Vermont ACO Shared Savings Program: Recommendations for Year 2 Quality Measures

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1 Vermont ACO Shared Savings Program: Recommendations for Year 2 Quality Measures Green Mountain Care Board October 9, /9/2014 1

2 ACOs & SSPs Accountable Care Organizations (ACOs) are composed of and led by health care providers who agree to be accountable for the cost and quality of care for a defined population. These providers work together to coordinate care for their patients. Shared Savings Programs (SSPs) are payment reform initiatives developed by health care payers and offered to health care providers (including ACOs); the providers will share in savings realized as a result of improved care and health outcomes. Provider participation in an ACO is voluntary; ACO participation in a SSP is also voluntary. Medicare initiated SSPs in 2012, which built momentum for these programs. Vermont s Medicaid and Commercial SSPs started in /9/2014 2

3 Shared Savings Program Standards in Vermont Insurers, providers, consumer advocates and other stakeholders developed ACO/SSP standards, with State facilitation. ACO/SSP standards include: Attribution of Patients Establishment of Expenditure Targets Distribution of Savings Impact of Quality Measures on Savings Distribution Annual Review and Modification of Measures Governance Other Aspects of ACO Operations 10/9/2014 3

4 What Needs to be Decided Whether recommended measure changes should be made to the Year 2 (2015) ACO SSP measure set: The VHCIP Quality and Performance Measures Work Group (QPMWG) recommended 11 measure changes: Re-classification of 9 existing measures Addition of 2 new measures The Core Team (CT) recommended 9 of those 11 changes: Re-classification of 7 existing measures Addition of 2 new measures 10/9/2014 4

5 Year 2 Measure Review Process Goals were to adhere to transparent process and obtain ongoing input from stakeholders and other interested parties March-June Interested parties and other VHCIP Work Groups vetted potential measures; presented a total of 22 Year 2 measure changes to Quality and Performance Measure Work Group (QPMWG) for consideration QPMWG reviewed and finalized criteria to be used in evaluating overall measure set and payment measures QPMWG reviewed and discussed proposed measure changes June-July QPMWG Co-Chairs/Staff/Consultant scored each recommended measure against approved criteria on point scale and prioritized Year 2 measure changes for the QPMWG s consideration QPMWG Co-Chairs and Staff presented proposed measure changes to Payment Models, Population Health, and DLTSS Work Groups 10/9/2014 5

6 Year 2 Measure Review Process (continued) June-July (continued) QPMWG reviewed and discussed proposals and input QPMWG voted on measures during July 29 th meeting: Adopted 11 recommended measure changes Rejected 3 recommended changes Did not vote on 8 recommended changes; they were also rejected August-September QPMWG Co-chairs and Staff presented recommendations to Steering Committee and Core Team Steering Committee and Core Team both sought public comment On September 3, Steering Committee voted to forward QPMWG recommendations to Core Team, expressing neither support nor opposition On October 8, Core Team voted to support 9 of the 11 QPMWG recommendations 10/9/2014 6

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8 Summary of QPMWG Recommendations QPM Work Group voted to: Re-classify 9 existing measures 3 to Payment 4 to Reporting 2 to M&E Add 2 new measures 1 to Reporting (Patient Experience Survey) 1 to M&E 10/9/2014 8

9 Summary of Core Team Recommendations Core Team voted to: Re-classify 7 existing measures 2 to Payment 3 to Reporting 2 to M&E Add 2 new measures 1 to Reporting (Patient Experience Survey) 1 to M&E 10/9/2014 9

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14 DLTSS Custom Survey Composite This measure would add 3 care coordination questions to the Patient Experience Survey that is coordinated and funded through DVHA and VHCIP: In the last 12 months, how often did the [primary care] provider seem informed and up-to-date about any care you got from other service and support providers (if applicable), such as home health agencies, area agencies on aging, developmental or mental health service agencies, substance abuse providers, and vocational rehabilitation? If you ask for something, does your case manager/service coordinator help you get what you need? In the last 12 months, how often did the specialist you saw seem informed and up-to-date about any care you got from other service and support providers (if applicable), such as home health agencies, area agencies on aging, developmental or mental health service agencies, substance abuse providers, and vocational rehabilitation? 10/9/

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18 APPENDIX: YEAR ONE MEASURE SET WITH RECOMMENDED YEAR 2 CHANGES 10/9/

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20 Year 1 and Recommended Year 2 Payment Measures Clinical Data Commercial & Medicaid Diabetes Care: HbA1c Poor Control (>9.0%)* (10-5 vote of QPM WG; move from Reporting) Pediatric Weight Assessment and Counseling (10-5 vote of QPM WG; move from Reporting) *Medicare Shared Savings Program measure Red font indicates measure change was recommended by QPM Work Group but not by Core Team. 10/9/

21 Year 1 and Recommended Year 2 Reporting Measures Claims Data Commercial & Medicaid Ambulatory Care-Sensitive Conditions Admissions: COPD* Breast Cancer Screening* Rate of Hospitalization for Ambulatory Care- Sensitive Conditions: Composite Appropriate Testing for Children with Pharyngitis Avoidable ED Visits (9-6 vote of QPM WG; move from M&E) Commercial- Only Developmental Screening in the First Three Years of Life (10-4 vote of QPM WG; already in Y1 Payment Measure Set for Medicaid SSP) *Medicare Shared Savings Program measure Red font indicates measure change was recommended by QPM Work Group but not by Core Team. 10/9/

22 Year 1 and Recommended Year 2 Reporting Measures Clinical Data Commercial & Medicaid Adult BMI Screening and Follow-Up* Screening for Clinical Depression and Follow-Up Plan* Colorectal Cancer Screening* Diabetes Composite HbA1c control* LDL control* High blood pressure control* Tobacco non-use* Daily aspirin or anti-platelet medication* Diabetes HbA1c Poor Control* Childhood Immunization Status Pediatric Weight Assessment and Counseling Cervical Cancer Screening (Unanimous vote of QPM WG, move from Pending) Tobacco Use: Screening & Cessation Intervention* (Unanimous vote of QPM WG, move from Pending) *Medicare Shared Savings Program measure Red font indicates measure change was recommended by QPM Work Group but not by Core Team. 10/9/

23 Year 1 and Recommended Year 2 Reporting Measures Patient Experience Survey Data Commercial & Medicaid Access to Care Communication Shared Decision-Making Self-Management Support Comprehensiveness Office Staff Information Coordination of Care Specialist Care Provider Knowledge of DLTSS Services and Help from Case Manager/Service Coordinator (11-3 vote of QPM WG; NEW) 10/9/

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25 Year 1 and Recommended Year 2 Pending Measures Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control (<100 mg/dl)* Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic* Influenza Immunization* Tobacco Use Assessment and Tobacco Cessation Intervention* Coronary Artery Disease (CAD) Composite* Hypertension (HTN): Controlling High Blood Pressure* Screening for High Blood Pressure and Follow-up Plan* Cervical Cancer Screening Care Transition-Transition Record Transmittal to Health Care Professional Percentage of Patients with Self- Management Plans How's Your Health? Patient Activation Measure Frequency of Ongoing Prenatal Care Elective delivery before 39 weeks Prenatal and Postpartum Care Screening, Brief Intervention, and Referral to Treatment Trauma Screen Measure Falls: Screening for Future Fall Risk* Pneumococcal Vaccination for Patients 65 Years and Older* Use of High Risk Medications in the Elderly Persistent Indicators of Dementia without a Diagnosis Proportion not admitted to hospice (cancer patients) Developmental Screening in the First Three Years of Life (commercial) *Medicare Shared Savings Program measure 10/9/