Introduction to NCQA & SNP Assessment June 25 and 27, 2013

2 SNP Training – Intro to NCQA & SNP Assessment Program Purpose of Training Provide brief overview of NCQA Describe the SNP assessment program NCQA is executing on behalf of CMS Give a general understanding of main components of SNP assessment – HEDIS ® measures – Structure & Process measures

3 SNP Training – Intro to NCQA & SNP Assessment Program A Brief Introduction to NCQA Private, independent non-profit health care quality oversight organization Founded in Celebrating 23 years Committed to measurement, transparency and accountability Unites diverse groups around common goal: improving health care quality

4 SNP Training – Intro to NCQA & SNP Assessment Program NCQA: Mission and Vision Mission – To improve the quality of health care Vision – To transform health care through measurement, transparency and accountability

5 SNP Training – Intro to NCQA & SNP Assessment Program NCQA: COMMITTED TO MEASUREMENT, TRANSPARENCY, ACCOUNTABILITY Quality measurement means: Use of objective measures based on evidence Results that are comparable across organizations Impartial third-party evaluation and audit Public Reporting NCQA’s quality programs include: Accreditation of health plans using performance data HEDIS clinical measures CAHPS consumer survey Measurement of quality in provider groups Physician Recognition ACOs

6 SNP Training – Intro to NCQA & SNP Assessment Program Achieving the Mission Over 70 percent of all Americans enrolled in health plans that are accredited by NCQA More than 90 percent of managed care organizations report HEDIS ® quality data 41 states and the federal government rely on NCQA Accreditation and HEDIS More than 42,846 clinicians and 5,804 practices* have earned NCQA Recognition; 6 programs form the basis of quality improvement programs and P4P nationwide *As of 5/31/13

7 SNP Training – Intro to NCQA & SNP Assessment Program Objectives of SNP Assessment Program Develop a robust and comprehensive assessment strategy Evaluate the quality of care SNPs provide Evaluate how SNPs address the special needs of their beneficiaries Provide data to CMS to allow plan-plan and year-year comparisons

8 SNP Training – Intro to NCQA & SNP Assessment Program SNP Assessment Process Year-to-Year Approach – Defining and assessing desirable structural characteristics – Assessing processes – Assessing outcomes Two main components – HEDIS Measures-focus on clinical performance – Structure & Process measures-focus on structural characteristics and systems

9 SNP Training – Intro to NCQA & SNP Assessment Program Year-to-Year Strategy FY 2008FY 2009 SNPs Effective as of January 2007SNPs Effective as of January 2008 HEDIS 2008HEDIS 2009 Measure Development 13 existing measures Introduced 2 new measures -- Care for Older Adults -- Medication Reconciliation Post-discharge Structure & Process Measures SNP 1: Complex Case Management SNP 1-3 SNP 2: Improving Member Satisfaction SNP 4: Care Transitions SNP 3: Clinical Quality Improvements SNP 5: Institutional SNP Relationship with Facility SNP 6: Coordination of Medicare & Medicaid

10 SNP Training – Intro to NCQA & SNP Assessment Program Year-to-Year Strategy FY 2010 FY 2011 SNPs Effective as of January 2009 SNPs Effective as of January 2010 HEDIS 2010 HEDIS 2011 Measure Development  Same as existing measures In development for 2011 Plan all-cause readmissions Introduced 1 new measure -- Plan all-cause readmissions Structure & Process Measures  Refinement of existing measures: SNP 4 & 6  Increased focus on evidence of implementation  Clarified requirements  Moved analyses to separate elements

11 SNP Training – Intro to NCQA & SNP Assessment Program Year-to-Year Strategy FY 2012 FY 2013 SNPs Effective as of January 2011 SNPs Effective as of January 2012 HEDIS 2012 HEDIS 2013 Measure Development 16 existing measures Includes 14 Effectiveness of Care Measures plus: --Plan all-cause readmissions --Board Certification Includes 14 Effectiveness of Care Measures plus: --Plan all-cause readmissions --Board Certification Clarified reporting requirements and methodology Structure & Process Measures  Enhanced documentation requirements  Clarified measure language  Strengthened focus on quality improvement and implementing interventions Changed requirements for SNP 1 from Case Management to Care Management—focus on assessment and individualized care plans Revised some existing requirements for SNP 2, SNP 3 and SNP 4

