2018 Practice Improvement Program (PIP) Orientation. January 4 th, 2018 San Francisco Health Plan Practice Improvement Program (PIP)

Transcription

1 2018 Practice Improvement Program (PIP) Orientation January 4 th, 2018 San Francisco Health Plan Practice Improvement Program (PIP)

2 Practice Improvement Program (PIP) Leadership Team James Glauber, Chief Medical Officer Adam Sharma Director, Health Outcomes Improvement Vanessa Pratt Manager, Population Health Kanelle Barreiro Program Manager, Pay for Performance Katherine Quen Specialist, Population Health

3 Agenda TIME ITEM 8:30 Welcome Review Agenda and Meeting Objectives 8:40 Program Overview 8:50 Review Changes in 2018 PIP Clinical Quality Domain Data Quality Domain Patient Experience Domain Systems Improvement Domain 9:40 Break 9:50 Review all other measures with no changes in 2018 Small group activity 10:25 Review 2018 Enrollment 10:45 Closing & Evaluation Distribution

4 Housekeeping Webinar will be recorded Slides will be sent out after Please mute phone lines, *6 Don t put phone lines on hold Ask questions throughout and at Q&A No question is silly

5 Objectives General overview of program Review changes and new measures Answer questions that will help you be successful

6 What is PIP? Incentive program for SFHP Medi-Cal clinics and medical groups to achieve improvements in system and health outcomes.

7 PIP Guiding Principles Comprehensive Collaborative Standardized Incentivizing Technical Assistance

8 The History of PIP 2011 Program launch Reporting only to incentivize building capacity for reporting data 2014 Strength in Numbers P4P measures rolled into CQ domain, all participants held accountable for data quality measures Fewer measures, simpler deliverables, specialty care access measures New measures were added to the Systems Improvement domain to support appropriate utilization of primary care visits and expansion of the palliative care Medi-Cal benefit Stronger commitment to quality-established clinical thresholds, incentivized outreach to higher risk populations 2015 Improving access, narrowing the number of measures to focus improvement on lowest performing Newer measures were added to the Clinical Quality domain to increase alignment with external entities.

9 Standardized PIP Participant Types Academic Medical Center (1) Individually Contracted Specialty (1) Community Clinic (7) IPA (3) Clinic-Based RBO (1)

10 PIP Incentives incentivizing Maximum quarterly payments are allocated based on capitation and actual member months accrued during each month of the quarter. 18.5% of Medi-Cal capitation 5% of Healthy Kids HMO capitation

11 Quadruple Aim comprehensive Patient Experience Domain Patient Experience Domain Improving Patient Experience Improving Staff Satisfaction All Domains Reducing the Per Capita Cost of Health Care Improving Population Health Clinical Quality Domain Data Quality Domain

12 collaborative PIP Measure Development PIP Participants, SFHP stakeholders, NCQA, HEDIS, QMED, Meaningful Use, DMHC, DHCS SFHP Subject Matter Experts Advisory Committee

13 PIP Reporting Timeline Quarter Quarter End Date Materials Due to SFHP Reporting Period Enrollment Friday, January 19, 2018* For all measures, the quarter s end date serves as 1 March 31, 2018 Monday, April 30, 2018 the last day of the reporting 2 June 30, 2018 Tuesday, July 31, 2018 period. Please see each 3 September 30, 2018 Wednesday, October 31, 2018 measure s specifications for the first day of the 4 December 30, 2018 Thursday, January 31, 2019 reporting period. *Late baseline data submissions jeopardize the PIP database setup. We thank you in advance for your timeliness with your baseline data!

