Value Based P4P Preliminary Quality Results. Lindsay Erickson Ginamarie Gianandrea May 31, 2016
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1 Value Based P4P Preliminary Quality Results Lindsay Erickson Ginamarie Gianandrea May 31, 2016
2 Agenda Time Topic 11:00 11:05 AM Welcome! 11:05 11:20 AM MY 2015 Timeline and Highlights 11:20 11:45 AM Accessing & Evaluating Your Reports 11:45 11:50 AM The Appeals Process 11:50 12:00 PM Wrap-Up & Questions Today s session will be recorded and posted on iha.org for reference. Submit questions during the call via WebEx chat 2016 Integrated Healthcare Association. All rights reserved. 2
3 MY 2015 Report Release Timeline May 25 report release includes preliminary results for both commercial and Medicare Advantage product lines for Measurement Year 2015 Activity Date Preliminary Quality Reports May 25, 2016 Quality Questions and Appeals Period May 25 - June 15, 2016 We are here! Final Quality Reports July 6, 2016 Preliminary ARU & TCC Reports June 29, 2016 ARU & TCC Review Period June 29 July 20, 2016 Final ARU & TCC Reports August 17, 2016 Full timeline available in the MY 2015 VBP4P Manual 2016 Integrated Healthcare Association. All rights reserved. 3
4 Commercial Value Based P4P Quality Reports 2016 Integrated Healthcare Association. All rights reserved. 4
5 Value Based P4P Domains 2016 Integrated Healthcare Association. All rights reserved. 5
6 Commercial VBP4P Quality Results About your preliminary reports Include results for all measures in clinical quality, patient experience, and MUHIT domains Based on 10 participating health plans Aetna Anthem Blue Cross Blue Shield of California Chinese Community Health Plan* Cigna Health Care of California Health Net Kaiser Permanente* Sharp Health Plan UnitedHealthcare Western Health Advantage 2015 Integrated Healthcare Association. All rights reserved. 6
7 Use of Quality Results Once final, results will be used accordingly for: PAYMENT Value Based P4P and quality incentive payments All participating health plans except two noted with asterisk on previous slide use the IHA results for incentive payments RECOGNITION Excellence in Healthcare Award and Bangasser Memorial Award for Quality Improvement PUBLIC REPORTING Office of the Patient Advocate s Report Card 2015 Integrated Healthcare Association. All rights reserved. 7
8 How a Measure Joins the VBP4P Set The three year measure adoption process is outlined below: Testing Reporting of testing measures is optional. 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 by all POs, 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 2016 Integrated Healthcare Association. All rights reserved. 8
9 MY 2015 Measure Set Quality Highlights 2 new paid and publicly reported measures Diabetes Care Combination Diabetes Care: Two HbA1c Tests 4 baseline measures will be paid and publicly reported in MY 2016, all represent updates/replacements to existing measure concepts Childhood Immunization Status Combo 10 Cervical Cancer Overscreening Cervical Cancer Screening Asthma Medication Ratio: Ages testing measures pending successful testing, will be baseline measures in MY 2016 Statin Therapy for Patients with Diabetes Statin Therapy for Patients with Hypertension Antidepressant Medication Management 2 nd year of e-measure results Final year of MUHIT EHR participation measure domain weights for clinical, patient experience, and e-measures will be increasing View the complete VBP4P Measure Set for MY Integrated Healthcare Association. All rights reserved. 9
10 Where to Start VBP4P Reporting Portal: Reports: Quality Composite Score Results and scoring for measures recommended for payment Reports: Summary Color-coded summary of result for every measure and indicator collected Downloads: MY 2015 Summary Statistics First preview of the benchmarks that will be used to score MY 2016 Measures: Encounters Summary of the encounter counts per member; reflects the completeness of the data received by the health plan as well as utilization trends Measures: Enrollment An easy, at-a-glance summary of reported HMO/POS enrollment Make sure you have selected the right year, product, and organization 2016 Integrated Healthcare Association. All rights reserved. 10
11 Measure Level Views - Overview The measures tabs includes measure-specific results organized by year and product line. Each measure includes a table with the numerator, denominator, and rate for each health plan contracted with your PO, as well as your PO self-reported rate if applicable. The measures include any underlying metrics (such as age bands) and are organized by VBP4P domain and clinical priority area Integrated Healthcare Association. All rights reserved. 11
