2018 measurement set webinar - partnership healthplan …€¦ · · 2018-02-072018 measurement...

Primary Care Provider (PCP)Quality Improvement Program (QIP)

2018 Measurement Set Webinar

Date: February 6, 2018

Presenters:Joy Dionisio, MPHRo Summers, MPH

Audio Instructions

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12:05 – 12:10 Background, Guiding Principles, and Timeline

12:10 – 12:15 Payment Methodology12:15 – 12:20 Resources

2018 Measures12:20 – 12:40 I. Core Measurement Set12:40 – 12:45 II. Unit of Service Measures

12:45 – 12:50 Next Steps12:50 – 1:00 Questions

Agenda

What measurement set will your site report on in 2018? - Family Medicine- Internal Medicine- Pediatric Medicine

Poll Question

How many years have you been involved in the QIP?- 3+- 1-2 years- About 1 year- I’m brand new!

Poll Question

I’d like a webinar focusing on…- Measurement specifications- Year-end performance- QI training opportunities- Peer-sharing- Other (please detail in chat box)

Poll Question

• The QIP provides financial incentives, data reporting, and technical assistance

• Core Measurement Set and Unit of Service Measures

• All primary care providers with Medi-Cal assigned members are automatically enrolled

• 2016-2017: 222 providers participated in the QIP; 135 in Southern Counties and 87 in Northern Counties

• A total of $32.1m in incentives was distributed for the 2016-2017 program year.

Background

1. Pay for outcomes, exceptional performance and improvement

2. Sizeable incentives3. Actionable Measures4. Feasible data collection5. Collaboration with providers6. Simplicity in the number of measures7. Comprehensive measurement set8. Align measures that are meaningful9. Stable measures

Guiding Principles

Measurement Year 2018January 1 – December 31, 2018

2018March 1 eReports LaunchJuly 31 Patient Experience Part 1 Due

2019January 31 Final Submission DeadlineApril 30 Payment Distribution

Timeline/ Important Dates

• 2018 Program Page: http://www.partnershiphp.org/Providers/Quality/Pages/Introduction-to-PCP-QIP-Current-Year.aspx

• Measure Specifications (one for each practice type)

• Code List• Webinars• QI Newsletter• [email protected]

Resources

http://www.partnershiphp.org/Providers/Quality/Pages/Introduction-to-PCP-QIP-Current-Year.aspx

mailto:[email protected]

Points earned: the number of points a site earns out of the total points distributed across the measurement set

Member months: the sum of monthly enrollment counts over the course of the 12 month measurement period

– Example: If a site has 1,000 members each month, for the full measurement year the site has accumulated 12,000 member months

PMPM (Per Member Per Month): amount budgeted for incentive payment

Payment Methodology

• Core Measurement Set• Individual performance• Single PMPM Amount

– 2018: $9.25/PMPM

QIP Score % ∗ Annual MMs ∗ PMPM = IncentiveExample:

- Site earns 55% of its QIP Core Measurement Set points (projected average for 2018)- 1000 members each month

12,000 member months- $9.25 PMPM

55% * 12,000 * $9.25 = $61,050

Payment Methodology

• Terminology• Core Measurement Set

• Clinical• Appropriate Use of Resources• Access & Operations• Patient Experience

• Unit of Service• Questions

Agenda

Core Measurement Set Terminology

• Assigned Medi-Cal PHC members

• Clinical Measures• Denominator/Numerator

• Less than 10• Continuous enrollment• Thresholds/Percentile• Relative improvement

• Non-clinical Measures• Denominator/Numerator• Risk Adjusted Targets

Measures Family Internal Pediatric

Monitoring Patients on Persistent Medications 10 10 --

Cervical Cancer Screening 10 10 --

Colorectal Cancer Screening (51-75 years) 5 5 --

Controlling High Blood Pressure (18-85 years) 5 10 --

Retinal Eye Exam (18-75 years) 5 5 --

HbA1C Control (18-75 years) 5 10 --

Nephropathy (18-75 years) 5 10 --

Breast Cancer Screening 5 5 --

Childhood Immunization Combo 3 5 -- 15

Well Child Visits (3-6 years) 5 -- 15

Immunization for Adolescents 5 -- 15

Asthma Medication Ratio -- -- 15

Nutrition Counseling (3-17 years) -- -- 10

Physical Activity Counseling (3-17 years) -- -- 10

Total Points: 65 65 80

Clinical Domain

• Breast Cancer Screening (Family, Internal): percentage of women 50-74 years of age who had a mammogram to screen for breast cancer

• Leading cause of premature mortality among women

• Routine mammograms are closely associated with less chance of dying from breast cancer

New Clinical Domain Measures - BCS

• Denominator: number of continuously enrolled Medi-Cal women 50-74 years of age as of 12/31/18

• CE: 10/1/16 through 12/31/18• No gap allowed from 10/1/16 to 12/31/16 • One month gap allowed from 1/1/17 to 12/31/17, and 1/1/18 to

12/31/18

• Numerator: number of eligible population in the denominator with one or more mammograms any time on or between October 1, 2016 and December 31, 2018


• Strategies: • Document last mammogram including results• Send reminders from PCP

• Exclusions: bilateral mastectomy, two unilateral mastectomies, unilateral mastectomy with a bilateral modifier


Receiving recommended vaccinations is the best defense against vaccine-preventable diseases,

including serious diseases that can cause breathing difficulties, heart problems, nerve damage,

pneumonia, seizures, cervical cancer and even death.

Immunization is considered one of the greatest public health achievements of the 20th century.

Studies have showed that vaccines prevent 33,000 deaths in the U.S annually, and between 2 and 3

million deaths worldwide.

