Washington Health Benefit Exchange

Transcription

1 Washington Health Benefit Exchange Consumer Rating System Update Advisory Committee Meeting October 2, 2014 Christine Gibert, Senior Policy Analyst

2 RECAP: Consumer Rating System Washington State legislation directs Exchange to establish a consumer rating system Three focus areas Enrollee Satisfaction Care Management Prevention Board chose to use HEDIS and CAHPS measures 25 proposed measures 21 HEDIS, 4 CAHPS Timeline: Display ratings in Healthplanfinder during Open Enrollment 2015 for 2016 coverage 2

3 Quality Rating System Federal Guidance ACA directs HHS to develop a quality rating system ( QRS ) for Qualified Health Plans Recent CMS guidance Final Quality Measures 43 measures Clinical measures HEDIS and Pharmacy Quality Alliance 12 CAHPS Proposed QRS Scoring System Five-Star rating system for QHPs Exchanges required to use federal QRS and display star ratings Display in Open Enrollment 2016 for 2017 coverage 3

4 QRS Phased-in Approach 2015 Beta Testing of QRS QHP Issuers must collect 2014 data, have it validated, and submit to CMS by mid-2015 CMS calculates QRS beta scores and shares with carriers Exchanges receive QRS beta scores but may not display star ratings or clinical measures in 2015 Open Enrollment for 2016 coverage 2016 QRS Implementation QHP Issuers collect and validate 2015 data in first half of 2016 CMS calculates QRS scores and provide to Exchanges by Fall 2016 Exchanges must display QRS scores in 2016 Open Enrollment for 2017 coverage 4

5 QRS Measures Clinical, Efficiency, & Access Clinical, Efficiency, and Access Measures Proposed for CRS? Adult BMI Assessment Annual Dental Visit Annual Monitoring for Patients on Persistent Medications Antidepression Medication Management Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Respiratory Infection Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis Breast Cancer Screening Cervical Cancer Screening Childhood Immunization Status (Combination 3) Chlamydia Screening in Women Colorectal Cancer Screening Comprehensive Diabetes Care: Eye Exam (Retinal) Performed Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing Comprehensive Diabetes Care: Medical Attention for Nephropathy 5

6 QRS Measures Clinical, Efficiency, & Access Clinical, Efficiency, and Access Measures (cont d) Proposed for CRS? Controlling High Blood Pressure Follow-Up After Hospitalization for Mental Illness (7-Day Follow-Up) Follow-Up Care for Children Prescribed ADHD Medication HPV Vaccination for Female Adolescents Immunizations for Adolescents (Combination 1) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Medication Management for People with Asthma (75% of Treatment Period) Plan All-Cause Readmissions Prenatal and Postpartum Care Proportion of Days Covered Relative Resource Use for People with Diabetes (Inpatient Facility) Use of Imaging Studies for Low Back Pain Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Well-Child Visits in the First 15 Months of Life (6+ visits) Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life 6

7 QRS Measures CAHPS/Consumer survey CAHPS and Consumer Survey Measures Proposed for CRS? Access to Care Access to Information Aspirin Use and Discussion Care Coordination Cultural Competence Flu Shots for Adults Medical Assistance with Smoking and Tobacco Use Cessation Plan Administration Rating of All Health Care Rating of Health Plan Rating of Personal Doctor Rating of Specialist 7

8 Proposed Consumer Rating System Measures not included in QRS Adolescent Well-Care Visits Cholesterol Management for Patients with Cardiovascular Conditions Comprehensive Diabetes Care: LDL-C Screening Customer Service: information (CAHPS) Customer Service: Courtesy and Respect (CAHPS) Getting Needed Care Without Delay (CAHPS) 8

9 QRS Hierarchical Structure Global Rating Summary Indicators Domains Composites Asthma Care Clinical Effectiveness Behavioral Health Cardiovascular Care Clinical Quality Management Patient Safety Diabetes Care Patient Safety Checking for Cancer Overall Plan Rating Star Rating System (1-5) Enrollee Experience Prevention Access Care Coordination Doctor and Care Maternal Health Staying Healthy Adult Staying Healthy Child Access to Care Care Coordination Doctor and Care Plan Efficiency, Affordability, & Management Efficiency and Affordability Plan Service Efficient Care Enrollee Experience with Health Plan 9

10 QRS Role of the Exchange Exchange must display Federal quality scores CMS collects measures from QHP carriers, performs analysis, and provides Five-Star rating scores to Exchanges Exchange must house the QRS data in its own website Guidance expected in 2015 on display requirements Exchange may display additional measures and quality data to address state priorities Future CMS guidance on requirements and limitations for states that collect and display additional quality data 10

11 Exchange Implementation of QRS During 2015, Exchange must build platform to support and display federal quality scores Federal grant funds awarded for consumer rating system can be used for quality rating system design Potential to build a flexible platform to allow for display of additional quality information in future years Exchange will display quality scores in Open Enrollment 2016 for 2017 coverage 11

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