1 SNP Educational Session – January 13, 2014 Model of Care Scoring Guidelines SNP Educational Session - January 13, 2014 Brett Kay, AVP, SNP Assessment,

1SNP Educational Session – January 13, 2014

Model of Care Scoring Guidelines

SNP Educational Session - January 13, 2014

Brett Kay, AVP, SNP Assessment, NCQA


Objectives of SNP MOC Scoring Guidelines

• Raise the bar and strengthen the guidelines

• Modeled after S&P measures format– Familiar to the SNPs – SNPs have publicly requested such a

change– Supports consistent scoring of MOCs


• Used revised Appendix 1 of the MA application Model of Care Matrix Upload Document—kept requirements intact, but revised formatting

MOC Scoring Guidelines


• Scoring will be similar to previous years

• MOC elements worth 0-4 points, based on # of factors met

• Total of 60 points (15 elements)• Converted to percentage scores

– E.g., 50 points = 83.33% (2-year approval)

How will NCQA Score the MOC?


ScoringPrevious MOC Scoring

GuidelinesElement Maximum Score

MOC 1: SNP-specific Population 4

MOC 2: Measurable Goals 12

MOC 3: Staff Structure/roles 12

MOC 4: ICT 12

MOC 5: Provider Network 20

MOC 6: MOC Training 16

MOC 7: HRA 16

MOC 8: ICP 20

MOC 9: Communication Network

16

MOC 10: Vulnerable Populations 8

MOC 11: Outcome Measurement

24

Total 160

New MOC Scoring GuidelinesElement Maximum Score

MOC 1: SNP Population 8

MOC 2: Care Coordination 20

MOC 3: Provider Network 12

MOC 4: Quality Measurement 20

Total 60


• NCQA held a two week public comment period to solicit comments on the draft scoring guidelines

• Received input from stakeholders– 222 comments– Health plans, trade associations,

provider groups, others• Used feedback to revise guidelines

and clarify expectations

Public Comment Process


• MOC Audit Issues—requests for clarification/interpretation of requirements; reaction to CMS’ review of MOC during the audit cycle

• Requests for better harmonization & coordination of MOC and S&P measures assessments

• Redundancy with existing MA requirements

Public Comment-Major Themes


• Network Model vs. Staff Model—some requirements not feasible/heavy burden for network model SNPs

• Plan level vs. member-level data and information

• High risk/stratification for ICP/ICT-focus on high need members

• Requests for examples, expectations of intent

Public Comment-Major Themes


• Element A: Overall SNP Population-– Intent: Identify and describe the target

population, including health and social factors, and unique characteristics of each SNP type

– Response to public comments: • Factor 1: Clarify that emphasis is on

process, not care coordination• Factors 2 & 3: Separated social and

medical/health factors

MOC 1: Description of SNP Population


• Element B: Most Vulnerable Beneficiaries– Intent: Describe the most vulnerable

beneficiaries and how their medical and social factors affect health outcomes and what services and resources the SNP provides to address these

– Response to public comments:• Clarify that focus is on population-level,

not individual members

MOC 1: Description of SNP Population


• Element A: Staff Structure– Intent: Describe administrative and

clinical staff roles and responsibilities– Response to public comments:

• Factor 2: Oversight functions related to license and competency verification relates to specific population being served

• Factor 4: Contingency plans are developed for plan-level operations

• Factors 5&6: Clarify that contracted staff do not include contracted network providers

MOC 2: Care Coordination


• Element B: Health Risk Assessment Tool – Intent: Describe process for using

HRAT to inform development of the ICP; communicate HRAT info to ICT; identify and stratify needs of beneficiaries

– Response to public comments:• Factor 3: Establish that all SNP

beneficiaries must receive an HRA• Factor 3: SNPs should describe how they

address beneficiaries that cannot or will not undergo an HRA



• Element C: Individualized Care Plan (ICP)– Intent: Describe essential elements of

the ICP, how the SNP develops and updates the ICP

– Response to public comments:• Clarify that CMS expects an ICP for all SNP

beneficiaries but allows flexibility for SNP to determine level of detail for ICPs—may stratify by risk and place priority on high risk/high need beneficiaries



• Element D: Interdisciplinary Care Team (ICT)– Intent: Describe the ICT, including key members, roles

and responsibilities and how they contribute to improving beneficiary health status.

– Response to public comments:• Clarify that the ICT may meet “virtually” using various

forms of communication and technology (face-to-face is not required)

• Element E: Care Transition Protocols– Intent: Describe the SNP’s processes to coordinate care

transitions and facilitate timely communications across settings and providers

– Response to public comments:• Factor 2: Delete requirement about providing staff

credentials• Factor 5: Revise to match AHRQ language on self

management



• Element A: Specialized Expertise– Intent: Demonstrate how the network is designed to

address the needs of the SNP’s target population– Response to public comments:

• Focus is on plan-level information for the provider network

• Factor 3: Remove language on credentialing

• Element B: Use of clinical practice guidelines (CPGs) and Care Transitions Protocols– Intent: Describe how the SNP ensures that

beneficiaries receive appropriate, evidence-based care and services

– Response to public comments:• Population level decision making, not individual clinician

level• Identify challenges to using CPGs and protocols

MOC 3: Provider Network


• Element C: Provider Network Training– Intent: Describe how the SNP provides

training for its provider network– Response to public comments:

• SNPs should show how they make training available to all network providers

• Make providers aware of trainings• Offer various training modalities to suit the

needs of network providers

MOC 3: Provider Network


• Element A: Quality Performance Improvement Plan– Intent: Describe how the SNP conducts

quality improvement related to its overall MOC

– Response to public comments:• Plan-level information focusing on goals

that measure overall plan performance related to all aspects of the MOC

MOC 4: MOC Quality Measurement & Performance Improvement


• Element B: Measureable Goals– Intent: Identify and define the

measureable goals and health outcomes for the target population, and how the SNP determines if goals are being met

– Response to public comments:• Plan-level measures and goals for the

target population• Focus is on health and clinical goals (e.g.,

controlling diabetes, mental health screening)



• Element C: Measuring Patient Experience– Intent: Describe how the SNP

measures beneficiary satisfaction and responds to results

– Response to public comments: • Plans may use wide variety of patient

experience/satisfaction surveys—CAHPS and HOS are acceptable, as are other alternatives

• Provide details of surveys and methodology for data collection



• Element D: Ongoing Performance Improvement Evaluation– Intent: Describe how the SNP uses the

results from its performance indicators and measures to support its ongoing quality improvement plan

– Response to public comments:• Include lessons learned and challenges in

obtaining timely data



• Element E: Dissemination of SNP Quality Performance– Intent: Describe how the SNP

communicates its quality improvement plan and performance to stakeholders

– Response to public comments:• Detail who receives the information, how

often they receive it, and what communication methods are used



QUESTIONS

Documents

1 SNP Educational Session – January 13, 2014 Model of Care Scoring Guidelines SNP Educational Session - January 13, 2014 Brett Kay, AVP, SNP Assessment,