New Clinical Domain Measures

• Childhood Immunization Combo 3 (Family, Pediatric): percentage of children two years of age who had four diphtheria, tetanus and acellularpertussis (DTaP); three polio (IPV); one measles, mumps and rubella ( MMR); three haemophilusinfluenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV)

New Clinical Domain Measures – CIS-3

• Denominator:Number of continuously enrolled Medi-Cal members that turn 2 years old during the measurement year

• Numerator: Members with different dates of service for doses of the same vaccines, on or before the child’s 2nd

birthday



Numerator Notes

A note that the “member is up to date” with all immunizations but which does not list the dates of all immunizations and the names of the immunization agents does not constitute sufficient evidence of

immunization for QIP reporting.

• Immunizations for Adolescents (Family, Pediatric):percentage of adolescents 13 years of age who had one dose of meningococcal conjugate vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine and two doses of the human papillomavirus (HPV) vaccine by their 13th birthday

New Clinical Domain Measures – IMA-2


Denominator:Number of members who turn 13 years of age during the measurement year.

Numerator: Number of members in the denominator who are compliant for all three indicators


Meningococcal: 1+ conjugate vaccine with a date of service on or between the members’ 11th and 13th

birthdays

Tdap: 1+ vaccine with a date of service between the member’s 10th and 13th birthdays

HPV: 2+ vaccines with different dates of service on or between the member’s 9th and 13th birthdays* Must have at least 146 days between 1st and 2nd

doses

New Clinical Domain Measures

Nine Practical Ways to Improve Clinic Immunization Rates1. Voice your strong support of immunizations. 2. Participate in state vaccine registry.3. Don’t let cost be a barrier: promote the VFC program. 4. Implement standing orders. 5. Follow true contraindications. 6. Offer immunization-only clinics at alternate times and

advertise them. 7. Minimize missed opportunities for immunization. 8. Use the accelerated ACIP immunization schedule. 9. Keep up to date on immunization recommendations.

• Asthma Medication Ratio (Pediatric): percentage of members 5-18 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater

New Clinical Domain Measures – AMR

Denominator: Number of members 5-18 years of age who were identified as having persistent asthma during the measurement year and the year prior to the measurement year

Numerator:Number of members in the eligible population who have a medication ratio of .5 or greater

New Clinical Domain Measures – AMR

Has your site identified your eReports eAdmin User and completed the survey?- Yes – ready to go!- No – but we’re working on it!- What’s that?

Poll Question

Clinical Domain: eReports


Admissions/1000 7.5 7.5 n/a

Readmission Rate 7.5 7.5 n/a


Appropriate Use of Resources

• Follow-Up Post Discharge (Family, Internal):back-up measure for missing Admissions/1000 or Readmissions

AUoR – Measure Removed


Primary Care Utilization 10 10 10


Access and Operations

• Primary Care Utilization (All): Two part measure rewarding low ED usage as well as high primary care access as measured by the number of PCP office visits.

• Must meet Avoidable ED Visits target to be eligible for points

Access & Operations – PCU

ED Visits/1000: PHC will extract facility or professional claims with a location code indicating an Emergency Department, using allowable PHC claim and encounter data, for services provided to the PCP site’s assigned members.

(Avoidable ED visits / Capitated Member Months)*12,000

PCP Office Visits: PHC will extract the total number of PHC office visits using allowable PHC claim and encounter data submitted by primary care sites for services provided to assigned members or on-call services provided by another primary care site.

(# Office Visits/ Non-Dual Capitated Member Months)*12

Access & Operations – PCU

Patient Experience


CAHPS/In-House Survey 10 10 10


• Patient Experience (All): This measure aims to improve the patient experience. There are two ways in which to earn points:

• CAHPS: Providers that have sufficient PHC patient volume can earn up to a maximum of 10 points on their performance on the Access and Communication composites in the Clinician-Group CAHPS survey.

• Survey Option: This option allows providers to fulfill the requirements by soliciting feedback from patients and implementing changes to improve the patient experience.

Patient Experience Domain

Measure Specifications



• Optional measures/BONUS measures

• Incentive is independent from the Core Measurement Set

• Available to all practice types

Unit of Service Measures


Advanced Care Planning• ACP attestations and Advance Directives or POLSTs• $5,000 for 50-99 submissions or $10,000 for 100+ submissions

Access/ Extended Office Hours• 10% capitation incentive• Must at least earned 35points in the previous MY• Must be open for 8 hrs or more beyond business hours

PCMH Certification• $1000 yearly for achieving or maintaining PCMH certification

Peer-led Self Management Support Groups• $1,000 per group, maximum of 5 groups per site


SBIRT• $5 per screening • Screen a minimum of 10% of eligible adult members

Health Information Exchange• one time $2,500 incentive for signing on with a local or regional HIE

Initial Health Assessment• $2000 for submitting all required parts of improvement plan• At least 1200 unique visits by PHC members between 4/1/17 to 3/31/18

Timely Data Submission via eReports• 1% of the site’s potential earning pool or $1000 • Upload at least 70% of data on eReports by 12/1/2018• Calculation:

70% = number of uploads by December 1, 2018____number of all uploads by end of grace period

2018 eReports Demo Webinar

• Wednesday, March 14th

• 12-1pm• New log-in process• New features• Portal navigation• Register:

https://attendee.gotowebinar.com/register/836928847428495873


Partnership Quality Dashboard Webinar

• Thursday, March 22nd

• Introduction to new portal• Non-Clinical measure data• Comparable, trended over time• Register:



Next Steps

Get familiarized with your measurement set!

Keep an eye out for the Monthly NewslettersMark your calendar for submission deadlines:

July 31, 2018 - Part I January 31, 2019 - Year end submissions

Register for upcoming webinars!!!

Evaluation

Questions

2018 measurement set webinar - partnership healthplan …€¦ · · 2018-02-072018 measurement...

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