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January 14, 2016
Value Based P4P
MY 2015 and MY 2016 Program Updates
© 2016 Integrated Healthcare Association. All rights reserved. 2
• Introductions
• News
• Check out the new IHA.org!
• Public Reporting: Total Cost of Care & Medicare Advantage Stars
• Reporting MY 2015 results
• Timeline
• Testing measures
• Measure set updates
• MUHIT Overview
• CMS EHR Incentive Measurement
• E-Measures
• Looking towards MY 2016
• Expanded VBP4P adoption
• Attainment Pathway
Agenda
© 2016 Integrated Healthcare Association. All rights reserved. 3
VBP4P Staff and Partners
Lindsay Erickson Director, Value Based P4P
Ginamarie Gianandrea Program Coordinator
Cayman NavaWeb Engineer/Developer
Anna HughesSenior Data Analyst
Gehry OateySenior Data Engineer
Our Partners
© 2016 Integrated Healthcare Association. All rights reserved. 4
• IHA has a new look—including a new logo and
website
• Easier to navigate and find the resources you need
• P4P Reporting Portal (https://analytics.iha.org)
• The Reporting Portal, where your results are released,
has not changed except with a refresh to match the new
IHA branding—sign in with the same username and
password
• Questions or issues logging in? Email [email protected]
The New www.IHA.org & Logo
© 2016 Integrated Healthcare Association. All rights reserved. 5
• Quality Report Card with MY 2014 quality results available
through Office of the Patient Advocate (OPA) at:
http://reportcard.opa.ca.gov
• Public Reporting of Total Cost of Care and Medicare
Advantage Stars:
• Beginning with MY 2014 results, Total Cost of Care will be publicly
reported as a component of the existing Quality Report Card
• For the first time, Medicare Advantage Stars Report Card published
by OPA
• MY 2014 physician organization-level Medicare Advantage Stars
results reported similarly to quality report cards
• MY 2014 Medicare Advantage award winners and results deck
available
Public Reporting: Total Cost of Care & Medicare
Advantage Stars
© 2016 Integrated Healthcare Association. All rights reserved. 6
MY 2015 MeasurementMY 2015 Measure SetMY 2015 Final P4P Manual
© 2016 Integrated Healthcare Association. All rights reserved. 7
MY 2015 Reporting Timeline
Activity Deadline
Quality Preliminary Reports May 25, 2016
Questions and Appeals Period May 26 - June 15, 2016
Quality Final Reports July 6, 2016
ARU & TCC Preliminary Reports June 29, 2016
Review Period June 29 – July 20, 2016
ARU & TCC Final Reports August 17, 2016
Available with the MY 2015 P4P Manual: http://www.iha.org/sites/default/files/resources/vbp4p-manual-my2015.pdf
© 2016 Integrated Healthcare Association. All rights reserved. 8
Data Sources & Collection
Copyright © 2014 Integrated Healthcare Association. All rights reserved. 8
Quality Measures
Clinical Quality
Organization-level results reported by health plan and physician organization
Not a sample – all members included
Audited
Patient Experience
Clinician and Group CAHPS survey of physician organization members
Administered by CHPI
Meaningful Use of Health IT
Physician organizations provide NPI lists
Compiled by NCQA from publicly available CMS meaningful use incentives data
e-Measures reported by POs
Total Cost of Care
Health plan supplements claims and encounter data with member-level total payments
Calculated by Truven Health Analytics
Appropriate Resource Use
Health plan submits complete claims and encounters for all members
Calculated by Truven Health Analytics
Resource Use Measures
© 2016 Integrated Healthcare Association. All rights reserved. 9
MY 2015 Submission Timeline
Activity Deadline
Intentions Period (complete) November 2 – December 14, 2015
Collection of MUHIT NPI lists January 4 – 29, 2016
Preliminary Data File Layout Available January 15, 2016
Supplemental Data Collection Deadline February 16, 2016
Supplemental Data Validation Deadline March 15, 2016
Data Layout Test Files March 21 – May 2, 2016
Submission Files to Auditors May 2, 2016
Auditor-Locked P4P Results May 9, 2016
Available with the MY 2015 P4P Manual:http://www.iha.org/sites/default/files/resources/vbp4p-manual-my2015.pdf
© 2016 Integrated Healthcare Association. All rights reserved. 10
• The following preliminary data file layouts will be available
January 15 on our Data Collection & Submission webpage:
• Self-Reporting POs:
• Clinical measure layout, including e-Measures
• Testing measure layout
• POs that do not self-report AND participate in the MUHIT domain:
• E-Measure layout
• Health Plan layouts
• Final data layouts will be available February 1. Please review
these data file layouts and share with the appropriate staff
member at your organization as needed.
