2018 practice improvement program (pip) orientation

2018 Practice Improvement Program (PIP) Orientation

January 4th, 2018

San Francisco Health Plan

Practice Improvement Program (PIP)

Practice Improvement Program (PIP)

Leadership Team

Vanessa Pratt Manager, Population Health

Adam Sharma Director, Health Outcomes Improvement

Kanelle Barreiro Program Manager, Pay for Performance

Katherine Quen Specialist, Population Health

James Glauber, Chief Medical Officer

Agenda TIME ITEM

8:30 Welcome Review Agenda and Meeting Objectives

8:40 Program Overview

8:50 Review Changes in 2018 PIP Clinical Quality Domain Data Quality Domain Patient Experience Domain Systems Improvement Domain

9:40 Break

9:50 Review all other measures with no changes in 2018 Small group activity

10:25 Review 2018 Enrollment

10:45 Closing & Evaluation Distribution

Housekeeping

• Webinar will be recorded

• Slides will be sent out after

• Please mute phone lines, *6

• Don’t put phone lines on hold

• Ask questions throughout and at Q&A

• No question is silly

Objectives

• General overview of program

• Review changes and new measures

• Answer questions that will help you be successful

What is PIP?

Incentive program for SFHP Medi-Cal clinics

and medical groups to achieve improvements

in system and health outcomes.

•Comprehensive

•Collaborative

• Standardized

• Incentivizing

• Technical Assistance

PIP Guiding Principles

The History of PIP

2011 Program launch

Reporting only to incentivize

building capacity for reporting data

2013 Stronger commitment to quality-established

clinical thresholds, incentivized outreach

to higher risk populations

2014

2015

2016 Fewer

measures, simpler

deliverables, specialty care

access measures.

2017 Newer measures

were added to the Clinical Quality

domain to increase alignment with

external entities.

2018 New measures were added to the Systems

Improvement domain to support appropriate

utilization of primary care visits and expansion

of the palliative care Medi-Cal benefit.

Strength in Numbers P4P

measures rolled into CQ domain, all participants

held accountable for data quality

measures.

Improving access, narrowing the

number of measures to focus improvement on lowest performing.

PIP Participant Types

Academic Medical

Center (1)

Community Clinic (7)

Clinic-Based RBO (1)

IPA (3)

Individually Contracted

Specialty (1)

Standardized

PIP Incentives

Maximum quarterly payments are allocated based on

capitation and actual member months accrued

during each month of the quarter.

• 18.5% of Medi-Cal capitation

• 5% of Healthy Kids HMO capitation

incentivizing

Quadruple Aim

comprehensive

• Clinical Quality Domain

• Data Quality Domain

• All Domains

• Patient Experience Domain

• Patient Experience Domain

Improving Patient

Experience

Improving

Staff

Satisfaction

Improving Population

Health

Reducing the Per Capita

Cost of Health Care

PIP Measure Development

PIP Participants, SFHP stakeholders, NCQA, HEDIS, QMED, Meaningful

Use, DMHC, DHCS

SFHP Subject Matter Experts

Advisory Committee

collaborative

PIP Reporting Timeline

*Late baseline data submissions jeopardize the PIP database setup. We thank you in advance for your timeliness with your baseline data!

Quarter Quarter End Date Materials Due to SFHP Reporting Period

Enrollment Friday, January 19, 2018* For all measures, the

quarter’s end date serves as

the last day of the reporting

period. Please see each

measure’s specifications for

the first day of the

reporting period.

1 March 31, 2018 Monday, April 30, 2018

2 June 30, 2018 Tuesday, July 31, 2018

3 September 30, 2018 Wednesday, October 31, 2018

4 December 30, 2018 Thursday, January 31, 2019

Clinical Quality Scoring collaborative

Deliverable Quarterly Scoring

(Self-Reported Data)

For each of the Priority Five measures:

Achieving 90th percentile HEDIS or 75th internal PIP percentiles or 15% or more

relative improvement

1.25 points

Achieving 75th percentile HEDIS or 60th internal PIP percentiles or 10-14%


1.0 point

Achieving 5-9% relative improvement over baseline 0.75 point

For each of the non-Priority Five measures:

