phc’s pay-for-performance quality improvement program ......2017/01/30 · • colorectal cancer...

PHC’s Pay-For-PerformanceQuality Improvement Program (QIP) Measurement Year Transition & 2018

Measure Feedback Webinar

Date: January 30, 2017

Presenters:QIP Team

Partnership HealthPlan of California

Audio Instructions

To avoid echoes and feedback, we request that you use the telephone instead of your computer microphone for listening/talking during the webinar.

Overview

Measurement Year Transition • Timelines 2016-2017 QIP Measurement Year Transition

• Transition Period Measurement Set

Introduction to Potential Measures for 2018I. Fixed Pool MeasuresII. Unit of Service Measures

Questions, Answers, & DiscussionComment Period Timeline

Measurement Year Transition

• Align with HEDIS measurement period• Six-month measurement period (July 1, 2017 to December

31, 2017)• Referred to also as “Mini Period” or “Transition Period” or

“MYT”• Based on 2016-2017 QIP measurement set: No new

measures• Data look back period is 2017 CY for Fixed Pool• Incentive amount will be based on member months 7/1/17

– 12/31/17

Measurement Year Transition

QIP Timeline

Fiscal year Transition Period Calendar Year

Jul 2016 to Jun 2017 Jul to Dec 2017 Jan to Dec 2018

2016-17 QIP

Transition Period

2018 QIP

2016 2017Jul Sep Nov 2017 Mar May Jul Sep

Final Payment for 2016-17 QIP mailed

10/31/2017

Final date for accepting all data (eReports and UOS submissions)7/31/2017

Transition Measurement Period begins

7/1/2017

7/1/2016 - 6/30/2017

QIP 2016-2017

2016-2017 QIP Timeline

2017 2018Jul Aug Sep Oct Nov Dec 2018 Feb Mar Apr

2018 QIP begins1/1/2018

Final Payment for Transition period mailed4/30/2018

Final date for accepting UOS submissions

1/31/2018

Final date to submit clinical data to eReports

2/15/2018

7/1/2017 – 12/31/2017

Transition Period

2017 Transition Period Timeline

Transition Period Measurement Set

I. Fixed Pool PMPM Measurement Set (Required, 100 pts. total)

Four Domains1. Clinical2. Appropriate Use of Resources3. Access and Operations4. Patient Experience

II. Unit of Service Measurement Set (Optional)

2017 Measurement Set Summary of Changes

• Removed from fixed pool measurement set: • Opioid Safety, Patient Experience

• Removed from unit of service measurement set:• CAIR utilization

• Change in point values for:• Family: MPM, Well-Child Visits, Cervical Cancer

Screenings• Internal: Cervical Cancer Screenings, HbA1C Good

Control; Retinal Eye Exams• Pediatric: Well-Child Visits, Asthma Care

Fixed Pool Measures – Clinical Domain

Measures Family Internal Pediatric

Monitoring Patients on Persistent Medications 10 10 --

Well Child Visits (3-6 years) 10 -- 15

Childhood Immunization – DTaP (2 years) 5 -- 10

Cervical Cancer Screening 10 10 --

Colorectal Cancer Screening (51-75 years) 5 5 --

Controlling High Blood Pressure (18-85 years) 5 10 --

Retinal Eye Exam (18-75 years) 5 10 --

HbA1C Control (18-75 years) 5 10 --

Nephropathy (18-75 years) 5 5 --

Childhood Immunization – MMR (2 years) -- -- 10

Asthma Care (5-18 years) -- -- 10

Nutrition Counseling (3-17 years) -- -- 10

Physical Activity Counseling (3-17 years) -- -- 10

Adolescent Immunizations (13 years) -- -- 10Total Points: 60 60 75

Fixed Pool Measures – Appropriate Use of Resources


Admissions/1000 or Follow-Up Post Discharge 7.5 7.5

Readmission Rate or Follow-Up Post Discharge 7.5 7.5

Pharmacy Utilization 10 10 10

Total Points: 25 25 10

Follow-up post discharge can be a back-up measure for either Acute Bed Days/1000 or Readmission Rate, but not both.

Opioid safety was removed from the measurement set for the transition period.

The Patient Experience domain was removed from the measurement set for the transition period.

Fixed Pool Measures – Access and Operations


Avoidable ED Visits 5 5 5

Practice Open to PHC Members 5 5 5

PCP Office Visits 5 5 5

Total Points: 15 15 15

There are no changes for these measures in the transition period

Unit of Service Measures

Unit of Service Measure Incentive amount

Advance Care Planning $100 per attestation/$100 per POLST/AD

PCMH Certification Level 1: $2000 Level 2: $3000 Level 3: $3500

Peer-Led Self Management Support Groups

$1000 per group per year

Access/Extended Office Hours Equivalent payment of 10% cap

Buprenorphine Qualified Providers

$500 per credential prescriber (max. 5 per site)

SBIRT $5 per screening

Health Information Exchange $2500 one time payment for participating in local HIE

The CAIR utilization measure was removed from the measurement set for the transition period.

