Practice Improvement Program 2014 Program Guide

Practice Improvement Program 2014 Program Guide Measure Set for NEMS & CCHCA Application due: January 31, 2014 Contacts: Lauren Baehner, Project Manager, Practice Improvement Program 415 615 4284 Lbaehner@sfhp.org Jessica Edmondson, Program Coordinator, Practice Improvement Program 415 615 5140 Jedmondson@sfhp.org Adam Sharma, Manager of Practice Improvement 415 615 4287 Asharma@sfhp.org Anna Jaffe, Director of Health Improvement 415 615 4459 Ajaffe@sfhp.org 1

Table of Contents Section I: Pay-for-Performance Program Changes..4 Table: PIP Distinguishing Characteristics.4 Section II: Practice Improvement Program (PIP) Description 5 Background and Objectives.5 Key Changes 6 2014 PIP Measure Domains.6 Clinical Quality Measures Overview.. 6 Data Quality Measures Overview..9 Patient Experience Measures Overview. 9 System Improvement Measures Overview..9 Test Measure Overview 10 Bonus Measures Overview...10 Reporting Rules and Timeline..10 Scoring and Payment Methodology. 10 Section III: 2014 Practice Improvement Program (PIP) Measure Specifications.12 Clinical Quality Domain.. 12 CQ 1: Diabetes HbA1c Test. 12 CQ 2: Diabetes A1c<8..13 CQ 3: Diabetes A1c>9..14 CQ 4: Diabetes LDL Test.15 CQ 5: Diabetes LDL<100.16 CQ 6: Diabetes Eye Exam..17 CQ 7: Diabetes Blood Pressure Control <140/90..18 CQ 8: Breast Cancer Screening (Mammograms)..19 CQ 9: Cervical Cancer Screening 20 CQ 10: Colorectal Cancer Screening..21 CQ 11: Labs for Patients on Persistent Medications..22 CQ 12: Medication Management for People with Asthma 23 CQ 13: Adolescent Immunizations..25 CQ 14: Children s Health: BMI % Documented..26 CQ 15: Anemia Screening..27 CQ 16a: Smoking Status Documented OR if EHR, Counseling..28 CQ 16b: Smoking Cessation Intervention Documented... 29 CQ 17: Controlling High Blood Pressure <140/90 for Patients Diagnosed Hypertensive.....30 Patient Experience Domain... 31 PE 1: Staff Satisfaction Improvement Strategies... 31 PE 2: Third Next Available Appointment... 34 PE 3: Visit Continuity of PCP or Care Team... 36 PE 4: Show Rate... 38 Systems Improvement Domain... 39 SI 1: Outreach to Patients Recently Discharged from Hospital... 39 2

SI 2: Interventions to Reduce Demand for Provider Visits... 40 SI 3: High Risk Care Management... 42 SI 4: Investing PIP Funds into Improvement Strategies 43 SI 5: Increasing Timely Prenatal Care......44 SI 6: Providers Open to New Members 46 SI 7: Comprehensive Chronic Pain Management..47 SI Bonus 1: Achieving PCMH Accreditation 50 SI Bonus 2: Emergency Department (ED) Visit Reduction..51 Data Quality Domain.... 52 DQ 1: Timeliness of Electronic Data Submissions....53 DQ 2: Acceptance Rate for Electronic Data Submissions.54 DQ 3: Commitment to Data Quality... 55 DQ 4: Mapping of Encounter Data Processing... 56 DQ 6: On Time Submissions of R3 Reports.. 57 DQ 7: Diagnostic Codes for Adult PCP Visits...58 Attachments Attachment 1: Overview of PIP Measures, Due Dates and Points Attachment 2: PIP Matrix of Measures Attachment 3: PIP Reporting Templates 3

Section I: Pay-for-Performance Program Changes in 2014 San Francisco Health Plan has fully merged SFHP s quality incentive programs by integrating Strength in Numbers into the Practice Improvement Program (PIP). Measures traditionally reported in Strength in Numbers are now measures within the PIP Clinical Quality Domain. This enhanced PIP program will: 1) Help to better match resources to improvement efforts, and 2) Ease the reporting and participation burden on San Francisco medical homes, while preserving the emphasis of panel management in San Francisco. Primary Objectives 2014 Practice Improvement Program Aligned with the Triple Aim: 1. Improving patient experience 2. Improving population health 3. Reducing the per capita cost of health care. Financial incentive for improvement efforts in the provider network Eligibility Requirements Contracted clinic or medical group with SFHP Funding Sources How surplus funds are managed Measurement Categories Three funding sources: 18.5% of Medi Cal capitation payments 7.5% of Medi Cal capitation (for members formerly in Healthy Families) 5% of Health Kids capitation payment Site s unearned funds roll over from one quarter to the next Unused funds roll into the program for the following year Clinical Quality Data Quality Patient Experience Systems Improvement Additional details on the PIP program can be found in Section II. 4

Section II: Practice Improvement Program (PIP) Description Background and Objectives Practice Improvement Program In 2010, San Francisco Health Plan s governing board approved the funding structure for the Practice Improvement Program (PIP) which launched in January 2011 with 26 participating provider organizations (clinics, medical groups and solo providers). While the long term objective of PIP is to reward performance based outcome measures, PIP 2011 started with the basics and focused mainly on payment for reporting. PIP 2012 focused on improving systems and improving outcomes. PIP 2013 facilitated a stronger commitment to quality by establishing thresholds for clinical measures, incentivizing outreach to higher risk populations, and further developing the infrastructure and tools for quality improvement. PIP 2014 incorporates additional measures, and continues to emphasize the importance of data quality. Integration of Strength in Numbers into the Practice Improvement Program In 2014, the PIP Clinical Quality Domain will expand to incorporate several of the clinical outcome measures which were traditionally reported through the Strength in Numbers program, which started in 2009 as a Healthy San Francisco (HSF) program to support population management. There will be one application, one reporting period, and one set of measures, all under PIP. The 2014 PIP measure set fully incorporates priorities of both programs. The 2014 PIP measure set will continue to focus on the four measurement domains developed by SFHP s Performance Improvement Advisory Group: Clinical Quality, Patient Experience, Data Quality and Systems Improvement, and were reviewed by the Healthy San Francisco Quality Improvement Committee. The Advisory Group is comprised of representatives across our provider network. The selected measures for PIP 2014 continue to align the program with other quality improvement initiatives, including Aligning Quality Improvement in California Clinics (AQICC), the federal Meaningful Use of Health Information Technology measures (MU), Preventing Heart Attack and Strokes Everyday (PHASE), and the Healthcare Effectiveness Data and Information Set (HEDIS). 5

