0 0 arkansas payment improvement initiative (apii) april statewide webinar april 17, 2013
TRANSCRIPT
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1
Arkansas Payment Improvement Initiative (APII)
April
Statewide Webinar
April 17, 2013
2
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update
▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update
Paula Miller, HP Enterprises Analyst - PAP Report Update
Arkansas aims to create a sustainable patient-centered health system
SOURCE: State Innovation Plan
Enablinginitiatives
Health information technology adoption
Payment improvement initiative
Health care workforce development
Consumer engagement and personal responsibility
Care delivery strategies
Episode-based care delivery▪ Common definition of the
patient journey▪ Evidence-based, shared
decision making▪ Team-based care coordination▪ Performance transparency
Population-based care delivery▪ Risk stratified, tailored care delivery▪ Enhanced access▪ Evidence-based, shared decision
making▪ Team-based care coordination▪ Performance transparency
ObjectiveAccountability for the Triple Aim▪ Improving the health of the population▪ Enhancing the patient experience of care▪ Reducing or controlling the cost of care
Focus of presentation
Overview
4
Payers recognize the value of working together to improve our system, with close involvement from other stakeholders…
Coordinated multi-payer leadership…
▪ Creates consistent incentives and standardized reporting rules and tools
▪ Enables change in practice patterns as program applies to many patients
▪ Generates enough scale to justify investments in new infrastructure and operational models
▪ Helps motivate patients to play a larger role in their health and health care
1 Center for Medicare and Medicaid Services
5
PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE
We have worked closely with providers and patients across Arkansas to shape an approach and set of initiatives to achieve this goal
▪ Providers, patients, family members, and other stakeholders who helped shape the new model in public workgroups
▪ Public workgroup meetings connected to 6-8 sites across the state through videoconference
▪ Months of research, data analysis, expert interviews and infrastructure development to design and launch episode-based payments
▪ Updates with many Arkansas provider associations (e.g., AHA, AMS, Arkansas Waiver Association, Developmental Disabilities Provider Association)
1,000+
29
26
Monthly
Key Design Elements
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PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE
Wave (description)Approach
Po
pu
lati
on
-bas
ed m
od
els
Ep
iso
de-
bas
ed m
od
els
Population & episode-based delivery systems roll-out: next 3-4 years
Timing
1 CPC practice participation as of March, 20132 Virtual aggregation of patient panels to meet scale of 5,000 persons
1
Episodes: Retros-pective risk-based
3Q 2012 –- 4Q 2012
4Q 2012 –- 4Q 2013
4Q 2013 –- 2Q 2016
▪ Multi-payer launch of first 5 episodes (ADHD, URI, CHF, Joint replacement, Perinatal)
▪ Transition to scale while maintaining momentum: 1-2 sub-waves of 5-10 episodes
▪ Accelerate scale up: quarterly launch of 5-10 episodes
2
3
1
Health Homes
1H 2013 –- 1H 2014
2H 2013 –- 2H 2014
▪ All adult DD providers (children follow 6-12 months)
Voluntary enrollment for eligible BH providers2
1
2Q 2012 –- 3Q 2012
3Q 2013 –- 3Q 2014
3Q 2014 –- 3Q 2015
▪ 69 CPC enrolled practices, ~230 providers, 100k+ Arkansans1
▪ Target voluntary enrollment up to 30% of practices (including “virtual practices,” 2), focusing initially on Pediatrics
▪ Target enrollment of remaining primary care practices
PCMH2
3
1
Episodes: Assess-ment based
2H 2013 –- 2H 2014 All adult DD and LTSS services (DD kids phase-in 6-12 months behind adult)
A
Source: State Innovation Model Application
7
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder
▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update
Paula Miller, HP Enterprises Analyst - PAP Report Update
8
PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE
For Medicaid, work has occurred on 15 Episodes, with 5 having gone live
Episode Legislative Review
Reporting Period Start Date
