value based p4p program updates my 2016 and …...• tcc trend gate: pending complete 2016 consumer...

Lindsay Erickson,

Ginamarie Gianandrea,

Brandi Melville

January 11, 2017

Value Based P4P Program Updates

MY 2016 and MY 2017

© 2016 Integrated Healthcare Association. All rights reserved. 2

• Objective: provide an update on the VBP4P program, prepare for MY 2016

data submission and calendar year 2017 care delivery

• Please submit questions using the Webex Q&A function.

• Today’s session will be recorded and available on http://www.iha.org/news-

events/webinars

Agenda

Topic Presenter

Introductions Lindsay Erickson, Director - VBP4P Program, IHA

Program Updates Lindsay Erickson, Director - VBP4P Program, IHA

Reporting MY 2016 Results:• Measure Set Updates• Data Submission & Timeline

Ginamarie Gianandrea, Sr. Program Coordinator, IHA

Reporting MY 2016 Results:• Advancing Care Information

Brandi Melville, Health Care Analyst, Quality Solutions Group, NCQA

Looking towards MY 2017 Lindsay Erickson, Director - VBP4P Program, IHA

Resources & Next Steps Lindsay Erickson, Director - VBP4P Program, IHA

http://www.iha.org/news-events/webinars


Key Program Dates

We are here


• OPA’s 2016-17 Medicare Advantage Report Card will be released

January 26, 2017. In addition to the release:

• MY 2015 high performing POs will be recognized on OPA and IHA websites

• MY 2015 OPA Report Card Data file download will be available to

participants through the Reporting Portal

• MY 2015 Medicare Advantage Results already available on iha.org

• OPA is asking physician organizations to review their contact

information and star ratings by 5:00 pm on Friday, January 13, 2017

• Questions and corrections may submitted to

[email protected]

OPA Preview Medicare Advantage Open Now

mailto:[email protected]


Program Updates


Core Program Elements

A Public Report Card Public Recognition

Health Plan Incentive Payments

A Common Set of Measures


Resources• Technical Design Document – updated September 2016

• VBP4P Key Design Decisions Issue Brief – released December 2016

New in MY 2016• Anthem implementing VBP4P

• First plans adding attainment to incentive payments

• Domain weights updated in Quality Composite Score

Updates• TCC Trend Gate: pending complete 2016 Consumer Price Index, estimate

based on data through November 2016 = 1.0%

Value Based P4P Incentives – Updates

MY 2016 Recommended TCC Trend Gate

Standard High Cost PO

CPI+2% CPI+0%

http://www.iha.org/sites/default/files/resources/vbp4p_incentive_design.pdf

http://www.iha.org/sites/default/files/resources/value-based-p4p-design-issue-brief.pdf


VBP4P Incentive Design

To earn ANY award:• Meet minimum level of quality

• Below TCC trend gate

• Net improvement on resource use

measures

To MAXIMIZE award:• Greater resource use improvement

and attainment

• Higher quality


Reminder: Updated Quality Domain Weights


MY 2016 Measurement

2016 – 2021 VBP4P Measure Set StrategyMY 2016 Measure SetMY 2016 Final P4P Manual

http://www.iha.org/sites/default/files/resources/2016-2021_vbp4p_measure_set_strategy_1.pdf

http://www.iha.org/sites/default/files/resources/my_2016_measure_set.pdf

http://www.iha.org/sites/default/files/resources/my_2016_value_based_p4p_manual_1.pdf


1. Increase alignment in the VBP4P measure set

• Work to align with other commonly used measure sets (QRS, NCQA health plan

accreditation, MACRA)

• Document and communicate where measure set diverges

• Decrease unwarranted variation in measure specs

2. Targeted development of the VBP4P measure set

• Expand and emphasize TCC measurement

• Evaluate potential of e-Measures

• Explore feasibility of patient centered measurement

3. Support less burdensome data collection and more timely reporting

• Understand and identify improvements to data sharing processes

• Support standard mid-year reporting

2016 – 2021 Measure Set Strategy


MY 2016 Value Based P4P Measures

Process and outcomes measures focused on six priority clinical areas

Cardiovascular (5)

Diabetes (7)

Musculoskeletal (1)

Prevention (10)

Respiratory (4)

