Medi-Cal P4P Core Measure Set - Integrated … P4P Core Measure Set © 2016 Integrated Healthcare...

Project Overview

November 2016

Medi-Cal P4P Core Measure Set

© 2016 Integrated Healthcare Association. All rights reserved. 2

Health care measurement important to assess health system performance and improve care delivered

Number and scope of measures providers held accountable for steadily increasing

Lack of alignment across incentive programs creates unnecessary burdens on providers and confusion among consumers

As Medi-Cal enrollment increases and Medi-Cal shifts to managed care, imperative emerging for consistent performance measurement

Performance Measurement Landscape


Medi-Cal P4P Inventory: Program Prevalence

Medi-Cal P4P Programs: 2014

Of the 20 Medi-Cal managed care plans interviewed, 16 have pay-for-performance programs in place

The P4P programs vary in extent and approach

Overview of Current P4P Activities

Number of Plans

P4P Programs in Place 16

Just Starting 1

Started 2009 - 2013 5

Started 2004 - 2008 3

Started 2003 and before 7

No P4P Program in Place 4

Total 20


Why do we need greater standardization?

Only 1 measure aligns across all programs:

Diabetes HbA1c Testing

California Health & Wellness

Cal Optima

CenCal

Central California Alliance

Health Net

Health Plan of San

JoaquinHealth

Plan of San Mateo

Inland Empire Health

Plan

Kern Health

Systems

LA Care

Partnership

San Francisco

Health Plan

Anthem

Medi-Cal

Only 2 measures align across all programs:

1. Controlling Blood Pressure for People with Hypertension

2. Diabetes: Medical Attention for Nephropathy

Federal Quality Rating

System for Covered

California

CMS & AHIP Core Quality

Measures Collaborative

Medicare Advantage

Stars

IHA Value Based P4P

DHCS External Accountability

Set

Cross Product

Only one measure out of 86 distinct measures align across all programs (based on IHA’s 2014 inventory)

Only two measures align across all measure sets


Reduce unnecessary burdens associated with the lack of

alignment across incentive programs

Enhance provider effectiveness by “strengthening the

signal” –focus improvement efforts and resources

Facilitate the comparability of performance results and

benchmarking statewide

Benefits of a Core Measure Set


Convene an Advisory Committee to provide expertise and guidance across project activities

Identify a core measure set that all plans could adopt as a part of their P4P programs

Develop a menu of additional measures that plans can use to supplement the core measure set at the local level as well as a set of incentive design principles and best practices

Funding – Blue Shield of CA Foundation

Timeline: April 2015 – March 2016

Medi-Cal P4P Core Measure Set


Health Plans Alameda Alliance for Health Anthem Blue Cross California Health & Wellness CalOptima Care 1st CenCal Health Central California Alliance for Health Gold Coast Health Plan Health Net Health Plan of San Joaquin Health Plan of San Mateo Inland Empire Health Plan Kern Health Systems LA Care Health Plan Molina Healthcare of California Partnership Health Plan San Francisco Health Plan UnitedHealthcare

Standardizing Medi-Cal Advisory Committee

Collaborators American Institutes of Research Blue Shield of California Foundation California HealthCare Foundation California Quality Collaborative Center for Care Innovations Center for Health Care Strategies Health Services Advisory Group John Snow, Inc.

Provider Representatives Alameda Health Consortium AltaMed CHOC Health Alliance Community Clinic Association of Los Angeles County Community Medical Centers County of San Mateo Family Care Specialists Medical Group Hill Physicians Integrated Health Partners Omnicare Medical Group IPA Palo Alto Medical Foundation San Mateo Medical Center Santa Clara Valley Health & Hospital System Santa Rosa Community Health Centers Shasta Community Health Center SynerMed West County Health Center

Associations California Association of Health Plans California Primary Care Association CAPG Local Health Plans of California Safety Net Institute