Multipayer Participation1
1 Upper Respiratory Infection Spring 2012 July 2012
2 Attention Deficit Hyperactivity Disorder (ADHD) Spring 2012 July 2012
3 Perinatal Spring 2012 July 2012
4 Congestive Heart Failure November 2012 December 2012
5 Total Joint Replacement (Hip & Knee) November 2012 December 2012
6 Colonoscopy May 2013 Q2 CY 2013
7 Cholecystectomy (Gallbladder Removal) May 2013 Q2 CY 2013
8 Tonsillectomy May 2013 Q2 CY 2013
9 Oppositional Defiance Disorder (ODD) May 2013 Q2 CY 2013
10 Coronary Artery Bypass Grafting (CABG) July 2013 Q3 CY 2013
11 Percutaneous Coronary Intervention (PCI)
12 Asthma July 2013 Q3 CY 2013
13 Chronic Obstructive Pulmonary Disease (COPD)
14 ADHD/ODD Comorbidity July 2013 Q3 CY 2013
15 Neonatal Q3 CY 2013 H2 CY 2013
… Undecided Q1 2014 …
… Undecided Q1 2014 …
… Undecided Q1 2014 …
… Undecided Q1 2014 …
Wa
ve
1a
Wa
ve
2a
Wa
ve
1
bW
av
e 2
bW
av
e 2
c
(no
t s
tart
ed
)
Wa
ve
1W
av
e 2
Live Pending legislative review
In Development Seeking clinical input
1 Participation includes development and rollout of episode
Episodes Update
9
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update
▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update
Paula Miller, HP Enterprises Analyst– PAP Report Update
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder
10
PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE
PCMH town hall schedule
AddressDate Location
April 164 – 6 pm
Little Rock UAMS at I. Dodd Wilson Education Building -- Rooms 126 & 2264301 W. MarkhamLittle Rock, AR 72205
April 184 – 6 pm
Mountain Home Arkansas State University-Mountain Home – McMullin Hall1600 South College StreetMountain Home, AR 72653
April 224 – 6 pm
Fort Smith Golden Living Building – Rogers Taylor Conference Room1000 Fianna WayFort Smith, AR 72919
April 254 – 6 pm
El Dorado South Arkansas Community College – Library Auditorium300 S. West AvenueEl Dorado, AR 71730
May 74 – 6 pm
Hot Springs National Park Community College – Auditorium101 College DriveHot Springs, AR 71913
May 94 – 6 pm
Bentonville Northwest Arkansas Community College – Wal-Mart Auditorium1 College DriveBentonville, AR 72712
May 154 – 6 pm
Paragould Arkansas Methodist Medical Center – Auditorium900 West Kings HighwayParagould, AR 72451
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Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder
▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update
Paula Miller, HP Enterprises Analyst - PAP Report Update
Guideline-concordant treatment pathway for clients diagnosed with ODD
SOURCE: Expert Interviews, Journal of Clinical Child and Adolescent Psychiatry and Clinical Guidelines for treatment of ODD, American Academy of Child and Adolescent Psychiatry
Assessment & Diagnosis
▪ Thorough assessment is performed
▪ Licensed clinician confirms diagnosis and is responsible for care
▪ Parent/caregiver notification
Treatment
▪ Initial treatment plan1: 2 visits per week2 for 12 weeks (based on evidence based programs)
– ~40% improve3
– Re-assess those that do not improve
▪ Second treatment plan1: 2 visits per week2 for 12 weeks (based on evidence based programs)
– ~30% improve3
– Re-assess those that do not improve
▪ Medication may be a useful adjunct (primarily with comorbidities)
– For comorbid ADHD/ODD, treatment should address ADHD symptoms first
Outcomes
▪ Effectiveness of treatment
▪ Reasons necessitating second treatment plan
▪ Continuing care
1 Evidence Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior; 2 Visits may include client or parent/caregiver therapy; 3 Expert Interviews
PRELIMINARY
Distribution of number of non-comorbid ODD clients treated by individual providers
Number of clients treated by individual providers (clients aged 6 – 17, no comorbid conditions) 1
# clients
101+ 51-100 21-50 11-20 6-10 1-5
240
Clients treated
40
0
10
50
20
30
Pro
vid
er
co
un
t
1 Episode defined as one 90 day program SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services SFY2010-SFY2011 Claims data (includes pharmacy)
Episodes ending in SFY 2010 – SFY 2011 (i.e., two years of data), Medicaid only
54% 9% 12% 13% 7% 5%
PRELIMINARY
% of Providers
1.2 1.6 2.0 2.3 2.6 2.5Average episodesper client1
