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BALANCING INCENTIVE PROGRAM NATIONAL CALL CMS in collaboration with Mission Analytics Group and New Editions Consulting January 15 th, 2014.

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Presentation on theme: "BALANCING INCENTIVE PROGRAM NATIONAL CALL CMS in collaboration with Mission Analytics Group and New Editions Consulting January 15 th, 2014."— Presentation transcript:

1 BALANCING INCENTIVE PROGRAM NATIONAL CALL CMS in collaboration with Mission Analytics Group and New Editions Consulting January 15 th, 2014

2 Presentation Outline 1. CMS Updates 2. Mission Analytics Updates 3. Disseminating Quality Data 4. State Updates

3 Medicaid Adult Core Set  Core Set of 26 measures identified through multi- stakeholder process and publicly released in 2012  Voluntary reporting  Began December 2013  CMS updates technical specifications manual annually  Technical Assistance and Analytic Support Program for states  Improvements to Core Sets are required (first update released Dec 2013)  Core measure data feeds into information loop  CMS collects, analyzes, and make publicly available the information reported by the states (Annual Secretary’s Reports, Reports to Congress)  States use data to drive quality improvement

4 Adult Medicaid Quality Grant Program  25 states participating in a two-year grant program that began December 2012  Three grant program goals: 1. Collect and report Adult Core Set measures in varying delivery care settings (e.g. managed care, fee-for-service, long term care settings such as nursing homes and intermediate care facilities) 2. Develop staff capacity to report, analyze, and use data for monitoring and improving access and the quality of care in Medicaid 3. Conduct at least two Medicaid quality improvement projects relating to Adult Core Set measures

5 Adult Medicaid Quality Grant Program  Grantees’ quality improvement topics relevant to BIP grantees:  Care transitions from nursing facilities  Initiation and treatment of substance use  Integration of physical and behavioral health  Follow-up care for mental health hospitalizations  Chronic conditions (diabetes, adult asthma, cardiovascular health)

6 States must report to CMS the methodology for collecting…  Service data: Reports all community long-term services and supports individuals receive at the individual level  Quality data: Captures the extent to which providers are supplying comprehensive, quality care  Outcomes data: Assesses beneficiary and family caregiver experience and satisfaction with providers

7 Methods for Collecting Quality Data  Clinical measures  Medicaid Adult Health Care Quality Measures (6)  Healthcare Effectiveness Data and Information Set (HEDIS) (6)  Waiver performance measures (5)  Other mechanisms  Money Follows the Person (MFP) Quality of Life survey (4)  State-specific surveys and reports (4)  Assessment data (1)

8 Analyzing and Disseminating Findings  Identifies systemic and plan- or provider- specific issues  Encourages quality improvements  Engages stakeholders

9 Method 1: Discussions with Case Managers and Providers Georgia:  State data quality and measures group reviews Healthcare Effectiveness Data and Information Set (HEDIS) measures and identifies trends within each waiver program  Data group meets monthly or quarterly with providers and case managers to: Discuss source of identified trends. Suggest best practices to remedy trends.

10 Georgia Performance Improvement Plan

11 Method 2: Provider-Specific Reports and Follow Up Maryland:  Waiver reports with provider-specific data are mailed to providers  Corrective and preventive action plans are required

12 Method 2: Provider-Specific Reports and Follow Up New York:  Plan-specific quality data are distributed to the respective managed care plans  Plans will be soon be able to access crude quality indicator (HCQI) reports directly from the state’s Uniform Assessment System (UAS-NY)*  The UAS-NY will include features that allow: Automatic production of the crude HCQI reports. The NYS Office of Quality and Patient Safety to review and “approve” the reports before they can be accessed by plans. * The crude reports are not risk adjusted nor do they represent all of the information on quality data that will be available to plans.

13 Method 3: Online Report  Makes plan- and provider-level performance public  Encourages plans and providers to improve performance to attract clients  Augments transparency and accessibility

14 Method 4: Collaborate with the state EQRO Illinois:  The Illinois Department of Healthcare & Family Services, State Medicaid Agency, contracts with the Health Services Advisory Group (HSAG) to serve as the External Quality Review Organization (EQRO) for the state’s Managed Care Organizations (MCOs).  The EQRO performs external oversight, monitoring, and evaluation of the quality assurance component of managed care.  The EQRO process includes review of MCO compliance with State standards for access to care, structure and operations, and quality measurement and improvement.  Validation of Performance Measures & PIPs  Monitoring of Corrective Action Plans

15 Method 4: Collaborate with the state EQRO (continued) Illinois:  HSAG findings are communicated to the MCO’s and stakeholders via: Monthly conference calls Written report following the EQRO’s on-site record review for the MCOs Quarterly face to face meetings EQR Technical Report: aggregated information on quality, timeliness, and access to health care services that the MCOs furnish to Medicaid recipients Development of a Performance Tracking Tool (PTT) to be used by each MCO to monitor and trend results for each performance measure Stakeholder meetings

16 Program Resources  Approved State applications and Work Plans Approved State applications and Work Plans  Revised Implementation Manual, FAQs, State Summaries, State Profiles, and other resources Revised Implementation Manual, FAQs, State Summaries, State Profiles, and other resources  CMS:   Mission Analytics: 

17 Quality Data Resources  Adult Core Set Measures Adult Core Set Measures  CMCS Informational Bulletin outlining 2014 update to Adult Core Set CMCS Informational Bulletin outlining 2014 update to Adult Core Set  2013 Technical Specifications and Resource Manual 2013 Technical Specifications and Resource Manual  Adult Medicaid Quality Grant Program Adult Medicaid Quality Grant Program  States can submit measurement questions to:

18 NQF #Measure NameMeasure Steward 0039Flu Shots for Adults Ages 50-64NCQA n/aAdult BMI AssessmentNCQA 0031Breast Cancer ScreeningNCQA 0032Cervical Cancer ScreeningNCQA 0027Medical Assistance with Smoking and Tobacco Use CessationNCQA 0418Screening for Clinical Depression and Follow-Up PlanCMS 1768Plan All-Cause ReadmissionNCQA 0272PQI 01: Diabetes, Short-Term Complications Admission RateAHRQ 0275PQI 05: Chronic Obstructive Pulmonary Disease (COPD) Admission Rate AHRQ 0277PQI 08: Congestive Heart Failure (CHF) Admission RateAHRQ 0283PQI 15: Adult Asthma Admission RateAHRQ 0033Chlamydia Screening in Women Ages 21-24NCQA 2014 Adult Core Measure Set

19 Adult Core Measure Set (continued) NQF #Measure NameMeasure Steward 0576Follow-Up After Hospitalization for Mental IllnessNCQA 0469PC–01: Elective DeliveryJoint Commission 0476PC–03 Antenatal SteroidsJoint Commission 2082Viral Load SuppressionHRSA 0018Controlling High Blood PressureNCQA 0063Comprehensive Diabetes Care: LDL–C ScreeningNCQA 0057Comprehensive Diabetes Care: Hemoglobin A1c TestingNCQA 0105Antidepressant Medication ManagementNCQA 1879Adherence to Antipsychotics for Individuals with SchizophreniaCMS 0021Annual Monitoring for Patients on Persistent MedicationsNCQA 0006/000 7 CAHPS Health Plan Survey v 4.0—Adult Questionnaire with CAHPS Health Plan Survey v 4.0H—NCQA Supplemental AHRQ, NCQA 0648Care Transition—Transition Record Transmitted to Health Care Professional AMA-PCPI 0004Initiation and Engagement of Alcohol and Other Drug Dependence Treatment NCQA 1391Prenatal and Postpartum Care: Postpartum Care RateNCQA


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