group (MSG)! This report falls under
our External Quality Review efforts. Most of the data is about our principal
Keith Torkelson (MS) and his relationship with the healthcare provider Brand
New Day (BND). As a minimum Brand New
Day services multiple regions in Californian.
Keith’s service center is located in Garden Grove California near
Disneyland. Keith’s relationship with
BND will be ongoing into 2019. He
shopped briefly about alternate healthcare providers such as CalOptima and
Kaiser Permanente. BND for the most
part continues to meet his service needs and educational interests. The overarching theme for this report is
centered about BND’s annual Centers for Medicare & Medicaid Services (CMS)
issued Stars performance scores. The
2019 Stars scores for BND just came out online last November (2018). BND’s overall performance for 2019 is 3.5
Stars with 5.0 Stars being the best or excellent. Since MSG has been tracking BND’s Stars BND has not improved
much. Most of the remainder of our
findings associated with this report are subjective. For a service window about 2013 we awarded BND 3.9 Stars for
virtuosity. For 2018 we dropped them
down to a virtue score of 2.8. After
BND peaked in reliability for 2013 they have become for us less reliable. Some factor that contribute to their
diminished reliability are:
-
- We have an ineffective Personal Services Coordination (PSC)
- BND subjected our most important medication to a determination
- Ruled and decided against us
- BND denied payment of service
- Monthly medically necessary lab work
- Yearly physical exam
- Sustained failure to be of help with respect to housing needs
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More Subjective Findings
There are more annoyances yet you
get the picture. About this report we
have many key doctors. Looking at six
of them, with these doctors, we have 2 summative relationships and 4 formative
relationships. We have high hopes for
our new Behavioral Health Doctor (BHD) Rimal B Bera. In league with BND we have intensive experience with at least
four healthcare Plans. Objectively,
based on CMS Stars score their performance relationship is: Kaiser >
CalOptima > BND. We have a product
here at MSG that we have been formally developing since 2014. We call it Health Related Engagement (HRE). It is a measure of service and support
intensity or dosage. For 2018 up to
October 21, 2018 Keith attended and participate in a total of 100 Health
Related Engagement (HREs). Forty-six
HREs were in the BND network whereas 54 HREs were out of the BND network. When we compare responsibility about BND
related Services and Support such as executing a Treatment Plan we found that
Keith contributes more than do his BND related resources. We found a glitch in a result for 2018. We will leave it for now. We calculated for Keith 92% participation
and for BND 63% participation. We are
fond with what we here at MSG call Steinberg Programming Language (SPL) and
MHSAIntel.
-
Satisfaction with Program
We created an assessment to take
a gander at BND from an innovative and obtuse angle. With our assessment we calculate and report what we call an: Innovative Health & Human Services
Fidelity Score. In keeping with the
5-star approach, for 2018 Fidelity BND earned 2.1 Stars whereas we here at MSG
earned 4.4 Stars. We tried two other
approaches to capture the service experience.
One we call: CMS Screening for Satisfaction with Program Score. For this we include Word Of Mouth (WOM)
testimony from at least ten unduplicated BND members. Let us say we personally give BND higher scores that do the other
members. Last we have been working on a
good formula(s) to calculate a CMS Stars Score ourselves. Remember roughly HEDIS + CAHPS + HOS = CMS
Stars. Based on literature we here at
MSG have defined completely new approach to score stars independent of HEDIS,
CAHPS or HOS. Using this new and
improve tool we discovered BND at 3.0 stars.
Closing, we are going to have to go through and better prove this method
for stars. For us here at MSG CMS Stars
are “Stars” and MSG calculate stars or star equivalents are “stars”. Well that is it – If interested please read
on and share some of our findings As Needed (PRN). (AVEY, 2018)
-
Compare: 20150122-TH: Abstract – Summary [UPDATED REPRINT]
Our 2015 “study found that Brand
New Day averages 3-stars in its’ yearly Star Assessment by Medicare. We compared this with Southern California
Kaiser (5-Stars) and Orange County CalOptima (4-Stars). [FOR US] Medicare’s Stars Assessment System
was chartered in 2012. There are enough
data points as of 2015 to predict a trend.
If something is not done including implementation of shared solutions
then [THE GRADUATE BY DEATH PROGRAM] GBDP’s [AKA BND's] rating for 2015 will
very likely be 3-Stars. As a member
TheDAG [KEITH] must integrate helping GBDP with its Stars into his
Collaborative Personal Recovery Plan (See Table CPRP) else [DEDICATING AN
EXHAUSTING AMOUNT OF TIME] helping out could be [BOTH] a harmful and
potentially overwhelming endeavor.”
