2015 2016 Peer Group 5 Hospital Pay for Performance Program

2015 2016 Peer Group 5 Hospital Pay for Performance Program April 2015 through March 2016 May 2015 UPDATE Program Overview Blue Cross Blue Shield of Michigan (BCBSM) designates small, rural acute care facilities that provide access to care in areas where no other care is available as peer group 5 facilities (PG 5). Additionally, many of these hospitals are also classified as Critical Access Hospitals (CAH) by Medicare. The BCBSM PG5 Hospital Pay for Performance (P4P) program provides these hospitals with an opportunity to demonstrate value to their communities and customers by meeting expectations for access, effectiveness and quality of care. The PG 5 Hospital P4P program described in this document is effective April 1st, 2015 through March 31st, 2016. Performance in the program determines up to six percentage points of a rural hospital s payment rate, effective October 1st, 2016. The PG5 hospital community can provide valuable feedback about the P4P program through the PG5 P4P Advisory Group. This group is dedicated to collaboratively discuss each year s P4P program and evaluate program measures to ensure each positively challenges rural hospitals to deliver the most value to the communities they serve. The PG5 P4P Advisory group includes representatives from BCBSM, the Michigan Health & Hospital Association (MHA), and members of the PG5 hospital community membership and contact information can be found in Appendix A. PG5 hospitals may contact these representatives to provide comments related to the P4P program, and any comments received will be presented at future Advisory Group meetings for consideration. Program Enhancements in 2015 2016 Although the overall structure of the PG5 P4P program remains largely unchanged, notable enhancements in the 2015 2016 PG5 P4P program year include: MHA SCORE Survey as an eligible patient safety assessment survey Introduction of two CMS influenza vaccination measures o Full credit for reporting in 2015 2016 o Measures introduced as potential replacement for ED throughput measure in future program years Enhancement of Population Health Management initiative Updates to eligible MHA Keystone Initiatives Contact: P4PHospital@bcbsm.com 1

2015 2016 P4P Program Structure Pre Qualifying Condition & CEO Attestation Form In order for hospitals to participate in the PG5 P4P program, each much first meet the culture of patient safety survey pre qualifying condition. PG5 hospitals must conduct a hospital wide patient safety assessment survey at least once every two years, in either 2014 or 2015. There are three eligible surveys: Hospital Survey on Patient Safety Culture (HSOPSC) Safety Assessment Questionnaire (SAQ) MHA SCORE Survey The survey can be assessed by a vendor, online assessment tool or a hospital self assessment process, but the assessment process must provide guidance on how to make improvements in patient safety culture. A hospital wishing to use an alternative survey may contact BCBSM for review and consideration. CEO Attestation Form The P4P also requires hospitals to submit a yearly CEO attestation to BCBSM, certifying that the information being sent to BCBSM for the PG5 P4P program is true and to the best of the knowledge of each hospital. This form also provides documentation for each of the individual program components, outlines information on the results of the patient safety assessment, and describes any activities the hospital plans to implement to address findings from the assessment. Completed CEO attestation forms should be submitted to BCBSM by fax or email at P4PHospital@bcbsm.com by June 1, 2016. Contact: P4PHospital@bcbsm.com 2