Self-reporting data quarterly 0.25 point

Maintaining performance relative to baseline* 0.25 point

PIP Payment Methodology

• 90‐100% of points = 100% of payment





• 40‐49% of points= 50% of payment

• 30‐39% of points= 40% of payment


• Less than 20% of points = no payment

Scorecard Review

PIP Website

Technical Assistance http://www.sfhp.org/providers/practice-improvement-

program-pip/

All 2018 measure resources will be listed here

http://www.sfhp.org/providers/practice-improvement-program-pip/







Program Guide

2018 Changes

All-Participant Program Guide

At the top of each page, each measure specification lists which participants have measure assigned in their measure set.

All-Participant Program Guide

Clinical Quality Domain:

2018 Changes

SFHP option discontinued

• Overall, this decision will benefit our provider network in

various ways:

o Fewer charts will be requested from providers during the SFHP

HEDIS pursuit

o Fewer SFHP dollars will be spent on the administration of the HEDIS

pursuit

o Further development of PIP self-reporting capacities

CQ 06: Labs for Patients on Persistent Medications

Measure Numerator/Denominator

CQ 06: Labs for Patients on

Persistent Medications

Numerator: Number of patients in denominator population who

received, in the last year:

At least one serum potassium,

AND

A serum creatinine within the measurement year

OPTIONAL:

AND (for members on digoxin)

A serum digoxin (applies only to members on digoxin)

Denominator: Number of active patients 18 years and older, on ACE

inhibitor, ARBs, digoxin or diuretics for 180 days or more in the last

year

HEDIS

Changes from 2017 • Digoxin has been removed from the reporting requirements for EAS and NCQA.

As such, PIP participants have the option of removing digoxin from their 2018

PIP reporting.

CQ09: Adolescent Immunizations


CQ09: Adolescent

Immunizations

Numerator: Number of patients in the denominator population who

received one meningococcal vaccine on or between the member’s

11th and 13th birthday and one (Tdap) or (Td) vaccine on or

between the member’s 10th and 13th birthdays, and two HPV

vaccines between the member’s 9th and 13th birthday.

Denominator: Number of active patients who turned 13 years old

during the last year

Changes from 2017 In alignment with clinical guidelines that recommend the inclusion of HPV in the vaccination schedule for adolescents, CQ9 Adolescent Immunizations was replaced by CQ12 Adolescent Immunizations (with HPV).

CQ09: Adolescent Immunizations

Measure 75th percentile 60th percentile

CQ09 Adolescent Immunizations 73.00% 50.40%

Measures without comparable NCQA HEDIS thresholds, a PIP network threshold will be used based on prior year’s PIP participant data:

CQ12: Chlamydia Screening


CQ14: Chlamydia Screening

Numerator: Number of patients in the denominator population with

at least one test for chlamydia in the last year

Denominator: Number of active patients who meet all of the

following criteria:

• are sexually active

• have the ability to become pregnant

• between the ages of 16-24 years old

Changes from 2017 • This measure will be scored as a non-Priority Five measure, earning points

maintaining baseline.

HEDIS

CQ13-CQ14: Perinatal Care

Measure Numerator

CQ15: Timely Access to

Prenatal Care

Numerator: Number of patients in the denominator population

who received a prenatal in the first trimester of their pregnancy or

within 42 days of enrollment into Medi-Cal, whichever is later.

CQ16: Postpartum Care


who had a postpartum visit between 21 - 56 days after delivery.

HEDIS Changes from 2017 • This measure will be scored as a non-Priority Five measure, earning points


Denominator: Number of active patients who had a live birth in the

last year.

CQ15: Asthma Medication Ratio


CQ17: Asthma Medication

Ratio


have a ratio of 0.5 or greater of controller asthma medications to

total asthma medications in the measurement year.