-
Objective Results Up Front (ORUF)
-
Figure – Brand New
Day (CMS) – 2018 Stars Scores
[PDF] - 2018 Medicare Star Ratings - Brand New Day (H0838)
Note: An Overall
Star Rating that combines all of our plan's scores.
-
-
Figure – Brand New Day (CMS) – 2019 Stars Scores
-
Retrieved: 20181130-F:
[PDF] - HPMS: 2019 Medicare Star
Ratings - Brand New Day
Note: The Medicare Program rates
all health and prescription drug plans each year.
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Table – CMS Stars Related Acronyms & Vocabulary
-
|
||
AcroCode
|
Description
|
|
-
|
||
CAHPS®
|
Consumer Assessment of Health Plan Study
|
|
CIBHS
|
The California Institute for Behavioral Health Solutions
|
|
CMS
|
Centers for Medicare & Medicaid Services
|
|
CPS
|
Consumer Perception Scale
|
|
HEDIS
|
The Healthcare Effectiveness Data and Information Set
|
|
HOS
|
Health Outcomes Survey
|
|
NCQA
|
National Committee for Quality Assurance
|
|
SPH
|
Symphony Performance Health
|
|
SPH-Analytics
|
Symphony Performance Health - Analytics
|
|
SR
|
(CMS) Star Ratings
|
|
TMG
|
The Myers Group
|
|
TMG-HOSS
|
The Myers Group Health Outcomes Survey Support
|
|
-
|
Table – Last Reviewed for 2019 BND Stars Report: 20181207-F:
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20181205-W: Formula Approximation
HEDIS + CAHPS + HOS = CMS Stars
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Query - What is the formula for
CMS Stars calculation?
“Stars are assigned to each
contract for each individual measure being evaluated, based on relative
performance compared to the other contracts. The overall summary score for each
contract is then calculated by averaging the star ratings for each individual
measure for a contract.” Jun 2, 2015
FYI - Primer: The Medicare Advantage Star Rating System -
AAF
-
-
Matrix – Stars Formula Discovery – Latest Attempt
-
|
|||||
Metric Category
|
Weight
(MAX)
|
Our Experience
2012-2018
|
CALC
|
||
-
|
-
|
||||
Improvement
|
5 (25.0)
|
Above Average
|
5.0*4=20.0
|
||
Outcomes
|
3 (15.0)
|
Average
|
3.0*3=9.0
|
||
Intermediate Outcomes
|
3 (15.0)
|
Average
|
3.0*3=9.0
|
||
Patient Experience
|
1.5 (7.5)
|
Average
|
1.5*3=4.5
|
||
Access
|
1.5 (7.5)
|
Below Average
|
1.5*2=3.0
|
||
Process
|
1 (5.0)
|
Below Average
|
1.0*2=2.0
|
||
-
|
|||||
Pooling
|
MAX = 80.0
|
SUM = 47.5
|
|||
Intermediate CALCS
|
SUM/MAX =
47.5/80.0 =
0.59
|
||||
Star Equivalents =
|
3.0
|
||||
-
|
-
Stars Formula Discovery
We still have yet to find the
exact and complete formula that CMS and their contractors use to calculate
their annual Stars scores. For us here
at MSG there remains a conceptual and quantitative gap between taking HEDIS,
CAHPS, and HOS figures to compose anything close to a reasonable CMS Stars
score. We are impressed that our latest
attempt above yields a figure very close to what CMS awarded Brand New Day for
2018.
-
FYI - New Intel For Us @:
American Action Forum [Ditto]
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Read more:
-
Promotion: Follow us: @AAF on
Twitter
-
Introduction
-
Legacy Report
We selected our 2015 Brand New
Day related CMS Stars report to work from for this years 2019 BND related CMS
Stars report. Looking back and
refreshing about MSG’s past work helps us realize how far we have come versus
how far Brand New Day has progressed.
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FYI - Brand New Day - Our Plan –
CMS-H0838-020
2019 Brand New Day Harmony Choice
Plan (HMO SNP) - H0838-020
2019 Medicare Star Ratings
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BND’s Position
“The Medicare Program rates all
health and prescription drug plans each year, based on a plan's quality and
performance. Medicare Star Ratings help you know how good a job our plan is
doing. You can use these Star Ratings to compare our plan's performance to
other plans. The two main types of Star Ratings are.”
