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PHC’s Pay-For-PerformanceQuality Improvement Program (QIP) Measurement Year Transition & 2018
Measure Feedback Webinar
Date: January 30, 2017
Presenters:QIP Team
Partnership HealthPlan of California
Audio Instructions
To avoid echoes and feedback, we request that you use the telephone instead of your computer microphone for listening/talking during the webinar.
Overview
Measurement Year Transition • Timelines 2016-2017 QIP Measurement Year Transition
• Transition Period Measurement Set
Introduction to Potential Measures for 2018I. Fixed Pool MeasuresII. Unit of Service Measures
Questions, Answers, & DiscussionComment Period Timeline
Measurement Year Transition
• Align with HEDIS measurement period• Six-month measurement period (July 1, 2017 to December
31, 2017)• Referred to also as “Mini Period” or “Transition Period” or
“MYT”• Based on 2016-2017 QIP measurement set: No new
measures• Data look back period is 2017 CY for Fixed Pool• Incentive amount will be based on member months 7/1/17
– 12/31/17
Measurement Year Transition
QIP Timeline
Fiscal year Transition Period Calendar Year
Jul 2016 to Jun 2017 Jul to Dec 2017 Jan to Dec 2018
2016-17 QIP
Transition Period
2018 QIP
2016 2017Jul Sep Nov 2017 Mar May Jul Sep
Final Payment for 2016-17 QIP mailed
10/31/2017
Final date for accepting all data (eReports and UOS submissions)7/31/2017
Transition Measurement Period begins
7/1/2017
7/1/2016 - 6/30/2017
QIP 2016-2017
2016-2017 QIP Timeline
2017 2018Jul Aug Sep Oct Nov Dec 2018 Feb Mar Apr
2018 QIP begins1/1/2018
Final Payment for Transition period mailed4/30/2018
Final date for accepting UOS submissions
1/31/2018
Final date to submit clinical data to eReports
2/15/2018
7/1/2017 – 12/31/2017
Transition Period
2017 Transition Period Timeline
Transition Period Measurement Set
I. Fixed Pool PMPM Measurement Set (Required, 100 pts. total)
Four Domains1. Clinical2. Appropriate Use of Resources3. Access and Operations4. Patient Experience
II. Unit of Service Measurement Set (Optional)
2017 Measurement Set Summary of Changes
• Removed from fixed pool measurement set: • Opioid Safety, Patient Experience
• Removed from unit of service measurement set:• CAIR utilization
• Change in point values for:• Family: MPM, Well-Child Visits, Cervical Cancer
Screenings• Internal: Cervical Cancer Screenings, HbA1C Good
Control; Retinal Eye Exams• Pediatric: Well-Child Visits, Asthma Care
Fixed Pool Measures – Clinical Domain
Measures Family Internal Pediatric
Monitoring Patients on Persistent Medications 10 10 --
Well Child Visits (3-6 years) 10 -- 15
Childhood Immunization – DTaP (2 years) 5 -- 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 10 --
HbA1C Control (18-75 years) 5 10 --
Nephropathy (18-75 years) 5 5 --
Childhood Immunization – MMR (2 years) -- -- 10
Asthma Care (5-18 years) -- -- 10
Nutrition Counseling (3-17 years) -- -- 10
Physical Activity Counseling (3-17 years) -- -- 10
Adolescent Immunizations (13 years) -- -- 10Total Points: 60 60 75
Fixed Pool Measures – Appropriate Use of Resources
Measures Family Internal Pediatric
Admissions/1000 or Follow-Up Post Discharge 7.5 7.5
Readmission Rate or Follow-Up Post Discharge 7.5 7.5
Pharmacy Utilization 10 10 10
Total Points: 25 25 10
Follow-up post discharge can be a back-up measure for either Acute Bed Days/1000 or Readmission Rate, but not both.
Opioid safety was removed from the measurement set for the transition period.
The Patient Experience domain was removed from the measurement set for the transition period.
Fixed Pool Measures – Access and Operations
Measures Family Internal Pediatric
Avoidable ED Visits 5 5 5
Practice Open to PHC Members 5 5 5
PCP Office Visits 5 5 5
Total Points: 15 15 15
There are no changes for these measures in the transition period
Unit of Service Measures
Unit of Service Measure Incentive amount
Advance Care Planning $100 per attestation/$100 per POLST/AD
PCMH Certification Level 1: $2000 Level 2: $3000 Level 3: $3500
Peer-Led Self Management Support Groups
$1000 per group per year
Access/Extended Office Hours Equivalent payment of 10% cap
Buprenorphine Qualified Providers
$500 per credential prescriber (max. 5 per site)
SBIRT $5 per screening
Health Information Exchange $2500 one time payment for participating in local HIE
The CAIR utilization measure was removed from the measurement set for the transition period.