Key Changes in 2014 All changes in the PIP measure set were brought to the PIP Advisory Group for their review and approval. For the purposes of PIP, Medical Groups include Hill Physicians, Brown and Toland Physicians, and the Chinese Community Health Care Association, all of whom have one shared measure set. The total number of measures depends on the participating entity: NEMS=34. Measures were developed and customized to clinics and medical groups to target the greatest opportunity for improvement. Total possible points increased to 131. Two bonus measures give participants additional opportunities to make up points which may have been missed on other measures. The addition of a test measure awards sites for reporting on high priority activities, while allowing time for infrastructure to be developed before scoring is dependent on outcomes. Strength in Numbers clinical measures are incorporated into PIP Clinical Quality domain. Previous pay for activity measures become outcome measures. Medical Groups are provided the option to self report for the Clinical Quality lab measures, promoting real time, actionable data collection. Claims and encounter data are used to track data quality issues, improvements, and outcomes. The Data Quality Domain is expanded to incorporate measures which will elucidate data quality issues and improvements. PIP participants will only be eligible for incentive payments during quarters where at least one encounter file is received each month in the correct HIPAA 837 file format. If no electronic submissions are received for the quarter, no incentive payments will be made that quarter. Funding from Strength in Numbers will now be redirected towards initiatives that align with SFHP and participant priorities (e.g. Improving access, Patient experience, PCMH accreditation, Healthier Living Program). NEW POLICY: Participants will ONLY be eligible for PIP incentive payments during quarters in which at least one encounter file is received each month in the correct HIPAA 837 file format. Failure to submit at least one data submission each month will result in disqualification from PIP points for the relevant quarter. 2014 PIP Measure Domains PIP 2014 provides additional opportunities to receive funds, as sites can now earn partial points for meeting milestones towards the goal threshold. Where possible, SFHP developed thresholds based on national targets, or set thresholds based on internal performance data. Clinical Quality Measures The Clinical Quality Domain has a unique scoring methodology that aims to reward providers for improvement at all performance levels, regardless of the population or demographic. In 2014, the PIP Clinical Quality Domain is expanding to incorporate several of the clinical outcome measures which were previously reported in the Strength in Numbers program. In previous years, the PIP Clinical Quality Domain measures have incentivized activity, whereas the new measures are based on clinical outcomes. Below is a summary of the changes. 1. Reporting: PIP participants may choose self reporting or SFHP HEDIS reporting for clinical data. 6

a. Self reporting. SFHP encourages self reporting of clinical data, as it is typically more current and thus more actionable than SFHP encounter data. i. Population level reporting. In Strength in Numbers, clinics reported on the entire clinic population, since providers do not treat patients differently based on payer. Clinics may continue population level reporting for PIP clinical measures in 2014. ii. SFHP member reporting. PIP participants may choose to report clinical measures for only the SFHP member population. This is the preferred option for clinics and medical groups where SFHP is a small portion of the patient population (e.g. CCHCA, Hill Physicians, Brown & Toland Physicians, and UCSF). b. SFHP HEDIS reporting. In the event that self reported data is not submitted, SFHP HEDIS data will be used to score measures. i. Administrative measures will be reported and scored twice yearly by SFHP. ii. Hybrid measures (measures requiring chart review) will be reported and scored in July 2015 by SFHP, after the HEDIS data collection season is complete. Note: PIP participants must choose a reporting methodology (self reporting vs. SFHP reporting, population data vs. SFHP data) and maintain it for the measurement year. 2. Scoring: SFHP is using a two pronged scoring approach whereby points are achieved by either improving over previous performance, or reaching performance targets (e.g. 90 th percentile, 75 th percentile, or 50 th percentile). Targets are set based on percentile ranking from NCQA s Medicaid HEDIS data, or thresholds based on 2013 performance on Strength in Numbers. This methodology allows all PIP participants to succeed, acknowledging diverse patient populations that may impact clinical performance. The pay for activity measures continue to be scored based on achieving specific milestones. Clinical Quality Reporting Process Measures: Specific deliverables will be due on one or more of the designated quarterly deadlines as described in the Deliverables and Reporting section of the individual measure specification. Outcome Measures: Medical Group participants have the option to self-report SFHP member data, OR to request that SFHP use HEDIS-Collected Data to score their PIP clinical outcome measures. Medical Groups may choose either option on a case by case basis for each measure. However, the reporting methodology for each measure must stay consistent throughout the year. The two reporting options are below: Option 1: Self-Report Quarterly As self reported data is preferred, medical groups will receive bonus points for submitting selfreported patient level lab data bi annually for the applicable 2014 HEDIS measures (for more information, refer to CQ Bonus 1 Self-Reporting Lab Data for Applicable HEDIS Measures). In order to ensure the validity of self reported rates, SFHP may review a random sample of medical records from medical groups that choose to self report. Option 2: SFHP HEDIS Data Collection Methodology 1 1 Because reporting is based on HEDIS data, non HEDIS measures (e.g. smoking cessation, colorectal cancer screening and anemia screening) cannot be reported by SFHP and must be self reported. 7

If a medical group participant chooses not to self report on a given measure, SFHP will report clinical outcomes to participants based on administrative data (for administrative measures) or chart review data collected for the annual HEDIS pursuit (for hybrid measures). Depending on the measure, SFHP will either report outcomes semiannually or annually. Semiannual Measures: For measures that are reported via claims/encounter data (HEDIS administrative measures), SFHP will report clinical outcomes twice per year, (once in September 2014 and once in June 2015). Annual Measures: For measures that require chart review (HEDIS hybrid measures), SFHP will report clinical outcomes in June 2015. Clinical Quality Scoring To account for the wide variation of clinical outcomes in diverse patient populations, points are awarded for achieving relative improvement over baseline, reaching a HEDIS percentile threshold, OR when no HEDIS threshold is available, reaching a prior year threshold, which reflects 2013 clinic performance. Achieving Relative Improvement (RI): Points will be awarded for demonstrating relative improvement, as a percent improvement over baseline as follows: Points for Relative Improvement Percent of RI Scoring >15% Full pts 10 14% 75% pts 5 9% 50% pts Below 5% 0 pts Relative Improvement: This formula will be used to calculate improvement for all measures: Relative Improvement = (Current Rate Baseline Rate) /(100 Baseline Rate) Percentile Thresholds: Participants will receive full points for achievement of the 90 th percentile. Partial points are available for reaching other percentile milestones as follows: Points for reaching HEDIS Percentile Percentile Threshold Scoring 90 th Full pts 75 th 75% pts 50 th 50% pts Below 50 th 0 pts Percentile thresholds are established from HEDIS percentiles or Strength in Numbers 2013 performance data percentiles. Clinical Quality Scoring Methodology for Process Measures Specific deliverables will be due on one or more of the designated quarterly deadlines as described in the Deliverables and Reporting section of each measure specification document. 8

