dsrip my3 performance summary2018/06/19 · of hea t june 19, 2018 2 progress and performance...

Department Medicaid of Health Redesign Team

DSRIP MY3 Performance Summary PAOP MEETING June 19, 2018

wvoRK Department TEOF l h ORTUNITY. of Hea t

2June 19, 2018

Progress and Performance Results along DSRIP Timeline We are here: Demonstration Year (DY) 4, Quarter 1

April 2014-March 2015

DYO


DY1


DY2


DY3


DY4


DY5 July 2014-June 2015

MY1

July 2015-June 2016

MY2

July 2016-June 2017

MY3

July 2017-June 2018

MY4

July 2018-June 2019

MY5

MY1/DY1: Performance Results Final MY2/DY2: Performance Results Final MY3/DY3: Performance Results Final June 2018 – 1st tests on Statewide Milestone performance complete MY4/DY4: July 1, 2018 marks beginning of MY4 and 2nd Quarter of DY4


3June 19, 2018

Statewide Accountability Milestones The STCs identify four measures for which statewide performance is evaluated, beginning in DY3:

Statewide Milestone Pass Criteria

1. Statewide metrics performance More metrics are improving on a statewide level than are worsening1

2. Success of projects statewide2 More metrics achieving an award than not

1) The growth in the total Medicaid spending is at or below the target trend rate (DY4-5 only) and 3. Total Medicaid spending3 2) The growth in statewide total IP & ED spending is at or below the target trend rate (DY3-5)

4. Managed care plan Achieving VBP roadmap goals related to value-based payment transition

If the state fails any of the four statewide milestones:

DY 3 – 4/2017-3/2018 DY 4 – 4/2018-3/2019 DY 5 – 4/2019-3/2020

Penalty $76.68M (5% of funds) $141.80M (10% of funds) $185.04M (20% of funds)

Notes: 1. Based on previous year and baseline comparisons 2. Based on project-specific and population-wide quality metrics 3. At or below target based on trend rate


4June 19, 2018

Statewide Accountability Milestones The STCs identify four measures for which statewide performance is evaluated, beginning in DY3

Statewide Milestone Performance Goal Pass/Fail

1. Statewide metrics At least 50% of measures are improving/maintaining vs. PASS! performance worsening (minimum of 9 out of 16 measures)

2. Success of projects At least 50% of eligible measures trigger an award (minimum PASS! statewide2 of 1,352 out of 2,702 measures)

3. Total Medicaid spending3 Total Statewide IP and ER Spending < $206.24 PMPM PASS!

At least 10% of total MCO expenditures are captured in Level PASS! 4. Managed care plan 1 or above.

PASS! Statewide Performance Must pass all four milestones

Notes: 1. Based on previous year and baseline comparisons 2. Based on project-specific and population-wide quality metrics 3. At or below target based on trend rate


5June 19, 2018

Performance Overview


6June 19, 2018

Pay for Performance Measures – MY2 to MY3 27 out of 32 measures with trendable data show improvement from MY2 to MY3 Measure MY2 Result MY3 Result Improving/Not Improving

Potentially Avoidable Readmissions 577.88 575.44 Improving

Potentially Preventable ED Visits (for persons with BH diagnosis) 86.17 83.70 Improving

Potentially Avoidable ED Visits 30.26 29.21 Improving

Children’s Access to Primary Care – 12 to 19 years 95.35 95.58 Improving

Children’s Access to Primary Care – 12 to 24 months 94.36 94.95 Improving

Adult Access to Preventive or Ambulatory Care – 65 and older 90.07 90.75 Improving

Adult Access to Preventive or Ambulatory Care – 45 to 64 years 90.33 90.34 Improving

Antidepressant Medication Management – Effective Acute Phase Treatment 51.26 51.71 Improving

Antidepressant Medication Management – Effective Continuation Phase Treatment 36.64 36.76 Improving

Diabetes Screening for People with Schizophrenia or Bipolar Disease who are using Antipsychotic Medication 78.77 79.21 Improving

Diabetes Monitoring for People with Diabetes and Schizophrenia 68.73 69.32 Improving

Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia 70.96 71.94 Improving

Follow-up after hospitalization for Mental Illness – within 30 days 62.14 66.82 Improving

Follow-up after hospitalization for Mental Illness – within 7 days 45.85 51.02 Improving

Initiation of Alcohol and Other Drug Dependence Treatment (1 visit within 14 days) 46.29 46.75 Improving

Engagement of Alcohol and Other Drug Dependence Treatment (initiation and 2 visits within 44 days) 19.86 20.67 Improving

Adherence to Antipsychotic Medications for People with Schizophrenia 60.45 60.95 Improving