Denominator: Number of active patients between the ages 5-64 with persistent asthma as defined as one or more of the following in the past two years: • At least one ED visit with a primary diagnosis of asthma • At least one inpatient encounter with a primary diagnosis of

asthma • At least four outpatient visits with a diagnosis of asthma and at

least two asthma medication dispensing events • At least four asthma medication dispensing events

• If the patient was only dispensed short acting medications (leukotriene modifier or antibody inhibitor) they should also have a diagnosis of asthma in any setting

HEDIS Changes from 2017 • This measure will be scored as a non-Priority Five measure, earning points


Data Quality Domain

2018 Changes

DQ1: Provider Roster Updates

Deliverable Due Dates Scoring

If there are no changes that need to be made to the current quarter’s provider roster, please submit the Provider Roster Attestation.

If changes do need to be made to the current quarter’s provider roster, please submit the supporting information in one of the two approved ways. Deductions will be made in these cases: o 0.10 point deduction (up to a maximum of 0.50

point) for each piece of missing information noted in Measure Description.

o 0.25 point deduction (up to a maximum of 1.0 point): Discrepancy between Medical Staff Office (MSO)/Profiles/Change Reports/Credentialing Packet and Provider Roster. Discrepancies that will affect scoring are: Providers in one source and not the other. Additions/terminations reported via PIP that

should have been reported via entity’s contractual method > 1 month prior

Quarter 2 Quarter 4

2.0 points

Changes from 2017 • Measure applies only to IPA & Academic Medical Center participants • Reporting frequency changed from quarterly to biannually.

Patient Experience Domain

2018 Changes

PE8: Expanding Access to Services

Changes from 2017 • There are two new options for 2018:

• Option Three: Patient-centered scheduling practices • Option Four: Improvements in transgender health are new in 2018

• The option to offer primary care services by staff other than PCPs was retired to create opportunity for new improvement projects.

• Option Five was modified to include a range of access improvement projects.

Option One: Best Practices in Hepatitis C Screening & Treatment

Option Two: Improvements in Opioid Safety

Option Three: Patient-Centered scheduling Practices

Option Four: Improvements in Transgender Health

Option Five: Access Improvement Project

PE8: Expanding Access to Services

Deliverables Due Dates Scoring

Deliverable A: Submit service

expansion plan using required

template

Quarter 1

2.0 points for completed template

Deliverable B: Submit example

materials from service expansion

Quarter 3 1.0 points for example materials

Deliverable C: Attestation service

expansion has occurred, signed by

Medical Director or equivalent

Quarter 4 1.0 points for signed attestation

Systems Improvement Domain

2018 Changes

SI1: Depression Screening and Follow-up

Depression

Screening

Rate

=

Numerator: Total number of patients in the denominator with a

depression screening in the measurement year.

Denominator: Total number of active patients at least 12 years

of age during the measurement year.

Numerator Measurement Option #2: Measure depression screening using other

registry methods. Participants choosing this option must report their methodology for

measuring depression screening.

Changes from 2017 • The Depression Screening Rate will become pay-for-performance in Q3 2018. • Follow-up to a positive screen was added as a qualitative component of this measure.

PART A: Rate of patients receiving depression screening


Appropriate Follow-up on or within 30 days of positive screen

1. Additional evaluation for depression

Follow-up with a case manager, with documented assessment of depression symptoms.

Telephone visit with diagnosis of depression or other behavioral health condition.

Assessment on the same-day as the positive screen, including additional depression assessment indicating no

depression or no symptoms that require follow-up.

2. Referral to a practitioner who is qualified to diagnose and treat depression

Follow-up behavioral health encounter, including assessment, therapy, collaborative care, medication

management, acute care, and telehealth encounters.

Follow-up outpatient visit, with a diagnosis of depression or other behavioral health condition.

3. Pharmacological Intervention

Dispensed anti-depressant medication

PART B: Create a system/clinic-wide protocol with pathways for each of the four appropriate follow-ups to a positive screen.


Deliverable Due Dates PIP Network

Threshold

Quarterly

Scoring

Deliverable A: Self-report the numerator and denominator as noted in the Measure Description.