Reporting Period For all clinical quality outcomes measures, the reporting period will be a rolling 12 months, ending one month prior to the reporting deadline as described in the table below: Report Reporting Periods (12 months) Submission Due to SFHP Baseline* Jan 1, 2013 Dec 31, 2013 Jan 31, 2014 Report 1 Apr 1, 2013 Mar 31, 2014 Apr 30, 2014 Report 2 Jul 1, 2013 Jun 30, 2014 Jul 31, 2014 Report 3 Oct 1, 2013 Sep 30, 2014 Oct 31, 2014 Report 4 Jan 1, 2014 Dec 31, 2014 Jan 31, 2015 *Participating sites have the option to use 2013 Quarter 4 data or 2013 year data as their baseline. Data Quality Measures Data quality is a key priority for the 2014 program year. Accordingly, measures have been added to the data quality domain that improve identification of data quality issues and increase the accuracy of claims and encounter data. This should improve the accuracy of tracking and reporting of clinical quality in future years and reduce the burden on sites. There is a New Policy for the Data Quality Domain: Timely submission of claim/encounter data is important to improving performance on quality measures, advocating for adequate rates from the state, and ensuring fair payments to providers. Participants will only be eligible for PIP incentive payments during quarters in which at least one encounter file is received each month in the correct HIPAA 837 file format. Failure to submit at least one data submission each month will result in disqualification from PIP points for the relevant quarter. Those funds will NOT be rolled over into the next quarter. All measures that are scored with claims/encounter data require data to be in the correct HIPAA 837 file format. Other formats will not be accepted. Many of the new Data Quality measures will be scored based on SFHP generated data, based on claims and encounters submitted by participating organizations. These measures will identify existing data quality issues and facilitate conversations on data quality improvements. Thresholds were identified by examining existing data and responding to provider recommendations, largely made through the PIP Advisory Board. Patient Experience Measures PIP 2014 Patient Experience measures have expanded to emphasize the importance of addressing access to care, and now includes opportunities for participating sites to examine the patient s experience through staff satisfaction. There are also opportunities for sites to earn partial points for relative improvement on many Patient Experience measures, if they cannot reach thresholds. System Improvement Measures There are several new measures in the System Improvement domain in 2014 which aim to support longterm improvements in the delivery system. Rather than just rewarding immediate clinical outcomes, these measures aim to impact the system of care overall: improving timely access to appointments coordination and communication through care management for high risk SFHP members and recently discharged patients improving accessibility of prenatal care improving the system of care for patients with chronic pain using PIP funds to drive improvement efforts 9

Test Measure There is one test measure category in 2014, awarding participating sites to begin reporting on newly prioritized health improvement activities and allowing time to develop relevant infrastructure before requiring sites to report outcomes. Bonus Measures There are 2 bonus measures in 2014. Bonus measures are designed to support achievement of important, yet challenging objectives that are beyond the current scope of PIP efforts. These bonus measures emphasize the movement towards Patient Centered Medical Home models through achievement of PCMH Accreditation and reduction of emergency department visits to reduce healthcare costs and improve health outcomes. PIP Reporting Rules and Timeline Reporting requirements vary based on the individual measure (see Section III for detailed measures specifications). There are four reporting deadlines during the program year and each falls on the last day of the month following the reporting quarter, as illustrated in the table below. Late reports will mean a delay in payment. Late reports for the final quarter will not be accepted. All deliverables from participating sites will be reported via an online Wufoo form. Some measures will require baseline data (2013 performance data) to be included with enrollment. Deliverables Reporting Period Report Due to SFHP Measures That Require Baseline Data The list of these measures will be released with the final program guide in December 2013. Jan 31, 2014 (Initial Enrollment) Quarter 1 Jan 1, 2014 Mar 31, 2014 Apr 30, 2014 Quarter 2 Apr 1, 2014 Jun 30, 2014 Jul 31, 2014 Quarter 3 Jul 1, 2014 Sept 30, 2014 Oct 31, 2014 Quarter 4 Oct 1, 2014 Dec 31, 2014 AND for annual measures Jan 1, 2014 Dec 31, 2014 Jan 31, 2015 (No late reports accepted) Late reports will not be accepted without advanced approval from SFHP program staff. Once reports have been processed each quarter, participating sites will receive a summary report indicating the score used to calculate payment. If sites decide to self report data in the first quarter, SFHP expects they will continue to self report data for the remaining quarters. Inconsistency in method of reporting will create challenges in scoring and determining earned funds. Scoring and Payment Methodology The total possible payment amount is based on your Medi Cal and Healthy Kids capitation payment rates, and the volume of patients in these programs assigned to your site. In November 2013, the SFHP Governing Board approved PIP 2014 funding from the following sources (no change from 2013): 18.5% of Medi Cal capitation payments 7.5% Medi Cal capitation, for members formerly enrolled in Healthy Families 5% of Healthy Kids capitation payments 10

Current membership will be used to estimate your total 2014 PIP bonus pool. This estimate will be sent in January 2014. Please note that Medi Cal membership is likely to change dramatically in 2014 and may affect your eligible PIP dollars. Any funds not earned in one quarter will be rolled over into the next quarter. Thus, eligible funds may change due to rollover and fluctuation in Medi Cal membership. For the 2014 program year, payments will be disbursed quarterly via electronic funds transfer. Participating organizations will receive their first PIP payment by May 2014, and their last payment by June 2015. All payments will be announced by letter and email notification. There are 34 measures with a maximum of 131 points possible over the program year, plus two bonus measures. The point allocation for each individual measure was determined based on the degree of alignment with overall program priorities, prioritization of the measure nationally, and input from our provider network (particularly the PIP Advisory Board) on their improvement priorities. See measure specification document for details. Incentive payments will be based on the percent of points achieved of the total points that a participant is eligible for in each quarter. Should a participant site be exempt from a given measure (as described in the measures specifications), the total possible points allocated to that measure will not be included when calculating the percent of total points received. Participants will receive a percent of the available incentive allocation based on the following algorithm: Sample Scoring Medical Home 90 100% 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 Sample Scoring for 3 Sites Max Points points Received % points Site A 96 88 92% 100% Site B (exempt from 1 measure) 92 80 87% 90% Site C (exempt from all pediatric measures) 80 76 95% 100% % of available incentive received The 2014 measures were designed to be reasonable and achievable, and our goal every year is to distribute the maximum funds possible. Any unearned PIP funds go back into the PIP incentive pool for the following year. 11

