Integrated Health Partnerships (IHP) Quality Measurement
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1 Integrated Health Partnerships (IHP) Quality Measurement 2014
2 Principles Overview Potential Shareable Savings Based on Quality Measurement Measure Categories and Weighting Data Measures Scoring Example Calculations Principles for Additional Measures
3 Principles Quality measurement serves more of a monitoring function relative to reductions in Total Cost of Care (TCOC); not to solely incentivize improvement from year to year Quality based on primary care and patient/family centered care No new reporting requirements Quality must be high for this program to be effective and sustaining Quality includes health care processes, health care outcomes, and patient experience Collaborative effort designed to engage providers in the quality effort Whenever possible measures should be able to compare IHP sites Measure differences should be clinically relevant as well as statistically valid
4 Potential Shareable Savings Based on Quality Measurement Year 1: 25% of shared savings based on pay for reporting Year 2: 25% of shared savings based on quality performance Year 3: 50% of shared savings based on quality performance
5 Measure Categories and Weighting 2 Measure Categories 8 clinical quality measures o 5 clinic measures o 2 hospital measures 2 patient experience measures 32 individual measure components, scored as 9 measures Weights Clinical measures category = 75% of total scoring Patient experience category = 25% of total scoring Integrated model hospital measures account for 40% of each category Virtual model hospital measures account for 20% of each category
6 Measures Clinic Measures 1. Optimal diabetes care composite (5 components) 2. Optimal vascular care composite (4 components) 3. Depression remission at six months 4. Optimal asthma care composite adults (3 components) 5. Optimal asthma care composite children and adolescents (3 components) 6. Patient experience : CG-CAHPS 12 month survey tool Hospital Measures 1. Heart failure measure 2. Pneumonia measure 3. Patient experience: HCAHPS tool (10 survey modules) Utilize most current measure specifications in the Statewide Quality Reporting and Measurement System
7 # Measure Category Measure Name Method of Data Submission Phase-in Year 1 (25% Impact) Phase-in Year 2 (25% Impact) Phase-in Year 3 (50% Impact) CLINIC QUALITY MEASURES 1 Clinical: Diabetes Optimal Diabetes Care (ODC) Composite (All or None Scoring): HbA1c Control (<8.0) 2 Clinical: Diabetes Optimal Diabetes Care (ODC) Composite (All or None Scoring): Low Density Lipoprotein (LDL) (<100) 3 Clinical: Diabetes Optimal Diabetes Care (ODC) Composite (All or None Scoring): Blood Pressure <140/90 4 Clinical: Diabetes Optimal Diabetes Care (ODC) Composite (All or None Scoring): Tobacco Non Use 5 Clinical: Diabetes Optimal Diabetes Care (ODC) Composite (All or None Scoring): Aspirin Use (for patients with Ischemic Vascular Disease) 6 Clinical: Ischemic Vascular Optimal Vascular Care (OVC) Disease Composite (All or None Scoring): Low Density Lipoprotein (LDL) (<100) 7 Clinical: Ischemic Vascular Disease Optimal Vascular Care (OVC) Composite (All or None Scoring): Blood Pressure <140/90 8 Clinical: Ischemic Vascular Optimal Vascular Care (OVC) Disease Composite (All or None Scoring): Tobacco Non Use 9 Clinical: Ischemic Vascular Optimal Vascular Care (OVC) Disease Composite (All or None Scoring): Aspirin Use 10 Clinical: Depression Depression Remission at Six Months 11 Clinical: Asthma Children and Optimal Asthma Care Composite (All or None Scoring): Asthma is well controlled Adolescents 12 Clinical: Asthma Children and Optimal Asthma Care Composite (All or None Scoring): Patient is not at Adolescents increased risk of exacerbations 13 Clinical: Asthma Children and Optimal Asthma Care Composite (All or None Scoring): Patient has a current Adolescents written asthma action/management plan 14 Clinical: Asthma Adults Optimal Asthma Care Composite (All or None Scoring): Asthma is well controlled 15 Clinical: Asthma Adults Optimal Asthma Care Composite (All or None Scoring): Patient is not at increased risk of exacerbations 16 Clinical: Asthma Adults Optimal Asthma Care Composite (All or None Scoring): Patient has a current written asthma action/management plan 17 Patient Experience CG-CAHPS: Getting Timely Appointments, Care, and Information Survey (12 Month Survey Tool) 18 Patient Experience CG-CAHPS: How Well Providers (or Doctors) Communicate with Patients Survey (12 Month Survey Tool) 19 Patient Experience CG-CAHPS: Helpful, Courteous, and Respectful Office Staff Survey (12 Month Survey Tool) 20 Patient Experience CG-CAHPS: Patients Rating of the Provider (or Doctor) (with a 9 or 10) Survey (12 Month Survey Tool)
