2018 Learning Collaborative Series. Access To Primary Care May 1, :00-12:00PM

Transcription

1 2018 Learning Collaborative Series Access To Primary Care May 1, :00-12:00PM

2 Welcome/Introductions Review of Primary Care Value Based Measure/DSRIP Measure Alignment Review and Discussion of 2017 CG CAHPS Results Strategies For Improvement: Coding Utilizing Data Medical Answering Services Independent Work Session: Evaluation of Access To Care LC Series Key Takeaways Wrap Up Next Meeting June 5 th, :00AM-12:00PM

3 2018 Value Based Payment Reporting Requirements - Measurement Year Measurement Year 2018 for Managed Long Term Care Measures

4 VBP Arrangements Overview 3 Arrangement Types Total Care for General Population (TCGP): Includes all costs and outcomes for all populations except Health and Recovery Plans (HARP), HIV/AIDS, Managed Long Term Care (MLTC) Total Care for Special Needs Subpopulation Arrangements: Includes costs and outcomes of total care for all members within the subpopulation HARP HIV/AIDS Managed Long Term Care Episodic Care Arrangements Integrated Primary Care (IPC): Includes all costs associated with primary care, sick care and chronic conditions that were selected due to high costs or volume Maternity Care: Includes episodes associated with a pregnancy, including prenatal care, delivery and postpartum care for mother and child

5 VBP Measure Overview State has bucketed measures into 3 categories Category 1 Selected as clinically relevant, reliable, valid and feasible Category 2 Seen as clinically relevant, valid, and likely reliable but has problematic feasibility Category 3 Rejected on the basis of a lack of relevance, reliability and validity and/or feasibility Each Category 1 Measure is Classified as either P4P for P4R P4P intended to be used in the determination of shared savings amounts for which the VBP Contractors are eligible. P4R intended to be used by MCOs to incentivize VBP Contractors for reporting data to monitor quality of care delivered to members under the VBP contract. 7 Prioritized VBP Quality Measure Sets Total Care for General Population (TCGP)/Integrated Primary Care (IPC) Health and Recovery Plan (HARP) HIV/AIDS Maternity Managed Long Term Care (MLTC) VBP MAP (Medicare Advantage Plus Plans) and FIDA (Fully Integrated Duals Advantage) VBP PACE (Programs of All-Inclusive Care for the Elderly)

6 Submission Requirements Medicaid Managed Care Organizations with Level 1 or high VBP Contracting Arrangements or MCOs with a VBP Pilot Contract are required to report Organizations must purchased HEDIS 2018 Technical Specifications for the descriptions of the required HEDIS Measures. For non-hedis Measures, contact the appropriate measure steward Measurement Year 2017 is due no later than 11:59 P.M. on 8/1/2018 via sftp Specific delivery instructions are given for each file The VBP Quality Measure Sets for each arrangement will be finalized and posted to the NYS DOH VBP website by the end of October of the year preceding the measurement year Measurement Year 2018 now available Only includes Category 1 and Category 2 Measures are included The VBP Measure Specification and Reporting Manual will be released in October of the Measurement Year

7 2017 VBP List of Required Measures Measure Arrangement Type Measure Specifications TCGP IPC Maternity HARP HIV/AIDS Class PCMH ecqm Total Care for the General Population (TCGP)/Integrated Primary Care (IPC) Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder NR NR NA NR NR HEDIS 2018 P4P Antidepressant Medication Management R R NA R R HEDIS 2018 P4P Breast Cancer Screening R R NA R R HEDIS 2018 P4P Yes Cervical Cancer Screening R R NA R R HEDIS 2018 P4P Yes Childhood Immunization Status R R NA NA NA HEDIS 2018 P4P Chlamydia Screening in Women R R NA R NA HEDIS 2018 P4P Yes Colorectal Cancer Screening R R NA R R HEDIS 2018 P4P Yes Comprehensive Diabetes Care: Eye Exams R R NA R R HEDIS 2018 P4P Yes Comprehensive Diabetes Care: Foot Exam NR NR NA NR NR HEDIS 2018 P4R Yes Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) R R NA R R HEDIS 2018 P4P Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) R R NA R R HEDIS 2018 P4P Yes Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing R R NA R R HEDIS 2018 P4P Comprehensive Diabetes Care: Medical Attention for Nephropathy R R NA R R HEDIS 2018 P4P Yes Comprehensive Diabetes Screening: Received All Three Tests (HbA1c, Eye Exam, and Medical Attention for Nephropathy) R R NA R R NYS 2018 P4P Controlling High Blood Pressure NR NR NA NR NR HEDIS 2018 P4P Yes Diabetes Screening for People with Schizophrenia or Bipolar Disorder Using Antipsychotic Medications R R NA R R HEDIS 2018 P4P Initiation and Engagement of Alcohol & Other Drug Abuse or Dependence Treatment R R NA R R HEDIS 2018 P4P Yes Initiation of Pharmacotherapy upon New Episode of Opioid Dependence R R NA R R P4P Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse and Dependence NR NR NA NR NR R Required to Report NR Not Required to Report