14 Clinical Quality Scoring collaborative Deliverable For each of the Priority Five measures: Achieving 90 th percentile HEDIS or 75 th internal PIP percentiles or 15% or more relative improvement Achieving 75 th percentile HEDIS or 60 th internal PIP percentiles or 10-14% relative improvement Achieving 5-9% relative improvement over baseline Self-reporting data quarterly Maintaining performance relative to baseline* For each of the non-priority Five measures: Quarterly Scoring (Self-Reported Data) 1.25 points 1.0 point 0.75 point 0.25 point 0.25 point

15 PIP Payment Methodology % of points = 100% of payment 80 89% of points = 90% of payment 70 79% of points = 80% of payment 60 69% of points = 70% of payment 50 59% of points = 60% of payment 40 49% of points= 50% of payment 30 39% of points= 40% of payment 20 29% of points = 30% of payment Less than 20% of points = no payment

16 Scorecard Review

17 PIP Website Technical Assistance All 2018 measure resources will be listed here

18 Program Guide 2018 Changes

19 All-Participant Program Guide At the top of each page, each measure specification lists which participants have measure assigned in their measure set.

20 All-Participant Program Guide

21 Clinical Quality Domain: 2018 Changes

22 SFHP option discontinued Overall, this decision will benefit our provider network in various ways: o Fewer charts will be requested from providers during the SFHP HEDIS pursuit o Fewer SFHP dollars will be spent on the administration of the HEDIS pursuit o Further development of PIP self-reporting capacities

23 CQ 06: Labs for Patients on Persistent Medications HEDIS Changes from 2017 Digoxin has been removed from the reporting requirements for EAS and NCQA. As such, PIP participants have the option of removing digoxin from their 2018 PIP reporting. Measure CQ 06: Labs for Patients on Persistent Medications Numerator/Denominator Numerator: Number of patients in denominator population who received, in the last year: At least one serum potassium, AND A serum creatinine within the measurement year OPTIONAL: AND (for members on digoxin) A serum digoxin (applies only to members on digoxin) Denominator: Number of active patients 18 years and older, on ACE inhibitor, ARBs, digoxin or diuretics for 180 days or more in the last year

24 CQ09: Adolescent Immunizations Changes from 2017 In alignment with clinical guidelines that recommend the inclusion of HPV in the vaccination schedule for adolescents, CQ9 Adolescent Immunizations was replaced by CQ12 Adolescent Immunizations (with HPV). Measure CQ09: Adolescent Immunizations Numerator/Denominator Numerator: Number of patients in the denominator population who received one meningococcal vaccine on or between the member s 11th and 13th birthday and one (Tdap) or (Td) vaccine on or between the member s 10th and 13th birthdays, and two HPV vaccines between the member s 9 th and 13 th birthday. Denominator: Number of active patients who turned 13 years old during the last year

25 CQ09: Adolescent Immunizations Measures without comparable NCQA HEDIS thresholds, a PIP network threshold will be used based on prior year s PIP participant data: Measure CQ09 Adolescent Immunizations 75 th percentile 60 th percentile 73.00% 50.40%

26 CQ12: Chlamydia Screening HEDIS Changes from 2017 This measure will be scored as a non-priority Five measure, earning points maintaining baseline. Measure Numerator/Denominator Numerator: Number of patients in the denominator population with at least one test for chlamydia in the last year CQ14: Chlamydia Screening Denominator: Number of active patients who meet all of the following criteria: are sexually active have the ability to become pregnant between the ages of years old

27 CQ13-CQ14: Perinatal Care Changes from 2017 This measure will be scored as a non-priority Five measure, earning points maintaining baseline. HEDIS Measure Numerator CQ15: Timely Access to Prenatal Care CQ16: Postpartum Care Numerator: Number of patients in the denominator population who received a prenatal in the first trimester of their pregnancy or within 42 days of enrollment into Medi-Cal, whichever is later. Numerator: Number of patients in the denominator population who had a postpartum visit between days after delivery. Denominator: Number of active patients who had a live birth in the last year.

