Managed Long-Term Care Quality Incentive Workgroup. April 7, 2016

Transcription

1 Managed Long-Term Care Quality Incentive Workgroup April 7, 2016

2 MLTC QI Workgroup Charge 2 The charge of MLTC Quality Incentive Workgroup is to advise the Department of Health on using measures of quality, satisfaction, compliance, and efficiency to create a total quality score. The total quality score will be the basis for payment distribution for the MLTC Quality Incentive.

3 2015 MLTC QI Scoring Methodology 3 Evolved over time Add/alter measures, drop measures that approach 100% Four components Quality: Ten measures, 50 points, percentile rank Satisfaction: Six measures, 30 points, significance test Compliance: Four measures, 10 points, yes/no Efficiency: One measure, 10 points, significance test Documentation Distributed to all MLTC plans in August 2015

4 2015 MLTC QI Handling Small Sample Size Measures with <30 members in the denominator Small Sample Size (SS) Results suppressed Some plans did not exist at the time of the satisfaction survey Not Surveyed (NS) Reduce base points where there are SS or NS results Example Total possible base points = 100 Total possible satisfaction points = 30; 30/6=5 points per measure Reduced base for plans all NS satisfaction results =70 Reduced base for plans 1 SS satisfaction result =95 4

5 MLTC QI Overall Results Distributed to all plans Content Award Tier Plan Name Quality Points Satisfaction Points Compliance Points Efficiency Points Total Points Base Points Ranking Percent Award Tier Quality Points (50 points possible) Satisfaction Points (30 points possible) Compliance Points (10 points possible) Efficiency Points (10 points possible) Ranking Percent (up to 100%) Total Base Plan Name Points Points 3 Catholic Health LIFE ElderServe dba RiverSpring Extended MLTC Empire BC/BS HealthPlus GuildNet Medicaid Advantage Plus WellCare Advocate Partial Fallon Health Weinberg 25.0 SS ArchCare Senior Life PACE CNY AlphaCare of New York North Shore LIJ Health Plan Montefiore MLTC 23.8 SS Complete Senior Care Elderplan GuildNet MHI Healthfirst Complete Care CenterLight PACE Senior Health Partners Senior Network Health Aetna Better Health AgeWell New York ElderOne Fidelis Medicaid Advantage Plus EverCare Choice Independence Care System VNS Choice Plus MAP Kalos Health 16.3 SS MetroPlus MLTC VillageCareMAX Elderplan dba Homefirst VNS Choice Partial Total Senior Care 11.3 SS ArchCare Community Life Centers Plan for Healthy Living Senior Whole Health Partial Integra MLTC CenterLight Select Fidelis Care at Home Hamaspik Choice 12.5 SS United Health Personal Assist VNA Homecare Options Health Insurance Plan HIP MLTC Eddy Senior Care 2.5 SS

6 2015 MLTC QI Plan Level Results Distributed to the plan Content Measure Name o o Five sections Value o o Points o o Quality Component Satisfaction Component Compliance Component Efficiency Component Scoring Lists each measure and section totals Rate, Yes/No SS, NS Earned for each measure, each component, overall, base, ranking percent Example plan base is 70 of 100 points. Measure name Value Points 1. Quality Component Risk adjusted percentage of members who did not have an emergency room visit in the last 90 days Risk adjusted percentage of members who did not have falls that required medical intervention in the last 90 days Risk adjusted percentage of members who did not experience uncontrolled pain Risk adjusted percentage of members who were not lonely and distressed Percentage of members who received an influenza vaccination in the last year Percentage of members who responded that a health plan representative talked to them about appointing someone to make decisions about their health if they are unable to do so Risk adjusted percentage of members who remained stable or demonstrated improvement in pain intensity Risk adjusted percentage of members who remained stable or demonstrated improvement in Nursing Facility Level of Care (NFLOC) score Risk adjusted percentage of members who remained stable or demonstrated improvement in urinary continence Risk adjusted percentage of members who remained stable or demonstrated improvement in shortness of breath Quality subtotal Satisfaction Component Risk adjusted percentage of members who rated their managed long term care plan as good or excellent NS Risk adjusted percentage of members who responded that they were usually or always involved in making NS decisions about their plan of care Risk adjusted percentage of members who rated the helpfulness of the plan in assisting them and their family to NS manage their illnesses as good or excellent Risk adjusted percentage of members who reported that within the last 6 months the home health aide/personal NS care aide/personal assistant services were always or usually on time Risk adjusted percentage of members who rated the helpfulness of the plan in assisting them and their family to NS manage their illnesses as good or excellent Risk adjusted percentage of members who rated the quality of care manager/case manager services within the NS last 6 months as good or excellent Risk adjusted percentage of members who rated the quality of home health aide/personal care aide/personal NS assistant services within the last 6 months as good or excellent Satisfaction subtotal SS 3. Compliance Component No statement of deficiency for failure to submit Provider Network data during the measurement year 2014 Yes 2.5 No statement of deficiency for timeliness or completeness of MEDS III submission for measurement year 2014 No 0 No statement of deficiency for timeliness or completeness of MMCOR submission for measurement year 2014 No 0 MEDS vs. MMCOR ratios of at least 75% encounter data gross dollars must represent at least 75% of MMCOR Yes 2.5 reported medical expense for measurement year 2014 Compliance subtotal 5 4. Efficiency Component Potentially Avoidable Hospitalization Efficiency subtotal 5 5. Scoring Total points 47.6 Base points 70.0 Ranking percent (up to 100%)