12 Adding a Contact on the Reporting Portal Only contacts associated with a physician organization or health plan can view that organization s VBP4P results on the Reporting Portal. To receive access to your organization s results: Sign up for an account on the Reporting Portal. Make sure you fully complete the registration process. Request to be added as a contact by an existing contact. Need to know who is already a contact at your organization? p4p@iha.org. The existing contact then needs to add you as a contact: Existing Contact logs in to the VBP4P Reporting Portal Click "Contacts" on the top navigation bar Click the "Add Contacts" button Search for New Contact by and click "Add Note that sometimes the system takes up to a day to sync new contacts - if a new contact doesn't show up immediately when you search for them, check back the next day. Reporting Portal contacts are automatically subscribed to the Value Based P4P newsletter, which includes upcoming deadlines, program updates, and other important VBP4P information Integrated Healthcare Association. All rights reserved. 12
13 Medicare Advantage 2016 Integrated Healthcare Association. All rights reserved. 13
14 Medicare Advantage PO Results Reports include clinical quality measures only 6 participating health plans: Anthem Blue Cross Blue Shield of California Health Net Kaiser Permanente SCAN Health Plan UnitedHealthcare Fall 2016 after CMS releases cutpoints, IHA calculates star ratings: Public reporting through Office of the Patient Advocate (OPA) 5 Star / Most Improved Award Winners recognized 2016 Integrated Healthcare Association. All rights reserved. 14
15 IHA Medicare Advantage Stars Measure Set IHA s measurement focuses on the three CMS Medicare Advantage Stars domains that are related to physician organization performance in delivering care: Staying Healthy - Screenings, Tests and Vaccines, Managing Chronic (Long Term) Conditions, and Drug Safety. Of the 22 PO-survey relevant measures that comprise these domains, IHA collects all 13 measures that do not require patient or chart review. Eight measures in the PO subset are also collected in the broader commercial HMO/POS measure set used in VBP4P (denoted by *). 1. Adult BMI assessment 2. All-cause readmissions* 3. Breast cancer screening* 4. Colorectal cancer screening* 5-7. Diabetes care: Blood Sugar Controlled* Kidney Disease Monitoring* Eye exam 8. Rheumatoid arthritis management 9. High risk medication 10. Osteoporosis management in women who had a fracture Medication Adherence for: Hypertension (RAS Antagonists)* Cholesterol (Statins)* Diabetes medications* 2016 Integrated Healthcare Association. All rights reserved. 15
16 Review and Appeals Period 2016 Integrated Healthcare Association. All rights reserved. 16
17 Question & Appeals Period: May 25 June 15 Key Dates Date Preliminary Quality Reports released to POs May 25, 2016 POs review their Quality results and submit Request for Quality Results Questions and Appeals Form if necessary Required from POs: Review preliminary quality results Ask questions Submit appeals using the appeals form May 25 June 15, 2016 Quality Appeals hearing June 22, 2016 Quality Appeals decisions communicated to POs June 22-29, 2016 Final Quality Reports released July 6, 2016 Get your questions in early! 2016 Integrated Healthcare Association. All rights reserved. 17
18 Submitting Questions and Appeals To submit requests for additional information or changes, please download and complete the Quality Results Questions and Appeals Form and send to beginning with "Appeals" in the subject line. For instructions, see the Quality Appeals Process (Description) Integrated Healthcare Association. All rights reserved. 18
19 Tips for a Successful Appeal Start early Ask questions Provide documentation Some data inconsistencies are inherent when using different data sources Help substantiate that there is a mistake, not just an inconsistency Ex: POs often have better rates than health plans for measures including supplemental data (like blood pressure control). Identifying this difference will not result in a successful appeal. POs must provide evidence that supplemental data was successfully shared with a contracted health plan, and the plan failed to include the data in rate calculation. If you re still not sure Ask more questions! Send questions to p4p@ncqa.org Please do not send IHA any Protected Health Information! 2016 Integrated Healthcare Association. All rights reserved. 19
20 Questions and Wrap-Up 2016 Integrated Healthcare Association. All rights reserved. 20
21 Key Date Reminders 6/15 Quality Review & Appeals Deadline 6/29 Preliminary Appropriate Resource Use Reports 9/1-10/ Public Comment including: Draft MY 2016 manual and measure specifications Proposed MY 2017 measure set 9/23 IHA Stakeholders Hilton LAX We are here 2016 Integrated Healthcare Association. All rights reserved. 21
22 Useful Resources Value Based P4P Program MY 2015 VBP4P Manual MY 2015 Measure Set Quality Composite Score Calculation Value Based P4P Newsletters Value Based P4P Webinars MY Program Updates Medicare Advantage Program Medicare Advantage Stars Fact Sheet Medicare Advantage Stars Methodology 2016 Integrated Healthcare Association. All rights reserved. 22
23 Questions? If you have any questions after today s session contact us at p4p@iha.org Thank you! 2016 Integrated Healthcare Association. All rights reserved. 23
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