28 CQ15: Asthma Medication Ratio Changes from 2017 This measure will be scored as a non-priority Five measure, earning points maintaining baseline. HEDIS Measure Numerator/Denominator Numerator: Number of patients in the denominator population who have a ratio of 0.5 or greater of controller asthma medications to total asthma medications in the measurement year. CQ17: Asthma Medication Ratio Denominator: Number of active patients between the ages 5-64 with persistent asthma as defined as one or more of the following in the past two years: At least one ED visit with a primary diagnosis of asthma At least one inpatient encounter with a primary diagnosis of asthma At least four outpatient visits with a diagnosis of asthma and at least two asthma medication dispensing events At least four asthma medication dispensing events If the patient was only dispensed short acting medications (leukotriene modifier or antibody inhibitor) they should also have a diagnosis of asthma in any setting

29 Data Quality Domain 2018 Changes

30 DQ1: Provider Roster Updates Changes from 2017 Measure applies only to IPA & Academic Medical Center participants Reporting frequency changed from quarterly to biannually. Deliverable Due Dates Scoring If there are no changes that need to be made to the current quarter s provider roster, please submit the Provider Roster Attestation. If changes do need to be made to the current quarter s provider roster, please submit the supporting information in one of the two approved ways. Deductions will be made in these cases: o 0.10 point deduction (up to a maximum of 0.50 point) for each piece of missing information noted in Measure Description. o 0.25 point deduction (up to a maximum of 1.0 point): Discrepancy between Medical Staff Office (MSO)/Profiles/Change Reports/Credentialing Packet and Provider Roster. Discrepancies that will affect scoring are: Providers in one source and not the other. Additions/terminations reported via PIP that should have been reported via entity s contractual method > 1 month prior Quarter 2 Quarter points

31 Patient Experience Domain 2018 Changes

32 PE8: Expanding Access to Services Changes from 2017 There are two new options for 2018: Option Three: Patient-centered scheduling practices Option Four: Improvements in transgender health are new in 2018 The option to offer primary care services by staff other than PCPs was retired to create opportunity for new improvement projects. Option Five was modified to include a range of access improvement projects. Option One: Best Practices in Hepatitis C Screening & Treatment Option Two: Improvements in Opioid Safety Option Three: Patient-Centered scheduling Practices Option Four: Improvements in Transgender Health Option Five: Access Improvement Project

33 PE8: Expanding Access to Services Deliverables Due Dates Scoring Deliverable A: Submit service expansion plan using required template Quarter points for completed template Deliverable B: Submit example materials from service expansion Quarter points for example materials Deliverable C: Attestation service expansion has occurred, signed by Medical Director or equivalent Quarter points for signed attestation

34 Systems Improvement Domain 2018 Changes

35 SI1: Depression Screening and Follow-up Changes from 2017 The Depression Screening Rate will become pay-for-performance in Q Follow-up to a positive screen was added as a qualitative component of this measure. PART A: Rate of patients receiving depression screening Depression Screening Rate = Numerator: Total number of patients in the denominator with a depression screening in the measurement year. Denominator: Total number of active patients at least 12 years of age during the measurement year. Numerator Measurement Option #2: Measure depression screening using other registry methods. Participants choosing this option must report their methodology for measuring depression screening.

36 SI1: Depression Screening and Follow-up PART B: Create a system/clinic-wide protocol with pathways for each of the four appropriate follow-ups to a positive screen. Appropriate Follow-up on or within 30 days of positive screen 1. Additional evaluation for depression Follow-up with a case manager, with documented assessment of depression symptoms. Telephone visit with diagnosis of depression or other behavioral health condition. Assessment on the same-day as the positive screen, including additional depression assessment indicating no depression or no symptoms that require follow-up. 2. Referral to a practitioner who is qualified to diagnose and treat depression Follow-up behavioral health encounter, including assessment, therapy, collaborative care, medication management, acute care, and telehealth encounters. Follow-up outpatient visit, with a diagnosis of depression or other behavioral health condition. 3. Pharmacological Intervention Dispensed anti-depressant medication