Potential Measures for Measurement Year 2018

Measure Development Timeline

January 30, 2017 through February 10, 2017

March 8, 2017 July 2017 January 1, 2018

Public Comment Period

Physician Advisory Committee Approval

Measure Specifications

Released

2018 Measurement Period Begins

Guiding Principles1. Pay for outcomes, exceptional performance and improvement2. Sizeable incentives3. Distribute 100% of Fixed Pool Per Member Per Month (PMPM)

Funds4. Actionable Measures5. Feasible data collection6. Collaboration with providers7. Simplicity in the number of measures8. Comprehensive measurement set9. Align measures that are meaningful10. Stable measures

2018 Proposed Measures

I. Fixed Pool PMPM Measurement Set by Domain (Required)a. Clinicalb. Appropriate Use of Resourcesc. Access and Operationsd. Patient Experience


2018 Proposed MeasuresOverall Changes- Greater focus on clinical measures

- More pediatric measures for family set

- Suggestions for potential measures and measure changes come from provider suggestions, HEDIS performance, updated recommendation guidelines

- Point values to be determined for final measurement set

- Thresholds to be determined for final measures


I. Fixed Pool PMPM Measurement Set by Domain (Required)a. Clinicalb. Appropriate Use of Resourcesc. Access and Operationsd. Patient Experience)


2018 Proposed Clinical Measures – Family Medicine

2016-2017 2018 Recommendations

1. Monitoring Patients on Persistent Medications


2. Well Child Visits (3-6 yrs) 2. Well Child Visits (3-6 yrs)

3. Childhood Immunization (DTaP) Childhood Immunization (DTaP)

4. Controlling High Blood Pressure 3. Controlling High Blood Pressure

5. Cervical Cancer Screening 4. Cervical Cancer Screening

6. Colorectal Cancer Screening 5. Colorectal Cancer Screening

7. HbA1C Good Control 6. HbA1C Good Control

8. Diabetes Mgnt - Retinal Eye Exams 7. Diabetes Mgnt - Retinal Eye Exams

9. Diabetes Mgnt - Nephropathy Diabetes Mgnt – Nephropathy

8. Breast Cancer Screening

9. Childhood Immunization Combo-3

10. Immunizations for Adolescents

2018 Proposed Clinical Measures – Internal Medicine




2. Controlling High Blood Pressure 2. Controlling High Blood Pressure3. Cervical Cancer Screening 3. Cervical Cancer Screening4. Colorectal Cancer Screening 4. Colorectal Cancer Screening5. HbA1C Good Control 5. HbA1C Good Control6. Retinal Eye Exams 6. Retinal Eye Exams7. Nephropathy Screenings 7. Nephropathy Screenings

8. Breast Cancer Screening

2018 Proposed Clinical Measures – Pediatric Medicine


1. Nutritional Counseling 1. Nutritional Counseling2. Physical Activity Counseling 2. Physical Activity Counseling3. Well Child Visits (3-6 years) 3. Well Child Visits (3-6 years)4. Childhood Immunization (DtaP) Childhood Immunization (DtaP)5. Childhood Immunization (MMR) Childhood Immunization (MMR)6. Adolescent Immunizations 4. Adolescent Immunizations7. Asthma Care Asthma Care

5. Childhood Immunization Combo-36. Asthma Medication Ratio

Changes to Existing Measures

• Colorectal Cancer Screenings (family and adult):• The percentage of members 51–75 years of age as of

June 30, 2017 who had appropriate screening for colorectal cancer.

• Change: National Medicaid data is not available to set a threshold for this measure. We will use a lower threshold based on QIP experience in 2016-2017.