CLINICAL QUALITY DOMAIN CQ 1: Diabetes HbA1c Test Formerly a Strength in Numbers Measure Participants will receive points for improvement of the percentage of diabetic patients in the eligible population who received an HbA1c test in the last 12 months. DM HbA1C Test = Numerator: Patients in denominator population who received at least one HbA1c test within the last 12 months (see codes below) Denominator: Active diabetic patients age 18 75 in registry, EHR, or practice management system (see codes below) The Department of Health Care Services (DHCS) requires SFHP to report HbA1c testing as part of the annual HEDIS report. This measure is also part of the DHCS auto assignment program measure set. In the auto assignment program, Medi Cal Managed Care members are preferentially assigned to the health plan with the highest performance on each of six measures, of which HbA1c screening is one. Definitions Codes to Identify HbA1c Tests (include in the numerator): CPT CPT Category II LOINC 83036, 83037 3044F, 3045F, 3046F 4548 4, 4549 2, 17856 6, 59261 8, 62388 4 Codes to Identify Diabetes (include in the denominator): Description ICD 9 CM Diagnosis Diabetes 250, 357.2, 362.0, 366.41, 648.0 Prescriptions to Identify Members with Diabetes (include in the denominator): alpha glucosidase inhibitors, amylin analogs, anti diabetic combinations, insulin, meglitinides, sulfonylureas, thiazolidinediones, nateglinide and repaglinide. Metformin alone is not included as an indicator of diabetes. Exclusions Patients with a diagnosis of polycystic ovaries (ICD 9 CM Code 256.4) are excluded from the measure. Patients with a diagnosis of gestational diabetes or steroid induced diabetes during measurement year or the year prior may also be excluded from the measure. Deliverable Relative Improvement 2 HEDIS Percentile Scoring Submit numerators and denominators each quarter via online Wufoo form. >15% 90 th 91 % or more 3 points annually 10 14% 75 th 87% 90% 2 points annually 5 9% 50 th 82% 86% 1 point annually Below 5% Below 50 th 0 pts 2 Relative Improvement (RI) = (Current Rate Baseline Rate) / (100 Baseline Rate) 12

CLINICAL QUALITY DOMAIN CQ 2: Diabetes A1c<8 (Good Control) Formerly a Strength in Numbers Measure Participants will receive points for improvement on the percent of diabetic patients in the eligible population whose most recent HbA1c results in the last 12 months were lower than 8. DM A1c<8 = Numerator: Patients in denominator with evidence that the most recent HbA1c level is < 8.0 in the last 12 months (see codes below) Denominator: Active diabetic patients age 18 75 in registry, EHR, or practice management system The Department of Health Care Services (DHCS) requires SFHP to report HbA1c control as part of the annual HEDIS report. Definitions Codes to Identify HbA1c Levels <8% (include in the numerator): Description Numerator compliant (HbA1c <8.0%) Not numerator compliant (HbA1c 8.0%) CPT Category II 3044F 3045F, 3046F Please refer to CQ 1: page 12 for diabetes ICD 9 codes and exclusions. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement HEDIS Percentile Scoring >15% 90 th 2 points 59 % or more annually 10 14% 75 th 1.5 points 56% 58% annually 5 9% 50 th 1 point 49% 55% annually Below 5% Below 50 th 0 pts 13

CLINICAL QUALITY DOMAIN CQ 3: Diabetes A1c>9 (Poor Control) Formerly a Strength in Numbers Measure Participants will receive points for improvement on the percent of diabetic patients in the eligible population whose most recent HbA1c results in the last 12 months were greater than 9. For this measure, a lower rate demonstrates better performance. DM A1c>9 = Numerator: Patients in denominator population with evidence that the most recent HbA1c level is > 9.0 in the last 12 months (see codes below) Denominator: Active diabetic patients age 18 75 in registry, EHR, or practice management system The Department of Health Care Services (DHCS) requires SFHP to report HbA1c control as part of the annual HEDIS report. Definitions Codes to Identify HbA1c Levels >9% (include in the numerator): Description Numerator compliant (HbA1c >9.0%) Not numerator compliant (HbA1c 9.0%) CPT Category II 3046F 3044F, 3045F Please refer to CQ 1: page 12 for diabetes ICD 9 codes and exclusions. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement HEDIS Benchmarks Scoring >15% High Performance 2 points 29% or less annually 10 14% Mid Performance 1.5 points 28 41% annually 5 9% Minimum 1 point Performance annually 42 50% Below 5% Above 50% 0 pts 14

CLINICAL QUALITY DOMAIN CQ 4: Diabetes LDL Test Formerly a Strength in Numbers Measure Participants will receive points for improvement on the percent of LDL C tests performed during the reporting period. DM LDL Screening = Numerator: Patients in denominator population who received at least one LDL C test during the last 12 months (see codes below) Denominator: Active diabetic patients age 18 75 in registry, EHR, or practice management system The Department of Health Care Services (DHCS) requires SFHP to report LDL screening as part of the annual HEDIS report. Definitions Codes to Identify LDL C Screening (include in the numerator): CPT CPT Category II LOINC 80061, 83700, 83701, 83704, 3048F, 3049F, 3050F 2089 1, 12773 8, 13457 7, 18261 8, 18262 6, 83721 22748 8, 39469 2, 49132 4, 55440 2 Please refer to CQ 1: page 12 for diabetes ICD 9 codes and exclusions. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement HEDIS Percentile Scoring >15% 90 th 2 points 83% or more annually 10 14% 75 th 1.5 points 81% 82% annually 5 9% 50 th 1 point 76% 80% annually Below 5% Below 50 th 0 pts 15

CLINICAL QUALITY DOMAIN CQ 5: Diabetes LDL<100 Formerly a Strength in Numbers Measure Participants will receive points for improvement on the percent of diabetic patients most recent LDL C tests that were below 100 mg/dl. DM LDL <100 = Numerator: Patients in denominator population with evidence that the most recent LDL C test is <100 mg/dl (see codes below) Denominator: Active diabetic patients age 18 75 in registry, EHR, or practice management system The Department of Health Care Services (DHCS) requires SFHP to report LDL control as part of the annual HEDIS report. In the auto assignment program, Medi Cal Managed Care members are preferentially assigned to the health plan with the highest performance on each of six measures, of which LDL control is one. Definitions Codes to Identify LDL C Levels (include in the numerator): Description Numerator compliant (LDL C <100 mg/dl) Not numerator compliant (LDL C 100 mg/dl) CPT Category II 3048F 3049F, 3050F Please refer to CQ 1: page 12 for diabetes ICD 9 codes and exclusions. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement HEDIS Percentile Scoring >15% 90 th 3 points 46% or more annually 10 14% 75 th 2 points 41% 45% annually 5 9% 50 th 1 point 36% 40% annually Below 5% Below 50 th 0 pts 16