37 SI1: Depression Screening and Follow-up Deliverable Due Dates PIP Network Threshold Quarterly Scoring Deliverable A: Self-report the numerator and denominator as noted in the Measure Description. Quarter 1 & Quarter 2 (reporting only) N/A 1.0 point Deliverable B: Documentation of system/clinic-wide protocol with pathways for each of the four appropriate follow-ups to a positive screen, submitted via Wufoo. Quarter 3 & Quarter 4 (pay-for-performance) Percentile TBD 1.0 point Percentile 0.5 point TBD Quarter 3 N/A 4.0 points IPA participants only: Provide an attestation signed by Medical Director, or equivalent, verifying at least three sites have developed a clinic-wide protocol with pathways for each of the four appropriate follow-ups to a positive screen described in the table below.

38 SI2: Follow-Up After Hospital Discharge Changes from 2017 Numerator definition was updated to support clinical best practice that a follow-up visit post discharge should not occur on the same-day as discharge. Quarterly Office Visit Follow-Up After Hospital Discharge Rate = Numerator: Total number of discharges in the denominator with an eligible follow-up visit 1-7 calendar days post discharge Denominator: Total number of inpatient discharges during the quarter Deliverable Due Date Threshold Scoring Submit quarterly numerator and denominator as noted above via quantitative data template. Quarter 1 Quarter 2 Quarter 3 Quarter 4 50% 1.0 point 40% 0.5 point

39 SI5: Percent of Members with a Primary Care Visit Quarterly Primary Care Visit Rate = Numerator: Number of SFHP members in the denominator population with at least one PCP visit in the last year Denominator: Total number of continuously enrolled SFHP Medi- Cal members assigned to your organization during the quarter. Deliverable Due Date Scoring SFHP to provide in Quarter 1, Quarter 2, Quarter 3, and Quarter 4 Deliverable A: Receive PCP visit rate. To be scored Q points for achieving 5% or more absolute improvement over baseline* or achieving SFHP average PCP visit rate. 1.5 points for achieving 3% absolute improvement over baseline.* 1.0 points for achieving 1% absolute improvement over baseline.* Deliverable B: Submit improvement plan template (for participants not meeting SFHP average PC visit rate in Q1 2018) Quarter points *Baseline will be determined by Q PCP visit rate

40 SI6: Palliative Care Part A (IPA, Clinic-Based RBO, and Academic Medical Center participants only): Complete an assessment of the palliative care resources available within your network. Part B (All Participants): Identify patients who may be eligible for referral to palliative care services by completing the following: Identify patients with COPD or CHF who are potentially eligible for palliative care by using an SFHP list of members who are potentially eligible for palliative care, or creating your own list of potentially eligible patients. For potentially eligible members with COPD or CHF, perform chart review to determine eligibility for referral to palliative care services. Attestation signed by medical director (or equivalent) verifying chart review of members eligible for palliative care and appropriate referrals were made.

41 SI6: Palliative Care Deliverable Due Date Scoring Deliverable A (for IPA, Clinic-Based RBO, and Academic Medical Center participants only): Submit template outlining the palliative care services and/or resources available within your network. Quarter points Deliverable B (All Participants) : Submit attestation signed by a medical director (or equivalent), verifying that chart review was performed for members with COPD potentially eligible for palliative care and appropriate referrals were made. Quarter points

42 Questions?

43 BREAK!

44 Review All Remaining Measures

45 Clinical Quality Domain

46 Clinical Quality Scoring collaborative Deliverable Quarterly Scoring (Self-Report) For each of the Priority Five measures: Achieving 90 th percentile HEDIS or 75 th internal PIP percentiles or 15% or more relative improvement Achieving 75 th percentile HEDIS or 60 th internal PIP percentiles or 10-14% relative improvement Achieving 5-9% relative improvement over baseline Self-reporting data quarterly Maintaining performance relative to baseline* For each of the non-priority Five measures: 1.25 points 1.0 point 0.75 point 0.25 point 0.25 point