12 SNP Training – Intro to NCQA & SNP Assessment Program Project Time Line 2013 June 17 – HEDIS submissions due to NCQA June & July – NCQA Releases 2013 Structure and Process measures in hardcopy and in ISS June through September– S&P Training for SNPs October 15, 2013 – S&P Measure submissions due to NCQA October 15, 2013 to April 30, S&P reviews conducted by NCQA and Surveyors June 2014– NCQA Delivers Final Report to CMS

HEDIS 101

14 SNP Training – Intro to NCQA & SNP Assessment Program What Is HEDIS? H ealthcare E ffectiveness D ata & I nformation S et HEDIS is an evolving set of standard specifications for measuring health plan performance

15 SNP Training – Intro to NCQA & SNP Assessment Program Where Did HEDIS Come From? Originally developed by employers and the HMO group in 1991; NCQA took charge of HEDIS in 1992 Expanded in 1996 to cover all three product lines: commercial, Medicare and Medicaid Addresses the leading causes of death and morbidity Includes information on quality, utilization and cost

16 SNP Training – Intro to NCQA & SNP Assessment Program How Are HEDIS Data Used? Federal, state and other regulatory requirements Performance-based accreditation Health plans use for RFP/RFI preparation Quality improvement activities and health plan operations

17 SNP Training – Intro to NCQA & SNP Assessment Program Data Reporting Data are reported to NCQA in June of the reporting year Data reflect events that occurred during the measurement year (calendar year)

18 SNP Training – Intro to NCQA & SNP Assessment Program Data Reporting Example: – HEDIS 2013 data are reported in June 2013 – Data reflects events that occurred January–December 2012 (per specs) – HEDIS 2013 = 2012 data

19 SNP Training – Intro to NCQA & SNP Assessment Program Effectiveness of Care Measures Clinical quality of care Focus – Preventive care – Up-to-date treatments for acute episodes of illness – Chronic disease care – Appropriate medication treatment

Collecting HEDIS Data

21 SNP Training – Intro to NCQA & SNP Assessment Program Three HEDIS Data Sources Administrative Medical Records Surveys ClaimsEncounterEligibilityProvider

22 SNP Training – Intro to NCQA & SNP Assessment Program Selecting an Eligible Population Member ID Age (DOB) Enrollment date and type Dates of service Diagnosis and procedure codes Provider specialty Pharmacy

23 SNP Training – Intro to NCQA & SNP Assessment Program Defining the denominator is critical Administrative: Claims and encounter data – Denominator: Based on all eligible members of the population Clinical Measures Data Collection

Structure & Process Measures

25 SNP Training – Intro to NCQA & SNP Assessment Program What is a S&P Measure? A statement about acceptable performance or results Assesses a plan’s ability to comply with specific requirements Focus on systems necessary for quality care – Policies & procedures, reports, materials

26 SNP Training – Intro to NCQA & SNP Assessment Program How are S&P Measures Developed Similar to HEDIS measure development Initial literature review and evidence Geriatric Measurement Advisory Panel (GMAP) – Diverse set of expert stakeholders – Technical expert panels also formed, if necessary Pilot Tests/Public Comment – Determine feasibility/burden – Input from stakeholders Final approval from GMAP and CMS

27 SNP Training – Intro to NCQA & SNP Assessment Program Components of the S&P Measure Standard Statement A statement about acceptable performance or results

28 SNP Training – Intro to NCQA & SNP Assessment Program Components of the S&P Measure Intent Statement A sentence that describes the importance of the S&P measure

29 SNP Training – Intro to NCQA & SNP Assessment Program Components of the S&P Measures Components of an S&P Measure ELEMENT FACTORS SCORING DATA SOURCES

30 SNP Training – Intro to NCQA & SNP Assessment Program Components of an S&P Measure The period of time for which NCQA evaluates the SNPs documentation to assess performance against an element The extent of the organization’s services evaluated during an NCQA survey.

