TECHNICAL ASSISTANCE REPORT ON VALUE- BASED PURCHASING

Size: px

Start display at page:

Download "TECHNICAL ASSISTANCE REPORT ON VALUE- BASED PURCHASING"

Mary Edwards
5 years ago
Views:

1 Agency for Health Care Administration TECHNICAL ASSISTANCE REPORT ON VALUE- BASED PURCHASING June East Northern Avenue, Suite 100 Phoenix, AZ Phone Fax

2 CONTENTS 1. Summary Report Introduction Purpose Background Summary of Technical Assistance Activities Next Steps Technical Assistance Activities Technical Assistance Report on Value-Based Purchasing Page i FL2007-8_TARpt_VBP_F2_0608

3 1. Summary Report Introduction Health Services Advisory Group, Inc. (HSAG), the contracted external quality review organization (EQRO) for the s Medicaid managed care program, is concluding the activities included in the second year of the external quality review (EQR) contract with the Agency for Health Care Administration (AHCA). One of the activities included in the EQR contract is the provision of technical assistance related to value-based purchasing. Technical assistance is one of the activities identified by the Centers for Medicare & Medicaid Services (CMS) that EQROs can provide to state clients. Value-based purchasing includes strategies for establishing metrics for evaluating quality and efficiencies in managed care organizations (MCOs) and implementing mechanisms for rewarding high-performing MCOs using either financial or nonfinancial incentives. Purpose The purpose of this report is to provide a summary of technical assistance activities provided to AHCA related to value-based purchasing. This report covers activities during State fiscal year (FY) Background During FY , HSAG prepared a report on value-based purchasing that included several key components. First, HSAG conducted a review of 14 existing state value-based purchasing and/or pay-for-performance initiatives, categorized the type of program used, and evaluated the advantages and disadvantages of each program. Second, HSAG developed a method for identifying superior plan performance. Finally, HSAG conducted and reported on a scenario analysis, evaluating the original model proposed by AHCA for use as an incentive program. The culmination of these activities was a report that summarized the key findings from these activities and proposed a value-based purchasing methodology for AHCA s consideration. The methodology incorporated a variety of performance data, including performance measures, survey data, results of compliance monitoring activities, focused study results, and Child Health Check-Up (CHCUP) participation rates. The model included a recommended weighting of the components, as well as proposed scoring algorithms. HSAG developed the model to give AHCA flexibility in the selection of performance activities to include in the value-based purchasing initiative. AHCA could modify the model as the needs of the Florida Medicaid managed care program grow and change. During FY , AHCA conducted a formal process to review and evaluate each of the EQR recommendations and consider the recommendations for implementation. AHCA management considered the value-based purchasing initiative for formal implementation. Although AHCA chose not to formally implement the initiative at this time, an internal bureau-led effort was authorized. The internal effort would continue to discuss models for future implementation, consider what Technical Assistance Report on Value-Based Purchasing Page 1-1

4 SUMMARY REPORT nonfinancial incentives could be explored, and review the most current approaches and initiatives through ongoing literature review efforts. HSAG s role in this effort was to provide technical assistance by exchanging current, pertinent articles on value-based purchasing, research potential nonfinancial incentives (specifically auto-assignment algorithms), and collaborate telephonically on an ongoing and as-needed, basis. Summary of Technical Assistance Activities HSAG conducted a second-year kick-off meeting in August 2007 to discuss next steps related to value-based purchasing and technical assistance needs. HSAG facilitated a second onsite meeting in January of 2008, during which HSAG presented the results of a literature review of value-based purchasing initiatives and different state approaches to financial and non-financial incentives. Throughout the year, AHCA tasked HSAG with researching specific areas (such as efficiency measures, nonfinancial incentives, auto-assignment algorithms, current pay-for-performance initiatives, and returns on investments) and providing any current articles or literature to AHCA for consideration. HSAG s value-based purchasing team experts participated in a series of conference calls to discuss AHCA s bureau-led efforts to continue exploring value-based purchasing. More details related to providing technical assistance can be found in Section 2 of this report. Next Steps Technical assistance efforts will continue, along with discussions of future implementation of nonfinancial incentives. HSAG will participate in monthly conference calls with appropriate AHCA staff and continue to conduct literature reviews on relevant value-based purchasing topics. HSAG is also prepared to assist in the development of an implementation plan for nonfinancial incentives and will participate in all appropriate internal AHCA meetings as requested Technical Assistance Report on Value-Based Purchasing Page 1-2

5 Table 2-1 Technical Assistance Activities FY for Value-Based Purchasing Date Description of Activity Status 08/29/07 Kick-off meeting conducted. HSAG reviewed the recommendations from the FY value-based purchasing (VBP) report, provided information on other VBP initiatives, and discussed the type, amount, and timing of technical assistance activities anticipated for this area. 09/28/07 Provided AHCA with the top 10 diagnoses within the MediPass data and a timeline for next steps/activities. 12/10/07 Conducted a literature review and posted various articles on the FTP site for review and discussion. Article topics included efficiency measures, incentives for encounter data submission, and current state VBP initiatives. Multiple action items for provision of additional information were completed subsequent to the meeting and are noted in this table. 01/08/08 Prepared a list of resources for VBP purchasing initiatives. 01/15/08 Facilitated a meeting with appropriate AHCA staff to discuss current initiatives and results of the literature review. 01/30/08 Conducted a conference call with HSAG staff (Dr. Mary Fermazin, Rick Potter, and Peggy Ketterer) and Brady Augustine of AHCA. AHCA has decided not to formally adopt the value-based purchasing initiative at this time; however, Mr. Augustine and Tom Warring, also from AHCA, will lead an internal effort to continue exploring VBP options and implementation of nonfinancial incentives. 02/05/08 Provided AHCA with articles and Web site links related to auto-assignment and return on investments related to value-based purchasing Various follow-up tasks were identified and provided to AHCA through subsequent interactions (included in this table). AHCA tasked HSAG with providing AHCA information on auto-assignment methodologies. This information was subsequently provided to Mr. Augustine. 02/06/08 Provided a business case article on value-based purchasing. 02/14/08 Conducted a conference call with HSAG staff (Dr. Fermazin, Mr. Potter, and Ms. Ketterer) and Mr. Augustine. Mr. Augustine plans to set up a task force meeting and would like HSAG to participate. 04/28/08 Conducted a conference call with HSAG staff (Dr. Fermazin, Mr. Potter, and Ms. Ketterer) and Augustine and Warring. Discussion items included encounter data quality and future implementation of nonfinancial incentives. 06/30/08 Provided articles on encounter data completeness/quality and use of encounter data for automated reporting of performance measures. HSAG will participate in internal AHCA meetings as needed. HSAG researched information on encounter data quality initiatives Technical Assistance Report on Value-Based Purchasing Page 2-1

Florida Agency for Health Care Administration

FLORIDA ANNUAL PERFORMANCE IMPROVEMENT PROJECT TECHNICAL ASSISTANCE PLAN State Fiscal Year 2006-2007 Issued October 2006 Amended January 2007 Florida Agency for Health Care Administration CONTENTS 1. Introduction...