47 CQ01-CQ03: Diabetes (All Participants) HEDIS Measure CQ 01: Diabetes HbA1c Test CQ 02: Diabetes HbA1c <8 (Good Control) CQ 03: Diabetes Eye Exam Numerator Numerator: Number of patients in denominator population who received at least one HbA1c test within the last 12 months Numerator: Number of patients in denominator whose most recent HbA1c level is < 8.0 in the last 12 months Numerator: Number of patients in denominator population with retinal exam or dilated eye exam performed by an eye care professional in the past 12 months OR a negative retinal or dilated eye exam performed by an eye care professional in last 24 months Denominator: Number of active patients with diabetes ages years old

48 CQ04: Cervical Cancer Screening (All Participants) HEDIS Measure CQ04: Routine Cervical Cancer Screening Numerator/Denominator Numerator: Number of patients with cervices ages who received one or more Pap tests during the past 3 years OR patients with cervices ages who received cervical cytology and HPV co-testing during the past 5 years Denominator: Number of active patients with cervices ages years old

49 CQ05: Colorectal Cancer Screening (Community Clinics & Clinic Based RBO s only) Measure Numerator/Denominator Numerator: Number of patients in denominator population who received a FOBT or FIT test during the past year, OR CQ05: Routine Colorectal Cancer Screening Number of patients in denominator population who received a sigmoidoscopy during the past 5 years, OR Number of patients in denominator population who received a screening colonoscopy during the past 10 years Denominator: Number of active patients ages years old

50 CQ 07: Smoking Cessation Intervention (Community Clinics & Clinic Based RBO s only) Measure Numerator/Denominator Numerator: Number of patients in denominator population with a documented smoking cessation counseling intervention in the EHR or registry in the last 2 years CQ 07: Smoking Cessation Intervention Denominator: Number of active patients who are (must meet all of the following): a) 18 years or older b) Have a documented history of tobacco use in the past 2 years c) Seen for at least one outpatient visit within the past 2 years

51 CQ08: Controlling High Blood Pressure (All Participants) HEDIS Measure Numerator/Denominator Numerator: Number of patients in the denominator population in which the most recent BP reading in an outpatient visit within the reporting period was documented as follows: years of age whose BP was <140/90 mm Hg; CQ08: Controlling High Blood Pressure years of age with a diagnosis of diabetes whose BP was <140/90 mm Hg; years of age without a diagnosis of diabetes whose BP was <150/90 mm Hg. Denominator: Number of active patients with hypertension ages years old

52 CQ10: Childhood Immunizations (All Participants) HEDIS Measure Numerator/Denominator Numerator: Number of patients in the denominator population who received all of the following vaccines by their second birthday: four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); CQ10: Childhood Immunizations three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); and four pneumococcal conjugate (PCV) Denominator: Number of active patients who turned 2 years old during the last year

53 CQ11: Well Child Visits for Children 3-6 Years of Age (All Participants) HEDIS Measure Numerator/Denominator CQ10: Childhood Immunizations Numerator: Number of patients in the denominator population who had at least one well-child visit with a PCP during the past year. Denominator: Number of active patients 3-6 years old

54 Patient Experience Domain

55 PE1: Third Next Available Appointment (Community Clinics & Clinic Based RBO s only) Deliverable Due Dates # of Days Reduced Threshold Scoring Submit the median established patient followup visit TNAA for each of the final 5 full weeks of the reporting period. Note: SFHP will determine median of five pieces of data and use it to score performance. Quarter 1 Quarter 2 Quarter 3 Quarter 4 n/a > 10 days 14 calendar days or less calendar days or less 2.0 points 1.5 points 5-9 days n/a 1.0 point