California Department of Health Care Services


Medi-Cal P4P Continuum

8

Voluntary Core

Measure Set; shared

specifications and

benchmarks

Voluntary Core & Supplemental

menu of measures;

shared specifications

and benchmarks

Quality based P4P in Medi-Cal; Core and Supplemental measure set

and incentive design

required; payment

amount not required

Quality based P4P in

Medi-Cal; payment amount required

Value based P4P in

Medi-Cal; payment based on

quality and resource use

Voluntary Core and

Supplemental menu of

measures and incentive

design options

IHA’s Standardizing Medi-Cal P4P Project

Current Status Medi-Cal P4P –Uniform/Broad Adoption

COORDINATION / COLLABORATIONLESS MORE

No formal coordination/collaboration;

Variation in performance measurement

& incentive design


Project Scope

WHAT THE PROJECT IS: WHAT THE PROJECT IS NOT:

1Incorporating a core measure set, developed by an Advisory Committee, into all Medi-Cal Managed Care P4P programs (voluntary)

Developing a new P4P program, similar to IHA’s commercial program, that all Medi-Cal plans can adopt

2Focusing provider level measurement on a subset of measures included in DHCS’s EAS

Focusing plan level measurement on all of the measures included in DHCS’s EAS, or on measures not included in the EAS

3Varying the unit of measurement by health plans and their contracted provider entities

Standardizing performance measurement at the physician group level across all Medi-Cal plans

4Potential for providing comparative data benchmarked to peers and national metrics, for internal reporting only

Publicly reporting provider performance data

5Creating a recommended approach to data collection and reporting for plans to consider

Developing a standard data collection method to be used across all plans

6Sharing incentive design best practices with participating health plans to facilitate discussion

Creating greater standardization of incentive design structures or universal adoption of one incentive design structure


IMPORTANCEThe core measure set for Medi-Cal P4P programs will measure areas

that have the greatest impact on Medi-Cal patients.

SCIENTIFIC

ACCEPTABILITY

The core measure set will include measures that are evidence-

based and have been appropriately vetted, endorsed, and

approved.

USEFULNESSThe core measure set will include measures in priority areas where

plans and providers have room for improvement and are able to

demonstrate meaningful changes in performance.

ALIGNMENT

The core measure set will align with other existing performance

measurement requirements for Medi-Cal providers and existing

Medi-Cal P4P programs in order to minimize resource demands and

allow for comparison across managed care plans and populations.

FEASIBILITYThe core measure set will include measures that have clear

specifications and data collection methodologies that do not

impose an undue burden on plans and their contracted providers.

Measure Selection Principles


Key features of the Core Measure Set:• No more than 10 measures

• Included in DHCS’s External Accountability Set

• Feasible for a wide array of providers to report using administrative only data

Core Measure Set Overview

CORE MEASURE SET

Domain Measures Steward NQF #

CardiovascularAnnual Monitoring for Patients on Persistent Medications: ACE or ARB NCQA 0021

Annual Monitoring for Patients on Persistent Medications: Diuretics NCQA 0021

Diabetes Care

HbA1c Testing NCQA 0057

HbA1c Control (<8.0%) NCQA 0575

Eye Exam NCQA 0055

Maternity Timeliness of Prenatal Care NCQA 1517

Prevention

Childhood Immunizations, Combo 3 NCQA 0038

Well-Child Visits in 3rd, 4th, 5th, and 6th Years of Life NCQA 1516

Cervical Cancer Screening NCQA 0032

Respiratory Asthma Medication Ratio NCQA 1800


A menu or library of additional measures that plans can use to supplement the core measure set at the local level

Selection Criteria:

1. EAS measures that were not included in the core measure set

2. Additional measures currently included in Medi-Cal P4P programs

3. Measures included in more than one of the other existing performance measurement requirements for Medi-Cal plans and providers, including:

o DHCS EAS

o Covered California’s Quality Rating System

o NCQA Medicaid Managed Care Health Plan Accreditation Standards

o CMS Medicaid Core Measures for Adults and Children

Supplemental Measure Set Overview


Supplemental Measure SetAccess Children and Adolescents’ Access to PCPs NCQA 1390