Behavioral Health (1)

Clinical (60%)

Patient ratings of five components, including care overall:

Communicating with Patients

Coordinating Care

Helpful Office Staff

Overall Rating of Care

Timely Care and Service

Patient Experience (30%)

Ability to report selected e-measures (2)

Advancing Care Information (10%)

Utilization metrics spanning:

Inpatient stays

Readmissions

ED visits

Outpatient procedures

Generic prescribing

Appropriate Resource Use

Average health plan and member payments associated with care for a member for the year, adjusted for risk and geography

Total Cost of Care


MY 2016 Measure Set Reminders

Paid and Publicly Reported Measures

• Childhood Immunization Status Combo 10 replaces Combo 3

• Cervical Cancer Screening & Cervical Cancer Overscreening replaces Evidence-Based Cervical Cancer Screening

Baseline

Measures

• Statin Therapy for Patients with Diabetes & Statin Therapy for Patients with Cardiovascular Disease

• Combo 2 added to Immunizations for Adolescents

Testing Measures

• None

Measure

Removals

• Diabetes Care: HbA1c Control <7% retired

• Childhood Immunization Status Combo 3 retired (see above)

• Evidence-based Cervical Cancer Screening retired (see above)

• CMS EHR incentive measure retired

• PAS Health Promotion Composite retired


• VBP4P works to incorporate the most current specifications available from a measure

developer.

• A full list of MY 2016 specification changes can be found in the MY 2016 VBP4P

Manual

MY 2016 Measure Specification Changes

Measure Specification Change

Colorectal Cancer Screening (COL)

• Added two new screening methods per updated USPSTF guidelines (FIT-DNA, CT colonography)

Immunizations for Adolescents (IMA)

• Added the HPV vaccine for adolescents to the IMA measure, creating Combination 2 (meningococcal, Tdap, HPV)

• Removed the tetanus, diphtheria toxoids (Td) and meningococcal polysaccharide vaccines• Added CVX codes (vaccine administered codes) to the measure

Use of Imaging Studies for Low Back Pain (LBP)

• Added instructions to identify ED visits and observation visits that result in an inpatient stay

• Include Physical Therapy and telehealth visits to the denominator• Shortened the lookback period to exclude members with recent trauma from 12-months

to 3-months• Added required exclusions and the following value sets: HIV Value Set, Spinal Infection

Value Set, Organ Transplant Other Than Kidney Value Set, Kidney Transplant Value Set• Added value sets and definition for ED visits that result in inpatient stay



Ongoing efforts to improve the Appropriate Resource Use and Total Cost of Care

measurement will be reflected in upcoming health plan data collection:

• Outpatient Procedures Utilization - Percent Done in Preferred Facility (OSU)

• Measure specifications will use a standard the definition of preferred facility – any contracted

freestanding ambulatory surgery center

• Based on recommendation from technical committee workgroup

• Total Cost of Care (TCC)

• Developing and testing addition of service category breakdowns

• For example, inpatient facility FFS, outpatient facility FFS, other facility FFS, professional FFS,

pharmacy FFS, other FFS, capitation

• Encounter Rate by Service Type (ENRST)

• Added to Medicare Advantage health plan clinical submission

• Key informational metric on data transmission quality – integral to RAF scores

Measure Specification Changes – Health Plan

Submissions


Throughout the data collection process, check back to see if

new FAQs have been posted.

Some commonly asked questions for MY 2016 include:

Q: Proportion of Days Covered by Medications

Q: VBP4P Value Set Directory

Q: New HPV Guidelines

Find the full FAQs on the manuals page.

MY 2016 Frequently Asked Questions

http://www.iha.org/our-work/accountability/value-based-p4p/participant-resources/program-manual


Data Submission & Reporting

MY 2016 Final P4P Manual



Data Sources & Collection

18

Quality Measures

Clinical Quality

Organization-level results reported by health plan and self-reporting physician organizations

Not a sample – all members included

Audited

Patient Experience

Clinician and Group CAHPS survey of physician organization members

Administered by CHPI

Advancing Care Information

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 2016 Data Submission Timeline


• The following preliminary data file layouts will be available

January 13 on Data Collection & Submission webpage:

1. PO Clinical measure layout (includes e-Measures)

• For self-reporting POs

2. E-Measure layout

• Only for POs that do not self-report and wish to participate in the

Advancing Care Information (formerly MUHIT) domain

3. Health Plan Clinical measure layout

• Please review and share with the appropriate staff member at

your organization. Send questions or needed clarifications on

the preliminary file layouts to [email protected] by Monday,

January 23.