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Stars Report Format
If you obtain and examine a
standardized CMS Stars report form online you we see that they are identical
when they are the ones reported usually in PDF Format by a provider. Providers such as BND report as follows: “An
Overall Star Rating that combines all of our plan's scores; Summary Star Rating
that focuses on our medical or our prescription drug services.” We find the one page report again usually in
PDF format to be quite nicely readable.
In other words the density of facts is not overburdening.
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Table - Q1Medicare’s Stars and
Related Approach
2019 Medicare Advantage Plan
Details - H0838-020-0: Statistics
2019 Medicare Advantage Plan
Benefit Details for the Brand New Day Harmony Choice Plan (HMO SNP) -
H0838-020-0
Side Notation
[LINK WAY TOO BURDENSOME TO
INCLUDE & FAILS HYPERTEXT CONVERSION]
Statistic
|
Value
|
|
Number of
Members enrolled in this plan
(H0838 - 020)
|
2277 Members
|
|
Plan’s Summary
Star Rating
|
3 out of 5 Stars
|
|
Customer Service
Rating
|
4 out of 5 Stars
|
|
Member
Experience Rating
|
3 out of 5 Stars
|
|
Drug Cost
Accuracy Rating
|
3 out of 5 Stars
|
|
Table Q1Medicare on BND Performance:
Last Reviewed: 201812-7-F:
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On Data Re-reporting – Example
Q1Medicare
How is it of value to work
re-reporting data? For us here at MSG
we find that re-reporting data as we do in this report may pose benefits for at
least two reasons. First, the pursuit
of the best data reporting form and formats that will save all interests
considerable time when stealing our data.
-
Second – Proven Value and Utility
Data reforming and formatting
that facilitates third party data migration and sharing. Q1Medicare is an organization that
participates in re-reporting. While
Q1’s formatting is not in line with any of the aforementioned reasons they do
include some facts and statistics that we have found on the Internet hard to
find. Last, Q1’s disclaimer information
is also helpful for writing Policies and Procedures.
-
[SEE DISCLAIMER HURDLE - PRO
SUBSTITUTE]
-
FYI – Promotion - About Us -
Q1Medicare.com
“Q1Group designed Q1Medicare.com
as a neutral online resource to objectively educate seniors, Medicare
beneficiaries, advocates, agents, and members of the general public who are
interested in Medicare Part D prescription drug plans and/or Medicare Advantage
plans."
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Table - Guide to Medicare Star
Ratings (Industry Standard)
Level
|
Interpretation
|
|
5 Stars
|
Excellent
|
|
4 Stars
|
Above Average
|
|
3 Stars
|
Average (AVG)
|
|
2 Stars
|
Below Average
|
|
1 Star
|
Poor
|
|
Last Reviewed: 20181207-F:
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Table - Some New Acronyms -
Measure Management
AcroCode
|
Meaning
|
|
NtED
|
Not enough data
available
|
|
NEW
|
Plan too new to
be measured
|
|
N/A
|
Not applicable
|
|
NtR
|
Plan not
required to report measure
|
|
SML
|
Plan too small
to be measured
|
|
NoD
|
No data
available
|
|
NtO
|
Benefit not
offered by plan
|
|
FYI – Source of Acronyms - https://q1medicare.com/
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Note On AcroCoding Conventions
We include these Acronyms used by
Q1Medicare for discussion purposes.
Obviously, Acronyms come in handy yet if data is to be shared with an
ease necessary to maximize cost / benefit someone or a body needs to
standardize them. Our in house
convention is to only use UPPERCASE and to relate each character to something
in the phrase. For example we would
code the first entry above as NEDA rather than NtED. We code N/A as NA. In programming
these codes would be acceptable to us.
This little tidbit peeve falls under Standards and Measures that are and
will remain out of scope for us at MSG.
-
20150125: Indications in The Literature
Figure – Self-Advocacy with Corporate
With Q1’s Help – MSG Improved
Disclaimer (PNP)
Some of our Medicare Advantage
and Medicare Part D prescription drug plan data in our reports come directly
from Medicare and is subject to change.
Medicare has neither reviewed nor endorsed the information in our Stars
(stars) reports. We provide our MSG
Blog information for educational purposes and strive to present unbiased and
accurate information. However, MSG is
not intended as a “substitute for your lawyer, doctor, healthcare provider,
financial advisor, or pharmacist”. “For more information on your Medicare
coverage, please be sure to seek legal, medical, pharmaceutical, or financial
advice from a licensed professional or telephone Medicare at 1-800-633-4227.'