Behavioral Health /

Substance Abuse

Antidepressant Medication Management NCQA 0105

Follow-Up for Children Prescribed ADHD Medication NCQA 0108

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment NCQA 0004

Cardiovascular Controlling blood pressure for people with hypertension NCQA 0018

Diabetes Care

Blood Pressure Control <140/90 mm Hg NCQA 0061

HbA1c Poor Control >9% NCQA 0059

Medical Attention for Nephropathy NCQA 0062

Maternity Timeliness of Postpartum Care NCQA 1517

Musculoskeletal Overuse of Imaging Studies for Low Back Pain NQCA 0052

Prevention

Adolescent Well-Care Visits NCQA n/a

Adult BMI Assessment NCQA n/a

Breast Cancer Screening NCQA 2372

Childhood Immunizations, Combo 10 NCQA 0038

Chlamydia Screening NCQA 0033

Colorectal Cancer Screening NCQA 0034

Flu Vaccinations for Adults Ages 18-64 NCQA 0039

Human Papillomavirus Vaccine for Female Adolescents NCQA 1959

Immunizations for Adolescents NCQA 1407

Medical Assistance with Smoking & Tobacco Cessation NCQA 0027

Weight Assessment & Counseling for Nutrition & Physical Activity for Children & Adolescents: NCQA 0024

Well-Child Visits in the First 15 Months of Life (6 or more visits) NCQA 1392

Respiratory

Appropriate Testing for Children with Pharyngitis NCQA 0002

Appropriate Treatment for Children with URI NCQA 0069

Avoidance of Antibiotic Treatment for Adults with Acute Bronchitis NCQA 0058

Resource UseAll-Cause Readmissions NCQA 1768

Emergency Department Visits NCQA n/a


• Core measure set adoption underway – intent to adopt by 9 plans for MY 2017, partial adoption by 6 more

Adoption Efforts to Date

Intent to adopt for MY 2017 Partial adoption for MY 2017

1. Alameda Alliance 1. CalOptima

2. Anthem Blue Cross 2. CalViva

3. California Health & Wellness 3. Health Net

4. Care 1st 4. Health Plan of San Joaquin

5. CenCal 5. Health Plan of San Mateo

6. Central California Alliance for Health 6. Partnership Health Plan

7. Inland Empire Health Plan

8. LA Care

9. San Francisco Health Plan


Next Phase of Standardizing Medi-Cal P4P

Create greater measure set alignment across the policy landscape

Support the implementation of the core measure set across all Medi-Cal P4P programs

Spread the adoption of the core measure set to plans not participating on the Advisory Committee

Funding – CMMI (included in Transforming Clinical Practices Initiative grant awarded to PBGH/CQC)

March 2016 – February 2018


Objective:

• Identify opportunities for greater measure set alignment across the policy environment

Planned Activities:

• Identify initiatives underway or planned in Medi-Cal & the safety net

• Develop crosswalk of key initiatives to use as a resource toward creating a shared performance measurement strategy

• Summarize findings in an issue brief

• Support DHCS’ EAS update efforts

Timeline:

• March 2016 – December 2016

Policy Initiatives -- Measure Set Status


Medi-Cal Initiative Landscape

Policies/Initiatives

Coordinated Care Initiative

Public Hospital Redesign and Incentives in Medi-Cal (PRIME)

Whole Person Care Pilots (WPC)

Alternative Payment Methodology (APM) Pilot

Health Homes for Patients with Complex Needs (Section 2703)

California Children’s Services (CCS) “Whole Child Model” Redesign

Global Payment Program (GPP)

Drug Medi-Cal Organized Delivery System (Drug Medi-Cal Waiver)


Objective:

• To support implementation efforts and create opportunities for collaboration and learning

Planned Activities:

• Convene quarterly Advisory Committee meetings

• Develop timeline and process for adopting new measures to core measure set and complete one update of core measure set

• Explore feasibility of developing benchmarks at provider level

• Explore providing access to IHA’s web-based portal

• Re-survey plans to identify issues and unintended consequences

Timeline:

• March 2016 – February 2018

Implementation of the Core Measure Set


Spread Core Measure Set

Objective:

• To spread the core measure set to Medi-Cal plans not currently participating on the Advisory Committee

Planned Activities:

• Schedule 1:1 meetings with plan representatives to share information about project and the core measure set

• Develop resources to support plans with adoption

• Provide technical support to plans interested in developing P4P programs

Timeline:

• March 2016 – December 2016

For more information:

Sarah Lally, [email protected]

Jill Yegian, [email protected]

Web: www.iha.org

mailto:[email protected]

mailto:[email protected]

http://www.iha.org/

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