MY 2015 Data File Layouts
© 2016 Integrated Healthcare Association. All rights reserved. 11
Adoption of a VBP4P Measure
Testing•Testing results are shared with P4P committees, who make the recommendation to adopt a measure
Baseline• Beginning the next measurement
year, measures become a “baseline” measure, which is internally collected and reported, but not paid or publicly reported
Paid & Publicly Reported• In the following measurement
year measures are recommended for payment and public reporting and can be commented on in public comment
For example, a measure tested in Measurement Year 2015 may be recommended for adoption as a baseline measure in Measurement Year 2016, and then recommended for payment and
public reporting in MY 2017.
© 2016 Integrated Healthcare Association. All rights reserved. 12
MY 2015 Testing Measures
P4P staff encourage self-reporting POs to participate in the collection of testing measures whenever possible—it allows the POs a first look at their performance, and allows for robust testing results which influence the measure’s adoption.
Statin Therapy for Patients with Diabetes
Receipt and adherence to statin therapy for:• members ages 40-75 with diabetes
Statin Therapy for Patients with Cardiovascular Disease
Receipt and adherence to statin therapy for:• males ages 21-75 and females ages 40-75 with ASCVD
Antidepressant Medication Management
Percent of members ages 18+ with major depression who remained on medication after being diagnosed and dispensed antidepressant
© 2016 Integrated Healthcare Association. All rights reserved. 13
MY 2015 Measure Set Reminders
Changes to the MY 2015 submission of clinical data are minimal—most changes allow for alignment with HEDIS.
Product Paid/Publicly Reported Measures
Baseline Measures
MeasureRemovals
Commercial HMO/POS
• Diabetes Care: 2 HbA1c Tests
• Optimal Diabetes Care: Combination
• Controlling Blood Pressure for People with Hypertension
• CIS Combo 10• Cervical Cancer
Screening• Cervical Cancer
Overscreening• Asthma Medication
Ratio (new age band)
• Diabetes Care: HbA1c Testing (1 test)
• CIS - 24 month continuous enrollment
Medicare Advantage
• None • None • Diabetes: Appropriate Treatment for Hypertension
For a list of all measures and details on use see the measure set document on IHA’s website:http://www.iha.org/sites/default/files/resources/vbp4p-measure-set-my2015.pdf
Included in clinical measure data file layouts
for the 1st time
No longer included in data file layouts
No changes to data file layouts—you reported
these in MY 2014
© 2016 Integrated Healthcare Association. All rights reserved. 14
• VBP4P incorporates the most current specifications available from a measure developer
• A full list of specification changes can be found in the MY 2015 P4P Manual
• Two changes of particular note to align with HEDIS:• Asthma Medication Ratio (AMR)
• HEDIS is expanding the age range for the AMR measure from 5-64 years to 5-85 years; both age bands will be collected in MY 2015
• Identification of inpatient events and discharges
• New value set and algorithm identified by HEDIS incorporated into following measures: MPM, CDC, ART, OMW, PCR
MY 2015 Specification Changes
© 2016 Integrated Healthcare Association. All rights reserved. 15
Questions?