-
Innovation and the Electronic
Future of Health Care
If Technology and Health Care
meld or mess to the common good and full potential possibly your laptop and the
Internet will substantially substitute for your lawyer, doctor, etc. This applies to services that do not involve
a risk of mortal or terribly moribund outcomes. Back 1982 we proposed that computer and information technology
could help healthcare more specifically veterinary medicine. A supervisor advised us that this is wrong
and should not happen. In 1986 we were
hired to write a program that could track movement, emergence and re-emergence
of pathogens within a huge commercial farming operation. So when we say that the medical model in
general and specific to Brand New Day needs improvement and possibly
supplanting with technology we think it tenable or able to be maintained or
defended against objection.
-
Introduction - Update on Legacies Outline
-
20150122: Why Study?
20150122: Why is the Overall Plan Rating Important?20150125: Indications in The Literature
-
20150122-TH: Why Study?
The reason we here at MSG are
studying the Stars system and ratings for local service providers is that it
may contribute to a cure for our principal’s disability. We hope this year by “making the effort
(Obama, 2015)” in 2015 that both GBDP [BND] and TheDAG [KEITH] can
improve. In addition, MSG hopes that a
synergy [WITH BND] (1+1 = 3) results.
-
20181207-F: Why Study?
By now one might conclude that
there is a relationship between the Graduate By DEATH Program and Brand New
Day. Yes, they are one and the
same. We discuss elsewhere that in 2015
we were trying to share the truth as we found it without harming Brand New Day
(Harm Reduction Policy). Another reason
we ciphered BND is that we feared being dropped. At some point we received a letter stating that we would not be
dropped over our quality assurance (complaints and grievances)
contributions. How is it we continue
studying CMS Stars? In short as we
learn more each year it has become rather enjoyable. It also helps us appreciate all that BND has done and is doing on
our behalf. We now know that we will
never really have an impact helping BND with their annual CMS Stars
Scores. One consumer cannot make a
difference particularly when BND's Stars longitudinal or time series curve is
flat across the last three years (2017-2019).
-
[FIND AND INCLUDE BND CORPORATE
LETTER]
-
-
Selected Reprints
20150122-TH: Why is the Overall
Plan Rating Important?
“The overall plan rating gives
you a single summary score that makes it easy for you to compare plans based on
quality and performance. Learn more
about differences among plans by looking at the detailed ratings” (GBDP). “The Medicare Star Quality Rating System
offers…an easy, objective resource to identify quality health plans in their
community,” said Amy Compton-Phillips, MD, associate executive director for
Quality at The Permanente Federation (Kaiser).
-
20150122-TH: Indications in The
Literature
The literature indicates The
Health Services evaluation “covers thirty-six (36) different topics in five (5)
categories (2011)”. Literature also
indicates Drug Services “covers seventeen (17) different topics in four (4)
different categories (2011).” Here
comes the dilemma either GBDP’s performance is wide ranging or clustered about
3.5-Stars. In other words either they
are "Average" across the board or "Poor" for some
“endeavors" and Excellent at others.
From the consumer perspective I commit to being mindful of their
shortcomings with the intent to help them out i.e. raise their Stars for
calendar year 2016. A couple of the
benefits for GBDP to improve are: Quality Bonus Payments and higher Rebates.
-
FYI - 20150122-TH: Interpretation
“Keep in mind that a plan that is
already doing well in most areas may not show much improvement. It is also
possible that a plan can start with low ratings, show a lot of improvement, and
still not be performing very well.”
-
Data Thread [HELD BACK]
20150127: Proofed by TheAE.
20150128-W: Released
FYI - 20150122-TH: Interpretation
-
Matrix – CMS Stars Quick Score
Method – Provider Brand New Day
-
HPMS Items 1-10 Last Reviewed: 20181207-F:
Extract from Standardized CMS
Report Format
-
|
|||||
Measure
|
Us
2018
|
WOM
2018
|
|||
-
|
|||||
How our members rate our plan's
services and care
|
AVG
(0.5)
|
Below AVG
(0.25)
|
|||
How well our doctors detect illnesses
and keep members healthy
|
Below AVG
(0.5)
|
Below AVG
(0.25)
|
|||
How well our
plan helps our members use recommended and safe prescription medications
|
AVG
(1.0)
|
AVG
(0.5)
|
|||
-
|
|||||
SUM/Total Items
Scored
|
2.0/3
|
1.0/3
|
|||
CMS Screening for
Satisfaction with Program Score =
|
67%
|
33%
|
|||
Star Equivalents =
|
3.4
|
1.7
|
|||
-
|
Compare Core
Doctors with Specialists
-
Word Of Mouth (WOM) Cohort = 10
Members
Just yesterday, December 4 2018,
we stopped by Brand New Day (BND) to touch base with the Smoking Area Cohort
(SAC). We counted ten individuals both
male and female including ourselves.