Potential Measures for Measurement Year 2018
Measure Development Timeline
January 30, 2017 through February 10, 2017
March 8, 2017 July 2017 January 1, 2018
Public Comment Period
Physician Advisory Committee Approval
Measure Specifications
Released
2018 Measurement Period Begins
Guiding Principles1. Pay for outcomes, exceptional performance and improvement2. Sizeable incentives3. Distribute 100% of Fixed Pool Per Member Per Month (PMPM)
Funds4. Actionable Measures5. Feasible data collection6. Collaboration with providers7. Simplicity in the number of measures8. Comprehensive measurement set9. Align measures that are meaningful10. Stable measures
2018 Proposed Measures
I. Fixed Pool PMPM Measurement Set by Domain (Required)a. Clinicalb. Appropriate Use of Resourcesc. Access and Operationsd. Patient Experience
II. Unit of Service Measurement Set (Optional)
2018 Proposed MeasuresOverall Changes- Greater focus on clinical measures
- More pediatric measures for family set
- Suggestions for potential measures and measure changes come from provider suggestions, HEDIS performance, updated recommendation guidelines
- Point values to be determined for final measurement set
- Thresholds to be determined for final measures
2018 Proposed Measures
I. Fixed Pool PMPM Measurement Set by Domain (Required)a. Clinicalb. Appropriate Use of Resourcesc. Access and Operationsd. Patient Experience)
II. Unit of Service Measurement Set (Optional)
2018 Proposed Clinical Measures – Family Medicine
2016-2017 2018 Recommendations
1. Monitoring Patients on Persistent Medications
1. Monitoring Patients on Persistent Medications
2. Well Child Visits (3-6 yrs) 2. Well Child Visits (3-6 yrs)
3. Childhood Immunization (DTaP) Childhood Immunization (DTaP)
4. Controlling High Blood Pressure 3. Controlling High Blood Pressure
5. Cervical Cancer Screening 4. Cervical Cancer Screening
6. Colorectal Cancer Screening 5. Colorectal Cancer Screening
7. HbA1C Good Control 6. HbA1C Good Control
8. Diabetes Mgnt - Retinal Eye Exams 7. Diabetes Mgnt - Retinal Eye Exams
9. Diabetes Mgnt - Nephropathy Diabetes Mgnt – Nephropathy
8. Breast Cancer Screening
9. Childhood Immunization Combo-3
10. Immunizations for Adolescents
2018 Proposed Clinical Measures – Internal Medicine
2016-2017 2018 Recommendations
1. Monitoring Patients on Persistent Medications
1. Monitoring Patients on Persistent Medications
2. Controlling High Blood Pressure 2. Controlling High Blood Pressure3. Cervical Cancer Screening 3. Cervical Cancer Screening4. Colorectal Cancer Screening 4. Colorectal Cancer Screening5. HbA1C Good Control 5. HbA1C Good Control6. Retinal Eye Exams 6. Retinal Eye Exams7. Nephropathy Screenings 7. Nephropathy Screenings
8. Breast Cancer Screening
2018 Proposed Clinical Measures – Pediatric Medicine
2016-2017 2018 Recommendations
1. Nutritional Counseling 1. Nutritional Counseling2. Physical Activity Counseling 2. Physical Activity Counseling3. Well Child Visits (3-6 years) 3. Well Child Visits (3-6 years)4. Childhood Immunization (DtaP) Childhood Immunization (DtaP)5. Childhood Immunization (MMR) Childhood Immunization (MMR)6. Adolescent Immunizations 4. Adolescent Immunizations7. Asthma Care Asthma Care
5. Childhood Immunization Combo-36. Asthma Medication Ratio
Changes to Existing Measures
• Colorectal Cancer Screenings (family and adult):• The percentage of members 51–75 years of age as of
June 30, 2017 who had appropriate screening for colorectal cancer.
• Change: National Medicaid data is not available to set a threshold for this measure. We will use a lower threshold based on QIP experience in 2016-2017.
2016-2017 Threshold Proposed 2018 Thresholds*
Partial Points (25th
Medicare percentile): 60.5%
Full Points (50th
Medicare percentile): 67.5%
Partial Points (75th percentile): 39.1%
Full Points (90th
percentile): 50.75%
*exact thresholds to be determined
Details for New Measures
• Immunizations for Adolescents (new to family):• Percentage of adolescents 13 years of age who had
TDaP, meningococcal, and two doses of the HPV vaccine by their 13th birthday
• Breast Cancer Screening (family and adult): • Percentage of women 50-74 years of age who had
at least one mammogram to screen for breast cancer in the past two years
Details for New Measures• Childhood Immunization Combo-3 (family and
pediatric):• The percentage of children 2 years of age who have had
all required doses of the below seven immunizations by their second birthday: DTaP, IPV, MMR, HiB, HepB, VZV, PCV
• Asthma Medication Ratio (pediatric): • Percentage of members 5-18 years old who were
identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year
2018 Proposed Measures
I. Fixed Pool PMPM Measurement Set by Domain (Required)a. Clinicalb. Appropriate Use of Resourcesc. Access and Operationsd. Patient Experience
II. Unit of Service Measurement Set (Optional)
2018 Proposed Non-Clinical Measures
2016-2017Family & Internal Medicine
2018 RecommendationsFamily & Internal Medicine
1. Admissions/1000* 1. Admissions/1000*2. Readmission Rate* 2. Readmission Rate*3. Pharmacy Utilization 3. Pharmacy Utilization4. Opioid Safety 4. Opioid Safety* Available back-up measure: Follow-up post discharge
* Available back-up measure: Follow-up post discharge
• Appropriate Use of Resources
2016-2017Pediatric Medicine
2018 RecommendationsPediatric Medicine
1. Pharmacy Utilization 1. Pharmacy Utilization
2018 Proposed Measures
I. Fixed Pool PMPM Measurement Set by Domain (Required)a. Clinicalb. Appropriate Use of Resourcesc. Access and Operationsd. Patient Experience
II. Unit of Service Measurement Set (Optional)
2018 Proposed Non-Clinical Measures
2016-2017All Practice Types
2018 RecommendationsAll Practice Types
1. Avoidable ED Visits 1. Avoidable ED Visits2. Practice “open” to PHC members 2. Practice “open” to PHC members3. PCP Office Visits 3. PCP Office Visits
• Access & Operations
• Patient Experience2016-2017
All Practice Types2018 Recommendations
All Practice Types
1. CAHPS for sites that meet member volume criteria, or Survey/Training Option for other sites
1. CAHPS for sites that meet member volume criteria, or Survey/Training Option for other sites
2018 Proposed Measures
I. Fixed Pool PMPM Measurement Set by Domain (Required)a. Clinicalb. Appropriate Use of Resourcesc. Access and Operationsd. Patient Experience
II. Unit of Service Measurement Set (Optional)
2018 Proposed Measures – Unit of Service
2016-2017 2018 Recommendations1. Advance Care Planning Attestations 1. Advance Care Planning Attestations
2. Extended Office Hours 2. Extended Office Hours
3. PCMH Certification PCMH Certification
4. Peer-led Self-Management Support Groups 3. Peer-led Self-Management Support Groups
5. Utilization of CAIR Utilization of CAIR
6. Buprenorphine Qualified Providers Buprenorphine Qualified Providers
7. SBIRT Screenings 4. SBIRT Screenings
8. Health Information Exchange 5. Health Information Exchange
6. Suboxone Induction
7. Initial Health Assessment
8. Timely Data Submission via eReports
9. Social Determinants of Health Screenings
10. Fluoride Varnish Application
Details for New Measures
• Suboxone Induction: • Incentivize providers for successfully transferring
opioid-addicted patients to Suboxone Therapy
Proposal: Primary Care Provider sites will receive $200 per successful transfer to treatment on Suboxone therapy, as indicated by an Induction Attestation, subject to audit by PHC. This measure is only valid for first-time inductions. The following components must be included in each attestation in order to receive incentive payment: 1) Patient Name, DOB, CIN 2) Clinician’s name and organization 3) Date of Induction 4) Attestation that this is a new induction 5) Attestation that the member was given a prescription, or the induction in-person
Details for New Measures
• Initial Health Assessment:• Reward provider sites for seeing newly enrolled
members within 120 days of plan enrollment
Proposal: Primary Care Provider sites will receive $50 per IHA claim processed by PHC, on top of the claim amount.
Details for New Measures
• Timely Data Submission via eReports: • Reward providers for entering the majority of their relevant
data records before the end of the measurement year
Proposal: PCP data entry will be tracked through eReports. If a target of 70% of records are entered before December 1st, sites will be eligible for an additional incentive.
Calculation: # of all uploads by December 1st/# of all uploads by end of measurement year
Incentive: Total Members Incentive Amount
Small 1-350 $3000
Medium 351-1,1300 $4000
Large 1,301 or greater $5000
Details for New Measures
• Social Determinants of Health Screenings:• Reward provider sites for screening patients for
social determinants of health, using the PRAPARE (or equivalent) social determinants of health screening tool
Proposal: Potential criteria include submission of one attestation form per screening to the QIP OR submission of an EHR generated report containing patient identification numbers for the PHC members screened
Details for New Measures
• Fluoride Varnish Application: • Sites will be reimbursed based on the number of
Fluoride Varnish Application claims for PHC members ages 5 and below.
Proposal: Primary care provider sites will receive $50 per processed fluoride application claim, on top of the claim amount. The CPT code for this claim is 99188. Claims submitted in excess of three applications per individual within a measurement year will be excluded.
Next Steps
• Time for discussion today
• Review materials provided
Contact QIP to share feedback by Friday, February 10th.
– http://www.partnershiphp.org/providers/quality/pages/pcpqiplandingpage.aspx