value based p4p my 2015 and my 2016 program updates · value based p4p my 2015 and my 2016 program...

January 14, 2016

Value Based P4P

MY 2015 and MY 2016 Program Updates

© 2016 Integrated Healthcare Association. All rights reserved. 2

• Introductions

• News

• Check out the new IHA.org!

• Public Reporting: Total Cost of Care & Medicare Advantage Stars

• Reporting MY 2015 results

• Timeline

• Testing measures

• Measure set updates

• MUHIT Overview

• CMS EHR Incentive Measurement

• E-Measures

• Looking towards MY 2016

• Expanded VBP4P adoption

• Attainment Pathway

Agenda


VBP4P Staff and Partners

Lindsay Erickson Director, Value Based P4P

Ginamarie Gianandrea Program Coordinator

Cayman NavaWeb Engineer/Developer

Anna HughesSenior Data Analyst

Gehry OateySenior Data Engineer

Our Partners


• IHA has a new look—including a new logo and

website

• Easier to navigate and find the resources you need

• P4P Reporting Portal (https://analytics.iha.org)

• The Reporting Portal, where your results are released,

has not changed except with a refresh to match the new

IHA branding—sign in with the same username and

password

• Questions or issues logging in? Email [email protected]

The New www.IHA.org & Logo

https://analytics.iha.org/

mailto:[email protected]

http://www.iha.org/


• Quality Report Card with MY 2014 quality results available

through Office of the Patient Advocate (OPA) at:

http://reportcard.opa.ca.gov

• Public Reporting of Total Cost of Care and Medicare

Advantage Stars:

• Beginning with MY 2014 results, Total Cost of Care will be publicly

reported as a component of the existing Quality Report Card

• For the first time, Medicare Advantage Stars Report Card published

by OPA

• MY 2014 physician organization-level Medicare Advantage Stars

results reported similarly to quality report cards

• MY 2014 Medicare Advantage award winners and results deck

available

Public Reporting: Total Cost of Care & Medicare

Advantage Stars

http://reportcard.opa.ca.gov/


MY 2015 MeasurementMY 2015 Measure SetMY 2015 Final P4P Manual

http://www.iha.org/sites/default/files/resources/vbp4p-measure-set-my2015.pdf

http://www.iha.org/sites/default/files/resources/vbp4p-manual-my2015.pdf


MY 2015 Reporting Timeline

Activity Deadline

Quality Preliminary Reports May 25, 2016

Questions and Appeals Period May 26 - June 15, 2016

Quality Final Reports July 6, 2016

ARU & TCC Preliminary Reports June 29, 2016

Review Period June 29 – July 20, 2016

ARU & TCC Final Reports August 17, 2016

Available with the MY 2015 P4P Manual: http://www.iha.org/sites/default/files/resources/vbp4p-manual-my2015.pdf



Data Sources & Collection

Copyright © 2014 Integrated Healthcare Association. All rights reserved. 8

Quality Measures

Clinical Quality

Organization-level results reported by health plan and physician organization

Not a sample – all members included

Audited

Patient Experience

Clinician and Group CAHPS survey of physician organization members

Administered by CHPI

Meaningful Use of Health IT

Physician organizations provide NPI lists

Compiled by NCQA from publicly available CMS meaningful use incentives data

e-Measures reported by POs

Total Cost of Care

Health plan supplements claims and encounter data with member-level total payments

Calculated by Truven Health Analytics

Appropriate Resource Use

Health plan submits complete claims and encounters for all members

Calculated by Truven Health Analytics

Resource Use Measures


MY 2015 Submission Timeline

Activity Deadline

Intentions Period (complete) November 2 – December 14, 2015

Collection of MUHIT NPI lists January 4 – 29, 2016

Preliminary Data File Layout Available January 15, 2016

Supplemental Data Collection Deadline February 16, 2016

Supplemental Data Validation Deadline March 15, 2016

Data Layout Test Files March 21 – May 2, 2016

Submission Files to Auditors May 2, 2016

Auditor-Locked P4P Results May 9, 2016

Available with the MY 2015 P4P Manual:http://www.iha.org/sites/default/files/resources/vbp4p-manual-my2015.pdf



• The following preliminary data file layouts will be available

January 15 on our Data Collection & Submission webpage:

• Self-Reporting POs:

• Clinical measure layout, including e-Measures

• Testing measure layout

• POs that do not self-report AND participate in the MUHIT domain:

• E-Measure layout

• Health Plan layouts

• Final data layouts will be available February 1. Please review

these data file layouts and share with the appropriate staff

member at your organization as needed.