56 PE2: Show Rate (Community Clinics, Clinic-based RBOs, & Academic Medical Centers only) Monthly Show Rate = Numerator: Of the total appointments in the denominator, the number of appointments which patients kept. Denominator: Total number of pre-scheduled appointments for a PCP/PCP team visit during any given calendar month. Deliverable Submit monthly data each quarter via the quantitative template. Note: SFHP will determine quarterly show rate by combining numerators and denominators for each month in the quarter, and using it to determine performance. Due Dates Quarter 1 (Timeframe: Jan, Feb, Mar) Quarter 2 (Timeframe: Apr, May, Jun) Quarter 3 (Timeframe: Jul, Aug, Sept) Quarter 4 (Timeframe: Oct, Nov, Dec) Relative Improvement Threshold Quarterly Scoring n/a 85% or 1.0 point more 10% 80-84% 0.75 point 5-9% n/a 0.5 point

57 PE3: Office Visit Cycle Time (Community Clinics, Clinic-based RBOs, & Academic Medical Centers only) Deliverable Due Dates # Minutes Reduced Self-report the median cycle time for each month in the quarter. Quarter 1 (Data Collection Period: Jan, Feb, Mar) Quarter 2 (Data Collection Period: Apr, May, Jun) Quarter 3 (Data Collection Period: Jul, Aug, Sept) Quarter 4 (Data Collection Period: Oct, Nov, Dec) 10 or more minutes reduced 5-9 minutes reduced PIP Network Threshold 75 th percentile 64 minutes or less 60 th percentile minutes Quarterly Scoring 1.0 point 0.5 point

58 PE4: Staff Satisfaction Improvement Strategies (All Participants) Deliverables Due Dates Scoring Deliverable A: Submit template with the following included: Baseline score of a staff satisfaction survey o If survey has multiple questions, only one score may be chosen. rate met. For participants using Net Promoter survey, chosen question must be How likely are you to recommend organization as a place to work? Survey type (Gallup, Net Promoter, etc.) Survey date (completed October 1, 2015-January 15, 2016) Survey question Response rate (numerator/denominator) 1-2 priority areas identified for improvement Deliverable B: Submit template with a report of activities implemented specifically to address priority areas identified for improvement Deliverable C: Submit template with the following included: Survey type (must be same as baseline) Survey date (completed August 1, 2016-October 15, 2016) Survey question (must be same as baseline) Response rate (numerator/denominator) Deliverable D: Improvement on staff satisfaction survey score, submitted via the Quantitative Data Template. o Score must represent question chosen for baseline. Quarter point for completed template, if required response 0 point if required response rate not met. Quarter point for completed template Quarter point for completed template, if required response rate met. 0 point if required response rate not met. Quarter 3 If required response rate met: 1.0 point for > 4.0% relative improvement 1.0 point for 2.0% - 3.9% relative improvement If required response rate not met: 0 point

59 PE5: Improvement in Patient Experience of Primary Care Access (All Participants) Patient Experience Survey Tool Criteria Criteria 1. Conducted and analyzed by or audited by third party 1. Surveyed population is a random sample of all Medi-Cal patients 1. Survey conducted at least twenty-four hours after visit concludes Rationale Supports consistent and unbiased survey methodology Results can be generalized across the population Surveys conducted during or immediately after a visit can offer a limited view of the patient s full experience, including follow-up services needed post visit 1. Tool has been validated Validation ensures that the tool is reliable; meaning, that it yields results that reflect patient perception of the health care system 1. Includes access-related questions Access to care represents the biggest opportunity for improvement for San Francisco s Medi-Cal population, as it is the lowest ranking area on member surveys 1. Sampling methodology ensures that each question obtains at least thirty responses Results can be considered statistically meaningful

60 PE5: Improvement in Patient Experience of Primary Care Access Deliverables Due Dates Scoring Deliverable A: Submit template with: CG-CAHPS or equivalent baseline data A description of the qualitative data collection methodology (sampling methodology, questions asked, and number of patients participating) An analysis of themes found in qualitative data Plan to improve results, based on qualitative data Deliverable B: Submit template with report of activities implemented Deliverable C: Submit re-measurement score for CG- CAHPS or equivalent survey on Quantitative Data Template Deliverable D: Submit template with re-measurement data collection methodology. Quarter 2 Quarter 3 Quarter 4 Quarter points for completed template 1.0 point for completed template 2.0 points for >3% absolute improvement 1.0 point for % absolute improvement 0.0 points for <2% absolute improvement 0.5 points