© 2016 Integrated Healthcare Association. All rights reserved. 16
Meaningful Use of Health IT
(MUHIT)
© 2016 Integrated Healthcare Association. All rights reserved. 17
The MY 2015 Meaningful Use of Health IT (MUHIT) Domain
for the Value Based P4P program includes the following
three measures:
• CMS EHR Incentive Program participation
• POs’ ability to report two Clinical Quality e-Measures
(CQMs):
• Controlling High Blood Pressure e-Measure
• Clinical Depression and Follow-Up Plan e-Measure
• MUHIT Domain is worth 30% of P4P Quality Composite
Score in MY 2015
MY 2015 MUHIT Measures
© 2016 Integrated Healthcare Association. All rights reserved. 18
• The MY 2015 P4P MUHIT Domain gives credit for participating in the CMS EHR
Incentive Program, based on the percentage of a PO’s providers that have
successfully attested through the Medicare or Medicaid EHR Incentive program, for
Stage 1 or Stage 2
• Credit for the CQM e-Measures will be given based on the PO’s ability to report these
two measures. While the data for these measures will be collected through the
Physician Organization Clinical Measure File Layout, points will be assigned to the
MUHIT Domain
MY 2015 MUHIT Scoring
Overall MUHIT Domain % of Providers Points PO’s Points
CMS EHR Incentive Program
XX% 25 (.XX)(25)
Blood Pressure eMeasure
XY% 2.5 (.XY)(2.5)
Depression eMeasure YZ% 2.5 (.YZ)(2.5)
Total Possible Points 30 Sum of Section Points
© 2016 Integrated Healthcare Association. All rights reserved. 19
CMS EHR Incentive Program
Participation
© 2016 Integrated Healthcare Association. All rights reserved. 20
• In order to receive credit for the MY 2015 P4P MUHIT
Domain, physician organizations (POs) must submit a
file containing the national provider identifiers (NPIs) for
the providers in their organization
• Each PO must submit one CSV file to NCQA using the
file specifications detailed on the next slide; submission
deadline is January 29, 2016 at 5 PM PST
• Instructions for submitting the CSV file were sent to all POs on
January 4, 2016
CMS EHR Incentive Program Participation
© 2016 Integrated Healthcare Association. All rights reserved. 21
• The following fields are required and should appear in
the header of the file, as follows:
• NPI
• PO P4P DMHC ID
• PO Name
• Provider Last Name
• Provider First Name
• Provider Professional Suffix (Limit providers to those with an MD or
a DO)
• Provider Specialty. Limit providers to the following specialties:
• 01 (family/general practice)
• 02 (internal medicine)
• 03 (pediatric/adolescent medicine)
CMS EHR Incentive Program Participation
© 2016 Integrated Healthcare Association. All rights reserved. 22
File Naming Convention:
• Files must be named according to specific logic:
NPIP4PMY2015_DMHCID.csv
• “DMHCID” should be the PO’s seven-digit P4P DMHC
ID. If you manage more than one PO, provide a separate
list for each organization
• Your P4P DMHC ID can be found on the IHA Analytics
website in your PO’s MY 2014 “VBP4P Worksheets”
download
• If your PO does not know your P4P DMHC ID please
contact [email protected]
CMS EHR Incentive Program Participation
© 2016 Integrated Healthcare Association. All rights reserved. 23
CSV File Layout Example
• Each row represents a provider
• Follow header requirements as shown
• FILES WITH INCORRECT HEADERS WILL NOT BE ACCEPTED
• Sample CSV file sent to all POs on Jan 4, 2016
CMS EHR Incentive Program Participation
© 2016 Integrated Healthcare Association. All rights reserved. 24
ANY FILES WITH PHI WILL BE IMMEDIATELY DELETED;
NO CREDIT WILL BE GIVEN IF FILES ARE DELETED DUE
TO PHI.
ANY FILES THAT DO NOT FOLLOW THE SPECIFIED NPI
FILE FORMAT WILL NOT BE ACCEPTED.