0.8% 2.4% 6.1% 18.1% 26.5% 46.0%% of Episodes
Assessment1
$1 M
Total
$19 M
Medication
$2 M
Non-medication interventions3
$13 M
Office visits
$2 M
Testing2
$1 M
Concordant with evidence-based programs, the most frequent services provided are non-medical interventions
Cost breakdown by service type for ODD episodes (clients aged 6 – 17, no comorbid conditions)Total cost, ($ millions)
% total cost 5% 6% 11% 9%
PRELIMINARY
% episodes with occurrence
69% 17% 78% 39%
68%
92%
1 Represents assessments billed to Medicaid. 58% of spend is from 90885 9 ZZZ, Psychiatric evaluation of hospital records; 42% of spend from 90801 9 ZZZ Psychiatric diagnostic interview exam
2 90% of spend from uncoded claims (no CPT code); 5% of spend from 90801 9 AR1, Psychological testing; 4% of spend from 96101 9 ZZZ, Psychological testing (includes psychodiagnostic tests of emotion); 1% other
3 Non-medication interventions includes all psychotherapy, counseling, community support, and therapeutic activitiesSOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services; Arkansas Department of Human Services (DHS),
Division of Medical Services SFY2011 Claims data (includes pharmacy)
Episodes ending in SFY 2011 (i.e., one year data), Medicaid only (N = 10,477)
Other1
$0.1M
Behavioral health provider organization
$18.5M
Physician (PCP or Psychiatrist)
$0.4M
Total
$19M
Behavioral Health Providers provide the vast majority of ODD care in Arkansas
Cost breakdown by provider for ODD episodes (clients aged 6 – 17, no comorbid conditions)Total cost, ($ millions)
% total episodes 1.8% 98% 0.5%
190 10,225 62Episode count
1 Other includes FQHC providers, non-behavioral health provider school-based providers, and non-standard providers of care
SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services SFY2011 Claims data (includes pharmacy)
Average cost / episode $1,311 $1,782 $731
PRELIMINARYEpisodes ending in SFY 2011 (i.e., one year data), Medicaid only (N = 10,477)
A third of clients (32%) are receiving care above and beyond what is recommended in guidelines and evidence-based treatments
Episode cost distribution for episodes (clients aged 6 – 17, no comorbid conditions)Average cost / episode ($)
0
500
1,000
1,500
2,000
Ep
iso
de
co
un
t
Average cost / episodeDollars
More
14,00013,00012,00011,00010,0009,0008,0007,0006,0005,0004,0003,0002,0001,0000
1 Evidence Based programs suggest 1-2 treatments per week for 12-14 weeks = ~30 treatments; Medicaid data shows median cost/treatment = $72; 30 treatments x $72/treatment = $2160 per episode.
SOURCE: Evidence Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior; Journal of Clinical Child and Adolescent Psychology and Clinical Guidelines for treatment of ODD, American Academy of Child and Adolescent Psychiatry; Arkansas Department of Human Services (DHS), Division of Medical Services; Arkansas Department of Human Services (DHS), Division of Medical Services SFY2010-SFY2011 Claims data (includes pharmacy)
Episodes ending in SFY 2010 – SFY 2011 (i.e., two years of data), Medicaid only
Estimated cost of effective evidence based programs1
These clients represent 63% of spend
PRELIMINARY
17
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder
▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update
Paula Miller, HP Enterprises Analyst - PAP Report Update
18
Arkansas Health Care Payment Improvement InitiativeProvider Report
MedicaidReport date: April 2013
Historical performance: April 1, 2012 – March 31, 2013
Medicaid Little Rock Clinic 123456789 April 2013
DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program. The data in the reports is neither intended nor suitable for other uses, including the selection of a health care provider. For more information, please visit www.paymentinitiative.org
19 19
Division of Medical ServicesP.O. Box 1437, Slot S-415 · Little Rock, AR 72203-1437
501-683-4120 · Fax: 501-683-4124
Dear Medicaid provider,
This is an update on the Arkansas Health Care Payment Improvement Initiative – a payment system developed with input from hundreds of health care providers, patients and family members. Our goal is to support and reward providers who consistently deliver high-quality, coordinated, and cost-effective care.
As a reminder, a core component of this multi-payer initiative is episodes of care. An episode is the collection of care provided to treat a particular condition over a given length of time. Since July, Arkansas Medicaid introduced five episodes: Upper Respiratory Infection (URI), Perinatal, Attention Deficit/Hyperactivity Disorder (ADHD), Total Joint Replacement (TJR), and Congestive Heart Failure (CHF), with many more episodes to be added over time.
For each episode, the provider that holds the main responsibility for ensuring that care is delivered at appropriate cost and quality will be designated as the Principal Accountable Provider (PAPs). For some episodes in the period covered in the attached report (Jul 2011 to Jun 2012), you were identified as the PAP. After appropriate risk-adjustments and exclusions, your average quality and cost was compared with previously announced thresholds. This determines any potential sharing of savings or excess cost indicated in the report. Note that all information described throughout your report is based on retrospective claims and all providers should continue to submit and receive reimbursement for claims as they do today.
The TJR and CHF episodes are currently in the preparatory phase and this current report is historical only, covering episodes completed between Jul 2011 and Jun 2012. The ‘performance period’ for these episodes will start February 1, 2013, and reports reflecting episodes eligible for risk and gain sharing will follow beginning in July 2013, due to time needed for appropriate claims to be received.
To aid you in your role as a PAP for future episodes, we have been working hard with providers and other payers to design a set of reports that give you detailed data about the quality and cost of your care as well as how this compares with the range of performance of other providers. As each payer will send a report covering their patients, you may receive similar reports from Arkansas Blue Cross Blue Shield or QualChoice.
We encourage you to log onto the provider portal at www.paymentinitiative.org to access your current and previous ‘preparatory period’ reports. As a PAP for either the CHF or TJR episodes, you should begin using this portal to enter selected quality metrics for each patient with an episode of care starting after February 1, 2013.
We have been working diligently to solicit feedback from the provider community and will continue in our efforts to respond to all questions, comments and concerns raised in a timely and consistent manner. For answers to frequently asked questions regarding the initiative and episodes, please refer to the payment initiative website (www.paymentinitiaitve.org). You can also call us at 1-866-322-4696 or locally at 501-301-8311 with questions or email [email protected]. Additionally, be sure to check the website regularly for updates on upcoming informational WebEx sessions, other resources, or to sign up for alerts.
Sincerely,
Andy Allison, PhD
Medicaid Director
DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program. The data in the reports is neither intended nor suitable for other uses, including the selection of a health care provider. For more information, please visit www.paymentinitiative.org
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Table of contents
Performance summary
Upper Respiratory Infection – Pharyngitis
Upper Respiratory Infection – Sinusitis
Upper Respiratory Infection – Non-specific URI
Perinatal
Attention Deficit/Hyperactivity Disorder (ADHD) – Level I
Total Joint Replacement
Congestive Heart Failure
Glossary
Appendix: Episode level detail
Colonoscopy
Oppositional Defiant Disorder
Cholecystectomy
Attention Deficit/Hyperactivity Disorder (ADHD) – Level II
Medicaid Little Rock Clinic 123456789 April 2013
Tonsillectomy
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Performance summary
Episode of CareQuality of Service
Share Amount
Average Episode Cost Your Gain/Risk Share
Upper Respiratory Infection – Pharyngitis
Not met $0.00Acceptable Not eligible for gain sharing
Upper Respiratory Infection – Sinusitis N/A Commendable Will receive gain sharing $349.50
Perinatal Met $0.00Acceptable Not eligible for gain sharing
Attention Deficit / Hyperactivity Disorder (ADHD) – Level II
Met $0.00Acceptable Not eligible for gain sharing
Quality of services and cost summary1
Across these Episodes of Care You are Subject to Risk Sharing: -$3,000.00Stop-loss was applied
Total Joint Replacement N/A $0.00Acceptable Not eligible for gain sharing
Congestive Heart Failure Not met $0.00Acceptable Not eligible for gain sharing
Upper Respiratory Infection – Non-specific URI
N/A Not acceptable Subject to risk sharing -$3,844.50
Colonoscopy Met $0.00Acceptable Not eligible for gain sharing
Cholecystectomy Met $0.00Acceptable Not eligible for gain sharing
Tonsillectomy Met $0.00Acceptable Not eligible for gain sharing
Attention Deficit / Hyperactivity Disorder (ADHD) – Level I
Met $0.00Acceptable Not eligible for gain sharing
Medicaid Little Rock Clinic 123456789 April 2013
Oppositional Defiant Disorder Met $0.00Acceptable Not eligible for gain sharing
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Quality summary Cost summary
Key utilization metrics
Overview
Cost of care compared to other providers
3
1
2
4
5
Summary – ADHD: Level I closed episodes
$1547-$1772
$700-$1547
<$700 $1772-$1998
$1998--$2223
$2223-$10157
50
100
You (non- adjusted)
You (adjusted)
512,000 466,000 1,750
All providersYou
2,000Your total cost overview, $
Distribution of provider average episode cost
Your episode cost distribution
Average cost overview, $
Total episodes: 262 Total episodes included: 233 Total episodes excluded: 29
Your average cost is acceptable
Selected quality metrics: Met Average episode cost: Acceptable
# e
piso
de
sC
ost,
$
You
Commendable Not acceptableAcceptable
> $4000
3862
Average number of visits per episodeAverage number of psychosocial visits per episode All providers
You
You are not eligible for gain sharing
$0
Percentile
Gain/Risk share
All providers
Not acceptableAcceptableCommendableYou
< $1,547 > $2,223$1,547 to $2,223
5000
2500
7500
Linked to gain sharing
Avg0%
50%
100%
You
% episodes with medication
4.1 3.9
>$10157
100%
50%
0%You Avg
% Level I episodes
Avg. physician visits/episode
AvgYou0%
50%
100%Completed certification
Stan
da
rd fo
r ga
in
sharin
g
You achieved selected quality metrics
20
10
0AvgYou
Medicaid Little Rock Clinic 123456789 April 2013
23
Quality and utilization detail – ADHD: Level I closed
Metric 25th 50thYou 75th 5025PercentilePercentile
0 100
Average number of visits per episode 4.1
Average number of psychosocial visits per episode
15 3862 74
2.3 3.9 4.3
75
Metric linked to gain sharingYou Minimum standard for gain sharing
Utilization metrics: Performance compared to provider distribution2
5025Percentile
Metric You 25th 50th 75thPercentile
0 100
92% 50%75% 85%% with completed certification
75
Quality metrics: Performance compared to provider distribution 1
48% 40%52% 67%% of episodes with medication
25% 20%30% 40%% of episodes that are Level I
4.1 2.3 3.9 4.3Avg. physician visits per episode
28% 10%30% 50%% non-guideline concordant
15% 5%15% 25%% non-guideline no rationale
You achieved selected quality metrics
--
-
Medicaid Little Rock Clinic 123456789 April 2013
24
189
175
84
97
744
828
1,200
1,120
1,995
2,457
14,904
14,904
16,796
16,796
552,000
555,450
116,500
128,150
Cost detail – ADHD: Level I closed
Care category
All providersYou
4%
3%
<1%
<1%
3%
5%
75%
78%
80%
75%
77%
79%
97%
95%
99%
99%
100%
100%
27
25
84
97
62
69
75
70
95
117
81
81
76
76
2,400
2,415
500
550
Total episode included = 233
Inpatient – PAP
Outpatient – PAP
Ancillary professional
Outpatient facility
Pharmacy
Emergency department
Other
233
230
221
184
21
16
12
1
7
# and % of episodes with claims in care category
Total vs. expected cost in care category, $
Average cost per episode when care category utilized, $
Inpatient readmission or transfer
Primary inpatient admission
Medicaid Little Rock Clinic 123456789 April 2013
25
Cost summary
Key utilization metrics
Overview
Cost of care compared to other providers
1
2
4
5
