1 Outline Development Timeline Development Team Quality Domains and WeightingCriteria for Measure SelectionMeasure Overview by Domain, Changes since initial ProposalQuality ScoringBenchmark SourcesMinimum Attainment LevelPoints systemSample Size
2 Quality Framework Development Aug 2013 – Feb 2014Convened AC Quality Framework TeamSep 30, 2013Presented proposed measures to Pathways to Excellence Physician and Systems for feedbackNov 2013Posted proposed Quality Framework (measures and scoring) on VBP website for public commentNov – Jan 2014Presented proposal to CMS, incorporated provider and CMS feedback, received informal approval
3 Quality Framework Team MaineCareHealth Homes/ Behavioral Health Homes representationDHHS Office of Substance Abuse and Mental Health ServicesDHHS Office of Continuous Quality ImprovementImproving Health Outcomes for Children (IHOC)Maine Health Management CoalitionPathways to ExcellenceAccountable Care Implementation (ACI)Maine State Innovation Model (SIM)HealthInfoNetMaine Quality CountsUniversity of Southern Maine, Muskie
4 Commitment to Annual Re-evaluation, Alignment State Innovation Model objectiveCMS directive
5 26 Measures Across 4 Quality Domains: 18 tied to payment Percent of Total ScoreCore PerformanceElective PerformanceMonitoring & Evaluation OnlyPatient Experience10%1Care Coordination/ Patient Safety30%42Preventive HealthAt-Risk Populations653Total100%15(must select 3)
6 Main Criteria for Selection of Metrics Metrics measure success of the Triple AimAddress populations and needs prevalent in MedicaidChildrenBehavioral healthLong Term Services & SupportsChronic conditionsMaximize alignment of metrics with currently reported metrics in the State and nationally (Medicare ACOs, Health Homes, PTE, IHOC, etc) to the extent feasible and appropriateMinimize reporting burden to providers, to extent feasibleKeep number of metrics to a reasonable numberPreference for claims-based measuresPhase in of pay for performance for non claims-based measures
7 Emphasize Alignment 9 measures align with Medicare ACO Out of those that don’t6 children specific4 Behavioral Health measuresAll others align with Health Homes; 2 with Meaningful Use19 measures align with Health Homes (4 with CMS Core Health Home measures)9 measures align with Meaningful Use5 align with CMS Core Adult Quality Measures4 align with CHIPRA5 align with IHOC
8 Minimize reporting burden to providers 22 of 26 measures are claims-based2 HbA1c Clinical measures will be reported through HealthInfoNet: Reporting only in Year 11 EHR measure will be reported by State using Meaningful Use reporting data1 Patient Experience measure will be reported by providers through national database: Reporting only on full population
9 Quality Domain: Patient Experience Percent of Total ScoreCore PerformanceElective PerformanceMonitoring & Evaluation Only10%Clinician Group CAHPSAlignment with Maine Quality Forum Patient Experience Matters InitiativeHope to achieve funding for 2014 survey administration; 2015 reporting through central national CAHPS databasePhase-in: Reporting only in Years 1-3All payer populationsIntent to focus on Medicaid population only in Year 3CG CAHPS is not a requirement for participation in Accountable Communities, but is required to achieve full quality score.
10 Quality Domain: Care Coordination/ Patient Safety Percent of Total ScoreCore PerformanceElective PerformanceMonitoring & Evaluation Only30%ACSC AdmissionsNon-emergent ED Use% PCPs qualifying for EHR Incentive PaymentAll-Cause ReadmissionsUse of High-Risk Medications in the ElderlyCardiovascular Health Screening for People on Antipsychotic MedsImaging for low back painChange from Initial Proposal:Changed Imaging for low back pain from Core to Monitoring due to lack of ideal benchmark goal
11 Monitoring & Evaluation Only Preventive HealthPercent of Total ScoreCore PerformanceElective PerformanceMonitoring & Evaluation Only30%Well-Child Visits ages 0-15 mo,Well-Child Visits ages 3-6 and 7-11Adolescent Well-Care Visit (12-20)Developmental Screening - First 3YrsChange from Initial Proposal:Removed Breast Cancer Screening Measure, but committed to CMS to add again once measure modifications are approved for NQF to align with new clinical guidelinesAdded Well-Child Visits ages 0-15 mo
12 Quality Domain: At-Risk Populations Percent of Total ScoreCore PerformanceElective PerformanceMonitoring & Evaluation Only30%AsthmaMedication Management (adults)DiabetesGlucose Control (HbA1c) (adults)Eye CareLDLBehavioral HealthFollow-Up After Hospitalization for Mental IllnessInitiation & Engagement of Alcohol & Other Drug Dependence TxMedication Management (children)HbA1c testing (adults)NephropathyCoronary artery diseaseCholesterol Management for Patients with Cardiovascular ConditionsCOPDSpirometry TestingGlucose Control (HbA1c) (children)HbA1c testing (children)Behavioral Health/ Long Term CareOut of home placement days
13 Quality Domain: At-Risk Populations (Cont.) Change from Initial Proposal:Behavioral Health measures changed to this domain from Care Coordination/ Patient SafetyAddition of Glucose Control (HbA1c) clinical measuresCMS required one clinical outcome “stretch” measureWill be collected through HealthInfoNet (HIN) lab dataHIN will leverage result information it is sending providersReporting Only in Year 1 (lab results must be sent to HIN during performance year)Years 2 & 3 scored on performanceHbA1c testing for children changed to Monitoring from Elective
14 Benchmark SourcesUse of national Medicaid data wherever available.Where not available, DHHS will utilize:MaineCare Health Homes and PCCM dataNational Medicare dataMaine EHR Meaningful Use incentive program dataShould a national Medicaid benchmark become available, the Department will begin use of that benchmark in the next performance year after it becomes available.
15 Minimum Attainment Level Minimum attainment level (MAL) of 30th percentile to receive score on individual measureAC is Eligible for shared savings payment if it meets MAL on at least one measure in each of three pay for performance domains (Patient Experience excluded)MAL on <70% of measures in a domainWarning and/or corrective action plan.Failure to meet the standard may result in termination and disqualification from shared savings.
16 Quality Scoring: Points per Measure EHR measure is worth up to 4 ptsAll other measures worth up to 2 pts eachAC Performance LevelQuality Points per MeasureEHR Measure Quality Points90+ percentile or percent benchmark2 points4 points70+ percentile or percent benchmark1.7 points3.4 points50+ percentile or percent benchmark1.4 points2.8 points30+ percentile or percent benchmark1.1 points2.1 points<30 percentile or percent benchmarkNo points
17 Quality Scoring: Points per Domain # Core Measures# Elective Measures (must choose 3)Total Possible Points Per DomainDomain WeightPatient/ Caregiver Experience1210%Care Coordination/ Patient Safety410 – 1230%Preventive Health8At-Risk Population65Total15(choose 3)38100%
18 Sample SizeMinimum sample size of 100 MaineCare members to enable scoring on performance on a measureIf there are no score-able measures in one domain, weighting will be equally distributed across remaining domainsSelection of Elective measures should take into account likely sample size
19 Thank you. michelle. probert@maine. gov https://www. maine