61 PE6: Primary Care Access as Measured by Appointment Availability Survey Compliance (Academic Medical Centers & IPAs) Primary Care Appointment Availability = Numerator: Total number of primary care providers in compliance with DMHC Appointment Availability standards listed in the measure specification (must be compliant in both categories) Denominator: Total number of primary care providers that respond to the Appointment Availability Survey Deliverable Due Date Scoring Quarter 4. No submission due from participants. Participate in provider appointment availability survey (via phone, online, or fax) 8.0 points for achieving a 80% compliance rate

62 PE7: Improvement in Specialty Access as Measured by HP-CAHPS (Clinic-Based RBOs & IPAs) Deliverable Due Date Scoring Deliverable A: Receive re-measurement score Deliverable B: Submit template with Score for HP-CAHPS specialist access question as reported by SFHP An analysis of themes found in qualitative data Plan to improve results, based on qualitative data SFHP to provide in August 2018 Quarter 4 To be scored Q points for achieving 4% or more absolute improvement over baseline score on the specialist access question 3.0 points for achieving % absolute improvement 2.0 points for achieving % absolute improvement 2.0 points for completed template

63 Systems Improvement Domain

64 SI3: Opioid Safety (Community Clinics, Clinic-based RBOs & Academic Medical Centers) Quarterly Opioid Safety Rate = Numerator: Total number of opioid registry patients who meet the opioid safety requirements: all of the following must be documented in the last 12 months: one drug urine screen (does not have to be random) a signed opioid treatment agreement CURES report reviewed Denominator: Total number of patients in Opioid Registry on the last day of the Quarter Deliverable Due Date Quarterly Scoring Deliverable A: Self-report the numerator and Quarter point for > 60% denominator as noted in the Measure Quarter point for 50-59% Description Quarter 3 0 points for 49% or less Quarter 4 Part B: Submit template with the names of 5 SFHP members with opioid safety risk reviewed during the months of the quarter by the Controlled Substance Review Committee. Include brief documentation of committee recommendations and attestation that CURES report reviewed. CURES must be run no more than one month prior to review. Quarter 1 Quarter 2 Quarter 3 Quarter point/member, up to 0.5 point, will be awarded for submitting (via secure ) the completed template listing the 5 SFHP members reviewed by the Controlled Substance Review Committee to PainManagement@sfhp.org.

65 SI4: Providers Open to New Members (IPAs only) Quarterly Rate of Providers Open to New Members = Numerator: PCPs in the denominator open to new members and to auto-assigned members. Auto-assigned members are new members who do not choose a Primary Care Provider on enrollment with SFHP. Denominator: Total number of PCPs affiliated with SFHP as of the last week of the Quarter. Deliverable Due Date Relative Improvement No deliverables Quarter 1 required for this Quarter 2 measure. Quarter 3 Quarter 4 Threshold Quarterly Scoring > 15% > 80% 2.0 points 10-14% 70-79% 1.5 points 5-9% 60-69% 1.0 point

66 PIP Enrollment Process Two steps: 1. Wufoo form 2. Enrollment Attestation: Data Sharing Consent form 2017 Q4 data will be used for 2018 baseline

67 Wufoo Form

68 Wufoo Form Section 1: General Information & Participant Contact Information

69 Wufoo Form Section 2: PIP Alignment Survey

70 Wufoo Form Section 3: Clinical Quality Domain Reporting

71 Wufoo Form Section 4: Patient Experience & Systems Improvement Domain Measure Questions

72 Wufoo Form Section 5: Attestations & Comments/Questions

73 Questions?

74 Evaluation We appreciate your honest feedback on the evaluation!

75 Questions? Contact information: Kanelle Barreiro Program Manager, Pay for Performance (415) Katherine Quen Specialist, Population Health (415) Website: