Value Based P4P Program Updates MY 2017 & MY 2018

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1 Value Based P4P Program Updates MY 2017 & MY 2018 January 31, 2018 Lindsay Erickson, Director Ginamarie Gianandrea, Senior Program Coordinator Thien Nguyen, Project Manager Brandi Melville, Health Care Analyst, NCQA

2 Agenda New in 2018 Measurement Year (MY) 2017 Timeline MY 2017 Measure Set MY 2017 Data Collection & Reporting MY 2018 & Beyond Q&A Questions? Submit them via the chat function. Today s webinar will be recorded and posted on Integrated Healthcare Association. All rights reserved. 2

3 New in 2018 Expanded Measurement Commercial ACO Medi-Cal New Health Plan Participation Sharp Health Plan: Medicare Advantage Care1st: Medi-Cal New Data Partner - Onpoint Health Data New program name coming soon! 2018 Integrated Healthcare Association. All rights reserved. 3

5 MY 2016: Total Cost of Care Update Governance Committee approved the release of MY 2016 TCC results based on the updated methodology for public reporting. IHA will release MY 2016 TCC results to participants for review and validation OPA will publicly report MY 2016 TCC in parallel with Medicare Advantage Report Card. Deliverable Preliminary Reports Released: IHA posts preliminary MY 2016 TCC reports for PO and Health Plan. Review Period: IHA & IBM Watson work with POs and health plans to address any questions or issues related to TCC results Final Reports Released: IHA releases TCC final reports to POs and health plans OPA Public Reporting Anticipated Timeline February 20, 2018 February 20 March 9, 2018 March 16, 2018 TBD 2018 Integrated Healthcare Association. All rights reserved. 5

7 Measure Set Strategy 1. Increase alignment in the VBP4P measure set Work to align with other commonly used measure sets (QRS, NCQA health plan accreditation, MACRA) Document and communicate where measure set diverges Decrease unwarranted variation in measure specifications 2. Targeted development of the VBP4P measure set Expand and emphasize TCC measurement Evaluate potential of e-measures Explore feasibility of patient centered measurement 3. Support less burdensome data collection and more timely reporting Understand and identify improvements to data sharing processes Support standard mid-year reporting 2018 Integrated Healthcare Association. All rights reserved. 7

8 Value Based P4P Measure Set (MY 2017) Clinical (60%) Process and outcomes measures focused on six priority clinical areas Cardiovascular (5) Diabetes (8) Musculoskeletal (1) Prevention (7) Respiratory (3) Patient Experience (30%) Patient ratings of five components, including care overall: Provider Communication Care Coordination Office Staff Overall Ratings of Care Access to Care Advancing Care Information (10%) Ability to report selected e- measures (2) Appropriate Resource Use Utilization metrics spanning: Inpatient stays (2) Readmissions (1) ED visits (2) Outpatient procedures (1) Generic prescribing (1) Total Cost of Care Average health plan and member payments associated with care for a member for the year, adjusted for risk and geography 2018 Integrated Healthcare Association. All rights reserved. 8

9 IHA Measure Set Development All IHA stakeholders have opportunity to influence the ongoing development of IHA measure sets. Every September, IHA holds public comment for proposed testing measures (current year) and adoption of validated measures (upcoming year). Adopted Testing Optional reporting. Baseline Internally collected and reported to establish baseline. Ready for program use fully validated with ability to benchmark attainment & improvement Integrated Healthcare Association. All rights reserved. 9

10 MY 2017 Measure Set Reminders Paid & Publicly Reported Measures Statin Therapy for Patients with Cardiovascular Disease Statin Therapy for Patients with Diabetes Baseline Measures Statin Therapy for Patients with Cardiovascular Disease (Medicare Advantage) Statin Use in Persons with Diabetes (Medicare Advantage) Testing Measures Measure Removals Comprehensive Diabetes Care Eye Exam Use of Opioids at High Dosage (Note: health plan claims submission only) Concurrent Use of Opioids & Benzodiazepines (Note: health plan claims submission only) Annual Monitoring for Patients on Persistent Medications: Digoxin HPV for Female Adolescents HPV for Male Adolescents Appropriate Treatment for Children with Upper Respiratory Infection 2018 Integrated Healthcare Association. All rights reserved. 10

11 MY 2017 Clinical Quality Measure Specification Changes VBP4P aligns with current specifications from measure developer whenever possible A full list of MY 2017 specification changes can be found in the MY 2017 VBP4P Manual Measure Specification Change Annual Monitoring of Patients on Persistent Medications Appropriate Treatment for Children with Pharyngitis Asthma Medication Ratio Breast Cancer Screening Controlling Blood Pressure for Patients with Hypertension Immunizations for Adolescents Use of Imaging Studies for Low Back Pain Removed digoxin rate Revised the episode date to allow for multiple diagnoses of pharyngitis and to exclude members who had other diagnoses on the same date of service. Clarified how to identify an ED visit or observation visit that resulted in an inpatient stay. Removed commercial reporting of age group Added digital breast tomosynthesis as a method for meeting numerator criteria. Revised the eligible population and timing of blood pressure readings as compared to diagnosis of hypertension, and clarified that blood pressure reading must be after the two diagnoses of hypertension. Added 2-dose HPV vaccination series to numerator compliance Added the Other Malignant Neoplasm of Skin Value Set in step 4 of the Event/diagnosis Integrated Healthcare Association. All rights reserved. 11

12 MY 2017 Measure Specification Changes Health Plan Submissions To continue improving Appropriate Resource Use and Total Cost of Care measurement, IHA is now using standard measure specifications! The following measure specification changes will be reflected in MY 2017 health plan data collection: Inpatient Utilization (IPU/IPBD) Inpatient Utilization-General Hospital/Acute Care (IPU) HEDIS utilization measure Acute Hospital Utilization (AHU) HEDIS risk-adjusted utilization measure Emergency Department Visits (EDV Observed & Risk Adjusted) Ambulatory Care (AMB) HEDIS utilization measure Emergency Department Utilization (EDU) - HEDIS risk-adjusted utilization measure Total Cost of Care (TCC) Total Cost of Care (TCOC) HealthPartners, NQF endorsed measure Reminders: Physician organization participants do not report these measures. IHA validates results of measures that undergo specification changes with participants and the Value Based P4P Committees Integrated Healthcare Association. All rights reserved. 12

Onpoint Health Data is IHA s New Data Partner Mission: to help inform the decisions driving healthcare transformation by delivering independent, innovative, and reliable health data solutions Onpoint

14 Onpoint Health Data is IHA s New Data Partner Mission: to help inform the decisions driving healthcare transformation by delivering independent, innovative, and reliable health data solutions Onpoint has built more than half of the currently functioning APCDs in the country; more than any other organization Experience with Commercial, Medicare, and Medicaid data HITRUST certified; culture of security Have built Claims Data Manager system and Performance Reporting Portal for efficient data intake, measure calculation, and reporting 2018 Integrated Healthcare Association. All rights reserved. 14

15 MY 2017 Reporting Reminder: POs can voluntarily self-report data for any of the product lines below either all measures, or a subset of measures NEW Health Plan Commercial HMO Medicare Advantage Commercial ACO Aetna X X Anthem Blue Cross X X Blue Shield of CA X X X Cigna X Health Net X X X Kaiser Permanente X X SCAN Health Plan X Sharp Health Plan X X UnitedHealthcare X X Western Health Advantage X 2017 Integrated Healthcare Association. All rights reserved. 15 Copyright 2015 Integrated Healthcare Association. All rights reserved. 15

Data Sources & Collection Quality Measures Clinical Quality

physician organizations Not a sample all members included Audited

organization members Administered by CHPI Resource Use Measures

Resource Use Health plan submits complete claims and encounters for

Health plan supplements claims and encounter data with member-level

16 Data Sources & Collection Quality Measures Clinical Quality Organization-level results reported by health plan and self-reporting physician organizations Not a sample all members included Audited Patient Experience Clinician and Group CAHPS survey of physician organization members Administered by CHPI Resource Use Measures Advancing Care Information e-measures reported by POs Appropriate Resource Use Health plan submits complete claims and encounters for all members Calculated by Onpoint Health Data Total Cost of Care Health plan supplements claims and encounter data with member-level total payments Calculated by Onpoint Health Data 2018 Integrated Healthcare Association. All rights reserved. 16