7 2015 MLTC QI Results Summary Overall Results Category Points Range Plan Type N Award Tier 3 % Award Tier 2 % Award Tier 1 % 7 Award Tier 0 % Overall Award Tier 3 Award Tier 2 Award Tier 1 Award Tier 0 Quality Satisfaction Compliance Efficiency Total points Partial MAP PACE Total plans excluded base points less than 50 Base points Percentile Rank

8 2015 MLTC QI Payment dollar amount $110 million for PACE, MAP and Partial Capitation plans Payment structure Lump sum Not part of capitation Payment related questions can be directed to mltcrs@health.ny.gov

9 2015 MLTC Over-Time Measure Questions 9 1. Do plans differ on the number of months between assessments? 2. As the number of months between assessments increases, is there a temporal trend of decrease in rate? 3. Do plans with higher average number of months between assessments have lower rates of stability/improvement?

10 Months Between Assessments Evaluation Months between assessments Average SD Minimum Maximum A member must have 6 to 13 months of continuous enrollment in the same plan between assessments to be considered for over-time measures. The statewide average months between assessments is 10.8 for 2015 over-time measures. Ninety-three percent of MLTC plans fall within one standard deviation of the statewide average months between assessments. 10

11 Temporal Trend Evaluation Plan specific risk-adjusted rates for each time interval between assessments were calculated. (blue circles) The means of the plan riskadjusted rates (red dashed line) show lower rates for assessments not conducted at the routine 6 month interval. This may be due to change in status assessments. Plan Specific Risk Adjusted Rate Nursing Facility Level of Care Score (NFLOC) 11 Rate of stability/improvement decreases as the number of months between assessments increases. (solid gray line) Temporal trend exists. Expected in this population. Months Between Assessments O = Plan risk-adjusted rate = Calculated slope ---= Mean of the plan risk-adjusted rates

12 Higher Average Number of Months Evaluation Nursing Facility Level of Care Score (NFLOC) 12 Plan change scores (blue circles) were calculated as: plan risk-adjusted rate (12 month between assessments) minus plan risk-adjusted rate (6 month between assessments). A negative change score means the rate for the 12 month group was lower than the rate for the 6 month group Change score was not significantly associated with average number of months between assessments. (solid gray line) For all over-time measures used in the 2015 Quality Incentive p > Plan Change Score Plan A Average 8.1 months between assessments, change score = 12.7 Plan B Average 11.4 months between assessments, change score = 13.5 Plan average months between assessments

13 2015 MLTC Over-Time Measure Summary 1. There is little difference among plans in the average number of months between assessments. 2. As expected, the rate of stability/improvement decreases as the number of months between assessments increases. 3. However, this decline was similar across plans and plans with more time between assessments were not more likely to have lower rates of stability/improvement. 4. We will continue to evaluate this relationship in the future. 13

14 2016 MLTC QI Methodology 14 Similar to 2015 methodology Four sections Quality Component Satisfaction Component Compliance Component Efficiency Component Handling of SS and NS results unchanged Distribute Overall summary document Plan specific documents Methodology document