The topic of the day was Legal Issues.
In general housing issues usually prevail, unless we ask about: How
satisfied they are? Most of the time
unless a member shows us the paperwork they are working on all observations
come via Word Of Mouth (WOM).
-
HPMS=Health Plan Management
System
For more than four (4) years we
have been attempting to help Brand New Day improve their CMS Stars scores. Yet one and maybe even ten percent of us
consumers can make little difference As Measured By (AMB) CMS Stars
scores. This year we found new material
to apply centering about the theme Health Plan Management (HPM) and Health Plan
Management Systems (HPMS). Most of
Brand New Day’s managing operations is and will probably remain Out Of Scope
(OOS) for us here at MSG. Next we
address some HPMS Business Processes.
We broke the some odd 21 items into two tables.
-
Table - Business Process –
Transformation (Part 1 of 2)
Source - Health Plan Management
System (HPMS)
The Centers for Medicare &
Medicaid Services (CMS)
-
|
|||||
##
|
Process
|
MSG
Familiarity
|
|||
-
|
|||||
01
|
Contract and plan enumeration
and management
|
?
|
|||
02
|
Application submission and
review
|
?
|
|||
03
|
Formulary submission and review
|
X
|
|||
04
|
Bid and benefit package
submission and review
|
?
|
|||
05
|
Electronic contracting and
certifications
|
?
|
|||
06
|
Marketing material submission
and review
|
X
|
|||
07
|
Audit and assessment of plan
performance
|
Here
|
|||
08
|
Plan payment reconciliation
data reporting
|
?
|
|||
09
|
Fiscal soundness
|
?
|
|||
10
|
Complaint tracking
|
X
|
|||
HPMS Items 1-10 Last Reviewed: 20181207-F:
-
Original Order Retained
The original list we found at the
link above. We retained the original
order even though we prefer the alphabetical approach. If we were ever to address all the items
(concepts) in the list we could generate a: Business Processes Fidelity Score
for Brand New Day. The “X’s” in the
tables indicate concepts for which we have some idea about. We lack sufficient records access to
determine and score our understanding of this business management
material. In other words, BND business
processes for the most part are out of our control as a consumer. Item-07 (Audit…) is of the most interest to
us here at MSG.
-
Rick Mark is The Coolest
Rick Mark is one of BND’s
enrollment officers. We first
officially met Rick back on April 18, 2012.
Whenever we see Rick around the BND clubhouse or at a conference we say
to ourselves now that is one BND employee that makes sense in his working hard!
-
Figure – Orientation Note by Rick Mark Date
20120418-W:
-
Table - Business Process –
Transformation (Part 2 of 2)
Source - Health Plan Management
System (HPMS)
The Centers for Medicare &
Medicaid Services
##
|
Process
|
MSG
Familiarity
|
|||
11
|
Surveillance and compliance
|
?
|
|||
12
|
Plan data reporting and
performance metrics
|
X
|
|||
13
|
Financial, plan bid, and plan
data reporting audits
|
?
|
|||
14
|
Coverage gap discount program
|
X
|
|||
15
|
Electronic health record
reporting
|
Specialist
|
|||
16
|
Cost reporting and audit
|
?
|
|||
17
|
Plan connectivity
|
?
|
|||
18
|
Operational data exchanges
|
?
|
|||
19
|
Data support for the Medicare
& You handbook and Medicare Plan Finder
|
X
|
|||
20
|
Quality improvement
|
X
|
|||
21
|
Research and evaluation
|
?
|
|||
HPMS Items 11-21 Last Reviewed:
20181207-F:
-
Binder Review – Agency V Consumer
We have been in many a provider’s
office just to observe a bookcase of binders associated with their work
efforts. If we could we would visit a
BND corporate associate in quality assurance (now a Vice President) to spend
about 4 hours to pull all her binders and peruse, inspect, scrutinize and study
them. One day possibly with improved
transparency as provided by Electronic Business Management and Electronic
Health Record systems we may get a higher Level Of Access (LOC) to records that
pertain to us as consumers in our paraprofessional health work. At this time we conclude that our efforts to
improve BND’s CMS Star scores has been futile in that they are demonstrating no
improvement. As far as deciphering all
21 business processes we will pick about three per month so that next year we
have made some headway forward into Business Intelligence about Health &
Human Services within the Non-profit sector.