CMS EHR Incentive Program Participation
© 2016 Integrated Healthcare Association. All rights reserved. 25
• Payment lists are updated periodically. P4P staff will use the most
current public files available on April 22, 2016
• Recipients of Medi-Cal EHR Incentive Program Payments can be
found on the DMHC website at:• http://www.dhcs.ca.gov/provgovpart/Pages/EHR_Incentive_Data_and_Reports.aspx
• Recipients of Medicare EHR Incentive Program Payments can be
found on the CMS website at:• http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html
• Scores will be calculated based on percentage of a POs providers in
the publicly available data. For example:
CMS EHR Incentive Program Participation
Calculating Scores
PO Total Providers Providers in public use files
% of providers attesting
Score
100 87 87% .87*25 = 21.75 pts
© 2016 Integrated Healthcare Association. All rights reserved. 26
E-Measures
© 2016 Integrated Healthcare Association. All rights reserved. 27
• Electronic Clinical Quality Measures (e-CQMs) are part of the CMS
EHR Incentive Programs
• Both measures are part of the CMS 2014 CQM Adult Recommended
Core Measures set and are NQF endorsed
• Measures are already programmed into the ONC-ATCB certified
EHR systems of providers who can report the measures – we are
looking for the results from those systems
Clinical Quality e-Measures
© 2016 Integrated Healthcare Association. All rights reserved. 28
Any PO may report the measures (self-reporting and non-self-reporting)
• For self-reporting POs, these measures are reported via the PO Clinical File Layout
• There is a separate file layout provided for non-self-reporting PO submission. The
preliminary files will be available on the IHA website on January 15, 2016
For each measure, collect two metrics:
• The percentage of providers who can report the e-Measure (i.e., report a
numerator and denominator to the PO)
• POs should use the same definition of “PCP” outlined in the NPI data file
specification instructions
• The aggregated numerator and denominator, for providers who can report
the e-Measure
• To calculate, pull the numerators and denominators from the EHR systems of all
providers who can report the measures
Clinical Quality e-Measures
© 2016 Integrated Healthcare Association. All rights reserved. 29
Example
Rate 1:
• The PO has 50 PCPs.
• 40 of the PCPs have an EHR and have the Controlling High Blood Pressure
e-Measure activated in their EHRs.• These 40 PCPs can report an individual performance rate to the PO, with patient numerators
and denominators, for this measure.
Rate 2: The total number of patients in the rates reported by these PCPs
(aggregated, across-PO denominator) is 1,000. Of those 1000 patients, 450 have
a controlled blood pressure.
Clinical Quality e-Measures
© 2016 Integrated Healthcare Association. All rights reserved. 30
• Every PO will collect e-Measure data in different ways
• POs on integrated systems may use a global report to
generate numerators and denominators for providers
across the PO
• IPA type organizations may need to collect numerator
and denominators from individual providers and
aggregate across the PO
EHR Sample Reports
© 2016 Integrated Healthcare Association. All rights reserved. 31
EHR Sample Reports
Individual Report
© 2016 Integrated Healthcare Association. All rights reserved. 32
EHR Sample Reports
Individual Report
© 2016 Integrated Healthcare Association. All rights reserved. 33
EHR Sample Reports
Individual Report
© 2016 Integrated Healthcare Association. All rights reserved. 34
• If all providers can report the Controlling High Blood
Pressure e-Measure, then the percent reportable would
be 100%
• Based on this example from a global report, the percent of
patients whose blood pressure was adequately controlled
would be 81% (74089/91019)
EHR Sample Reports
Global Report
© 2016 Integrated Healthcare Association. All rights reserved. 35
• Exclusions: The MUHIT section of the MY 2015 P4P Manual lists
the optional exclusions for each measure (page 140-141)
• Pediatricians: Pediatricians are to be included in your NPI file
submission. After results have been calculated for the Incentive
Program measure, P4P staff will run the results with and without
pediatricians, and report the higher of the two scores.
• CMS Timing: P4P staff are aware that there can be a lag for an NPI
to appear in the public use files; staff will use the most current public
files available on April 22, 2016. Credit is given for having attested to
Stage 1 or 2 at any time, not just the most recent measurement year.
Frequently Asked Questions
© 2016 Integrated Healthcare Association. All rights reserved. 36
• NPI file submission period: January 4 –
January 29, 2016
• e-Measure submission deadline: May 9, 2016
• Included in PO Clinical Data Submission for self-
reporters
• Separate submission file for non-self-reporters
MUHIT Reminders
© 2016 Integrated Healthcare Association. All rights reserved. 37
Questions?
© 2016 Integrated Healthcare Association. All rights reserved. 38
MY 2016 MeasurementMY 2016 Measure Set
© 2016 Integrated Healthcare Association. All rights reserved. 39
Updated Quality Domain Weights
The MY 2016 measure set is fairly consistent. One of the few changes from MY 2015 is the retirement of the EHR incentive measure and updated domain weights reflect increased focus on clinical quality, patient experience, and collection of e-Measures.