Health of the Community (30%) Community Service Plan (10%) In order to offer hospitals credit for the investments each is already making to improve the health of their communities, BCBSM has included the Community Service Plan (CSP) dimension to the P4P. The goal of the CSP is for each hospital to provide a high level narrative of their community service initiatives. As with years past, hospitals will receive full credit for submitting at least one CSP proposal (Appendix C). With the approval of individual P4P participating hospitals, BCBSM will compile CSP responses into a single Community Benefit Information Booklet with the intent to share best practices for improving population health within rural hospital communities. HCAHPS Survey (10%) Hospitals will also be required to collect HCAHPS survey information, at a minimum, for the following four questions: Question 3 During this hospital stay, how often did nurses explain things in a way you could understand? Question 7 How often did doctors explain things in a way you could understand? Question 19 Did hospital staff talk with you about whether you would have the help you needed when you left the hospital? Question 20 Did you get the information in writing about what symptoms or health problems to look out for after you left the hospital? Please note: beginning with the 2014 2015 program year, HCAHPS survey submission is no longer accepted as an alternative to participation in one or more MHA Keystone quality initiatives. Hospitals can either submit HCAHPS data directly to BCBSM or attest that HCAHPS data has been submitted to the CMS Hospital Compare website via CEO attestation form. Population Health Management Initiative (10%) BCBSM would like to further increase awareness of population health management within rural hospital communities, and as part of the 2015 2016 program year, each hospital or health system will designate a Population Health Champion as the point of contact for all population health management activities and collaboration efforts with other healthcare providers in the community. In summer 2015, the Champion is expected to attend one of the following informational webinars to learn more about how rural hospitals can use BCBSM s Population Insights Reports. Champions are strongly encouraged to attend the webinar scheduled for their region, however, this is not a requirement. Upper Peninsula: Tuesday, July 14 th, 10 11:30am Thumb Region: Monday, July 27 th, 1 2:30pm Northern Lower Peninsula: Tuesday, July 21 st, 10 11:30am Southern Lower Peninsula: Thursday, July 30 th 10 11:30am Contact: P4PHospital@bcbsm.com 3

Hospitals may use the following link to designate their Champion and register for a webinar: BCBSM 2015 2016 PG5 P4P Population Health Management Champion Registration Hospitals will only receive full credit when a Champion is designated and the Champion attends the webinar. Completed Population Health Champion attestation forms (forthcoming) must be returned to BCBSM by June 1, 2016. Health information exchange and population based performance metrics may be considered in future program years. Clinical Quality Indicators (30%) The Clinical Quality Indicator program component of the 2015 2016 program year will maintain the four outpatient measures from the prior program year, with the addition of two influenza measures each worth 3%; OP 27 and IMM 2 (full credit for reporting). Each quality indicator will be worth 6% (with the influenza measures totaling 6%) and program weights for measures with less than 20 cases will be equally redistributed across remaining eligible measures. CMS Indicator Program Weight OP 4a Aspirin at arrival overall (AMI & chest pain) 6% OP 5a Median time to ECG overall (AMI & chest pain) 6% OP 18b Median Time from ED Arrival to ED Departure for Discharged ED Patients OP 20 Door to Diagnostic Evaluation by a Qualified Medical Personnel 6% OP 27 Influenza Vaccination Coverage among Healthcare Personnel 3% IMM 2 Immunization for Influenza 3% 6% Scoring Thresholds Hospitals will be scored on the above clinical quality indicator measures by comparing actual performance against scoring thresholds. BCBSM encourages that thresholds increase each year or that measures be retired when nearly all hospitals meet > 95% compliance. Each June, representatives from BCBSM, MHA and the hospital community meet to review the prior year s hospital performance on these measures and establish new scoring thresholds. Because the quality data from the previous program year is not available until June 1 st, thresholds are established during the first quarter of current program year. Scoring thresholds for the 2015 2016 program year will be communicated to hospitals no later than June 30, 2015. Contact: P4PHospital@bcbsm.com 4