Most of our enterprise level work has been associated with the Public
Health sector.
-
Results – Matrix - Component Grades - Applying MHSA
Intelligence
MHSAIntel (MSG, 2019)
Alternate Approach – Using Steinberg Programming Language
(SPL)
Addendum – Assess by Health & Human Services (HHS)
Component
-
|
|||||||
##
|
Component
|
Us
2018
|
BND
2012
|
BND
2015
|
BND
2018
|
||
-
|
|||||||
01
|
Service
|
0.75
|
1.00
|
0.50
|
0.75
|
||
Support
|
0.75
|
0.75
|
0.50
|
0.50
|
|||
Prevention
|
1.00
|
0.50
|
0.75
|
0.50
|
|||
Intervention
|
1.00
|
0.75
|
0.50
|
0.25
|
|||
05
|
Housing
|
0.75
|
0.75
|
0.00
|
0.00
|
||
Technology
|
1.00
|
1.00
|
0.50
|
0.50
|
|||
Facilities
|
1.00
|
0.75
|
0.75
|
0.75
|
|||
Innovation
|
1.00
|
0.50
|
0.00
|
0.00
|
|||
09
|
Business
|
0.75
|
0.75
|
0.75
|
0.50
|
||
-
|
-
|
||||||
SUM/Total Items
Scored
|
8.00/9
|
6.75/9
|
4.25/9
|
3.75/9
|
|||
Innovative Health
& Human Services Fidelity Score =
|
89%
|
75%
|
47%
|
42%
|
|||
Star Equivalents =
|
4.4
|
3.8
|
2.4
|
2.1
|
|||
-
|
Date Scored: 20181130-F: Last
Reviewed: 20181207-F:
-
Consumer Driven
“Consumer-driven healthcare,
defined narrowly, refers to third-tier health insurance plans that allow
members to use health savings accounts, Health Reimbursement Accounts, or
similar medical payment.” We were surprised
to find this standard definition for Consumer-Driven. In Steinberg Programming Language (SPL) Consumer-Driven is more
likely a desirable and productive partnership between practitioner and
consumer. With a fruitful and
relatively equal partnership the doctor cannot stamp the clients record with
non-compliant. Surgery is one area
where the professional does and should dominate about their share in the
partnership. The matrix above indicates
that with BND, as a whole, the Locus Of Power (LOP) is likely to stay with us.
-
Figure – BND Participation Letter
[INSERT BND LETTER ABOUT PARTICIPATION]
-
Proof of ProSumer Concept
-
Process On Mind -
Counter DESTRUCTIONISM
-
-
Matrix - Brand New Day Prescribed - Collaborative Personal
Recovery Plan (CPRP)
Personal Mission – Promising Practices – Action Items
-
|
||||||
Life Domain
|
Promising Practices
|
Us
2018
|
BND
2015
|
BND
2018
|
||
-
|
||||||
Improve Relationships
|
Harm Reduction Model &
Motivational Interviewing
|
1.00
|
0.50
|
0.50
|
||
Improve Physical Health
|
Focus on what it take to lose 10 pounds
Comply with next suggestion yet prepare statement
|
1.00
|
0.50
|
1.00
|
||
Improve Emotional/Mental Health
|
Address using WHODAS V 2.0 Assessment ID’d shortcomings
|
0.75
|
0.50
|
0.75
|
||
Appreciate Pleasurable Activities
|
And not Drinking EtOH
|
1.00
|
0.25
|
0.50
|
||
Satisfaction and QOL In General
|
AMB – BND QOL Assessment
|
0.75
|
0.50
|
0.75
|
||
Education
|
Apply self to Promising Practices study
Example Blogging
|
1.00
|
0.25
|
0.25
|
||
-
|
||||||
SUM/Total Items
Scored
|
5.5/6
|
2.5/6
|
3.75/6
|
|||
Percent Contribution
to TX Plan =
|
92
|
42
|
63
|
|||
Star Equivalents =
|
3.1
|
|||||
-
|
Table – Taken from CPRP: 20150122-TH: Last Update:
20181203-M:
-
Within Our Power - Promising
Practices
We are for the most part
powerless to help BND with their 2020 CMS Stars Scores. What we can do is be the best consumer
possible (ProSumer). Having materials
associated with BND to work with presents us with a huge opportunity in
developing some of our products in the HHS context. Three of our most promising products for which we test about BND
are: Immersive Housing, Structure Temporal Reconciliation, and Heath Related
Engagement (ProSumption). In the end it
is prudent to take this direction: “Accept Program Limitations as reflected in
their Stars Scores”.