Quarter 1 & Quarter 2 (reporting only)

N/A 1.0 point

Quarter 3 & Quarter 4 (pay-for-performance)

Percentile

TBD

1.0 point

Percentile

TBD

0.5 point

Deliverable B: Documentation of system/clinic-wide protocol with pathways for each of the four appropriate follow-ups to a positive screen, submitted via Wufoo. IPA participants only: Provide an attestation signed by Medical Director, or equivalent, verifying at least three sites have developed a clinic-wide protocol with pathways for each of the four appropriate follow-ups to a positive screen described in the table below.

Quarter 3 N/A 4.0 points

SI2: Follow-Up After Hospital Discharge

Quarterly Office

Visit Follow-Up

After Hospital

Discharge Rate

=

Numerator: Total number of discharges in the

denominator with an eligible follow-up visit 1-7

calendar days post discharge

Denominator: Total number of inpatient discharges

during the quarter

Deliverable Due Date Threshold Scoring

Submit quarterly numerator

and denominator as noted

above via quantitative data

template.

Quarter 1 Quarter 2 Quarter 3 Quarter 4

50% 1.0 point

40% 0.5 point

Changes from 2017 • Numerator definition was updated to support clinical best practice that a follow-up visit

post discharge should not occur on the same-day as discharge.

SI5: Percent of Members with a Primary Care Visit

Quarterly Primary

Care Visit Rate =

Numerator: Number of SFHP members in the denominator

population with at least one PCP visit in the last year

Denominator: Total number of continuously enrolled SFHP Medi-

Cal members assigned to your organization during the quarter.

Deliverable Due Date Scoring

Deliverable A: Receive PCP

visit rate.

SFHP to provide

in Quarter 1,

Quarter 2,

Quarter 3, and

Quarter 4

To be scored Q4 2018

2.0 points for achieving 5% or more absolute

improvement over baseline* or achieving SFHP average

PCP visit rate.

1.5 points for achieving 3% absolute improvement over

baseline.*

1.0 points for achieving 1% absolute improvement over

baseline.*

Deliverable B: Submit

improvement plan

template (for participants

not meeting SFHP average

PC visit rate in Q1 2018)

Quarter 2 2.0 points

*Baseline will be determined by Q4 2017 PCP visit rate

SI6: Palliative Care

Part A (IPA, Clinic-Based RBO, and Academic Medical Center participants only): Complete an assessment of the palliative care resources available within your network. Part B (All Participants): Identify patients who may be eligible for referral to palliative care services by completing the following: • Identify patients with COPD or CHF who are potentially eligible for palliative

care by using an SFHP list of members who are potentially eligible for palliative care, or creating your own list of potentially eligible patients.

• For potentially eligible members with COPD or CHF, perform chart review to

determine eligibility for referral to palliative care services.

• Attestation signed by medical director (or equivalent) verifying chart review of members eligible for palliative care and appropriate referrals were made.

SI6: Palliative Care


Deliverable A

(for IPA, Clinic-Based RBO, and

Academic Medical Center participants

only):

Submit template outlining the palliative

care services and/or resources available

within your network.


Deliverable B (All Participants) : Submit

attestation signed by a medical director

(or equivalent), verifying that chart

review was performed for members with

COPD potentially eligible for palliative

care and appropriate referrals were

made.


Questions?

BREAK!

Review All Remaining Measures

Clinical Quality Domain

Clinical Quality Scoring collaborative

Deliverable Quarterly Scoring (Self-Report)

For each of the Priority Five measures:

Achieving 90th percentile HEDIS or 75th internal PIP percentiles or 15% or more


1.25 points

Achieving 75th percentile HEDIS or 60th internal PIP percentiles or 10-14% relative

improvement

1.0 point

Achieving 5-9% relative improvement over baseline 0.75 point

For each of the non-Priority Five measures:

Self-reporting data quarterly 0.25 point

Maintaining performance relative to baseline* 0.25 point

CQ01-CQ03: Diabetes (All Participants)

Measure Numerator

CQ 01: Diabetes HbA1c Test

Numerator: Number of patients in denominator population

who received at least one HbA1c test within the last 12

months

CQ 02: Diabetes HbA1c <8

(Good Control)