© 2016 Integrated Healthcare Association. All rights reserved. 40
• Measures were tested in MY 2014 and adopted by the P4P Committees
• To be collected in the MY 2015 measure set as baseline measures, which
are not recommended for payment or public reporting
• Intended for inclusion in MY 2016 measure set for both payment and public
reporting
New Paid Measures in MY 2016
© 2016 Integrated Healthcare Association. All rights reserved. 41
Health Plan Adoption of VBP4P
All participating health plans pay physician organization incentives using the IHA measure results. Most participating health plans have committed to adopting the Value Based P4P shared savings design.
Health Plan VBP4P Adoption
Blue Shield of CA MY 2013
Aetna MY 2014*
Cigna MY 2014
UnitedHealthcare MY 2014
Anthem Blue Cross MY 2016
Health Net Quality Incentive
SHARP Health Plan Quality Incentive
Western Health Advantage Quality Incentive
*Data issues encountered in the MY 2014 results collection and reporting delayed implementation of VBP4P shared savings payments
© 2016 Integrated Healthcare Association. All rights reserved. 42
VBP4P Recommended TCC Trend Gate
Standard High Cost PO
MY 2015 CPI+3% CPI+1%
MY 2016, MY 2017 CPI+2% CPI+0%
MY 2018, MY 2019 CPI+1% CPI-1%
Based on data through Nov 2015 CPI estimate for MY 2015 = 1.1%
Balancing the needs for continued improvements in affordability and consistency and
attainable standards, the P4P committees approved the following schedule for the
recommended TCC trend gate thresholds:
© 2016 Integrated Healthcare Association. All rights reserved. 43
VBP4P Attainment Pathway
The attainment pathway has been added as an available feature in the recommended VBP4P design. The recommended design provides POs with the opportunity to earn an attainment incentive by maintaining highly efficient ARU performance. Health plans that have implemented VBP4P may choose to implement the attainment pathway beginning in MY 2015.
Performance Gates
• Quality
• TCC Trend
ARU Improvements
• Shared savings on ARU measures
Quality Adjustment
Net Adjusted Shared Savings
Combined Shared
Savings &Attainment
IncentivePerformance
Gates
• Quality
• TCC Amount
ARU Attainment
• Assess ARU against benchmark
Adjusted Attainment
Incentive
© 2016 Integrated Healthcare Association. All rights reserved. 44
• Submit your NPI files for the CMS EHR Program Participation measure to get credit in the MUHIT Domain
• If you are a self-reporting PO:• Download the preliminary data file layouts from iha.org beginning
tomorrow, January 15th
• Submit the testing measures to get a preview of your performance
• Prepare for MY 2016:• Greater emphasis on clinical quality, patient experience, and e-
measures
• Targeting resource use integral for VBP4P shared savings and attainment
• Stay connected to VBP4P:• Check out the new IHA.org
• VBP4P Newsletter
Takeaways – What to Do Right Now in VBP4P
© 2016 Integrated Healthcare Association. All rights reserved. 45
We are working with the P4P Committees to refine the Outpatient Procedure Utilization – Percentage Done in a
Preferred Facility (OSU) measure and need your feedback to inform these discussions.
• There will be a survey that automatically pops up in a new window after the webinar ends today. Please complete this survey!
• Your feedback via the survey will help inform the process of making the OSU measure a stronger, more meaningful measure.
Further Opportunities for Engagement
© 2016 Integrated Healthcare Association. All rights reserved. 46
Practice Transformation InitiativeIn partnership with the Pacific Business Group on Health
• Is your PO currently pursuing a practice transformation strategy?
• Does your PO have at least 200 primary care clinicians?
• Is your PO interested in using data to help drive change?
• Would your PO benefit from practice coaching, sharing of best practices, and some funding?
If so, PTI may be for you! Spaces are available.
Come learn more at the informational webinar:
Practice Transformation Webinar
Tuesday, February 2nd, 2016
12:00 – 1:00 PM PST
Register Here
Further Opportunities for Engagement
© 2016 Integrated Healthcare Association. All rights reserved. 47
• Questions regarding P4P program and policies should
be directed to [email protected]
• Questions regarding MUHIT should be directed to
• Questions regarding measure specifications should be
submitted through the P4P Policy Clarification Support
(PCS) system at https://my.ncqa.org/. For instructions on
how to submit a question, visit the PCS User Guide
Questions?