Bringing The Pieces Together: Attribution for Performance, Provider Counts By Service Type & Speed & Scale Templates
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1 Bringing The Pieces Together: Attribution for Performance, Provider Counts By Service Type & Speed & Scale Templates Greg Allen, Director of Policy Office of Health Insurance Programs NYS Department of Health December 2014
2 December Presentation Overview Types of Attribution and Their Purposes Attribution for Valuation (A4V) Attribution for Performance (A4P) Member Differences: A4V vs. A4P Provider Counts By Service Type Speed and Scale Templates Next Steps & Timeline
3 December Attribution for Performance vs. attribution for valuation Attribution for Valuation: Creates a number of Medicaid and uninsured lives for use in the calculation of potential performance awards as part of the DSRIP valuation process Goal: Attempts to align the value of potential performance awards with the depth, breadth and type of a given PPS network: the more lives covered by a PPS, the higher the potential valuation Attribution for Performance Measurement: For use in performance and outcome measurement Goal: Defines the actual population of individuals a given PPS network is responsible for (based purely on PPS network loyalty irrespective of PPS type) when evaluating performance. The Interim Performance Attribution Data distributed to PPS on Tuesday, 12/23 should be used to complete updated scale and speed templates (distributed on 12/29) for the DSRIP Project Plan Application due to DOH in MAPP on 1/12/15.
4 December Attribution for Performance Attribution for performance numbers should NOT be interpreted as indicative of a PPS s final valuation At this time, the interim attribution for performance results should only be used by PPS in completion of the speed and scale sections of the DSRIP application The attribution for performance results (distributed to PPS on 12/23) contain two categories of attribution results: Domain 2 and 3 projects other than 2.d.i ( domain 2 & 3 results ) Results used for completion of project 2.d.i ( 2.d.i results ) based on attribution for valuation. Performance Attribution results are considered interim until OMIG has completed its review of PPS partner networks. At that time, attribution will be run again and finalized performance numbers will be released To reiterate, performance attribution numbers should NOT be interpreted as indicative of a PPS s final valuation
5 December Member Classification differences Member Attribution for Valuation (A4V) Attribution for Performance (A4P) Utilizing Medicaid (UM) members Attributed based on traditional DSRIP loyalty logic (swim lanes & buckets) excludes low utilizing members (see below) Attributed based on traditional DSRIP loyalty logic (swim lanes & buckets) but includes low utilizing members (see below). Low-Utilizing (LU) Medicaid members Low-utilizing members are excluded from the utilizing member counts and not run through the loyalty logic; but instead, are captured in their own category and attributed based on the following: Attributed only to those approved for 11 th project In Multi PPS counties LUs are attributed based on the prevailing county UM %. No low-utilizing members exist in A4P. Low-utilizing members are included in the utilizing member counts for A4P and are run through the loyalty logic Non-Utilizing (NU) Medicaid members Uninsured (UI) Non-utilizing members are not run through the loyalty logic; but instead, are captured in their own category and attributed based on following: Attributed only to those approved for 11 th project In Multi PPS counties NUs are attributed based on the prevailing county UM percentage. Attributed based on 11th project selection: In Multi PPS counties UIs are attributed based on the prevailing county UM percentage. Non-utilizing Medicaid are captured in their own category and attributed to a PPS based on following: Non-utilizing members with a plan-assigned PCP in a PPS network are included in the attribution counts for that PCP s PPS(s). If no PCP assignment exists or a PCP tie exists, member is attributed to PPS with largest presence in member s zip code. Attributed based on A4V method.
6 December Interim Attribution for Performance Results (12/23)
7 December Presentation Overview Types of Attribution and Their Purposes Attribution for Valuation Attribution for Performance Member Differences: A4V vs. A4P Provider Counts By Service Type Speed and Scale Templates Next Steps & Timeline
8 December DSRIP Provider Type Classifications DSRIP Provider Type Classification: Clinic Behavioral Health Hospice Case/Care Mgmt Health Homes Hospital/Freestanding Inpatient/Rehab SNF Nursing Home Substance Abuse Pharmacy PCP & Non-PCP (Practitioner) Services Included (e.g.): Free standing diagnostic and treatment centers (including FQHCs); also OASAS and OMH clinics providing medical services; *Some hospitals may be included primarily due to hospital labs ordered by community practitioners Inpatient and Outpatient Mental Health, Psychiatric, Residential Treatment services Free standing hospice providers Case Management (Early Intervention, OMH, OASAS, HIV/AIDS), Health Home Inpatient and Outpatient Hospital; Mental Health and Substance Abuse free standing inpatient services; Rehab Hospitals Nursing Homes & Rehab Inpatient and Outpatient Substance Abuse Pharmacies Physicians, Physician Practices, Nurse Practitioners, Dentists, Non- Institutional Long Term Care Providers, other professional services All Other Home Health, OPWDD Inpatient and Outpatient, Labs (Including practitioners on lab claims), other
9 December Important Takeaways from DSRIP Provider Types LISTs DSRIP Provider Type Classifications were assigned based on a crosswalk that takes into account the type of service provided on a claim. In some cases, providers meeting the classification criteria were further refined using the MMIS Provider Type and procedure codes. Providers are further classified according to their designation as a Safety Net Provider. This designation is assigned based on the approved list of Facility, Physician, and Pharmacy Safety Net Providers. Providers were identified based on MMIS or NPI ID. Practitioners have been classified as Primary Care (PCP) based on a list of Managed Care Plan Panel Primary Care Providers. Counts for DSRIP Provider Types (Excluding PCP and Non-PCP) in the Summary Table are based on the Entity IDs, which role up multiple MMIS IDs and NPIs to a single corporate identifier. For lists of DSRIP Provider Types, the Entity Name will be listed once for each relevant DSRIP Provider Type Classification. We are providing a spreadsheet crosswalk that will allow PPS to convert Entity IDs into NPIs and MMIS numbers for the provider s loaded in the network tool. A provider may be included in a Provider Type that they would not traditionally be associated with if they submitted at least one claim that qualifies for that provider type.