8 # Measure Category Measure Name Method of Data Submission Phase-in Year 1 (25% Impact) Phase-in Year 2 (25% Impact) Phase-in Year 3 (50% Impact) HOSPITAL QUALITY MEASURES 21 Clinical: Heart Failure Heart Failure Appropriate Care Measure (HF-ACM) Composite (All or None CMS Hospital Compare Scoring): LVF Assessment 22 Clinical: Pneumonia Pneumonia Appropriate Care Measure (PN-ACM) Composite (All or None CMS Hospital Compare Scoring): Initial Antibiotic Selection for CAP in Immunocompetent Patient 23 Patient Experience HCAHPS: Communication with Nurses Survey 24 Patient Experience HCAHPS: Communication with Doctors Survey 25 Patient Experience HCAHPS: Responsiveness of Hospital Staff Survey 26 Patient Experience HCAHPS: Pain Management Survey 27 Patient Experience HCAHPS: Communication about Medications Survey 28 Patient Experience HCAHPS: Cleanliness of Hospital Environment Survey 29 Patient Experience HCAHPS: Quietness of Hospital Environment Survey 30 Patient Experience HCAHPS: Discharge Information Survey 31 Patient Experience HCAHPS: Overall Hospital Rating Survey 32 Patient Experience HCAHPS: Recommend the Hospital (with a 9 or 10) Survey
9 Quality Measure Data Statewide Quality Reporting and Measurement System, administered by MDH (Minnesota Rules, Chapter 4654) Clinic Measures Clinical measure Clinic summary-level data submitted to MDH via MN Community Measurement (MNCM) Results used for IHP will be Medicaid-only data Patient experience (CG-CAHPS) Clinic summary-level data submitted to MDH via MNCM using a CMSapproved vendor Survey results used for IHP will be based on total population surveyed Hospital Measures Hospital summary-level Hospital Compare data submitted to MDH via MNCM and subcontractors (MHA and Stratis Health) Clinical and patient experience results used for IHP will be based on total population
10 Summary of IHP Quality Measure Scoring (Integrated) Measure Category Tot Indiv Total Measures for Scoring Purposes Pts Wt Meas Clinical (clinic) 16 5 measures - including 5 component diabetes composite measures, 4 component vascular disease composite measures, 3 component asthma children/adolescents composite measures, 3 component asthma adults composite measures, depression remission measure Clinical (hospital) 2 2 measures - including heart failure measure, pneumonia 4 30 measure Clinical (Total) 18 7 measures Patient Experience (clinic) 4 1 measure with survey module measures combined 2 15 Patient Experience (hospital) 10 1 measure with survey module measures combined 2 10 Patient Experience (Total) 14 2 measures 4 25 Total
11 Summary of IHP Quality Measure Scoring (Virtual) Measure Category Tot Indiv Total Measures for Scoring Purposes Pts Wt Meas Clinical (clinic) 16 5 measures - including 5 component diabetes composite measures, 4 component vascular disease composite measures, 3 component asthma children/adolescents composite measures, 3 component asthma adults composite measures, depression remission measure Clinical (hospital) 2 2 measures - including heart failure measure, pneumonia 4 15 measure Clinical (Total) 18 7 measures Patient Experience (clinic) 4 1 measure with survey module measures combined 2 20 Patient Experience (hospital) 10 1 measure with survey module measures combined 2 5 Patient Experience (Total) 14 2 measures 4 25 Total