17 MY 2017 Data Submission Checklist Reminder: full data collection and reporting timeline available for reference in the VBP4P Manual (pgs. 6-7) Deadline Physician Organization Health Plan Download final data file layouts February 2 Encounter Data Submission to TransUnion February 16 N/A Supplemental Data Collection Ends February 16 March 1 Supplemental Data Validation March 15 March 30 Test Files to TransUnion March 21 May 2 Supplemental data to health plans March 30 Self-reporting PO review period April 18 May 2 N/A Submission files to auditors May 2 Final, auditor-locked files to TransUnion May Integrated Healthcare Association. All rights reserved. 17

18 MY 2017 Data File Layouts The following preliminary data file layouts are available on Data Collection & Submission webpage: Self Reporting POs Clinical measure file layout (audited) Testing measure file layout Non-Self Reporting POs E-Measure file layout Health Plans Clinical measure file layout (audited) Testing measure file layout Self Reporting ACOs (NEW) Clinical measure file layout Please review and share with the appropriate staff member at your organization. Final data layouts will be available February Integrated Healthcare Association. All rights reserved. 18

19 MY 2017 Reporting Timeline Reminder: full data collection and reporting timeline available for reference in the VBP4P Manual (pgs. 6-7) Milestone Date Preliminary Reports May 25, 2018 Quality Questions and Appeals Period May 25 - June 15, 2018 Final Reports August 6, 2018 ARU & TCC Preliminary Reports August 6, 2018 Review Period August 6 27, 2018 Final Reports September 10, Integrated Healthcare Association. All rights reserved. 19

Data Sharing The Value Based P4P program encourages data sharing between POs and health plans; however, VBP4P staff are not prescriptive about how this is done.

20 Data Sharing The Value Based P4P program encourages data sharing between POs and health plans; however, VBP4P staff are not prescriptive about how this is done. POs and health plans are expected to work together early in the process to establish a data sharing process and requirements Integrated Healthcare Association. All rights reserved. 20

22 VBP4P e-measurement Overview There are two e-measures in the ACI domain: NQF # Measure CMS CQM Domain 0018 Controlling High Blood Pressure Clinical Process/Effectiveness 0418 Screening for Clinical Depression & Follow Up Plan Population/Public Health These measures are already programmed into the ONC-ATCB certified EHR systems of providers who can report the measures. E-measure reporting is worth 10% of the VBP4P Quality Composite Score in MY Integrated Healthcare Association. All rights reserved. 22

23 VBP4P e-measurement Overview Reminder: Both self-reporting and non self-reporting POs may report e-measures. For each measure, collect two rates: Rate 1: Percent Reportable: The percentage of providers in your PO who can report the e-measure (i.e., denominator = total physicians in your PO, numerator = total physicians who can report the measure from the EHR). Rate 2: PO-level aggregated performance: The aggregated patient numerator and denominator, for those providers who can report the e-measure. To receive credit, POs must submit both rates for each e-measure, with rates >0. POs are only scored on Rate 1: the percent of providers in the PO who can report the e-measures Integrated Healthcare Association. All rights reserved. 23

VBP4P e-measurement Overview Example: Controlling High Blood Pressure e-measure Rate 1: Percent Reportable Rate 2: PO-Level Aggregated Performance The PO has 50 PCPs that meet the measure denominator

24 VBP4P e-measurement Overview Example: Controlling High Blood Pressure e-measure Rate 1: Percent Reportable Rate 2: PO-Level Aggregated Performance The PO has 50 PCPs that meet the measure denominator criteria. Of these 50 PCPS, 40 have the e-measure activated in their EHRs. These 40 PCPs can report an individual performance rate to the PO, with patient numerators and denominators, for this measure. The total number of patients in the rates reported by these 40 PCPs (aggregated, across-po denominator) is 1,000. Of those 1,000 patients, 450 have a controlled blood pressure 2018 Integrated Healthcare Association. All rights reserved. 24

25 VBP4P e-measurement Reminders e-measure reporting is voluntary You do not need to be a self-reporting PO to report e-measures. All POs can choose to report the e-measures, whether or not their PO self-reports other VBP4P results Every PO will collect e-measure data in different ways (integrated EHR report, provider survey, etc.) ACI section of the MY 2017 VBP4P Manual lists the optional exclusions for Rate 1 of each e-measure (page 142) POs must submit both rates for each e-measure; rates must >0 to receive points on the e- measures Data file layouts for self-reporting POs and non self-reporting POs are available on iha.org; final data file layouts published February 2, e-measure test files are accepted from March 21, May 2, 2018 e-measure submission deadline is May 9, Integrated Healthcare Association. All rights reserved. 25