15 2016 Proposed Quality Measures (1) Risk adjusted percentage of members who did not have an emergency room visit in the last 90 days 2. Risk adjusted percentage of members who did not have falls that required medical intervention in the last 90 days 3. Risk adjusted percentage of members who did not experience uncontrolled pain 4. Risk adjusted percentage of members who were not lonely and distressed 5. Percentage of members who received an influenza vaccination in the last year 6. Percentage of members who responded that a health plan representative talked to them about appointing someone to make decisions about their health if they are unable to do so

16 2016 Proposed Quality Measures (2) Risk adjusted percentage of members who remained stable or demonstrated improvement in pain intensity 8. Risk adjusted percentage of members who remained stable or demonstrated improvement in Nursing Facility Level of Care (NFLOC) score 9. Risk adjusted percentage of members who remained stable or demonstrated improvement in urinary continence 10. Risk adjusted percentage of members who remained stable or demonstrated improvement in shortness of breath

17 2016 Proposed Satisfaction Measures 1. Risk-adjusted percentage of members who rated their managed long-term care plan as good or excellent 2. Risk-adjusted percentage of members who responded that they are usually or always involved in making decisions about their plan of care 3. Risk-adjusted percentage of members who reported that within the last six months the home health aide/personal care aide/personal assistant services were usually or always on time 4. Risk-adjusted percentage of members who rated the helpfulness of the plan in assisting them and their family to manage their illnesses as good or excellent 5. Risk-adjusted percentage of members who rated the quality of care manager/case manager services within the last six months as good or excellent 6. Risk-adjusted percentage of members who rated the quality of home health aide/personal care aide/personal assistant services within the last six months as good or excellent 17

18 2016 Proposed Compliance Measures No statement of deficiency for failure to submit Provider Network data during the measurement year No statement of deficiency for timeliness or completeness of MEDS III submission for measurement year No statement of deficiency for timeliness or completeness of MMCOR submission for measurement year MEDS vs. MMCOR ratios of at least 75%-encounter data gross dollars must represent at least 75% of MMCOR reported medical expense for measurement year No statement of deficiency for incompleteness of UAS assessments for January through June 2016.

19 2016 New Measure Percent Incomplete UAS Assessments Proposed new compliance measure for 2016 Definition No statement of deficiency for incompleteness of UAS assessments for January through June Numerator The number of members meeting the denominator criteria without a finalized UAS assessment in the same six month time frame. Denominator The number of members for which six capitation payments were received in the six month time frame. Benchmark, January through June Statewide Numerator Statewide Denominator Statewide Percent Plan Percent Range Plans above Statewide 8, ,

20 20 New Measure Importance & Implementation Importance Accurate reflection membership in MLTC measures Accurate risk-adjustment of measures and payment rates Timely modification to plan of care Six month assessment interval is a programmatic requirement Implementation will provide an opportunity for plans to work on this measure before it is included in the 2016 MLTC Quality Incentive. Implementation In April 2016, plans will receive an about the Incompleteness of the UAS measure. The will ask plans to provide a contact person for this measure. The contact person will be sent reports for two time periods, January through June 2015 and July through December 2015, via the HCS. The report will contain statewide and plan specific results, including a list of member IDs that are in the plan s numerator.

21 2016 Proposed Efficiency Measure 1. Potentially Avoidable Hospitalizations (PAH) A hospitalization was considered potentially avoidable if any one of the following conditions was the admitting diagnosis. o o o o o o Heart failure Respiratory infection Electrolyte imbalance Sepsis Anemia Urinary tract infection Rate is the total number of PAH events divided by the total number of days members are enrolled in the MLTC plan. 21

22 2016 MLTC QI Anticipated Changes 22 Based on benchmarks, replace or drop measures that approach 100% Addition of one compliance measure.

23 2016 MLTC QI Measures and Benchmarks 23 January-June 2015 MLTC data is available on Health Data NY ( July-December 2015 MLTC data will soon be available on Health Data NY Measures (handout) Benchmarks January through June 2015 (handout) Crude statewide rates Plan ranges

24 2016 MLTC QI Proposed Time Frames 24 Data Quality Measures -January through June 2016 UAS Satisfaction Measures survey Compliance Measures MEDS III, MMCOR, Provider network, January through June 2016 UAS and Medicaid capitation payments Efficiency Measure -April through December 2015 for UAS and July through December 2015 for SPARCS Releases Methodology document -April, 2016 Report feedback -Oct. to Nov Quality Incentive finalized -Nov. to Dec. 2016

25 Questions and Comments 25