MY 2015 Data File Layouts

http://www.iha.org/our-work/accountability/value-based-p4p/participant-resources/data-collection-submission


Adoption of a VBP4P Measure

Testing•Testing results are shared with P4P committees, who make the recommendation to adopt a measure

Baseline• Beginning the next measurement

year, measures become a “baseline” measure, which is internally collected and reported, but not paid or publicly reported

Paid & Publicly Reported• In the following measurement

year measures are recommended for payment and public reporting and can be commented on in public comment

For example, a measure tested in Measurement Year 2015 may be recommended for adoption as a baseline measure in Measurement Year 2016, and then recommended for payment and

public reporting in MY 2017.


MY 2015 Testing Measures

P4P staff encourage self-reporting POs to participate in the collection of testing measures whenever possible—it allows the POs a first look at their performance, and allows for robust testing results which influence the measure’s adoption.

Statin Therapy for Patients with Diabetes

Receipt and adherence to statin therapy for:• members ages 40-75 with diabetes

Statin Therapy for Patients with Cardiovascular Disease

Receipt and adherence to statin therapy for:• males ages 21-75 and females ages 40-75 with ASCVD

Antidepressant Medication Management

Percent of members ages 18+ with major depression who remained on medication after being diagnosed and dispensed antidepressant


MY 2015 Measure Set Reminders

Changes to the MY 2015 submission of clinical data are minimal—most changes allow for alignment with HEDIS.

Product Paid/Publicly Reported Measures

Baseline Measures

MeasureRemovals

Commercial HMO/POS

• Diabetes Care: 2 HbA1c Tests

• Optimal Diabetes Care: Combination

• Controlling Blood Pressure for People with Hypertension

• CIS Combo 10• Cervical Cancer

Screening• Cervical Cancer

Overscreening• Asthma Medication

Ratio (new age band)

• Diabetes Care: HbA1c Testing (1 test)

• CIS - 24 month continuous enrollment

Medicare Advantage

• None • None • Diabetes: Appropriate Treatment for Hypertension

For a list of all measures and details on use see the measure set document on IHA’s website:http://www.iha.org/sites/default/files/resources/vbp4p-measure-set-my2015.pdf

Included in clinical measure data file layouts

for the 1st time

No longer included in data file layouts

No changes to data file layouts—you reported

these in MY 2014



• VBP4P incorporates the most current specifications available from a measure developer

• A full list of specification changes can be found in the MY 2015 P4P Manual

• Two changes of particular note to align with HEDIS:• Asthma Medication Ratio (AMR)

• HEDIS is expanding the age range for the AMR measure from 5-64 years to 5-85 years; both age bands will be collected in MY 2015

• Identification of inpatient events and discharges

• New value set and algorithm identified by HEDIS incorporated into following measures: MPM, CDC, ART, OMW, PCR

MY 2015 Specification Changes



Questions?


Meaningful Use of Health IT

(MUHIT)


The MY 2015 Meaningful Use of Health IT (MUHIT) Domain

for the Value Based P4P program includes the following

three measures:

• CMS EHR Incentive Program participation

• POs’ ability to report two Clinical Quality e-Measures

(CQMs):

• Controlling High Blood Pressure e-Measure

• Clinical Depression and Follow-Up Plan e-Measure

• MUHIT Domain is worth 30% of P4P Quality Composite

Score in MY 2015

MY 2015 MUHIT Measures


• The MY 2015 P4P MUHIT Domain gives credit for participating in the CMS EHR

Incentive Program, based on the percentage of a PO’s providers that have

successfully attested through the Medicare or Medicaid EHR Incentive program, for

Stage 1 or Stage 2

• Credit for the CQM e-Measures will be given based on the PO’s ability to report these

two measures. While the data for these measures will be collected through the

Physician Organization Clinical Measure File Layout, points will be assigned to the

MUHIT Domain

MY 2015 MUHIT Scoring

Overall MUHIT Domain % of Providers Points PO’s Points

CMS EHR Incentive Program

XX% 25 (.XX)(25)

Blood Pressure eMeasure

XY% 2.5 (.XY)(2.5)

Depression eMeasure YZ% 2.5 (.YZ)(2.5)

Total Possible Points 30 Sum of Section Points


CMS EHR Incentive Program

Participation


• In order to receive credit for the MY 2015 P4P MUHIT

Domain, physician organizations (POs) must submit a

file containing the national provider identifiers (NPIs) for

the providers in their organization

• Each PO must submit one CSV file to NCQA using the

file specifications detailed on the next slide; submission

deadline is January 29, 2016 at 5 PM PST

• Instructions for submitting the CSV file were sent to all POs on

January 4, 2016

CMS EHR Incentive Program Participation


• The following fields are required and should appear in

the header of the file, as follows:

• NPI

• PO P4P DMHC ID

• PO Name

• Provider Last Name

• Provider First Name

• Provider Professional Suffix (Limit providers to those with an MD or

a DO)

• Provider Specialty. Limit providers to the following specialties:

• 01 (family/general practice)

• 02 (internal medicine)

• 03 (pediatric/adolescent medicine)



File Naming Convention:

• Files must be named according to specific logic:

NPIP4PMY2015_DMHCID.csv

• “DMHCID” should be the PO’s seven-digit P4P DMHC

ID. If you manage more than one PO, provide a separate

list for each organization

• Your P4P DMHC ID can be found on the IHA Analytics

website in your PO’s MY 2014 “VBP4P Worksheets”

download

• If your PO does not know your P4P DMHC ID please

contact [email protected]




CSV File Layout Example

• Each row represents a provider

• Follow header requirements as shown

• FILES WITH INCORRECT HEADERS WILL NOT BE ACCEPTED

• Sample CSV file sent to all POs on Jan 4, 2016



ANY FILES WITH PHI WILL BE IMMEDIATELY DELETED;

NO CREDIT WILL BE GIVEN IF FILES ARE DELETED DUE

TO PHI.

ANY FILES THAT DO NOT FOLLOW THE SPECIFIED NPI

FILE FORMAT WILL NOT BE ACCEPTED.



• Payment lists are updated periodically. P4P staff will use the most

current public files available on April 22, 2016

• Recipients of Medi-Cal EHR Incentive Program Payments can be

found on the DMHC website at:• http://www.dhcs.ca.gov/provgovpart/Pages/EHR_Incentive_Data_and_Reports.aspx

• Recipients of Medicare EHR Incentive Program Payments can be

found on the CMS website at:• http://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html

• Scores will be calculated based on percentage of a POs providers in

the publicly available data. For example:


Calculating Scores

PO Total Providers Providers in public use files

% of providers attesting

Score

100 87 87% .87*25 = 21.75 pts

http://www.dhcs.ca.gov/provgovpart/Pages/EHR_Incentive_Data_and_Reports.aspx

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html


E-Measures


• Electronic Clinical Quality Measures (e-CQMs) are part of the CMS

EHR Incentive Programs

• Both measures are part of the CMS 2014 CQM Adult Recommended

Core Measures set and are NQF endorsed

• Measures are already programmed into the ONC-ATCB certified

EHR systems of providers who can report the measures – we are

looking for the results from those systems

Clinical Quality e-Measures


Any PO may report the measures (self-reporting and non-self-reporting)

• For self-reporting POs, these measures are reported via the PO Clinical File Layout

• There is a separate file layout provided for non-self-reporting PO submission. The

preliminary files will be available on the IHA website on January 15, 2016

For each measure, collect two metrics:

• The percentage of providers who can report the e-Measure (i.e., report a

numerator and denominator to the PO)

• POs should use the same definition of “PCP” outlined in the NPI data file

specification instructions

• The aggregated numerator and denominator, for providers who can report

the e-Measure

• To calculate, pull the numerators and denominators from the EHR systems of all

providers who can report the measures



Example

Rate 1:

• The PO has 50 PCPs.

• 40 of the PCPs have an EHR and have the Controlling High Blood Pressure

e-Measure activated in their EHRs.• These 40 PCPs can report an individual performance rate to the PO, with patient numerators

and denominators, for this measure.

Rate 2: The total number of patients in the rates reported by these PCPs

(aggregated, across-PO denominator) is 1,000. Of those 1000 patients, 450 have

a controlled blood pressure.



• Every PO will collect e-Measure data in different ways

• POs on integrated systems may use a global report to

generate numerators and denominators for providers

across the PO

• IPA type organizations may need to collect numerator

and denominators from individual providers and

aggregate across the PO

EHR Sample Reports


EHR Sample Reports

Individual Report


• If all providers can report the Controlling High Blood

Pressure e-Measure, then the percent reportable would

be 100%

• Based on this example from a global report, the percent of

patients whose blood pressure was adequately controlled

would be 81% (74089/91019)

EHR Sample Reports

Global Report


• Exclusions: The MUHIT section of the MY 2015 P4P Manual lists

the optional exclusions for each measure (page 140-141)

• Pediatricians: Pediatricians are to be included in your NPI file

submission. After results have been calculated for the Incentive

Program measure, P4P staff will run the results with and without

pediatricians, and report the higher of the two scores.

• CMS Timing: P4P staff are aware that there can be a lag for an NPI

to appear in the public use files; staff will use the most current public

files available on April 22, 2016. Credit is given for having attested to

Stage 1 or 2 at any time, not just the most recent measurement year.

Frequently Asked Questions



• NPI file submission period: January 4 –

January 29, 2016

• e-Measure submission deadline: May 9, 2016

• Included in PO Clinical Data Submission for self-

reporters

• Separate submission file for non-self-reporters

MUHIT Reminders


Questions?


MY 2016 MeasurementMY 2016 Measure Set



Updated Quality Domain Weights

The MY 2016 measure set is fairly consistent. One of the few changes from MY 2015 is the retirement of the EHR incentive measure and updated domain weights reflect increased focus on clinical quality, patient experience, and collection of e-Measures.


• Measures were tested in MY 2014 and adopted by the P4P Committees

• To be collected in the MY 2015 measure set as baseline measures, which

are not recommended for payment or public reporting

• Intended for inclusion in MY 2016 measure set for both payment and public

reporting

New Paid Measures in MY 2016


Health Plan Adoption of VBP4P

All participating health plans pay physician organization incentives using the IHA measure results. Most participating health plans have committed to adopting the Value Based P4P shared savings design.

Health Plan VBP4P Adoption

Blue Shield of CA MY 2013

Aetna MY 2014*

Cigna MY 2014

UnitedHealthcare MY 2014

Anthem Blue Cross MY 2016

Health Net Quality Incentive

SHARP Health Plan Quality Incentive

Western Health Advantage Quality Incentive

*Data issues encountered in the MY 2014 results collection and reporting delayed implementation of VBP4P shared savings payments


VBP4P Recommended TCC Trend Gate

Standard High Cost PO

MY 2015 CPI+3% CPI+1%

MY 2016, MY 2017 CPI+2% CPI+0%

MY 2018, MY 2019 CPI+1% CPI-1%

Based on data through Nov 2015 CPI estimate for MY 2015 = 1.1%

Balancing the needs for continued improvements in affordability and consistency and

attainable standards, the P4P committees approved the following schedule for the

recommended TCC trend gate thresholds:


VBP4P Attainment Pathway

The attainment pathway has been added as an available feature in the recommended VBP4P design. The recommended design provides POs with the opportunity to earn an attainment incentive by maintaining highly efficient ARU performance. Health plans that have implemented VBP4P may choose to implement the attainment pathway beginning in MY 2015.

Performance Gates

• Quality

• TCC Trend

ARU Improvements

• Shared savings on ARU measures

Quality Adjustment

Net Adjusted Shared Savings

Combined Shared

Savings &Attainment

IncentivePerformance

Gates

• Quality

• TCC Amount

ARU Attainment

• Assess ARU against benchmark

Adjusted Attainment

Incentive


• Submit your NPI files for the CMS EHR Program Participation measure to get credit in the MUHIT Domain

• If you are a self-reporting PO:• Download the preliminary data file layouts from iha.org beginning

tomorrow, January 15th

• Submit the testing measures to get a preview of your performance

• Prepare for MY 2016:• Greater emphasis on clinical quality, patient experience, and e-

measures

• Targeting resource use integral for VBP4P shared savings and attainment

• Stay connected to VBP4P:• Check out the new IHA.org

• VBP4P Newsletter

Takeaways – What to Do Right Now in VBP4P


We are working with the P4P Committees to refine the Outpatient Procedure Utilization – Percentage Done in a

Preferred Facility (OSU) measure and need your feedback to inform these discussions.

• There will be a survey that automatically pops up in a new window after the webinar ends today. Please complete this survey!

• Your feedback via the survey will help inform the process of making the OSU measure a stronger, more meaningful measure.

Further Opportunities for Engagement


Practice Transformation InitiativeIn partnership with the Pacific Business Group on Health

• Is your PO currently pursuing a practice transformation strategy?

• Does your PO have at least 200 primary care clinicians?

• Is your PO interested in using data to help drive change?

• Would your PO benefit from practice coaching, sharing of best practices, and some funding?

If so, PTI may be for you! Spaces are available.

Come learn more at the informational webinar:

Practice Transformation Webinar

Tuesday, February 2nd, 2016

12:00 – 1:00 PM PST

Register Here

Further Opportunities for Engagement

http://tcpi-02-2016-intro.eventbrite.com/


• Questions regarding P4P program and policies should

be directed to [email protected]

• Questions regarding MUHIT should be directed to

[email protected]

• Questions regarding measure specifications should be

submitted through the P4P Policy Clarification Support

(PCS) system at https://my.ncqa.org/. For instructions on

how to submit a question, visit the PCS User Guide

Questions?



https://my.ncqa.org/

https://www.ncqa.org/Portals/0/Programs/Recognition/PCMH/PCS_External_System_Users_Guide_for_RP.pdf

value based p4p my 2015 and my 2016 program updates · value based p4p my 2015 and my 2016 program...

Documents