27 MY 2018 Measure Set MY 2018 measure set was finalized in December 2017 to provide participants with measure set information prior to when care is provided to members Opportunity to shape testing measures through September Public Comment period Paid & Publicly Reported Measures Baseline Measures Statin Therapy for Patients with Cardiovascular Disease (Medicare Advantage) Statin Use in Persons with Diabetes (Medicare Advantage) Optimal Diabetes Care: Combination (due to 2 Tests retirement) Use of Opioids at High Dosage (pending MY 2017 testing results) Concurrent Use of Opioids and Benzodiazepines (pending MY 2017 testing results) Testing Measures TBD Open for Public Comment beginning Sept. 1 Measure Removals Annual Monitoring of Patients on Persistent Medications HbA1c Screening (Two Tests) 2018 Integrated Healthcare Association. All rights reserved. 27

9 Strategic Priorities Based on Your Input Measure Set 1. Advance measure set consistent with identified strategy 2.

Reporting & Awards General 3. Develop Total Cost of Care service categories 4.

Support uniform / consistent adoption of shared savings design, including attainment incentive 6.

28 9 Strategic Priorities Based on Your Input Measure Set 1. Advance measure set consistent with identified strategy 2. Expand VBP4P success to ACO & Medi-Cal Objectives Expand to other products Data Information & Provision Incentives Public Reporting & Awards General 3. Develop Total Cost of Care service categories 4. Advance IHA data & analytics infrastructure; simplify data sharing for performance measurement 5. Support uniform / consistent adoption of shared savings design, including attainment incentive 6. Revisit standard full risk design to simplify & promote implementation 7. Consider breakthrough options for public reporting 8. Reexamine VBP4P awards structure 9. Rename Value Based P4P program More efficient collection and informative data Meaningful incentive opportunities Engage new audiences & reflect relative performance of integrated care Reflect program s breadth and innovation 2017 Integrated Healthcare Association. All rights reserved. 28 Copyright 2015 Integrated Healthcare Association. All rights reserved. 28

30 National Value-Based Payment and Pay for Performance Summit February 28 March 2, 2018 Upcoming Events Grand Hyatt San Francisco, San Francisco, CA Including IHA-led sessions about Cost Atlas, Provider Directory Utility and the Commercial ACO Measurement & Benchmarking Initiative California Primary Care Association Quality of Care Conference March 1 2, 2018 Hyatt Regency Sacramento, Sacramento, CA Including IHA-led session about Provider Directory Utility & Value Based P4P APG Annual Conference April 19 21, 2018 Manchester Grand Hyatt, San Diego, CA Including IHA-led session about Cost Atlas 2017 Integrated Healthcare Association. All rights reserved. 30 Copyright 2015 Integrated Healthcare Association. All rights reserved. 30

31 Takeaways What to Do Right Now in VBP4P Prepare for your MY 2017 submission Submit encounters to ensure your population s risk is most accurately assessed Share supplemental data with health plans where possible Identify process for collecting and submitting e-measures Download final data file layouts February 2 Send TransUnion test files beginning March 21 Send final MY 2017 data submission to TransUnion May 9 Deliver great care in 2018 Continue work to improve clinical quality, patient experience, and e-measures Understand and work to bend your Total Cost of Care trend Stay connected to VBP4P with the VBP4P Newsletter 2018 Integrated Healthcare Association. All rights reserved. 31

32 Resources Fact Sheets Value Based P4P Medicare Advantage VBP4P Incentive Design Total Cost of Care Data Collection & Reporting MY 2017 Manual MY 2017 Measure Sets Data File Layouts Stay in touch Newsletters 2017 Integrated Healthcare Association. All rights reserved. 32 Copyright 2015 Integrated Healthcare Association. All rights reserved. 32

Value Based P4P MY 2016 Total Cost of Care Preliminary Results. February 27, 2018 Lindsay Erickson, Director Thien Nguyen, Project Manager

Value Based P4P MY 2016 Total Cost of Care Preliminary Results February 27, 2018 Lindsay Erickson, Director Thien Nguyen, Project Manager Agenda Total Cost of Care measure overview Methodology Update MY