CLINICAL QUALITY DOMAIN CQ 6: Diabetes Eye Exam Formerly a Strength in Numbers Measure Participants will receive points for improvement on the percent of diabetic members who received a retinal eye exam in the past two years. Blindness is NOT an exclusion for a diabetic eye exam because it is difficult to distinguish between individuals who are legally blind but require a retinal exam, and those who are completely blind and therefore do not require an exam. DM Eye Exam = Numerator: Self report or chart documentation of retinal exam in last 24 months (see codes below) Denominator: Active diabetic patients age 18 75 years old in registry, EHR, or practice management system The Department of Health Care Services (DHCS) requires SFHP to report Diabetes Eye Exam Screening as part of the annual HEDIS report. Definitions Codes to Identify Eye Exams (include in the numerator): CPT CPT Category II** HCPCS 67028, 67030, 67031, 67036, 67039 67043, 67101, 67105, 2022F, 2024F, 2026F, S0620, S0621, 67107, 67108, 67110, 67112, 67113, 67121, 67141, 67145, 3072F*** S0625**, S3000 67208, 67210, 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92134, 92225 92228, 92230, 92235, 92240, 92250, 92260, 99203 99205, 99213 99215, 99242 99245 Please refer to CQ 1: page 12 for diabetes ICD 9 codes and exclusions. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement HEDIS Percentile Scoring >15% 90 th 2 points 70% or more annually 10 14% 75 th 1.5 points 62% 69% annually 5 9% 50 th 1 point 53% 61% annually Below 5% Below 50 th 0 pts 17

CLINICAL QUALITY DOMAIN CQ 7: Diabetes Blood Pressure <140/90 Formerly a Strength in Numbers Measure Participants will receive points for meeting a HEDIS threshold or demonstrating relative improvement on the percentage of patients diagnosed with diabetes who had a blood pressure (BP) reading <140/90 during the most recent outpatient visit of the reporting period. DM Blood Pressure Control <140/90 = Numerator: Patients in denominator population in which the most recent BP reading in an outpatient visit within the reporting period was documented below 140/90 Denominator: Active diabetic patients age 18 75 in registry, EHR, or practice management system Diabetes affects about 17 million Americans and contributes significantly to annual healthcare costs. Blood pressure control is known to be important in preventing complications among diabetic patients. (AHRQ, National Quality Measures Clearinghouse, 2013) Blood Pressure Control (<140/90) is a HEDIS measure required by DHCS for Medi Cal plans. SFHP will report this measure s rate to DHCS and NCQA in June 2014. Definitions Please refer to CQ 1: page 12 for diabetes ICD 9 codes and exclusions. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement HEDIS Percentile Scoring >15% 90 th 2 points 75% or more annually 10 14% 75 th 1.5 points 70% 74% annually 5 9% 50 th 1 points 64% 69% annually Below 5% Below 50 th 0 pts 18

CLINICAL QUALITY DOMAIN CQ 8: Breast Cancer Screening (Mammograms) New measure Participants will receive points for meeting a HEDIS percentile or demonstrating relative improvement on the percentage of women 50 74 years of age who had a mammogram to screen for breast cancer in the last 2 years. This measure evaluates primary screening. Do not count biopsies, breast ultrasounds or MRIs because they are not appropriate methods for primary breast cancer screening. Breast Cancer Screening = Numerator: Patients in denominator population who received a mammogram during the measurement year or the year prior to the measurement year (see codes below) Denominator: Female patients ages 50 74 during the reporting year Breast cancer screening is a priority for the health plan and was a Strength in Numbers measure. DHCS has indicated that they will add this measure to the required HEDIS measurement set in the future. Definitions Codes to Identify Breast Cancer Screening (include in the numerator): CPT HCPCS ICD 9 CM UB Revenue Procedure 77055 77057 G0202, G0204, G0206 87.36, 87.37 0401, 0403 Exclusions Women who have had a bilateral mastectomy prior to the reporting period can be excluded. Codes to Identify Exclusions: Description CPT ICD 9 CM Procedure Bilateral mastectomy 85.42, 85.44, 85.46, 85.48 Unilateral mastectomy 19180, 19200, 19220, 19240, 19303 19307 85.41, 85.43, 85.45, 85.47 Bilateral modifier (a bilateral procedure 50, 09950 performed during the same operative session) Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement HEDIS Percentile Scoring >15% 90 th 2 points 63% or more annually 10 14% 75 th 1.5 points 57% 62% annually 5 9% 50 th 1 point 51% 56% annually Below 5% Below 50 th 0 pts 19

CLINICAL QUALITY DOMAIN Cervical Cancer Screening CQ 9: Cervical Cancer Screening Formerly a Strength in Numbers Measure Participants will receive points for improvement on either the percentage of women 21 64 years of age who received one or more Pap tests in the last 3 years to screen for cervical cancer or women 30 64 years of age who received cervical cytology/human papillomavirus (HPV) co testing in the past 5 years. = Numerator: The denominator population that received one or more Pap tests during the measurement period or during the two years prior Denominator: Females age 21-64 years old who are considered an active patient in registry, EHR or practice management system. The Department of Health Care Services (DHCS) requires SFHP to report Cervical Cancer Screening as part of the annual HEDIS report. This measure is also part of the DHCS auto assignment program measure set. In the autoassignment program, Medi Cal Managed Care members are preferentially assigned to the health plan with the highest performance on each of six measures, of which Cervical Cancer Screening is one. Definitions Codes to Identify Cervical Cancer Screening (include in the numerator): ICD-9-CM CPT 88141 88143, 88147, 88148, 88150, 88152 88155, 88164 88167, 88174, 88175 HCPCS G0123, G0124, G0141, G0143 G0145, G0147, G0148, P3000, P3001, Q0091 Procedure UB Revenue LOINC 91.46 0923 10524 7, 18500 9, 19762 4, 19764 0, 19765 7, 19766 5, 19774 9, 33717 0, 47527 7, 47528 5 Exclusions Women who had a hysterectomy with no residual cervix prior to the measurement period are excluded. Codes to identify exclusions: ICD-9-CM ICD-9-CM Description CPT Hysterectomy 51925, 56308, 57540, 57545, 57550, 57555, 57556, 58150, 58152, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290 58294, 58548, 58550 58554, 58570 58573, 58951, 58953, 58954, 58956, 59135 Deliverable Submit numerators and denominators each quarter via online Wufoo form. OR Numerator: The denominator population that had cervical cytology/human papillomavirus (HPV) cotesting during the measurement period or four years prior Denominator: Females age 30-64 years old who are considered an active patient in registry, EHR or practice management system. Diagnosis 618.5, V67.01, V76.47, V88.01, V88.03 Procedure 68.4 68.8 Relative HEDIS Improvement Percentile Scoring >15% 90 th 3 points 79 % or more annually 10 14% 75 th 2 points 73% 78% annually 5 9% 50 th 1 point 69% 72% annually Below 5% Below 50 th 0 pts 20