Quality Initiatives (40%) The Quality Indicator program component requires hospitals to participate in at least two of the following initiatives: Michigan Critical Access Hospital Quality Network (MICAHQN) Participation MHA Keystone Initiatives o CAUTI o Obstetrics o Pain Management Participation in the MICAHQN and attendance at quarterly meetings is mandatory for all CAH facilities. If a hospital chooses to participate in more than two quality initiatives, BCBSM will score the P4P program using the two highest performing quality initiatives (excluding MICAHQN for CAH). Hospitals will also be eligible to participate in selected MHA Keystone Initiatives for credit in the 2015 2016 program year. For detailed scoring information, please refer to the MHA Appendix of this program document or the supplemental MHA Keystone Peer Group 5 Quality Initiative Performance Index. Hospitals with questions regarding MHA Keystone Initiatives or eligibility may contact Ewa Panetta at MHA, EPanetta@mha.org. Quality Initiative Performance Index A hospital s quality initiative score is determined by its performance on specific measures related to MICAHQN and MHA Keystone initiatives and will each be worth up to 20%. Performance Index scores will be shared with hospitals prior to their submission to BCBSM. Hospitals should contact either the MHA Keystone or MICAHQN representative if interested in obtaining performance status at any time during the program period. P4P Incentive Payments BCBSM will communicate P4P payment rates to hospitals by July 31, 2016 with rates becoming effective October 1, 2016. The BCBSM Peer Group 5 P4P program, established by the BCBSM Participating Hospital Agreement for Peer Group 5 facilities, determines up to six percentage points of a participating hospital s inpatient and outpatient payment rate. Regardless of a hospital s fiscal year end, the P4P payment rate is effective for a twelve month period beginning on October 1 st. Pay for Performance payment rates are calculated by multiplying a facility s final P4P score by the 6 percent maximum payment rate that each peer group 5 hospital is eligible to receive. For those hospitals earning a P4P score less than 100%, the difference between the corresponding P4P payment rate and six percent maximum is subtracted from your overall reimbursement rate. If applicable, any rate adjustments made for the 2014 2015 P4P program year will be added back at this time. In October, hospital s earning less than the full six percentage points attributed to P4P performance can expect to receive a revised rate sheet from BCBSM s Facility Reimbursement department. Contact: P4PHospital@bcbsm.com 5

Appendix A PG5 Advisory Group Representatives PG5 Hospital Representatives Chris Wilhelm Barb Cote Wanda Bartholomew COO Director, Total Quality Management Director of Quality & Outcomes Charlevoix Area Hospital Spectrum Health Reed City Hayes Green Beach Memorial Hospital 14700 Lake Shore Dr 300 North Patterson Rd 321 East Harris St Charlevoix, MI 48720 Reed City, MI 49677 Charlotte, MI 48813 (231) 547 4024 (231) 832 7159 (517) 543 1050 x 1225 cwilhelm@cah.org barb.cote@spectrum health.org wbartholomew@hgbhealth.com Brenda Bolsby Rodney Nelson Carolyn Vanwert QA/Risk Management CEO Case Management & Quality Analyst Marlette Regional Hospital Mackinac Straits Health System MidMichigan Gladwin 2270 Main Street 1140 North State Street 515 Quarter St Marlette, MI 48452 St. Ignace, MI 49781 Gladwin, MI 48624 (989) 635 4009 (906) 643 0456 (989) 246 9426 bbolsby@mrhcares.org rnelson@mshosp.org carolyn.vanwert@midmichigan.org sdoran@mshosp.org Anne Barton William Roeser Joanne Urbanski Director, Quality Resources CEO CEO Promedica Herrick Hospital Sparrow Ionia Hospital South Haven Community Hospital 500 East Pottawattamie St 479 Lafayette St 955 South Bailey Ave Tecumseh, MI 49286 Ionia, MI 48846 South Haven, MI 49090 (517) 424 3461 (616) 527 4200 (269) 639 2810 anne.barton@promedica.org william.roeser@sparrow.org jurbanski@sh hs.org dana.harrison@promedica.org kendra.langmaack@sparrow.org Contact: P4PHospital@bcbsm.com 6