12 Scoring and Calculation Max of 2 points per measure can be earned Composite measure components will not be scored separately, but results of these individual components will be reported back to IHPs in addition to their overall composite score Patient experience module results will be aggregated to determine the overall patient experience result IHPs consisting of multiple clinics/hospitals numerators and denominators for each clinic/hospital will be summed and points will be awarded based on overall score Total points in each category are summed up and divided by the total points available for that category to produce an overall category score of the percentage of points earned versus points available Total points available is determined by the number of measures for which an IHP meets minimum N
13 Awarding Points for Performance For Performance Periods 2 and 3, the IHP rate for each measure will be assessed for both achievement and improvement Sliding scale measure scoring The score for each measure will be the greater of the achievement or improvement score
14 Performance: Achievement < Minimum attainment threshold = 0 points Defined as the previous measurement period s 30 th percentile Upper threshold = 2 points Defined as the previous measurement period s 80 th percentile Minimum attainment threshold and < Upper threshold = even distribution between 1 point and 2 points Percentile < < < < < < Points
15 Performance: Improvement < 5% Relative improvement = 0 points 10% Relative improvement = 2 points 5% and < 10% = even distribution between 1 point and 2 points Percent (%) Relative Improvement Points Example < 5% 0.0 Performance Period 1 (Baseline) rate = 25% 5% - < 6% 1.0 6% - < 7% 1.2 7% - < 8% 1.4 8% - < 9% 1.6 9% - < 10% % 2.0 Performance Period 2 rate achieved = 28% Absolute improvement = 3% (28% - 25% = 3%) Relative improvement = 12% (3% / 25% = 12%) Improvement points earned for measure = 2
16 Example Calculation (Integrated) Category Points Earned Points Possible Weight (%) Percentage of Possible Points Optimal Diabetes Care Optimal Vascular Care Depression Remission Asthma Children / Adolescent Asthma - Adults Clinical (clinic) % Heart Failure Pneumonia Clinical (hospital) % Clinical (Total) Patient Experience (clinic) % Patient Experience (hospital) % Patient Experience (Total) Total Overall Quality Score 88% Example: Year 3 50% Impact on shared savings Total shared savings = $2,000; IHP total potential shared savings = $1,000 IHP total shared savings impacted by quality results = $500 IHP total shared savings impacted by quality results = $500 * 88% = $440 IHP total shared savings earned = $500 + $440 = $940
17 Example Calculation (Virtual) Category Points Earned Points Possible Weight (%) Percentage of Possible Points Optimal Diabetes Care Optimal Vascular Care Depression Remission Asthma Children / Adolescent Asthma - Adults Clinical (clinic) % Heart Failure Pneumonia Clinical (hospital) % Clinical (Total) Patient Experience (clinic) % Patient Experience (hospital) % Patient Experience (Total) Total Overall Quality Score 85.3% Example: Year 3 50% Impact on shared savings Total shared savings = $2,000; IHP total potential shared savings = $1,000 IHP total shared savings impacted by quality results = $500 IHP total shared savings impacted by quality results = $500 * 85.3% = $ IHP total shared savings earned = $500 + $ = $926.25
18 Principles for Additional Measures Existing data collection mechanism Data must be validated and audited State or nationally recognized quality measure specification Not impacted by high variability due to coding changes Ensure needed appropriate care is not negatively impacted
19 Data Reporting Requirements Applies to MDH Statewide Quality Reporting and Measurement System clinical measures required of physician clinics Total population reporting No sample-based data submission Direct Data Submission (DDS) method Not Summary Data Submission (SDS) method
20 Dates of Service Dates of Service (DOS) / Discharge Dates Clinic Measures: Optimal diabetes care, optimal vascular care: CY 2015 DOS Depression remission: February 2015 January 2016 DOS Optimal asthma care: July 2014 June 2015 DOS Patient experience: September 2014 November 2014 Survey Period Hospital Measures: October 2013 September 2014 Discharge Dates Clinic Patient Experience Measure (CG-CAHPS) 2014: Required by MDH (Sept-Nov DOS) Use for Year 1 (2015) 2016: Required by MDH (Sept-Nov DOS) Use for Year 2 (2016) 2017: Not required by MDH DHS is evaluating options
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