CLINICAL QUALITY DOMAIN CQ 10: Colorectal Cancer Screening Formerly a Strength in Numbers Measure Participants will receive points for improvement on the percentage of members 51 75 years of age screened for colorectal cancer during the eligible time period. Numerator: Patients in denominator population with a FOBT or FIT test during the specified time frame OR Colorectal Patients in denominator population with a sigmoidoscopy during the 5 years prior to the end of the Cancer specified time frame Screen = OR Patients in denominator population with a screening colonoscopy during the 10 years prior to the end of the specified time frame Denominator: Active patients age 51 75 in EHR or practice management system Colorectal cancer kills more Californians than any other cancer except for lung cancer, yet it is one of the most preventable cancers. Despite an effective screening test, racial and ethnic disparities exist in colorectal cancer rates. San Francisco s citywide dashboard, Community Vital Signs, tracks this measure and it is also a national HEDIS measure reported in Medicare and commercial health plans. (Anderson, 2013) Definitions Codes to Identify Colorectal Cancer Screening (include in the numerator): Description CPT HCPCS ICD 9 CM Procedure LOINC FOBT 82270, 82274 G0328 2335 8, 12503 9, 12504 7, 14563 1, 14564 9, 14565 6, 27396 1, 27401 9, 27925 7, 27926 5, 29771 3, 56490 6, 56491 4, 57905 2, 58453 2 Flexible 45330 45335, 45337 G0104 45.24 sigmoidoscopy 45342, 45345 Colonoscopy 44388 44394, 44397, 45355, 45378 45387, 45391, 45392 G0105, G0121 45.22, 45.23, 45.25, 45.42, 45.43 Exclusions Either of the following any time during the member s history through December 31 of the measurement year: Colorectal cancer Total colectomy Deliverable Relative Improvement Strength in Numbers Thresholds Scoring Submit numerators and >15% Top 10% Rate 2 points annually denominators each quarter via online Wufoo form. 10 14% 74% or more Top 25% Rate 64% 73% 1.5 points annually 5 9% Top 50% Rate 1 point annually 51% 63% Below 5% Below 51% 0 pts 21

CLINICAL QUALITY DOMAIN CQ 11: Labs for Patients on Persistent Medications Threshold in 2013 was to reach the HEDIS 75 th percentile. In 2014, points will be awarded for reaching 50 th, 75 th and 90 th percentile or for demonstrating relative improvement. Participants will receive points for demonstrating improvement on the rate of patients on ACE inhibitors, ARBs, digoxin or diuretics who have received at least one serum potassium and either a serum creatinine or a blood urea nitrogen test during the measurement year. Labs for Patients on Persistent Medications = Numerator: Denominator population who received: At least one serum potassium, AND Either a serum creatinine OR blood urea nitrogen test (BUN) within the measurement year Denominator: SFHP members, 18 years and older, on ACE inhibitors, ARBs, digoxin or diuretics for 180 days or more Patients on these medications are at risk of adverse drug events. Monitoring allows opportunities to adjust dosage when necessary. (AHRQ, 2013) Data Source SFHP will provide sites with a list of qualifying patients in September 2014. SFHP lab data will be used to determine the score. Exclusions Sites with < 30 SFHP members in the eligible population, according to SFHP s HEDIS 2013 results (available June 2014), are exempt from this measure. Deliverables No deliverables are required for this measure. Performance on this measure will be reported to participants from SFHP in August 2014 and July 2015. Relative Improvement HEDIS Percentile Scoring >15% 90 th 2 points 89% or more annually 10 14% 75 th 1.5 points 87% 88% annually 5 9% 50 th 1 point 85% 86% annually Below 5% Below 50 th 0 pts 22

CLINICAL QUALITY DOMAIN CQ 12: Medication Management for People with Asthma Now includes adults with asthma. The 2013 measure applied to children and adolescents only. Measures clinical outcomes; outreach is not required. Participants will receive points for meeting a threshold or demonstrating relative improvement on the rate of members 5 64 years of age that were identified as having persistent asthma, were dispensed appropriate medications, and remained on an asthma controller medication for at least 50% of their treatment period. Rate of Pts with Asthma Medication Mgmt = Numerator: Patients in denominator population who achieved a Proportion of Days Covered (PDC) of at least 50% for their asthma controller medications (see codes below) Denominator: Patients having persistent asthma who met at least one of the following criteria during both the measurement year and the year prior to the measurement year (criteria need not be the same across both years): At least one ED visit, with asthma as the principal diagnosis At least one acute inpatient claim/encounter, with asthma as the principal diagnosis At least four outpatient asthma visits on different dates of service, with asthma as one of the listed diagnoses and at least two asthma medication dispensing events At least four asthma medication dispensing events Appropriate adherence to medications can reduce the severity of asthma related symptoms and longterm morbidity for people with asthma. (AHRQ, National Quality Measures Clearinghouse, 2013) Data Source SFHP can provide a list of qualifying members upon request for participants who wish to conduct panel management among this population. SFHP will provide updates on participants scores semiannually, as determined by SFHP pharmacy data. Definitions Codes to Identify Asthma (include in the denominator): Description ICD 9 CM Diagnosis Asthma 493.0, 493.1, 493.8, 493.9 Asthma Controller Medications (include in the numerator): Inhaled steroids, leukotriene modifiers, mast cell stabilizers, methylxanthines, antibody inhibitor, and combinations. 23

CLINICAL QUALITY DOMAIN Proportion of Days Covered (PDC): proportion of days of the measurement period covered by a dispensed controller medication (e.g. a three month supply of inhaled steroids dispensed in a three month period would be a PDC of 100%). Exclusions Patients with emphysema, COPD, cystic fibrosis or acute respiratory failure are excluded from this measure. Sites with < 30 SFHP members in the eligible population are exempt from this measure. Codes to Identify Exclusions: Description ICD 9 CM Diagnosis Emphysema 492, 518.1, 518.2 COPD 491.2, 493.2, 496, 506.4 Cystic fibrosis 277.0 Acute respiratory failure 518.81 Deliverables No deliverables are required for this measure. Performance on this measure will be reported to participants by SFHP in July 2015. Relative Improvement HEDIS Percentile Scoring >15% 90 th 2 points 62% or more annually 10 14% 75 th 1.5 points 57% 61% annually 5 9% 50 th 1 point 52% 56% annually Below 5% Below 50 th 0 pts 24