Appendix A PG5 Advisory Group Representatives MHA Representatives Bill Jackson Sam Watson Joe Stephansky Senior Vice President Senior Vice President Senior Director, Policy MHA MHA Keystone Center MHA 2112 University Park Drive 2112 University Park Drive 2112 University Park Drive Okemos, MI 48864 Okemos, MI 48864 Okemos, MI 48864 (517) 323 3443 (517) 886 8362 (517) 703 8649 bjackson@mha.org swatson@mha.org jstephansky@mha.org jjones@mha.org Marilyn Litka Klein Brittany Bogan Ewa Panetta Vice President, Health Finance Senior Director Project Coordinator MHA MHA Keystone Center MHA Keystone Center 2112 University Park Drive 2112 University Park Drive 2112 University Park Drive Okemos, MI 48864 Okemos, MI 48864 Okemos, MI 48864 (517) 703 8603 (517) 886 8313 (517) 886 8364 mklein@mha.org bbogan@mha.org epanetta@mha.org dconklin@mha.org BCBSM Representatives Kristen Frey Mike Andreshak Jerry Noxon Health Care Manager Director II Director II BCBSM BCBSM BCBSM 600 E. Lafayette 600 E. Lafayette 600 E. Lafayette Detroit, MI 48226 Detroit, MI 48226 Detroit, MI 48226 (313) 448 4746 (313) 448 3905 (313) 448 6916 kfrey@bcbsm.com mandreshak@bcbsm.com gnoxon@bcbsm.com pligon@bcbsm.com pligon@bcbsm.com Mark Huizenga Lauren Rossi BCBSM BCBSM 600 E. Lafayette 600 E. Lafayette Detroit, MI 48226 Detroit, MI 48226 (313) 448 4746 (313) 448 3905 mhuizenga@bcbsm.com Lrossi2@bcbsm.com Contact: P4PHospital@bcbsm.com 7

Appendix B Quality Initiative Scoring Index Michigan Critical Access Hospital Quality Network (MICAHQN) Measure Name Weight Measure Performance Points Earned Participation in Meetings 100 All four meetings (in person or teleconference) 100 Two or three meetings 75 One meeting 25 Did not attend any meeting 0 Hospitals with questions regarding MICAH Quality Network measure performance may contact Crystal Barter, Email: Crystal.Barter@hc.msu.edu; Phone: (517) 432 0006 Contact: P4PHospital@bcbsm.com 8

Appendix C Community Benefit Information Community Service Program Peer Group 5 Hospital Pay for Performance Program Community Service Program April 2015 through March 2016 Hospital Name: Identify Program Counties Served Health Status of Population Monitoring/Measurements of population (baseline and remeasurement) Communication of program/interventions Participation/Partnerships Rate of success Completed Community Service Program(s) must be returned to BCBSM with a signed, PG5 P4P CEO Attestation form by June 1, 2016. Fax form to: 877 233 9459 or P4PHospital@bcbsm.com 9

MHA Keystone: CAUTI Scoring Index 2015-2016 BCBSM Peer Group 5 Hospital Pay-for-Performance Program MHA Keystone Center Quality Initiatives Measure Description Completion of Gap Analysis Tool [2]* - Gap Analysis completed and submitted by Aug. 1, 2015 - Gap Analysis completed and submitted by Sept. 1, 2015 - Gap Analysis completed and submitted by Oct. 1, 2015 - Gap Analysis not completed Available Points 2 15 points 1 Data submission [2] - At least 90 percent of outcome data submitted - 75 89 percent of all outcome data submitted - 50 74 percent of all outcome data submitted - Less than 50 percent of all outcome data submitted 2 15 points 1 Completion of Learning from Defects [2]** - At least 90 percent of all Learning from Defects submitted - 75 89 percent of all Learning from Defects submitted - 50 74 percent of all Learning from Defects submitted - Less than 50 percent of all Learning from Defects submitted 2 15 points 1 Participation in CUSP training [4] (see Table 1) - Completion of full program - Not completed 4 Total Possible Points 10 * The Gap Analysis Tool will be completed online and can be found HERE. The link to the tool will also be emailed after completion of designation survey. ** Learning from Defects tool is required each month if your designated BCBSM unit has one or more CAUTI. If there is not a CAUTI in your BCBSM designated unit for a given month you will not be required to complete a Learning from Defects tool for that month. The tool is to be completed online and can be found HERE. 2015-2016 BCBSM P4P Peer Group 5 MHA Keystone: CAUTI Scoring Index

