Making Sense of What’s Next: Value Based P4P Measurement ... · accreditation, MACRA) •Document and communicate where measure set diverges •Decrease unwarranted variation in

Mike Weiss, DO

September 23, 2016

Making Sense of What’s Next: Value

Based P4P Measurement & MACRA

© 2016 Integrated Healthcare Association. All rights reserved.

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• Background

• Drivers and Imperatives

• 2016-2021 Measure Set Strategy

• MACRA and the New Landscape

• Now What?

Making Sense of What’s Next in VBP4P


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• IHA Board

• Governance Committee

• Technical Payment Committee

• Technical Measurement Committee

Measure Sets: The Process


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• Importance

• Scientific Acceptability

• Feasibility

• Usefulness

• Alignment with Other Initiatives

Criteria for Selecting Measures


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• Importance

• Scientific Acceptability

• Feasibility

• Usefulness

• Alignment with Other Initiatives

Criteria for Selecting Measures


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• Patients • Valid, meaningful, informative

• Physicians/Advanced Practice Providers • Relevance, realistic

• Health Plans • Quality, satisfaction, cost

• Physician Organizations • Relevance, ability to influence

• Federal and State Agencies • Certification requirements

The Many Stakeholders


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• Internal Medicine Practice, Philadelphia, PA

• 23.7 Calls per day

• 16.8 E-mails per day

• 12.1 Rx Refills per day

• 19.5 Lab Reviews per day

• 11.1 X-ray Reviews per day

• 13.9 Consult Reviews per day

What Does a Doctor Do?

Baron. NEJM, 2010, 362(17) 1632-1636


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• Relevance

• Team-based Care

• Innovative Measures and Methodologies

• Quality, Resource Use, and Cost

• Measure Suites in Defined Clinical Areas

• Increase Alignment

• Target Development Efforts

• Reduce Data Collection Burden and Improve Reporting Timeliness

VBP4P Measure Set Strategy

2012-2015 Strategy 2016-2021 Strategy


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Key strategies and supporting tactics:

1. Increase alignment in the VBP4P measure set

• Work to align with other commonly used measure sets (QRS, NCQA health plan accreditation, MACRA)

• Document and communicate where measure set diverges

• Decrease unwarranted variation in measure specs

2. Targeted development of the VBP4P measure set

• Expand and emphasize Total Cost of Care measurement

• Evaluate potential of e-Measures

• Explore feasibility of patient centered measurement

3. Support less burdensome data collection and more timely reporting

• Understand and identify improvements to data sharing processes

• Support standard mid-year reporting

2016 – 2021 Measure Set Strategy


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• The MY 2017 VBP4P measure set includes 43 measures recommended for payment and/or public reporting – 27 clinical quality, 2 Meaningful Use e-measures, 6 patient experience (CG-CAHPS), 7 resource use, and 1 total cost of care

• 38 measures are recommended for payment and 22 of those are publicly reported

• Of the 27 measures in the clinical quality domain:

• Nearly 75% of measures are currently NQF endorsed

• 19 are NCQA Health Plan Accreditation measures

• 16 are QRS measures (CMS’ Quality Rating System 2016)

• 8 overlap with the MA stars measure set

MY 2017 Measure Set Summary


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Paid/Publicly Reported • Statin Therapy for Patients with Cardiovascular Disease: Received Statin

Therapy • Statin Therapy for Patients with Diabetes: Received Statin Therapy • Immunizations for Adolescents will use Combination 2, including HPV

Vaccination for Adolescents

Retirements • Appropriate Treatment for Children with URI • HPV Vaccinations for Female Adolescents & HPV Vaccinations for Male

Adolescents

Testing • Use of Opioids from Multiple Providers at High Dosage in Persons without

Cancer

MY 2017 Measure Set Changes


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How This Prepares Us For The Future

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Making Sense of What’s Next: Value Based P4P Measurement ... · accreditation, MACRA) •Document and communicate where measure set diverges •Decrease unwarranted variation in