Numerator: Number of patients in denominator whose most

recent HbA1c level is < 8.0 in the last 12 months

CQ 03: Diabetes Eye Exam

Numerator: Number of patients in denominator population

with retinal exam or dilated eye exam performed by an eye

care professional in the past 12 months OR a negative retinal

or dilated eye exam performed by an eye care professional in

last 24 months

HEDIS

Denominator: Number of active patients with diabetes ages 18-75 years old

CQ04: Cervical Cancer Screening (All Participants)


CQ04: Routine Cervical

Cancer Screening

Numerator: Number of patients with cervices ages 24-64 who

received one or more Pap tests during the past 3 years OR patients

with cervices ages 30-64 who received cervical cytology and HPV

co-testing during the past 5 years

Denominator: Number of active patients with cervices ages 24-64

years old

HEDIS

CQ05: Colorectal Cancer Screening (Community Clinics & Clinic Based RBO’s only)


CQ05: Routine Colorectal

Cancer Screening

Numerator: Number of patients in denominator population who

received a FOBT or FIT test during the past year,

OR

Number of patients in denominator population who received a

sigmoidoscopy during the past 5 years,

OR

Number of patients in denominator population who received a

screening colonoscopy during the past 10 years

Denominator: Number of active patients ages 51 - 75 years old

CQ 07: Smoking Cessation Intervention (Community Clinics & Clinic Based RBO’s only)


CQ 07: Smoking Cessation

Intervention

Numerator: Number of patients in denominator population with a

documented smoking cessation counseling intervention in the EHR or

registry in the last 2 years

Denominator: Number of active patients who are (must meet all of

the following):

a) 18 years or older

b) Have a documented history of tobacco use in the past 2 years

c) Seen for at least one outpatient visit within the past 2 years

CQ08: Controlling High Blood Pressure (All Participants)


CQ08: Controlling High

Blood Pressure

Numerator: Number of patients in the denominator population in

which the most recent BP reading in an outpatient visit within the

reporting period was documented as follows:

• 18-59 years of age whose BP was <140/90 mm Hg;

• 60-85 years of age with a diagnosis of diabetes whose BP was

<140/90 mm Hg;

• 60-85 years of age without a diagnosis of diabetes whose BP was

<150/90 mm Hg.

Denominator: Number of active patients with hypertension ages 18-

85 years old

HEDIS

CQ10: Childhood Immunizations (All Participants)


CQ10: Childhood

Immunizations


received all of the following vaccines by their second birthday:

• four diphtheria, tetanus and acellular pertussis (DTaP);

• three polio (IPV); one measles, mumps and rubella (MMR);

• three haemophilus influenza type B (HiB);

• three hepatitis B (HepB),

• one chicken pox (VZV); and

• four pneumococcal conjugate (PCV)

Denominator: Number of active patients who turned 2 years old during

the last year

HEDIS

CQ11: Well Child Visits for Children 3-6 Years of Age

(All Participants)


CQ10: Childhood

Immunizations


who had at least one well-child visit with a PCP during the past

year.

Denominator: Number of active patients 3-6 years old

HEDIS

Patient Experience Domain

PE1: Third Next Available Appointment (Community Clinics & Clinic Based RBO’s only)

Deliverable Due Dates # of Days

Reduced

Threshold Scoring

Submit the median

established patient follow-

up visit TNAA for each of

the final 5 full weeks of

the reporting period.

Note: SFHP will determine

median of five pieces of

data and use it to score

performance.

Quarter 1

Quarter 2

Quarter 3

Quarter 4

n/a

14

calendar

days or

less

2.0

points

> 10 days

15-21

calendar

days or

less

1.5

points

5-9 days n/a 1.0 point

PE2: Show Rate (Community Clinics, Clinic-based RBOs, & Academic Medical Centers only)

Monthly Show Rate =

Numerator: Of the total appointments in the denominator,

the number of appointments which patients kept.

Denominator: Total number of pre-scheduled

appointments for a PCP/PCP team visit during any given

calendar month.

Deliverable Due Dates Relative

Improvement Threshold Quarterly

Scoring

Submit monthly data each quarter via the quantitative template. Note: SFHP will determine quarterly show rate by combining numerators and denominators for each month in the quarter, and using it to determine performance.