31 SNP Training – Intro to NCQA & SNP Assessment Program Components of an S&P Measure Descriptive information illustrating performance against an element’s requirements. Examples are for guidance and are not intended to be all-inclusive Guidance for demonstrating performance against the element

32 SNP Training – Intro to NCQA & SNP Assessment Program Data Source Types Documented Process Reports Materials

33 SNP Training – Intro to NCQA & SNP Assessment Program Data Source Types--Process This policy applies to all ABC Health staff unless otherwise noted. Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Nam nibh. Nunc varius facilisis eros. Sed erat. In in velit quis arcu ornare laoreet. Curabitur adipiscing Bibendum a, adipiscing vitae, commodo et, dui. Ut tincidunt tortor. Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Nam nibh. Nunc varius facilisis eros. Sed erat. In in velit quis Documented Process

34 SNP Training – Intro to NCQA & SNP Assessment Program Data Source Types--Reports Report

35 SNP Training – Intro to NCQA & SNP Assessment Program Data Source Types—Reports (cont’d)

36 SNP Training – Intro to NCQA & SNP Assessment Program Data Source Types--Materials Materials

2013 Assessment Against S&P Measures

38 SNP Training – Intro to NCQA & SNP Assessment Program SNP Assessment Process S&P Measures assessment – Data collection through Web-based Interactive Survey System (ISS) survey tool. Several levels of review: – Off-site Review (Level 1) – Executive Review/Plan Comment (Level 2) – Final Eyes (Level 3) – Final Stage Review (Level 4)

39 SNP Training – Intro to NCQA & SNP Assessment Program S&P Assessment Plan Comment Period – Plans will have an opportunity to provide additional information to clarify issues from original submission materials – Quick turnaround: Plans will have to respond to NCQA requests for more information rapidly – One-time opportunity: Only chance plans have to provide additional documentation before data is finalized and sent to CMS

40 SNP Training – Intro to NCQA & SNP Assessment Program S&P Assessment Plan Comment Period (continued) – If you have questions, please contact a SNP team member immediately – Please ensure additional data submitted is within the look-back period or it will not meet the requirements

41 SNP Training – Intro to NCQA & SNP Assessment Program Final Stage Review Occurs after plans receive preliminary final scores One last opportunity for review Only for scoring inconsistencies – Radio buttons and support text language differ – Different scores for similar SNP PBPs No new documentation will be reviewed

42 SNP Training – Intro to NCQA & SNP Assessment Program Look-Back Period What is the Look-Back Period & how does it work? – The look-back period is the six-month period prior to survey submission – April 15, 2013 to October 15, All documentation must be current as of the look-back period but it could have been developed before that time. – Data used for reports can go back up to 1 year prior to submission, unless the explanation indicates otherwise. – For evidence consisting of a policy, an organization that did not have one in place can develop and incorporate it into its operations during the look-back period.

43 SNP Training – Intro to NCQA & SNP Assessment Program Who Reports HEDIS measures – All SNP plan benefit packages with 30+ members as of February 2012 Comprehensive Report (CMS website) S&P measures – All SNP plan benefit packages – Plans with zero enrollment are exempt for certain elements

44 SNP Training – Intro to NCQA & SNP Assessment Program SNP Reporting Returning SNPs— all SNPs that were operational as of January 1, 2012 AND renewed for 2013 AND have previously submitted. – SNP 1-6 New SNPs — all SNPs operational as of January 1, 2012 AND renewed for 2013 AND are reporting for the first time. – SNP 1 A-D, SNP 2, SNP 4-6

45 SNP Training – Intro to NCQA & SNP Assessment Program 2013 S&P Measures SNP 1: Care Management – Major changes to measure to align with MOC requirements – All SNP Types – Focus on assessment, individualized care plans, how SNPs coordinate services and manage care for members SNP 2: Member Satisfaction – Added examples – All SNP Types – Focus on monitoring member satisfaction to identify areas for improvement & take action