10 December PPS Provider Count by Provider Type (Saturday, 12/20) Data used for speed and scale for all projects other than 2di. Provider type Count in network Safety net in Network Non safety net in network Total safety net in service area (inc. your PPS + others) Primary Care Physicians Non-PCP Practitioners Hospitals Clinics Health Home / Care Management Behavioral Health Substance Abuse Skilled Nursing Facilities / Nursing Homes Pharmacy Hospice Community Based Organizations Count provided in a separate from DOH on Saturday, 12/27 All Others
11 December Presentation Overview Types of Attribution and Their Purposes Attribution for Valuation Attribution for Performance Member Differences: A4V vs. A4P Provider Counts By Service Type Speed and Scale Templates Next Steps & Timeline
12 December Updated Speed & Scale Templates (Distributed 12/29) Purpose: DSRIP projects will be evaluated based upon the overall scale and broadness in scope, in terms of expected impact the project will have on the Medicaid program and patient population. Those projects larger in scale and impact will receive more funding than those smaller in scale/impact. Progress towards and achievement of PPS commitments to these scale measures as provided in the application will be included in achievement milestones for future PPS funding. The provider numbers in this tool reflect the Provider Count files sent to you on 12/20-21 and the CBO numbers reflect the list of Community-Based Organizations issued on 12/27. For each of the projects that you have selected, please fill in the corresponding tables in the appropriate project tabs for Domains 2 and 3*. You do not need to fill in tabs for projects you have not selected. * Domain 4 projects have no Scale or Speed tables and are thus not included in this tool.
13 December Fixed Values Tab on Speed & Scale Template Project Table Project Number Select your Projects Completion Check* 1 Select One Please select from drop down 2 Select One 3 Select One Please select from drop down Please select from drop down 4 Select One Please select from drop down 5 Select One Please select from drop down 6 Select One Please select from drop down 7 Select One Please select from drop down 8 Select One Please select from drop down 9 Select One Please select from drop down 10 Select One Please select from drop down 11 Select One Please select from drop down Reminder: a PPS must undertake at least 5 projects, but no more than 11. Reminder: Project 11, if undertaken, must be 2.d.i. * When the project's tab has been provided with all required data, it will be listed as Complete Once all projects are listed as Complete or Complete by Default, this template is finished and may be returned to the DSRIP Support Team Total Attribution Table Total Attributed Population Network Size Table - by Provider Type Provider Type Total Providers in Network Safety Net Providers in Service Area Primary Care Physicians Non-PCP Practitioners Hospitals Clinics 5 10 Health Home / Care Management 10 5 Behavioral Health Substance Abuse Skilled Nursing Facilities / Nursing Homes Pharmacy Hospice 1 0 Community Based Organizations 20 N/A All Other In the Fixed Values tab of the Scale and Speed template: - Select all the projects your PPS is undertaking in the Project Table - Fill in the total attribution value for your PPS in the Total Attribution Table - Review the number of proviers by type in the Network Size table
14 December Example Scale & Speed Template Project Scale Total Committed (10 Points) Primary Care Physicians 200 Non-PCP Practitioners 400 Hospitals 10 Clinics 15 Health Home / Care Management Behavioral Health 100 Substance Abuse Number in Network Skilled Nursing Facilities / Nursing Homes 10 Pharmacy 10 Hospice 5 Community Based Organizations All Other
15 December Speed and Scale Whiteboard Video For more information on speed and scale approach please watch the YouTube Video on Speed and Scale Located Here. Web address for YouTube Video on Speed & Scale
16 December Presentation Overview Types of Attribution and Their Purposes Attribution for Valuation Attribution for Performance Member Differences: A4V vs. A4P Provider Counts By Service Type Speed and Scale Templates Next Steps & Timeline
17 December Next Steps Top Priority: Please use the Performance Attribution Results and Counts of Providers by Type to complete your PPS Speed & Scale Tables for the Monday, 1/12 submission via MAPP System. Participate in DOH led operator assisted call on Monday, 1/5 from 1pm - 3pm to discuss speed and scale questions (sign-up information to be sent out shortly). PPS have until Monday, 1/5 to submit draft Scale and Speed templates to the DSRIP Support Team for review and feedback (send to DST General mailbox: [email protected]) Section 4a of the DSRIP Project Plan Application (where PPS can submit their updated Speed and Scale tables) will become available to PPS Lead Representatives in the MAPP System on Tuesday, 1/6. Contact your DSRIP Support Team Representative for questions related to performance attribution, provider type counts as well as speed and scale calculations Attribution for performance is NOT a proxy for attribution for valuation.
18 December Speed & Scale Timeline Date Activity Monday, January 5 th DOH Lead Operator Assisted Conference Call with PPS Leads to discuss Scale & Speed Questions Monday, January 5 th Draft Scale & Speed Tables due to DSRIP Support Team (via ) for Review Tuesday, January 6 th Section 4a (speed & scale table upload capability) becomes available in MAPP System for PPS Lead Representative Monday, January 12 th Project Plan Application Section 4a (Upload of Finalized Scale & Speed Tables) Due at 4:00pm
19 December Useful Links and More Information Salient Public Facing Dashboards: MAPP Analytics Performance Portal (MAPP): _analytics_performance_portal.htm KPMG DSRIP Support Team:
20 We want to hear from you! DSRIP Like the MRT on Facebook: Follow the MRT on
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