Quarter 1

(Timeframe: Jan, Feb, Mar)

Quarter 2

(Timeframe: Apr, May, Jun)

Quarter 3

(Timeframe: Jul, Aug, Sept)

Quarter 4

(Timeframe: Oct, Nov, Dec)

n/a 85% or

more

1.0 point

10%

80-84% 0.75

point

5-9% n/a 0.5 point

PE3: Office Visit Cycle Time (Community Clinics, Clinic-based RBOs, & Academic Medical Centers only)

Deliverable Due Dates # Minutes

Reduced

PIP

Network

Threshold

Quarterly

Scoring

Self-report the median cycle time for each month in the quarter.

Quarter 1

(Data Collection Period: Jan, Feb, Mar)

Quarter 2

(Data Collection Period: Apr, May, Jun)

Quarter 3

(Data Collection Period: Jul, Aug, Sept)

Quarter 4

(Data Collection Period: Oct, Nov, Dec)

10 or more

minutes

reduced

75th

percentile

64 minutes

or less

1.0 point

5-9 minutes

reduced

60th

percentile

65-69

minutes

0.5 point

PE4: Staff Satisfaction Improvement Strategies (All Participants)


Deliverable A: Submit template with the following included:

Baseline score of a staff satisfaction survey o If survey has multiple questions, only one score may be chosen.

For participants using Net Promoter survey, chosen question must be “How likely are you to recommend organization as a place to work?”

Survey type (Gallup, Net Promoter, etc.) Survey date (completed October 1, 2015-January 15, 2016) Survey question Response rate (numerator/denominator) 1-2 priority areas identified for improvement

Quarter 1 0.5 point for completed template, if required response rate met.

0 point if required response rate not met.

Deliverable B: Submit template with a report of activities implemented

specifically to address priority areas identified for improvement

Quarter 3 0.5 point for completed template

Deliverable C: Submit template with the following included:

Survey type (must be same as baseline) Survey date (completed August 1, 2016-October 15, 2016) Survey question (must be same as baseline) Response rate (numerator/denominator)

Quarter 3 0.5 point for completed template, if required response rate met.

0 point if required response rate not met.

Deliverable D: Improvement on staff satisfaction survey score, submitted via

the Quantitative Data Template.

o Score must represent question chosen for baseline.

Quarter 3 If required response rate met: 1.0 point for > 4.0% relative

improvement 1.0 point for 2.0% - 3.9% relative

improvement

If required response rate not met: 0 point

PE5: Improvement in Patient Experience of Primary Care Access (All Participants)

Patient Experience Survey Tool Criteria

Criteria Rationale 1. Conducted and analyzed by or audited by

third party

Supports consistent and unbiased survey methodology

1. Surveyed population is a random sample

of all Medi-Cal patients

Results can be generalized across the population

1. Survey conducted at least twenty-four

hours after visit concludes

Surveys conducted during or immediately after a visit can

offer a limited view of the patient’s full experience, including

follow-up services needed post visit

1. Tool has been validated Validation ensures that the tool is reliable; meaning, that it

yields results that reflect patient perception of the health

care system

1. Includes access-related questions Access to care represents the biggest opportunity for

improvement for San Francisco’s Medi-Cal population, as it is

the lowest ranking area on member surveys

1. Sampling methodology ensures that each

question obtains at least thirty responses

Results can be considered statistically meaningful

PE5: Improvement in Patient Experience of Primary Care Access


Deliverable A: Submit template with:

CG-CAHPS or equivalent baseline data

A description of the qualitative data collection

methodology (sampling methodology, questions

asked, and number of patients participating)

An analysis of themes found in qualitative data

Plan to improve results, based on qualitative

data

Quarter 2 2.0 points for completed template

Deliverable B: Submit template with report of

activities implemented

Quarter 3 1.0 point for completed template

Deliverable C: Submit re-measurement score for CG-

CAHPS or equivalent survey on Quantitative Data

Template

Quarter 4 2.0 points for >3% absolute

improvement

1.0 point for 2-2.99% absolute

improvement

0.0 points for <2% absolute

improvement

Deliverable D: Submit template with re-measurement

data collection methodology.