-
Summary – HREs
-
Matrix - Health Related Engagement (HRE) Summary
-
|
||||||
Year
|
In Network
|
Total
|
Out of Network
|
Note
|
||
2012
|
NR
|
NR
|
No CALC
|
|||
2013
|
NR
|
NR
|
No CALC
|
|||
2014
|
NR
|
82
|
No CALC
|
|||
2015
|
33
|
80
|
47
|
|||
2016
|
45
|
88
|
33
|
|||
2017
|
78
|
120
|
32
|
|||
2018
|
46
|
100 As of
10/21/18
|
54
|
|||
2019
|
-
|
Pending
|
||||
Matrix - Health Related Engagement (HRE) Summary – NR = Not
Recorded
Last Scoring: 20181121-SUN: Last Reviewed: 20181207-F:
-
Health Related Engagement (HRE) – Brief
From: 2016022801 HREs Step-03 V2018
-
20180711-W: Defining a Health
Related Engagement (HRE)
The first note in our database
regarding HREs is February 28, 2016.
Our planners indicate we have been tracking our HREs since 2014. Since then we have worked on a standard
definition for our HRE (MSG) Product.
The definition includes requirements and specifications. As of today, July 11, 2018, our Beta
Definition is as follows. For us the
HRE method looks like a promising practice.
We have applied it more than 100 times.
HREs require preparing in advance for and attending an engagement. HREs are assessment driven. HREs might be likened to dosage. Dosages have been linked to better
outcomes. We track the impact about our
HREs. We also focus on
Satisfaction. When it comes to in house
engagements we do not count an HRE. We
strive to maximize the value of others’ and our time. We take measurements at an HRE.
We apply Para-health worker principles while at an HRE. Our role in an engagement is that of a
ProSumer (MSG).
-
Behavior & Compensation
Our behavior at an HRE is that of
ProSumption (MSG). In most cases we
share the results from our findings.
Google (Blogger) is our partner in ProSumption. In general HREs are either medical or social
in nature. ProSumption about HREs
addresses arriving at standards. In
general, an HRE has therapeutic value as measured by assessment. We prefer Commercial-Of-The-Shelf (COTS)
assessment to the ones we here at MSG write.
To balance things out we schedule HREs to be with healthy people. As a practicing ProSumer we attempt to
maximize transparency. Naturally we
score ourselves high as a ProSumer applying HRE principles. Finally, our HRE time is Voluntary. At times we receive non-monetary
compensation for our HRE efforts.
-
Table - Method – Star System Legend (Applied)
Stars
|
Performance
|
Example
|
|||
-
|
|||||
5
|
Excellent
|
Kaiser (2018)
|
|||
4
|
Above Average
|
CalOptima (2018)
|
|||
3
|
Average
|
GBDP/BND (2018)
|
|||
2
|
Below Average
|
||||
1
|
Poor
|
||||
-
|
Last Reviewed: 20181207-F:
-
Table – Agencies Considered – Health Plans - Programs
-
|
||||
Institution
|
Served Us Ever
|
Note
|
||
-
|
||||
BND (GBDP)
|
X
|
|||
Kaiser
|
X
|
|||
CalOptima (OneCare)
|
||||
CareMore
|
||||
HealthNet
|
X
|
|||
OCHCA
|
X
|
|||
-
|
Last Reviewed: 20181207-F:
-
Table - Decipher for BND Associated MD Level Professionals
-
|
|||||
Cipher MD
|
Actual
|
Note (Status)
|
|||
-
|
|||||
PCP=TheCM-MD
|
Chester D Mojica
|
Formative
|
|||
L-MD
|
Bum Soo Lee
|
Summative
|
|||
W-MD
|
Raphael Waknine
|
Summative
|
|||
B-MD
|
Rimal B Bera
|
Formative
|
|||
Derm-MD
|
Tien Q Nguyen
|
Formative
|
|||
Dentist
|
Formative
|
||||
-
|
Last Reviewed: 20181207-F:
-
How is it Cipher? – Harm
Reduction
Our original report about this
scheme was published back in 2015. For
that study we adhered to our Harm Reduction Policy (HRP). We ciphered both Brand New Day and the
practitioners for which we reported on.
In 2015 we reported Brand New Day as a Graduate By DEATH Program
(GBDP). If you have lived experience
with any of these practitioners we suggest rating them for yourself on Vitals
dot COM or Healthgrades.