2016-2017 Threshold Proposed 2018 Thresholds*

Partial Points (25th

Medicare percentile): 60.5%

Full Points (50th

Medicare percentile): 67.5%

Partial Points (75th percentile): 39.1%

Full Points (90th

percentile): 50.75%

*exact thresholds to be determined

Details for New Measures

• Immunizations for Adolescents (new to family):• Percentage of adolescents 13 years of age who had

TDaP, meningococcal, and two doses of the HPV vaccine by their 13th birthday

• Breast Cancer Screening (family and adult): • Percentage of women 50-74 years of age who had

at least one mammogram to screen for breast cancer in the past two years

Details for New Measures• Childhood Immunization Combo-3 (family and

pediatric):• The percentage of children 2 years of age who have had

all required doses of the below seven immunizations by their second birthday: DTaP, IPV, MMR, HiB, HepB, VZV, PCV

• Asthma Medication Ratio (pediatric): • Percentage of members 5-18 years old who were

identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year

2018 Proposed Non-Clinical Measures

2016-2017Family & Internal Medicine

2018 RecommendationsFamily & Internal Medicine

1. Admissions/1000* 1. Admissions/1000*2. Readmission Rate* 2. Readmission Rate*3. Pharmacy Utilization 3. Pharmacy Utilization4. Opioid Safety 4. Opioid Safety* Available back-up measure: Follow-up post discharge

* Available back-up measure: Follow-up post discharge

• Appropriate Use of Resources

2016-2017Pediatric Medicine

2018 RecommendationsPediatric Medicine

1. Pharmacy Utilization 1. Pharmacy Utilization

2018 Proposed Non-Clinical Measures

2016-2017All Practice Types

2018 RecommendationsAll Practice Types

1. Avoidable ED Visits 1. Avoidable ED Visits2. Practice “open” to PHC members 2. Practice “open” to PHC members3. PCP Office Visits 3. PCP Office Visits

• Access & Operations

• Patient Experience2016-2017

All Practice Types2018 Recommendations

All Practice Types

1. CAHPS for sites that meet member volume criteria, or Survey/Training Option for other sites

1. CAHPS for sites that meet member volume criteria, or Survey/Training Option for other sites

2018 Proposed Measures – Unit of Service

2016-2017 2018 Recommendations1. Advance Care Planning Attestations 1. Advance Care Planning Attestations

2. Extended Office Hours 2. Extended Office Hours

3. PCMH Certification PCMH Certification

4. Peer-led Self-Management Support Groups 3. Peer-led Self-Management Support Groups

5. Utilization of CAIR Utilization of CAIR

6. Buprenorphine Qualified Providers Buprenorphine Qualified Providers

7. SBIRT Screenings 4. SBIRT Screenings

8. Health Information Exchange 5. Health Information Exchange

6. Suboxone Induction

7. Initial Health Assessment

8. Timely Data Submission via eReports

9. Social Determinants of Health Screenings

10. Fluoride Varnish Application


• Suboxone Induction: • Incentivize providers for successfully transferring

opioid-addicted patients to Suboxone Therapy

Proposal: Primary Care Provider sites will receive $200 per successful transfer to treatment on Suboxone therapy, as indicated by an Induction Attestation, subject to audit by PHC. This measure is only valid for first-time inductions. The following components must be included in each attestation in order to receive incentive payment: 1) Patient Name, DOB, CIN 2) Clinician’s name and organization 3) Date of Induction 4) Attestation that this is a new induction 5) Attestation that the member was given a prescription, or the induction in-person


• Initial Health Assessment:• Reward provider sites for seeing newly enrolled

members within 120 days of plan enrollment

Proposal: Primary Care Provider sites will receive $50 per IHA claim processed by PHC, on top of the claim amount.


• Timely Data Submission via eReports: • Reward providers for entering the majority of their relevant

data records before the end of the measurement year

Proposal: PCP data entry will be tracked through eReports. If a target of 70% of records are entered before December 1st, sites will be eligible for an additional incentive.

Calculation: # of all uploads by December 1st/# of all uploads by end of measurement year

Incentive: Total Members Incentive Amount

Small 1-350 $3000

Medium 351-1,1300 $4000

Large 1,301 or greater $5000


• Social Determinants of Health Screenings:• Reward provider sites for screening patients for

social determinants of health, using the PRAPARE (or equivalent) social determinants of health screening tool

Proposal: Potential criteria include submission of one attestation form per screening to the QIP OR submission of an EHR generated report containing patient identification numbers for the PHC members screened


• Fluoride Varnish Application: • Sites will be reimbursed based on the number of

Fluoride Varnish Application claims for PHC members ages 5 and below.

Proposal: Primary care provider sites will receive $50 per processed fluoride application claim, on top of the claim amount. The CPT code for this claim is 99188. Claims submitted in excess of three applications per individual within a measurement year will be excluded.

Next Steps

• Time for discussion today

• Review materials provided

Contact QIP to share feedback by Friday, February 10th.

– [email protected]

– http://www.partnershiphp.org/providers/quality/pages/pcpqiplandingpage.aspx

mailto:[email protected]

http://www.partnershiphp.org/providers/quality/pages/pcpqiplandingpage.aspx

phc’s pay-for-performance quality improvement program ......2017/01/30 · • colorectal cancer...

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