Summary – ADHD: Level II closed episodes
100
50
$7112-$12601
$6543-$7112
$5973-$6543
$5403-$5973
$2223-$5403
<$2223
You (adjusted)
466,000
You (non- adjusted)
512,000
All providers
1,750
You
2,000Your total cost overview, $
Distribution of provider average episode cost
Your episode cost distribution
Average cost overview, $
Total episodes: 262 Total episodes included: 233 Total episodes excluded: 29
Your average cost is acceptable
Selected quality metrics: Met Average episode cost: Acceptable
# e
piso
de
sC
ost,
$
You
Commendable Not acceptableAcceptable
> $4000
3862
Average number of visits per episodeAverage number of psychosocial visits per episode All providers
You
You are not eligible for gain sharing
$0
Percentile
Gain/Risk share
All providers
Not acceptableAcceptableCommendableYou
< $5,403 > $7,112$5,403 to $7,112
7500
5000
2500
3.94.1
>$12601
Quality summary3
Linked to gain sharing
% episodes with medication
% Level II episodes
Avg. physician visits/episode
AvgYou0%
50%
100%Completed certification
Stan
da
rd fo
r ga
in
sharin
g
You achieved selected quality metrics
Avg0%
50%
100%
You
100%
50%
0%You Avg
20
10
0AvgYou
Medicaid Little Rock Clinic 123456789 April 2013
26
Quality summary Cost summary
Key utilization metrics
Overview
Cost of care compared to other providers
3
1
2
4
5
Summary – Perinatal
$3735-$3906
$3906-$5399
>$5399
50
100
$3565–$3735
$3394–$3565
$2000-$3394
<$2000
850,000
You (non- adjusted)
You (adjusted)
815,500 3500 3400
You All providers
Distribution of provider average episode cost
Your episode cost distribution
30%17%
C-section rate Avg. number of ED visits per episode
Total episodes: 262 Total episodes included: 233 Total episodes excluded: 29
You achieved selected quality metrics Your average cost is acceptable
All providers
You
Gain/Risk share
You are not eligible for gain sharing Selected quality metrics: Met Average episode cost: Acceptable
# e
piso
de
sC
ost,
$
You All providers
Commendable Not acceptableAcceptable
> $4000$0
Percentile
12000
8000
4000
Not acceptableAcceptableCommendableYou
< $3,394 > $3,906$3,394 to $3,906
100%
50%
0%AvgYou
50%
0%AvgYou
100%
50%
AvgYou0%
100%
AvgYou0%
100%
50%
You0%
Avg
50%
100%
You Avg
50%
0%
100%
HIV screening
Group B Strep screening
Chlamydia screening
Gestational DM screening
Bacteriuria screening
Hepatitis B screening
Stan
da
rd fo
r ga
in
sharin
g
Stan
da
rd fo
r ga
in
sharin
g
Stan
da
rd fo
r ga
in
sharin
g
Linked to gain sharing Your total cost overview, $ Average cost overview, $
2.11.3
Medicaid Little Rock Clinic 123456789 April 2013
27
Quality and utilization detail – Perinatal
5025Percentile
Metric You 25th
97% 50%HIV screening rate
Group B strep screening rate 87% 60%
Chlamydia screening rate 90% 63%
You achieved selected quality metrics
Metric 25th 50th
C-section rate 23% 30%
% episodes with an ultrasound 71% 75%
50th
66%
83%
84%
75th
99%
93%
87%
You
17%
78%
75th
40%
81%
5025Percentile
Gestational diabetes screening rate 56% 42% 50% 65%
Asymptomatic bacteriuria screening rate 90% 43% 62% 73%
Hepatitis B screening rate 58% 41% 55% 69%
Percentile
Percentile
Avg number of ED visits per episode 1.7 2.11.3 5.1
--
--
--
0
0
100
100
75
75
Metric linked to gain sharingYou Minimum standard for gain sharing
Quality metrics: Performance compared to provider distribution
Utilization metrics: Performance compared to provider distribution
1
2
Medicaid Little Rock Clinic 123456789 April 2013
28
Questions
29
For more information talk with provider support representatives…
▪ More information on the Payment Improvement Initiative can be found at www.paymentinitiative.org
– Further detail on the initiative, PAP and portal
– Printable flyers for bulletin boards, staff offices, etc.
– Specific details on all episodes
– Contact information for each payer’s support staff
– All previous workgroup materials
Online
Phone/ email▪ Medicaid: 1-866-322-4696 (in-state) or 1-501-301-8311 (local
and out-of state) or [email protected]
▪ Blue Cross Blue Shield: Providers 1-800-827- 4814, direct to EBI 1-888-800-3283, [email protected]
▪ QualChoice: 1-501-228-7111, [email protected]