46 SNP Training – Intro to NCQA & SNP Assessment Program S&P Measures: What’s New for 2013 SNP 3: Clinical Quality Improvement – revised methodology for calculating significant improvement to address small numbers – All SNP types – Focus on demonstrating quality improvement SNP 4: Care Transitions – Added new factor in Element E – All SNP Types – Focus on how SNPs manage and support members through planned and unplanned transitions in care

47 SNP Training – Intro to NCQA & SNP Assessment Program S&P Measures: What’s New for 2013 SNP 5: Institutional SNP Relationship With Facility – No major changes – I-SNPs only – Focus on how SNPs communicate with facilities to monitor services and members’ needs SNP 6: Coordination of Medicare and Medicaid Coverage – No major changes – Different requirements for Duals and I & C SNPs – Focus on coordination and administration of benefits for Duals

SNP Data & Reporting

49 SNP Training – Intro to NCQA & SNP Assessment Program Data Submissions S&P measures – Submission date: October 15, 2013 – ISS data collection tool – No Fees required to submit – All SNPs that were operational as of January 1, 2012, AND renewed in – Plans with zero enrollment are exempt for certain elements NCQA will verify enrollment using CMS Comprehensive Report—publicly available enrollment data

50 SNP Training – Intro to NCQA & SNP Assessment Program What happens after submission? NCQA Analysis of HEDIS and S&P measures – Comparison to MA plans (HEDIS) and to other SNPs – Demographic (size, type, region) – Statistical significance Deliver report to CMS – CMS will make all decisions regarding the use of the data – NCQA will not publicly report any of the SNP data

51 SNP Training – Intro to NCQA & SNP Assessment Program And now… Questions?

52 SNP Training – Intro to NCQA & SNP Assessment Program Contacts Brett Kay Assistant Vice President, SNP Assessment Casandra Monroe Assistant Director, SNP Assessment Sandra Jones Assistant Director, SNP Assessment

53 SNP Training – Intro to NCQA & SNP Assessment Program Contacts Anthony Davis Accreditation Manager, SNP Assessment Nidhi Dalwadi Accreditation Manager, SNP Assessment

54 SNP Training – Intro to NCQA & SNP Assessment Program Contacts Priyanka Oberoi Accreditation Manager, SNP Assessment Ling Chen Accreditation Manager, SNP Assessment Delia Ponce Coordinator, SNP Assessment

55 SNP Training – Intro to NCQA & SNP Assessment Program Additional Resources NCQA SNP Webpage: FAQs – Training descriptions & schedule – Final HEDIS and S&P measures NCQA Policy Clarification Support (PCS) HEDIS Audit information

56 SNP Training – Intro to NCQA & SNP Assessment Program Additional Information HEDIS 2013 Volume 2 Publication Specifications Update

57 SNP Training – Intro to NCQA & SNP Assessment Program Additional SNP Trainings Introduction to NCQA & SNP Assessment – June 25 ~ 2-4:00 pm – June 27 ~ 2-4:00 pm Structure and Process Measures (S&P 1-3) – July 9 ~ 2-4:00 pm – July 11 ~ 2-4:00 pm – July 16 ~ 2-4:00 pm

58 SNP Training – Intro to NCQA & SNP Assessment Program Additional SNP Trainings Structure and Process Measures (S&P 4-6) – July 18 ~ 2-4:00 pm – July 24 ~ 2-4:00 pm – July 30 ~ 2-4:00 pm Interactive Survey System (ISS) – August 6 ~ 2-3:30 pm – August 13 ~ 2-3:30 pm – September 12 ~ 2-3:30 pm

59 SNP Training – Intro to NCQA & SNP Assessment Program Additional SNP Seminars Open Door Forums – August 15 ~ 2-3:00 pm – September 10 ~ 2-3:00 pm – September 25 ~ 2-3:00 pm