8 2017 VBP List of Required Measures Measure Arrangement Type Measure Specifications TCGP IPC Maternity HARP HIV/AIDS Class PCMH ecqm Medication Management for People with Asthma R R R R HEDIS 2018 P4P Potentially Avoidable Complications (PAC) in Routine Sick Care or Chronic Care NR NR NA NA NA Altarum P4R Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan NR NR NA NR NR CMS 2018 P4R Preventive Care and Screening: Influenza Immunization NR NR NA NR NR AMA v1.0 P4R Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan NR NR NR NR NR CMS 2018 P4R Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention NR NR NA NR NR AMA v1.0 P4R Statin Therapy for Patients with Cardiovascular Disease R R NA R R HEDIS 2018 P4R Yes Statin Therapy for Patients with Diabetes R R NA R R HEDIS 2018 P4R Use of Spirometry Testing in The Assessment and Diagnosis of COPD NR NR NA R R HEDIS 2018 P4R Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents R R NA NR NR HEDIS 2018 P4P Maternity Contraceptive Care Postpartum Women NA NA NR NA NA CMS 2018 P4R C-Section for Nulliparous Singleton Term Vertex (NSTV) NA NA NR NA NA TJC 2018 P4R Frequency of On-Going Prenatal Care NA NA NR NA NA Percentage of Babies Who Were Exclusively Fed with Breast Milk During Stay NA NA NR NA NA TJC 2017 P4R Incidence of Episiotomy [% of Vaginal Deliveries with Episiotomy] NA NA NR NA NA NPIC P4R Low Birth Weight [Live births weighing less than 2,500 grams (preterm v. full term)] NA NA R NA NA AHRQ v7.0 P4R Percentage of Preterm Births NA NA NR NA NA NYS 2018 P4R Prenatal and Postpartum Care NA NA R NA NA HEDIS 2018 P4P R Required to Report NR Not Required to Report

9 2017 VBP List of Required Measures Measure Arrangement Type Measure Specifications TCGP IPC Maternity HARP HIV/AIDS Class Health and Recovery Program (HARP) Continuity of Care from Inpatient Detox to Lower Level of Care NA NA NA R NA NYS 2018 P4P Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care NA NA NA R NA NYS 2018 P4P Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence NA NA NA R NA HEDIS 2018 P4P Follow-Up After Emergency Department Visit for Mental Illness NA NA NA R NA HEDIS 2018 P4P Follow-Up After Hospitalization for Mental Illness NA NA NA R NA HEDIS 2018 P4P Maintaining/Improving Employment or Higher Education Status NA NA NA R NA NYS 2018 P4R Maintenance of Stable or Improved Housing Status NA NA NA R NA NYS 2018 P4R No or Reduced Criminal Justice Involvement NA NA NA R NA NYS 2018 P4R Percentage of Members Enrolled in a Health Home NA NA NA R NA NYS 2018 P4R Percentage of Members who Receive PROS or HCBS for at least 3 Months in Reporting Year NA NA NA R NA TBD Potentially Preventable Mental Health Related Readmission Rate 30 Days NA NA NA R NA NYS 2018 P4P HIV/AIDS Viral Load Suppression NA NA NA NA R NYS 2018 P4P Potentially Avoidable Complication (PAC) in Patients with HIV/AIDS NA NA NA NA NR Altarum P4R Substance Abuse Screening NA NA NA NA NR NYS 2018 P4R R Required to Report NR Not Required to Report PCMH ecqm

10 2017 VBP List of Required Measures Measure Arrangement Type Measure MLTC Specifications Class Managed Long Term Care (MLTC) Percentage of members who did not experience uncontrolled pain R NYS 2018 P4P Percentage of members who did not have an emergency room visit in the last 90 days R NYS 2018 P4P Percentage of members who did not have falls resulting in medical intervention in the last 90 days R NYS 2018 P4P Percentage of members who received an influenza vaccination in the last year R NYS 2018 P4P Percentage of members who remained stable or demonstrated improvement in Nursing Facility Level of Care (NFLOC) score R NYS 2018 P4P Percentage of members who remained stable or demonstrated improvement in pain intensity R NYS 2018 P4P Percentage of members who remained stable or demonstrated improvement in shortness of breath R NYS 2018 P4P Percentage of members who remained stable or demonstrated improvement in urinary continence R NYS 2018 P4P Percentage of members who were not lonely and not distressed R NYS 2018 P4P Potentially Avoidable Hospitalizations (PAH) for a primary diagnosis of heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection R NYS 2018 P4P PCMH ecqm R Required to Report NR Not Required to Report