MHA Keystone: Pain Management Scoring Index 2015-2016 BCBSM Peer Group 5 Hospital Pay-for-Performance Program MHA Keystone Center Quality Initiatives Measure Description Completion of Gap Analysis Tool [3]* - Gap Analysis completed and submitted by Aug 1, 2015 - Gap Analysis completed and submitted by Sept. 1, 2015 - Gap Analysis completed and submitted by Oct. 1, 2015 - Gap Analysis not completed Available Points 3 2 1 Completion of two action plans [3]** - Action plans completed and submitted by Dec. 1, 2015 - Action plans completed and submitted by Jan. 1, 2016 - Action plans completed and submitted by Feb. 1, 2016 - Action plans not completed 3 2 1 Participation in CUSP training [4] (see Table 1) - Completion of full program - Not completed 4 Total Possible Points 10 * The Gap Analysis Tool will be completed online and can be found HERE. The link to the tool will also be emailed after completion of designation survey. ** Both action plans need to be completed and returned by the designated date in order to receive specified points. A blank action plan form will be emailed upon completion of the gap analysis tool. The completed action plans will be returned via email to keystonep4p@mha.org. 2015-16 BCBSM P4P Peer Group 5 MHA Keystone: Pain Management Scoring Index

MHA Keystone: OB Scoring Index 2015-2016 BCBSM Peer Group 5 Hospital Pay-for-Performance Program MHA Keystone Center Quality Initiatives Measure Description Completion of Gap Analysis Tool [3]* - Gap Analysis completed and submitted by Aug. 1, 2015 - Gap Analysis completed and submitted by Sept. 1, 2015 - Gap Analysis completed and submitted by Oct. 1, 2015 - Gap Analysis not completed Available Points 3 2 1 Completion of two action plans [3]** - Action plans completed and submitted by Dec. 1, 2015 - Action plans completed and submitted by Jan. 1, 2016 - Action plans completed and submitted by Feb. 1, 2016 - Action plans not completed 3 2 1 Participation in CUSP training [4] (see Table 1) - Completion of full program - Not completed 4 Total Possible Points 10 * The Gap Analysis Tool will be completed online. The link to the tool will be emailed after receipt of enrollment form. ** Both action plans need to be completed and returned by the designated date in order to receive specified points. A blank action plan form will be emailed upon completion of the gap analysis tool. The completed action plans will be returned via email to keystonep4p@mha.org. 2015-16 BCBSM P4P Peer Group 5 MHA Keystone: OB Scoring Index

Table 1: Required CUSP Training CUSP training will have two components: Eight hour online module (to be completed prior to the application workshop) CUSP Application Workshop To register, click HERE! Status Date Time (ET) Description Participation in one CUSP Training*** 3/19/2015 8 a.m. 4 p.m. Applications of CUSP Online and Face to Face Training Location: Baronette Renaissance Hotel, Novi 4/21/2015 8 a.m. 4 p.m. Applications of CUSP Online and Face to Face Training Location: Courtyard Grand Rapids Downtown, Grand Rapids 4/22/2015 8 a.m. 4 p.m. Applications of CUSP Online and Face to Face Training Location: Hampton Inn, Okemos 5/14/2015 8 a.m. 4 p.m. Applications of CUSP Online and Face to Face Training Location: Shanty Creek Resort, Bellaire 10/14/2015 8 a.m. 4 p.m. Applications of CUSP Online and Face to Face Training Location: The Landmark Inn, Marquette 10/15/2015 8 a.m. 4 p.m. Applications of CUSP Online and Face to Face Training Location: Baronette Renaissance Hotel, Novi ***Hospitals should send two staff members representing the unit that is implementing CUSP. It is recommended that both a nurse and physician champion attend.