Case Study: Humana PCO, Conviva Physician Group
Enhancing Medicare Stars and Patient Engagement

Customers served! 0 % Drove improved Risk Management performance

Medicare Stars Performance Year over Year

Customers served! 0 % Drove improved Risk Management performance

Enhanced risk adjustment performance

Customers served! 0 % Drove improved Risk Management performance

Improved NPS Score

Customers served! 0 % Drove improved Risk Management performance

Medication Adherence Performance

Team Lead

Dr. Vergena Clark, an innovative physician executive and healthcare consultant, served as the National Medical Director for Clinical Outcomes, Quality, and Medicare Risk Adjustment at Humana/Conviva Care Solutions from 2018 to 2023. During her tenure, she served 100+ primary care clinics, approximately 400 employed physicians, and 300 Independent Physician Affiliate (IPA) physicians, managing a patient base of 230,000.

Challenge

Humana PCO, Conviva Physician Group sought to enhance its Risk Adjustment Strategy and Medicare Stars ratings and improve patient engagement metrics while maintaining high clinical outcomes and operational efficiency. The goal was to implement a robust strategy that could address underperformance in certain practices and improve overall patient and physician engagement.

Approach

Dr. Clark spearheaded several strategic initiatives to address these challenges:

Organization-Wide Patient Experience Strategy

  • Developed and implemented a comprehensive patient experience strategy to improve CAHPS/HOS performance by 1%, NPS scores by 3%, and Google Rating Scores.
  • Focused on enhancing patient retention and clinical outcomes through systematic improvements.

Quality Improvement Best Practices

  • Formalized quality improvement best practices and workflow strategies across the enterprise.
  • Collaborated with underperforming owned and IPA practices to boost Medicare Stars performance by 4% year over year.

Risk Adjustment Management Team Performance

  • Supported the Risk Adjustment Management Team by identifying and scaling program guidelines for targeted chronic conditions.
  • Improved risk adjustment performance by over 25% through clinical pathway development, onboarding training, and quality assurance analytics.

Patient Outreach Strategy

  • Redesigned the Call Team Patient Outreach Strategy to significantly increase patient engagement and medication adherence performance by 8%.
  • Enhanced the Medicare Stars program by implementing effective patient outreach and engagement tactics.

Quality Data Analytic Dashboard

  • Directed the creation and implementation of a Quality Data Analytic Dashboard to support the organization’s clinical quality strategy.
  • Provided real-time actionable information at the market center, provider, patient level, and by measure.

Educational and Training Programs

  • Authored, developed, and maintained over 40 chronic disease training decks for peer-to-peer activities.
  • Ensured appropriate documentation and coding standards aligned with CMS Medicare Stars Program.

Conclusion & Results

Drive clinical and operational excellence

Outcomes:

Medicare Stars Performance: Improved the Medicare Stars performance rating by 4% year over year.

Patient Engagement: Increased CAHPS/HOS scores by 1%, NPS by 3%, and medication adherence performance by 8%.

Risk Adjustment Management: Enhanced risk adjustment performance by over 25%, contributing to better management of chronic conditions and overall patient health.

Quality Improvements: Formalized and disseminated quality improvement best practices, leading to significant enhancements in clinical outcomes across the enterprise.

Real-Time Data Utilization: Implemented a Quality Data Analytic Dashboard, enabling real-time decision-making and improvements in clinical strategies.

Dr. Vergena Clark’s strategic initiatives at Humana PCO, Conviva Physician Group exemplify her ability to drive clinical and operational excellence. Her leadership and innovative approaches significantly improved Medicare Stars ratings, patient engagement, and overall clinical outcomes, showcasing her expertise in transforming healthcare delivery systems through value-based care strategies.

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