PE6: Primary Care Access as Measured by Appointment Availability Survey Compliance (Academic Medical Centers & IPAs)

Primary Care

Appointment

Availability

=

Numerator: Total number of primary care providers in compliance

with DMHC Appointment Availability standards listed in the measure

specification (must be compliant in both categories)

Denominator: Total number of primary care providers that respond

to the Appointment Availability Survey


Participate in provider

appointment availability

survey

(via phone, online, or

fax)

Quarter 4. No submission

due from participants.

8.0 points for achieving a

80% compliance rate

PE7: Improvement in Specialty Access as Measured by HP-CAHPS

(Clinic-Based RBOs & IPAs)


Deliverable A: Receive re-measurement score SFHP to provide in

August 2018

To be scored Q2 2018

4.0 points for achieving 4% or more

absolute improvement over baseline

score on the specialist access question

3.0 points for achieving 3.0-3.9%

absolute improvement

2.0 points for achieving 2.0-2.9%

absolute improvement

Deliverable B: Submit template with

Score for HP-CAHPS specialist access

question as reported by SFHP

An analysis of themes found in qualitative

data

Plan to improve results, based on

qualitative data

Quarter 4 2.0 points for completed template

Systems Improvement Domain

SI3: Opioid Safety (Community Clinics, Clinic-based RBOs & Academic Medical Centers)

Quarterly Opioid

Safety Rate =

Numerator: Total number of opioid registry patients who meet the opioid safety

requirements: all of the following must be documented in the last 12 months:

one drug urine screen (does not have to be random)

a signed opioid treatment agreement

CURES report reviewed

Denominator: Total number of patients in Opioid Registry on the last day of the

Quarter

Deliverable Due Date Quarterly Scoring

Deliverable A: Self-report the numerator and

denominator as noted in the Measure

Description


0.5 point for > 60%

0.25 point for 50-59%

0 points for 49% or less

Part B: Submit template with the names of 5

SFHP members with opioid safety risk

reviewed during the months of the quarter by

the Controlled Substance Review Committee.

Include brief documentation of committee

recommendations and attestation that CURES

report reviewed. CURES must be run no more

than one month prior to review.


0.1 point/member, up to 0.5 point,

will be awarded for submitting (via

secure email) the completed

template listing the 5 SFHP

members reviewed by the

Controlled Substance Review

Committee to

[email protected].

SI4: Providers Open to New Members (IPAs only)

Quarterly Rate of

Providers Open to

New Members

=

Numerator: PCPs in the denominator open to new members and

to auto-assigned members. Auto-assigned members are new

members who do not choose a Primary Care Provider on

enrollment with SFHP.

Denominator: Total number of PCPs affiliated with SFHP as of the

last week of the Quarter.

Deliverable Due Date Relative

Improvement

Threshold Quarterly

Scoring

No deliverables required for this measure.


> 15% > 80% 2.0 points

10-14% 70-79% 1.5 points

5-9% 60-69% 1.0 point

PIP Enrollment Process

Two steps:

1. Wufoo form

2. Enrollment Attestation: Data Sharing Consent form

2017 Q4 data will be used for 2018 baseline

Wufoo Form

Wufoo Form

Section 1: General Information & Participant Contact

Information

Wufoo Form Section 2: PIP Alignment Survey

Wufoo Form Section 3: Clinical Quality Domain Reporting

Wufoo Form Section 4: Patient Experience & Systems Improvement

Domain Measure Questions

Wufoo Form Section 5: Attestations & Comments/Questions

Questions?

Evaluation

We appreciate your honest feedback on the

evaluation!

Questions? Contact information:

Kanelle Barreiro

Program Manager, Pay for Performance

[email protected]

(415) 615-5102

Katherine Quen

Specialist, Population Health

[email protected]

(415) 615-5660

Website: http://www.sfhp.org/providers/practice-improvement-program-pip/

mailto:[email protected]

mailto:[email protected]








2018 practice improvement program (pip) orientation

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