• Final data layouts will be available February 1.

MY 2016 Data File Layouts

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



• The Value Based P4P program encourages data sharing

between POs and health plans; however, VBP4P staff are

not prescriptive about how this is done.

• POs and health plans are expected to work together early

in the process to establish a data sharing process and

requirements.

Data Sharing


Based on feedback from the MY 2015 Questions and Appeals

period, process improvements may include the following.

• An agreement between the PO and the health plan on:

• Allowable data types

• File formatting

• Timing

• Confirmation of data received

• Confirmation of data use in health plan reports

Data Sharing


MY 2016 Reporting Timeline

Activity Deadline

Quality Preliminary Reports May 25, 2017

Questions and Appeals Period May 26 - June 15, 2017

Quality Final Reports July 13, 2017

ARU & TCC Preliminary Reports June 29, 2017

Review Period June 29 – July 20, 2017

ARU & TCC Final Reports August 17, 2017


Advancing Care Information

(formerly known as MUHIT)


• In continued alignment with CMS, VBP4P has changed the name of

the Meaningful Use of Health IT (MUHIT) domain to the Advancing

Care Information (ACI) domain and will continue to collect Clinical

Quality e-Measures (CQMs) in alignment with the transition from

Meaningful Use to MIPS.

• EHR incentive participation measure retired, NPI lists will not be

collected.

New for MUHIT in MY 2016


• Merit-based Incentive Payment System (MIPS):• Composite scoring system that will determine bonus payments or

penalties to Medicare FFS providers based on performance across four performance categories.

• Advancing Care Information (ACI) category

• Replaces the Meaningful Use program and will account for 25% of the MIPS score.

• No longer requires quality reporting.

• Quality category

• Replaces the current PQRS program and will account for 50% of the MIPS score.

• There is a bonus for EHR reporting.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Advancing-Care-Information-Fact-Sheet.pdf

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Performance-Category-training-slide-deck.pdf

National Context: MACRA and MIPS

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Advancing-Care-Information-Fact-Sheet.pdf

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Performance-Category-training-slide-deck.pdf


• 3rd year collected as part of VBP4P

• Both measures are part of the CMS 2014 CQM Adult

Recommended Core Measures set and are NQF

endorsed.

• These measures are already programmed into the ONC-

ATCB certified EHR systems of providers who can report

the measures.

VBP4P e-Measures Overview

NQF # Measure CMS CQM Domain

0018 Controlling High Blood Pressure Clinical Process/Effectiveness

0418 Screening for Clinical Depression & Follow Up Plan

Population/Public Health


• The ACI Domain is worth 10% of VBP4P Quality Composite Score in

MY 2016.

• POs are scored based on the percent of providers in the PO who

can report the e-Measures, not on patient level performance, but

you must report the aggregated patient numerators and

denominators in order to receive credit.

• While the data for these measures will be collected through the

Clinical Measure File Layout, points will be assigned to the ACI

Domain.

MY 2016 e-Measure Scoring

Overall ACI Domain % of Providers Points PO’s Points

Blood Pressure e-Measure XY% 5 (.XY)(5.0)

Depression e-Measure YZ% 5 (.YZ)(5.0)

Total Possible Points 10 Sum of Section Points


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.

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)

• 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

MY 2016 e-Measure Reporting


MY 2016 Advancing Care Information Reporting

Example: Controlling High Blood Pressure e-Measure

Rate 1:Percent Reportable

• The PO has 50 PCPs that meet the measure denominator criteria.• Of these 50 PCPS, 40 have the 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:PO-Level Aggregated Performance

• The total number of patients in the rates reported by these 40 PCPs (aggregated, across-PO denominator) is 1,000. Of those 1,000 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.

• POs not using a common EHR system may need to

collect numerator and denominators from individual

providers and aggregate across the PO.