7June 19, 2018

Pay for Performance Measures – MY2 to MY3 27 out of 32 measures with trendable data show improvement from MY2 to MY3 Measure MY2 Result MY3 Result Improving/Not Improving

Asthma Medication Ratio (5 – 64 years) 60.90 61.75 Improving

Medication Management for People with Asthma (5 – 64 years) – 50% of Treatment Days Covered 59.02 60.24 Improving

Medication Management for People with Asthma (5 – 64 years) – 75% of Treatment Days Covered 32.13 33.20 Improving

HIV/AIDS Comprehensive Care – Syphilis Screening 53.57 59.10 Improving

HIV/AIDS Comprehensive Care – Viral Load Monitoring 52.06 56.56 Improving

Chlamydia Screening (16 – 24 years) 74.51 75.22 Improving

Care Coordination with provider up to date about care received from other providers (CAHPS measure) 82.92 84.02 Improving

Primary Care – Length of Relationship (CAHPS measure – Q3) 76.08 77.91 Improving

Primary Care – Usual Source of Care (CAHPS measure – Q2) 80.91 86.89 Improving

Getting Timely Appointments, Care, and Information (CAHPS measure – Q6, 8, 10, and 12) 83.30 85.98 Improving

Children’s Access to Primary Care – 7 to 11 years 97.07 97.04 Not Improving

HIV/AIDS Comprehensive Care – Engaged in Care 83.87 81.34 Not Improving

Adult Access to Preventive or Ambulatory Care – 20 to 44 years 83.14 82.17 Not Improving

Children’s Access to Primary Care – 25 months to 6 years 92.85 92.54 Not Improving

Care Transition Metrics (H-CAHPS measure – Q23, 24, and 25) 93.91 93.82 Not Improving

• ~ ... ---··

• • • •


8June 19, 2018

Preventable Hospital Use Continues to Decline Preventable Readmissions Preventable ED Visits Preventable ED Visits (per 100,000 Medicaid members) (per 100 Medicaid members) (BH Population)

(per 100 Medicaid members) 800

100

700 678.7 100 98.4

83.7 80 575.4 80600

60 500 60

400 40 34.1 29.2 40

300 20 20

200 MY0 MY1 MY2 MY3

0 MY0 MY1 MY2 MY3

0 MY0 MY1 MY2 MY3

All PPS rate change since baseline: -15.2% All PPS rate change since baseline: -14.3% All PPS rate change since baseline: -14.9%

Data Source: All PPS rate

PP S S

PP S G

PP S I

PPS M

PP S R

PP S C

PP S D

PP S F

PP S H

PPSY

PP S E

PP S X

PP S L

PP S 0

PP S T

PP S B

PP S Q

PP S P

Performance

_.'.._~~_'!'I_ _ ------------PP S U

PP S K

PP S J

PP S N

PPSA

PPSV

Goal=180.7

•

e

• • • •

• e • e

• ------------------••

• • 250

• •

• • • • 0 • • e

~ -----------------• --------------------- - ---

500

• • 750

tel G •

G1

••

• 1000

s • •

,.

1250

•

• • PPSResu lt

~~,WYORK ~-gw~NITY .

Department of Health

9June 19, 2018

Potentially Preventable Readmissions +

19 PPS Improve, 13 Meet Annual Improvement Target + A lower rate is desirable MY3 P4P Funds Earned

$24,920,036 + HPF

Improving

Not Improving

PP S I Performance Goal=6.1

PP S M

PP S G

PP S R •

• PP S S

PPSY

PP S E

PP S T • • PPSW

PP S K

PP S C • PP S 0

PP S P

PPSJ

PP S F

PP S Q

PP S 8 -PP S X

PP S U G PP S L

PP S D

PP S H

PPSA

PPSV

PP S N

10 20

• • G • •• • G

e • •• •

• ••• G • • • • G •• 0

• G

------------------------• -------------------------------

• 0 g 0

30 40 50

•

60

• • PPSResult

t th e AIT • = MY3 result me

~~,wvoRK Department ~1JR1~NITY. of Health

10June 19, 2018

Potentially Preventable Emergency Room Visits ± 20 PPS Improve, 11 Meet Annual Improvement Target + A lower rate is desirable MY3 P4P Funds Earned

$22,862,872 + HPF

Improving

Not Improving

PP S I

PP S Y

PP S R

PP S 0

PPS G

PP S C

PPSW

PP S F

PP S K

PPS E

PP S B

PP S P

PP S S

PPS Q

PP S L

PPS H

PP S T

Performance Goal=35.3

• G

---------~~~-~ -----------------------------PPS M

PP S X

PP S A

PPS U

PPS D

PP SV

PPS N

20 40

•

• •

•

60

• • •

• 0

• G • •

G

•• G

• • • •

G G

•• ················~ ······························································· ·····························

• • • •• •

80

•• \

100 120

• • PPSResult

• = MY3 re su lt met the AIT


11June 19, 2018

Potentially Preventable Emergency Department Visits (for persons with BH diagnosis) ± 18 PPS Improve, 12 Meet Annual Improvement Target + A lower rate is desirable

MY3 P4P Funds Earned $7,716,820 + HPF

Improving

Not Improving

PP S M

PP S G

PP S Q

• •• •• PP S J • PP S E • • PP S P • PP S F

PP S U

PP S 0 G PPSA

PP S S •• PPSY

PP S R

PP S N • PP S C

PP S H G • • PP S L

PPSV G 0

• •

• t

• • • • • •

G

• •


• •

•

• • • • • • o• "" .

"" 0 ' • .... ......... ::::.......................................................................................................... G 0 0 GG . PP S K

PPSW --------=:----~~ -~--------;,;-~ --------;;;-A • •

90

PP S D 80

70 60

• • PPSResult

• = MY3 result met the AIT

wvoRK Department TEOF l h oRTUNITY. of Hea t

12June 19, 2018

Primary Care - Usual Source of Care 22 PPS Improve, 21 Meet Annual Improvement Target MY3 P4P Funds Earned

$31,787,100

Improving

Not Improving

• • •


13June 19, 2018

Behavioral Health Measures: Mental Illness Follow-up After Hospitalization for Follow-up After Hospitalization for Mental Illness Within 7 Days Mental Illness Within 30 Days

100% 100%

80% 80%

66% 59%

60% 60%50% 44%

40% 40%

20% 20%

0% MY0 MY1 MY2 MY3

0% MY0 MY1 MY2 MY3

All PPS rate change since baseline: 14.1% All PPS rate change since baseline: 10.6% Data Source: All PPS rate

Performance Goal= 7 4.2 • • • • • • PPS Result

• •

PP S D

• • • • t h AIT

PP S U

• • = MY3 result met e

PP S B

0 G 0 • •

PP S S

• • • • • PP S F

PP S K

• • •

PP S G

• PP S R

• t •• PP S L

•

PPSA

G G PP SW

• •

PP S X

0 • • PP S 0

G • • PP S T

G • PPSV

• PP S E • PP S H

0 G • i PP S C

• •

PP S Q

• PPSY

0 • PP S J

PP S M

PP S P --------- ----.-------------;,-ps ,-----------

PP S N • G • 30 40 50 60 70

~WVORK Department TEOF

of Health ORTUNITY.

14June 19, 2018

Follow Up After Hospitalization for Mental Illness – within 7 Days 23 PPS Improve, 20 Meet Annual Improvement Target


Improving

Not Improving

,,...

PP S U

PP S K

PP S D

PP S S

PP S X

PP S F

PP S R

PP S L

PPSA

PP S B

PP S C

PPSV

PP S 0

PPSW

PP S G

PP S Q

PP S T

PP S E

PP S J

---_ f ~§ -lj _ - - - - - - - - - - - - - -

PP S N

PP S M

PP S I

PP S P

PPSY

• G

G ••

e

e • G G •

• • • e

e G

• e • •

• • •

•

• .i • •

• • •

• • ···································· ········ : ······························· ·

•

•• •• • • • 50 60 70

Performance Goa1=88.2

••

•

• 80 90

J

• • PPS Result

• = MY3 result met t he AIT

Department 4WVORK TEOF

of Health ORTUNITY.

15June 19, 2018

Follow Up After Hospitalization for Mental Illness – within 30 Days 20 PPS Improve, 19 Meet Annual Improvement Target


Improving

Not Improving

• • • •


16June 19, 2018

Behavioral Health Measures: Schizophrenia Related Diabetes Screening for People with Schizophrenia or Bipolar Disease who are Using Antipsychotic Medication

100%

80% 77% 79%

60%

40%

20%

0% MY0 MY1 MY2 MY3

All PPS rate change since baseline: 3.0%

Diabetes Monitoring for People with Diabetes & Schizophrenia

100%

80% 69%65%

60%

40%

20%

0% MY0 MY1 MY2 MY3


Cardiovascular Monitoring for People with Cardiovascular Disease & Schizophrenia

100%

80% 72%68%

60%

40%

20%

0% MY0 MY1 MY2 MY3


Data Source: All PPS rate

PP S B

PP S D

PP S G

PP S H

PP S X

PP S R

PP S S

PP S Q

PPSW

PPSA

PP S J

PP S K

PP S U

PP S T

PP S P

PPSY

PPSV

PP S 0

PP S F

PP S L

PP S E

PP S I

PP S C

PP S N

PP S M

65

•

••• ' • G G • G •

G • G O

G G •

• •

• • • • •

G •

o • •• ., I. e e

G G G

----------------------------------------------. --,r• ·---• G • e 0

••• • 70 75 80 85

Performance Goal=89

90

J

• • PPSResu lt

• = MY3 result met the AIT


17June 19, 2018

Diabetes Screening for People with Schizophrenia or Bipolar Disease, Using Antipsychotic Medication 20 PPS Improve, 12 Meet Annual Improvement Target