CLINICAL QUALITY DOMAIN CQ 13: Adolescent Immunizations Formerly a Strength in Numbers Measure Participants will receive points for improvement on the rate of adolescents 13 years of age who had one dose of meningococcal vaccine and one (Tdap)/(Td) vaccine by their 13th birthday. Adolescent Immunizations = Numerator: Patients from the denominator population who received one meningococcal vaccine on or between the member s 11th and 13th birthday and (Tdap) or (Td) on or between the member s 10th and 13th birthdays Denominator: Active patients who turned 13 years of age during the reporting period Recommendations for immunizations for adolescents have changed in recent years, including assessing missed and new immunizations. Low rates of adolescent immunizations can potentially lead to outbreaks of preventable diseases. (AHRQ, National Quality Measures Clearinghouse, 2013) Definitions Codes to Identify Adolescent Immunizations ( include in the numerator): Immunization CPT ICD 9 CM Procedure Meningococcal 90733, 90734 Tdap 90715 99.39 Td 90714, 90718 Tetanus 90703 99.38 Diphtheria 90719 99.36 Exclusions: Sites with < 30 SFHP members in the eligible population are exempt from this measure. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement HEDIS Percentile Scoring >15% 90 th 2 points 81% or more annually 10 14% 75 th 1.5 points 71% 80% annually 5 9% 50 th 1 point 62% 70% annually Below 5% Below 50 th 0 pts 25

CLINICAL QUALITY DOMAIN CQ 14: Children s Health: BMI % Documented Formerly a Strength in Numbers Measure Participants will receive points for meeting a threshold or demonstrating relative improvement on the BMI measurement rate during clinic visits for children and adolescents between the ages of 3 and 17 years. Children s BMI % = Numerator: All patients in the denominator population with at least one BMI percentile documented in an outpatient visit during the reporting period Denominator: All active patients age 3 17 years BMI is a useful screening tool for assessing and tracking obesity; preventing and managing childhood obesity is a national priority. (AHRQ, National Quality Measures Clearinghouse, 2013) Definitions ICD 9 CM Description Diagnosis BMI percentile V85.5 Exclusions Members who have a diagnosis of pregnancy during the measurement period can be excluded. Codes to identify pregnancy: Description ICD 9 CM Diagnosis Pregnancy 630 679, V22, V23, V28 Deliverable Relative Improvement HEDIS Percentile Scoring Submit numerators and denominators each quarter via online Wufoo form. >15% 90 th 77% or more 2 points annually 10 14% 75 th 67% 76% 1.5 points annually 5 9% 50 th 47% 66% 1 point annually Below 5% Below 50 th 0 pts 26

CLINICAL QUALITY DOMAIN CQ 15: Anemia Screening Formerly a Strength in Numbers Measure Participants will receive points for improvement in the rate of children ages 9 18 months old who received a valid anemia screening during the measurement period. Anemia Screening = Numerator: Patients in denominator population with at least one hemoglobin assessed between the ages of 9 18 months during measurement year. (Finger stick point of care hemoglobin testing or lab tests are both valid screening methods) Denominator: Children ages 18 24 months in the active patient population. In 2001, the American Academy of Pediatrics recommended screening for children 9 12 months, with subsequent screens for high risk children. Unrecognized anemia can lead to developmental delay. (AHRQ, National Quality Measures Clearinghouse, 2013) Definitions List of appropriate Hemoglobin Assessment (include in the numerator): CPT Code Description 85018 Blood count; hemoglobin (Hgb) 85046 Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content [CHr], immature reticulocyte fraction [IRF], reticulocyte volume [MRV], RNA content), direct measurement 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Exclusions Sites with < 30 SFHP members in the eligible population are exempt from this measure. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Improvement Strength in Numbers Threshold Scoring >15% Top 10% Rate 86% or more 2 points annually 10 14% Top 25% Rate 82% 85% 1.5 points annually 5 9% Top 50% Rate 48% 81% 1 point annually Below 5% Below 48% 0 pts 27

CLINICAL QUALITY DOMAIN CQ 16a: Smoking Status Documented Formerly a Strength in Numbers Measure Participants without an Electronic Health Record (EHR) will receive points for electronically documenting the smoking status of patients who have been seen within 24 months prior to the end of the reporting period. Smoking Status Documented = Numerator: Patients in denominator population with a documented smoking status in disease registry or practice management system Denominator: Active patients 13 years or older in disease registry or practice management system Smoking is known to be a leading cause of death and the leading cause of disease, resulting in lung and other cancers, chronic obstructive pulmonary disease, heart disease, stroke, complications of pregnancy, and other respiratory problems. Providers can work with patients and encourage them to quit smoking and prevent many diseases. (AHRQ, National Quality Measures Clearinghouse, 2013) Data Source Self reported quarterly by clinics Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Strength in Numbers Improvement Thresholds Scoring >15% Top 10% Rate 2 points 88% or more annually 10 14% Top 25% Rate 1.5 points 78% 87% annually 5 9% Top 50% Rate 1 point 67% 77% annually Below 5% Below 67% 0 pts 28

CLINICAL QUALITY DOMAIN CQ 16b: Smoking Cessation Intervention Documented Formerly a Strength in Numbers Measure Participants with an Electronic Health Record (EHR) will receive points for documenting that a smoking cessation intervention took place with the last two years for all patients who have a documented history of tobacco use and have been seen for an outpatient visit during that time. Smoking Cessation Intervention = Numerator: Patients in denominator population with a documented smoking intervention in the EHR in the last 12 months Denominator: Active (seen in last 24 months) patients in EHR who are 18 years or older and have a documented history of tobacco use. Though not all patients will be motivated to quit, it is well known that brief interventions can be effective in moving patients into a more advanced stage of change. (AHRQ, National Quality Measures Clearinghouse, 2013) Additional recommendations on effective intervention strategies can be found here: http://www.aafp.org/afp/2006/0715/p262.html Data Source Self reported quarterly by clinics Deliverable Submit numerators and denominators each quarter via online Wufoo form. Relative Strength in Numbers Improvement Thresholds Scoring >15% Top 10% Rate 2 points 93% or more annually 10 14% Top 25% Rate 1.5 points 82% 92% annually 5 9% Top 50% Rate 1 point 65% 81% annually Below 5% Below 65% 0 pts 29