MY 2016 Advancing Care Information Reporting


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


• Optional Exclusions: The ACI section of the MY 2016

VBP4P Manual lists the optional exclusions for Rate 1 of

each e-Measure (page 144)

• e-Measure submission deadline: May 9, 2017

• Included in PO Clinical Data Submission for self-reporters

• Separate submission file for non-self-reporters

• To receive credit, POs must submit both rates for

each e-Measure.

Reminders



MY 2017 Measurement

MY 2017 Measure Set

http://www.iha.org/sites/default/files/resources/my_2017_measure_set.pdf


MY 2017 Measure Set Summary

Testing• Use of Opioids from

Multiple Providers or at High Dosage in Persons without Cancer

Baseline• None

Paid & Publicly Reported• Statin Therapy for

Patients with Diabetes

• Statin Therapy for Patients with Cardiovascular Disease

• Immunizations for Adolescents Combo 2


Use of Opioids from Multiple Providers or at High Dosage in

Persons without Cancer (Steward: Pharmacy Quality Alliance)

3 Rates:

• Opioid High Dosage: >120mg morphine equivalent dose for 90+ days

• Multiple Prescribers and Multiple Pharmacies: 4 or more prescribers and 4 or more

pharmacies

• Multi-Provider, High Dosage: combination of rates of high dosage and multiple

prescribers/pharmacies

• IHA testing internally in MY 2016 to assess feasibility

• Full measure specifications were provided during public comment

MY 2017 Testing Measure

http://www.iha.org/sites/default/files/resources/2016_vbp4p_public_comment_response.pdf


Reminders & Summary


Prepare for your MY 2016 submission• Submit encounters to ensure your population’s risk is most accurately

assessed

• Share supplemental data with health plans where possible

• Download and review the preliminary data file layouts beginning January 13th

• Identify process for collecting and submitting e-measures

Deliver great care in MY 2017• Continue work to improve clinical quality, patient experience, and e-

measures

• Understand and work to bend your Total Cost of Care

Stay connected to VBP4P with the VBP4P Newsletter

Don’t forget to preview your Medicare Advantage results on the OPA Report Card

Takeaways – What to Do Right Now in VBP4P


Total Cost of Care (TCC) Collaborative

California Quality Collaborative (CQC)

Total Cost of Care (TCC) is critical to PO success in VBP4P and is an area of opportunity for continued improvement.

Modest reductions in TCC and/or Institutional Utilization Reductions can yield substantial increases in VBP4P bonus

payments.

To help POs succeed, the California Quality Collaborative (CQC) has designed a Learning Collaborative to help POs assess

and improve critical medical management processes. The collaborative will help POs implement improvements in

Medicare Advantage, Commercial and Medi-Cal managed care performance. You can work on all or a subset of

populations.

The collaborative will address a range of issues central to success in managing TCC:

• Improving infrastructure: network management, aligning with external partners, accountability and transparency.

• Reducing facility and outpatient costs through improved management of inpatient and outpatient populations:

enhancing medical management for rising risk and other target populations, optimizing risk stratification,

deploying an integrated care management strategy.

• Addressing relevant cost centers: maternity care, NICU, specialty injectibles, etc.

The collaborative will kick-off in mid-2017 and participation will be capped at four POs in the first year. More information

on the collaborative, including how to participate, can be found on CQC's website or you can contact:

Bart Wald, MD, CQC Medical Director: [email protected]

Sandra Newman, Collaborative Co-Director: [email protected]

CQC TCC Collaborative Opportunity




Prepare for your MY 2016 submission• Submit encounters to ensure your population’s risk is most accurately

assessed

• Share supplemental data with health plans where possible

• Download and review the preliminary data file layouts beginning January 13th

• Identify process for collecting and submitting e-measures

Deliver great care in MY 2017• Continue work to improve clinical quality, patient experience, and e-

measures

• Understand and work to bend your Total Cost of Care

Stay connected to VBP4P with the VBP4P Newsletter

Don’t forget to preview your Medicare Advantage results on the OPA Report Card

Takeaways – What to Do Right Now in VBP4P


Thank You! Questions?

• Questions regarding P4P program and policies 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


https://my.ncqa.org/

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

value based p4p program updates my 2016 and …...• tcc trend gate: pending complete 2016 consumer...

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