MY3 P4P Funds Earned $6,164,297

Improving

Not Improving

• • • •

• • • •


18June 19, 2018

Behavioral Health Measures: Substance Use Alcohol & Other Drug Dependence Treatment (1 visit within 14 days)

100%

80%

60% 49.9% 46.7%

40%

20%

0% MY0 MY1 MY2 MY3

All PPS rate change since baseline: -6.3%

Alcohol & Other Drug Dependence Treatment (Initiation and 2 visits within 44 days)

100%

80%

60%

40%

21.4% 20.7% 20%

0% MY0 MY1 MY2 MY3

All PPS rate change since baseline: -3.4% Data Source: All PPS rate

.......

.......


19June 19, 2018

Behavioral Health Measures: Substance Use

100

Initiation of Alcohol and Other Drug Dependence Treatment, Medicaid HMO Members, NCQA, National Average

90

80

70

60

49.9 49.3

30 38.2 38.3 38.2

20

10

0 2010 2011 2012 2013

Year 2014 2015 2016

42.9 39.2 39.4 40.8

46.3 46.7

40

50

Percent

NCQA

DSRIP

.......

.......


20June 19, 2018

Behavioral Health Measures: Substance Use Percent

100

Engagement of Alcohol and Other Drug Dependence Treatment, Medicaid HMO Members, NCQA, National Average

90

80

70

60

50

40

NCQA

DSRIP

30

21.4 20.9 19.9 20.7

0

10.6 10.2 14.2

11.9 10.8 11.3 12.5 10

20

2010 2011 2012 2013 2014 2015 2016 Year

PP S T

PP S Y

PPSW

PP S L

PP S 0

PPSV

PP S G

PP S Q

PP S S

PP S M

PP S E

PP S R

PP S D

PP S F

PP S U

PPSA

PP S P

PP S C

PP S N

PP S K

PP S H

PP S X

PP S I

PPS J

PP S B • 30

• • 0

35 40

• G

i G ., • G

G O

a. •

•

•

•

Goal=57.1 Performance

e •

G G G G .JI. ....................... . ---------------------------------------------------------~---- --

G G G •• • G O • • •• • e • G • • G G

G •• • • G • • • 45 50 55

• 60

J

• • PPS Result

t t he AIT • = MY3 result me

4WVORK 1lW~NITY .

Department of Health

21June 19, 2018

Initiation of Alcohol and Other Drug Dependence Treatment (1 visit within 14 days) 12 PPS Improve, 8 Meet Annual Improvement Target


Improving

Not Improving

PPS T 0 PPS G

PPSW CD 0 PPS L CD 0 PPS 0

PPSY

PPS F

PPS M G PPS Q

PPS U G PPSV

PPS D

PPS H

PPS X G • ---------~~~ ~------------------------------------. . ----

PP S P

PP S K

PPS C

PPSA

PPS N

PPS J

PP S E

PPS I

PP S B

0

0 0

15

i 0

G G i G

G G 0

0

• •

•

•

• • •

20

• •

• •

• • • • •

• e e e e

•

• G G

G

25


---------------• ---------------

e •

30

J _./

• • PPS Result

• = MY3 result met t he AIT


22June 19, 2018

Engagement of Alcohol and Other Drug Dependence Treatment (Initiation and two visits within 44 days) 15 PPS Improve, 12 Meet Annual Improvement Target


Improving

Not Improving


23June 19, 2018

Discussion

Substance Use Disorder: Best Practices and Challenges from the Field


24June 19, 2018

Speakers • Suffolk Care Collaborative (SCC)

• Dr. Linda Efferen – Executive Director for SCC. PPS has 3 hubs – SUNY Stonybrook, Northwell and the Catholic Health System

• Central New York Care Collaborative (CNYCC) • Dr. Ross Sullivan – Assistant Professor Emergency Medicine and Director, Emergency Opioid Bridge Clinic at SUNY Upstate Hospital, Syracuse NY

• Bronx Partners for Healthy Communities (BPHC) • Irene Kaufman – Executive Director for BPHC PPS • Pam Mattel – Chief Operation Officer, Acacia Network

• Nassau Queens PPS (NQPPS) • John Javis – Director of Behavioral Health for NQPPS. PPS has system hubs – Nassau University Medical Center, Northwell Health and the Catholic Health System.

dsrip my3 performance summary2018/06/19 · of hea t june 19, 2018 2 progress and performance...

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