11 2017 CG-CAHPS Results

12 2017 CAHPS Clinician & Group Survey (CG-CAHPS) CG-CAHPS Assesses patients experiences with health care providers and staff in doctor s offices. Survey results can be used to: Improve care provided by individual providers, site of care, medical groups, or provider networks Survey Methodology Random sample of 1500 adults for each PPS Medicaid Members At least one qualifying outpatient visit to one provider in the PPS network Survey administered over a twelve-week period using mixed mode (mail and telephone) Up to 5 outreaches resulted in 30.6%(520 responses) response rate in 2017

13 CAHPS Clinician & Group Survey (CG-CAHPS)

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16 Strategies For Improvement

17 Strategies For Improvement Utilizing Data Cassie Winter, Rome Memorial Hospital

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19 Oneida County Joint RPAC/Care Transitions Coalition - Encouraged Providers to Request Data Measure Measure Rate Annual Target Measure Gap Adult Access Preventive (20-44) Adult Access Preventive (45-64) Adult Access Preventive (65 and Older) Child Access - Primary Care (12 to 19) Child Access - Primary Care (12 to 24 Months) Child Access - Primary Care (25 Months to 6) Child Access - Primary Care (7 to 11) PDI 90 - Pediatric Composite Potentially Avoidable Readmissions Potentially Preventable ED Visits PQI 90 - Overall Composite (Version 2) , Access to care impacts other measures

20 PCP Provider A Provider B Provider C Provider D Provider E Provider F Values # Members Numera * tor Multipli er Measure Result Annual Target Cassie's Calculations # Members missing measure Measure Gap Adult Access Preventive (20-44) Adult Access Preventive (45-64) Adult Access Preventive (20-44) Adult Access Preventive (45-64) Adult Access Preventive (65 and Older) Adult Access Preventive (20-44) Adult Access Preventive (45-64) Adult Access Preventive (65 and Older) Adult Access Preventive (20-44) Adult Access Preventive (20-44) Adult Access Preventive (20-44) Looked for Providers in the Red as well as those in the green who had large panel sizes that could impact the overall measure Members were missing the measure Measure

21 Next Steps: Requested Patient Level Data from CNYCC (July 2016-May 2017) Some names not provided because consent not provided Provided List of Outliers to the Office Manager of my PCP Group Emphasized that many of the DSRIP measures are consistent with our VBP Arrangements with our Medicaid MCOs. Must pass quality gate to earn shared savings Staff members are working the list Some patients are inactive/transferred out (dating back to 2011) Appointments are being scheduled for active patients Team is going to reconnect with Medicaid MCOs to proactively identify patients who need to be seen Meeting with team Friday to review all DSRIP outcome measures

22 Strategies For Improvement Access To Care Prepared by Michelle Slade, Upstate University Hospital

23 Medicaid Benefits Adults and children have an annual wellness visit available Visits can include Screenings Vaccines Other care Not guaranteed as free but advertised as little to no costs *Medicare has very specific benefits

24 Coding is Key HEDIS measure Adults Access to Preventive/ Ambulatory Health Services includes both well and sick visits for adults age 20 years or older What screening can be included? What immunizations can be included? What counseling can be included? Use the resource listed on the next page AAFP Documenting and Coding Preventive Visits: A Physician s Perspective Required components of a preventative visit: Comprehensive H&P Status of chronic, stable problems that are not significant enough to require additional work (this includes labs, Rx refills, etc.) Appropriate ICD 10 coding is a must

25 Resources AHIMA Coding Preventive Care Services AAFP Documenting and Coding Preventive Visits: A Physician s Perspective AAFP Medicare Preventive Services Expansion booklet

26 Medicaid Answering Services Presenter: Leslie Ann Regan

27 Access to Care LC Series: Evaluation Did you find the material presented to be informative and useful? Did you find the best practice demonstrations (partner panel discussions) to be beneficial? Do you find the frequency and duration of sessions to be appropriate for the material covered? Any suggestions? What did you learn from the Access To Care Series? Any key takeaways?

28 Learning Collaborative 2018 Series 1: Access To Care Series 2: CBOs: Positioning For VBP (June, July) Tuesday June 5 th, :00AM-12:00PM Series 3: Cardiovascular: Monitoring & Treatment (August, September, October) Series 4: Behavioral Health (November, December)

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