CLINICAL QUALITY DOMAIN CQ 17: Controlling High Blood Pressure <140/90 for Patients Diagnosed Hypertensive (Test Measure) Formerly a Strength in Numbers Measure Participants will receive points for reporting on the percentage of patients diagnosed with hypertension who had a blood pressure reading <140/90 during the most recent outpatient visit of the reporting period. Controlling High Blood Pressure <140/90 = Numerator: The eligible population in which the most recent BP reading in an outpatient visit within the reporting period was documented below 140/90 18 59 years of age who BP was <140/90 mm Hg; 60 85 years of age with a diagnosis of diabetes who BP was <140/90 mm Hg; 60 85 years of age without a diagnosis who BP was <150/90 mm Hg. Denominator: Patients with hypertension ages 18 85 years in the EHR, registry, or practice management system (see codes below) Controlling blood pressure has been proven to lower morbidity and mortality. This HEDIS measure is not currently an area of focus for participating sites. To facilitate emphasis on this measure in the 2014 program, sites will be rewarded for developing data collection and reporting mechanism, but points will not be awarded based on performance. Please refer to page 10 for a description of a test measure. (AHRQ, National Quality Measures Clearinghouse, 2013) Definitions Codes to Identify Hypertension (include in the denominator): Description ICD 9 CM Diagnosis Hypertension 401 Codes to Identify Outpatient Visits: Description ICD 9 CM Diagnosis Outpatient Visits 99201 99205, 99211 99215, 99241 99245, 99384 99387, 99394 99397 Exclusions Hypertensive patients who also have End Stage Renal Disease (ESRD) are exempt from this measure. Hypertensive patients who have been pregnant during the measurement period are exempt from this measure. Members who had an admission to a non acute setting within the measurement period are exempt from this measure. Deliverable Submit numerators and denominators each quarter via online Wufoo form. Scoring 0.5 points per quarter for reporting 30

PATIENT EXPERIENCE DOMAIN PE 1: Staff Satisfaction Improvement Strategies New Measure Participants will receive points for: 1) biannual participation in the staff satisfaction Net Promoter Survey or equivalent; and 2) submission of a staff satisfaction improvement plan; and 3) submission of a summary of the staff satisfaction project undertaken OR presentation of results at September 2014 SF Quality Culture Series. Staff satisfaction is directly tied with patient experience. The purpose of this measure is to make changes to improve staff satisfaction using the results of the Net Promoter Survey. The Net Promoter staff survey is a national best practice evaluation tool for understanding staff loyalty and satisfaction. The Center for Excellence in Primary Care (CEPC) will be administering the Net Promoter survey to clinics and medical groups at no cost. However, if a medical group or clinic prefers to use its own staff satisfaction measurement tool, this would also be an acceptable means to earn PIP points for this measure. (Experia, 2013) Data Source Net Promoter Survey: SFHP will provide your organization with results and analysis of the staff Net Promoter Survey in February 2014 (baseline assessment) and November 2014 (final assessment). The Net Promoter Survey consists of the following two questions: 1. On a scale from 0 10, how likely are you to recommend your organization as a place to work to a friend or relative? a) Please explain why you gave this rating 2. On a scale from 0 10, how likely are you to recommend your organization as a place to come for care to a friend or relative? a) Please explain why you gave this rating The Net Promoter Score for each question is calculated as follows: Net Promoter Score (NPS) = Promoters (% of employees who responded with a 9 10 rating) - Detractors (% of employees who responded with a 0 6 rating) The qualitative responses from the survey can be used to design improvement projects. Please see Appendix for further details about the content and scoring of the Net Promoter Survey. 31

PATIENT EXPERIENCE DOMAIN Resources SFHP will fund a Staff Satisfaction Improvement program in 2014. To assess staff satisfaction and uncover improvement opportunities, the Center for Excellence in Primary Care (CEPC) will administer the staff Net Promoter Survey to clinic and medical group staff in both February and November and provide your clinic with an analysis of the results. SFHP is also sponsoring the CEPC to provide technical assistance for this project in the form of trainings at the SF Quality Culture Series, webinars, and one on one coaching sessions with your clinic. Deliverables and Due Dates Deliverables Due Dates Scoring Participate in CEPC administered baseline Net Promoter Survey (or other baseline staff satisfaction survey) Completed by March 2014 (no deliverable to SFHP required) 1 point will be awarded if at least 65% of staff complete the baseline staff satisfaction survey Submit a staff satisfaction improvement plan and a goal score (See Improvement Plan Template attachment) Participate in CEPC administered final Net Promoter Survey (or other postintervention staff satisfaction survey) Submit summary of staff satisfaction project work to date (See Project Summary Template attachment) OR Present at September 2014 Quality Culture Series April 30, 2014 Completed by December 2014 (no deliverable to SFHP required) Jan 31, 2015 1 point will be awarded based on the completeness and quality of the staff satisfaction improvement plan 0.5 point will be awarded for achieving at least 65% of staff complete the post intervention staff satisfaction survey AND 0.5 point will be awarded for meeting goal score 1 point will be awarded based on the completeness and quality of the staff satisfaction project summary or presentation at September 2014 Quality Culture Series 32

PATIENT EXPERIENCE DOMAIN Net Promoter Score Overview Net Promoter Score (NPS) is a measure of customer loyalty developed by Harvard Business School and Bain consulting. Their research demonstrated that the question most highly correlated to growth and customer likelihood to repurchase or return was: On a scale of 0 10, how willing would you be to recommend Company X to a friend or colleague? To calculate the NPS based on this question, the percentage of detractors who gave a rating of 0 6 is subtracted from the percentage of promoters who responded 9 or 10 as follows: The Net Promoter survey uses this question to measure employee engagement. The reason for this approach is that years of research have demonstrated the link between employee engagement and customer (patient) satisfaction and loyalty. Of note, employee responses to the NPS question can be substantially lower than customer scores as our teams often hold their company to even higher standards than do customers. The Net Promoter Survey Questions include: 1. On a scale from 0 10, how likely are you to recommend your organization as a place to work to a friend or relative? a) Please explain why you gave this rating 2. On a scale from 0 10, how likely are you to recommend your organization as a place to come for care to a friend or relative? a) Please explain why you gave this rating Each participating clinic will receive a report summarizing quantitative and quantitative results. The Improvement Plan The data from the Net Promoter survey should be used to: a) Establish a Baseline Create a measurable starting point for improvement and an understanding of the current employee experience and employee perceptions of the patient and family experience. b) Identify Opportunities Identify specific, actionable improvement opportunities and potential solution based on verbatim comments. c) Take Action The greatest value in establishing a baseline and collecting feedback is in the ability to act on the feedback and communicate back to survey participants what was done as a result their feedback. d) Measure Results CEPC will repeat the Net Promoter survey later in the calendar year to allow each team to see the impact they have had in improving the experience in their clinics. 33