-
Appendix - Matrix - BSA Virtue
Assessment – Applied to Brand New Day
-
|
|||||
LAW
#
|
Key Word
|
BND
20181204-TU:
For – 2013 - BL
Retro
|
BND
20181204-TU:
For – 2018 - RT
|
||
-
|
|||||
1
|
Trustworthy
|
8
|
6
|
||
2
|
Loyal
|
8
|
6
|
||
3
|
Helpful
|
8
|
4
|
||
4
|
Friendly
|
8
|
4
|
||
5
|
Courteous
|
8
|
4
|
||
6
|
Kind
|
9
|
5
|
||
7
|
Obedient
|
8
|
4
|
||
8
|
Cheerful
|
9
|
6
|
||
9
|
Thrifty
|
8
|
8
|
||
10
|
Brave
|
8
|
8
|
||
11
|
Clean
|
5
|
5
|
||
12
|
Reverent
|
6
|
6
|
||
-
|
|||||
AVG =
|
7.8
|
5.5
|
|||
Star Equivalents =
|
3.9
|
2.8
|
|||
-
|
|||||
Bonus
|
Reliable
|
YES
|
LESS SO
|
||
-
|
Matrix – Boy Scouts’ of America –
Virtue Assessment (1-10 Scoring Scheme with 10 Best)
-
Key: BL=Baseline |
Retro=Retroactive | RT=Real Time
-
Appendix - Table – Report Guide - Outline
-
|
||||
Element
|
Addressed
Here
|
Note
|
||
-
|
||||
Abstract – Executive Summary
|
X
|
|||
Dedication – Etc
|
X
|
|||
Partners
|
X
|
|||
List – Tables/Matrices/Figures
|
X
|
|||
Embedded Images PRN
|
X
|
|||
Objective Results Up Front
|
X
|
|||
Introduction – Feature Considerations
|
X
|
|||
Materials
|
||||
Prescribed Material
|
||||
Collaborative Personal Recovery Plan
|
X
|
|||
Method – Align with
|
||||
Results - Subjective
|
X
|
|||
Results – Component Grades
|
X
|
|||
HHS Component
|
||||
Discussion
|
||||
Summary (HREs)
|
X
|
|||
Appendices
|
X
|
|||
-
|
-
Appendix - Table – Outline of Feature Item Consideration
-
|
||||
Feature
|
Addressed
Here
|
Note
|
||
-
|
||||
FAV Time of Year
|
X
|
|||
CMS Stars Scores Published Online
|
X
|
|||
GBDP V BND
|
X
|
|||
Stars and Satisfaction
|
||||
Stars and QOL
|
||||
CMS Stars Relationship to HEDIS
|
||||
Participation Letter
Sample February 14, 2017
|
X
|
|||
How is it we care?
|
X
|
|||
Open Enrollment Ends – December 7, 2018
|
X
|
|||
Deadline – December 7, 2018 (F)
|
||||
CalOptima Solicitation
|
||||
-
|
-
Appendix - Table – Outline of Considerations (Elimination)
-
|
||||
Consideration
|
Addressed
Here
|
Note
|
||
-
|
||||
Personal Mission – Best Practices
|
||||
Life Domains
|
||||
Method - Legend
|
||||
Methods - Comparing Programs
|
||||
2014 – GBDP Contractor Comparison Study
|
||||
Profile of the Quarter - Leadership
(Sophia compared with Mary)
|
||||
Introduction - Materials
|
||||
2011 Criteria
|
||||
Health Services
|
X
|
|||
Drug Services
|
X
|
|||
Applied Materials
|
X
|
|||
Sources of Information
|
X
|
|||
For Quality of Health Services
|
X
|
|||
For Quality of Drug Services
|
X
|
|||
Disability Update Report (DUR)
|
||||
Best (Promising) Practice Checklist
|
||||
-
|
-
Promotions
-
One Health Initiative - One World One Medicine One Health
-
WorldWafers (2059)
-
Images @ The End
-
FYI & Promoting OC-Links
BND 2017 CMS Stars Report
Needs Help & Not Getting It
For the moment he is MIA
Some Info Via Our Patient Portal
How did CalOptima OneCare Get Away with This?
-
FYI - A CMS Stars Related Drop Down
Can We Counteract DESTRUCTIONISM?
-
Brand New Day - Free Food
You Can't Beat Free Food
This is Pizza Tuesday
-
This is Pizza Tuesday
-
-
BND Member Intensive Care - Infectious Disease Ward
Stabilized & Left
Stabilized & Left
-
-
A Bigger Picture
We will address Chest Medicine and COPD in a 2019 Special Report
-
The End
-30-
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