Agenda Items #4 and #5 of Metrics and Scoring Committee Meeting #5 - - PowerPoint PPT Presentation

Agenda Items #4 and #5 of Metrics and Scoring Committee Meeting #5

Oregon Metrics and Scoring Committee Michael Bailit October 22, 2012

Meeting Agenda

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#5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Algorithm Design #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #4 Continue Setting Performance and Improvement Targets

Measures that Require Additional Discussion Regarding Targets

• 1. CAHPs Composite
• 2. Rate of PCPCH Enrollment
• 3. Colorectal Cancer Screening
• 4. Screening for Clinical Depression and Follow-up Plan
• 5. EHR Composite

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CAHPS Composite Measure

OHA will present an alternative to the seven-question composite. Proposed Improvement Target: MN method with 3% floor Proposed Performance Target: Medicaid 75th percentile

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Rate of PCPCH Enrollment

OHA recommends no improvement target for Year One. OHA recommends selecting a performance target based

• n a desired Year One distribution of PCPCH enrollment

across the three recognition tiers. Performance target options:

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Option 1 Option 2a Option 2b Option 3a Option 3b

Target .875 .75 .75 .67 .67

Tier 3 (x3) 75% 50% 60% 33.3% 20% Tier 2 (x2) 12.5% 25% 15% 33.3% 70% Tier 1 (x1) 12.5% 25% 14% 33.3% 0% Not certified 11% 10%

Colorectal Cancer Screening

Proposed Improvement Target: MN method with 3% floor Proposed Performance Target: 61.34% or above 2012 Commercial data 75th percentile: 65.76% Adjustment factor: -4.42 (average difference between Medicaid measures and commercial measures for adult populations1)

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Commercial Benchmark Adjustment Factor Adjusted Performance Target 65.76%

• 4.42

= 61.34%

1: See Excel spreadsheet for calculation of the adjustment factor.

Screening for Clinical Depression and Follow-up

OHA recommends no performance targets and data reporting only for Year One.

– If the CCO reports data in Year One, it should receive credit for this measure.

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EHR Composite Measure

OHA continues to await benchmark data from CMS to inform target setting.

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Meeting Agenda

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#5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Algorithm Design #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #4 Continue Setting Performance and Improvement Targets

Review Feedback on Structural Elements

• f the Incentive Pool

OHA is responsible for determining the structure of the incentive pool, but would appreciate comments from the Committee. OHA requested that members submit feedback through email in response to the following questions: – What should happens to eligible incentive funds not earned by a CCO? – How should the amount of incentive funds that are potentially available to the CCOs be determined? – What should be the timing of the distribution of funds?

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Meeting Agenda

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#5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Algorithm Design #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #4 Continue Setting Performance and Improvement Targets

How should the incentive pool be divided among the CCOs?

Distribution Options: 1.The incentive pool opportunity is apportioned based

• n CCO enrollment.

2.There is a minimum available amount (floor) established for all CCOs and those CCOs above the floor subsidize those below it (based on enrollment) 3.The incentive pool is available such that smaller CCOs are eligible for a disproportionate share relative to larger CCOs based on a tiering of CCOs by enrollment. 4.The incentive pool is available such that smaller CCOs are eligible for a disproportionate share relative to larger CCOs using a continuous scale adjustment across all CCOs.

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Assumptions for the Examples

The program will receive a 4.4% increase. The Governor has said that 2-3% of this will be allocated based on performance relative to the quality incentive pool measures. Assumptions for options modeling: The incentive pool is $46 million (2% of the 4.4% increase). Enrollment for the year is the same as in September 2012. There are 16 participating CCOs. Total enrollment is 461,584.

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Distribution Option 1: Even Distribution

• 1. The incentive pool opportunity is apportioned

based on CCO enrollment.

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Option 1: Even Distribution

Example : PMPM is $8.30 (same across all CCOs) Total potential ranges from $560,071 to $11,352,608 Average potential incentive payment is $2,875,000 Median potential incentive payment is $2,033,099 Three of the 16 CCOs are eligible to receive less than $1 million

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Distribution Option 2: Floor Subsidized by Others

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• There is a minimum available amount (floor) established for

all CCOs and those CCOs above the floor subsidize those below it on a pro-rata basis.

• Those CCOs that would have received less than the floor by

an even distribution are subsidized by the rest of the “donor”

• CCOs. The amount of the donation is distributed among the

donor CCOs relative to their enrollment, with the largest CCOs contributing the most.

Distribution Option 2: Floor Subsidized by Others

Example: Floor of $1 million All CCOs receive at least $1 million dollars All donor CCOs “contribute” different amounts: $14,401 to $153,736. The amount of “donation” relative to total is the same for all: 1.4% PMPM ranges from $8.19 to $14.83 Total potential ranges from $1,000,000 to $11,198,871 Average total amount is $2,875,000 Median total amount is $2,005,567 Average PMPM is $8.71 Median PMPM is $8.19

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Distribution Option 3: Subsidized Tiered Distribution

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The CCOs are divided into tiers based on enrollment and each tier gets a set PMPM, with the smaller CCOs receiving a greater PMPM than the larger CCOs.

Distribution Option 3: Subsidized Tiered Distribution

Example: Four tiers Tiers based on natural groupings of enrollment Total potential ranges from $673,726 to $9,555,358 Average total amount is $2,875,037 Median total amount is $2,200,860 Average PMPM is $9.05 Median PMPM is $8.99

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Tier 1 Tier 2 Tier 3 Tier 4 Percent of enrollment 25%+ 9%-13% 4%-7% 1%-2% PMPM $6.99 $8.00 $8.99 $9.99

Distribution Option 4: Subsidized Continuous Distribution

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Each CCO receives variable PMPM based on enrollment with the smaller CCOs receiving a greater PMPM than the larger CCOs

Distribution Option 4: Subsidized Continuous Distribution

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Example: Each CCO receives an individualized PMPM based on enrollment

CCO Name PMPM Health Share/CareOregon $6.73 Willamette Valley Community Health $7.50 Trillium Community Health Plan $7.75 FamilyCare CCO $8.00 … Eastern Oregon $11.00 Columbia Pacific $11.25 PrimaryHealth Josephine Co $11.50

Distribution Option 4: Subsidized Continuous Distribution

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Example: Each CCO receives an individualized PMPM based on enrollment Total potential ranges from $9,199,937 to $775,560 Average total amount is $2,874,801 Median total amount is $2,349,356 Average PMPM is $9.44 Median PMPM is $9.63

Meeting Agenda

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#5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Algorithm Design #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #4 Continue Setting Performance and Improvement Targets

Review: What happens to incentive funds not earned by CCOs?

• A. Distribute the remaining funds among all of the CCOs

that achieved a minimum level of overall performance.

• B. Distribute the remaining funds among all of the CCOs

that achieved a minimum level of overall performance and did not significantly decline in performance on any measures.

• C. Distribute the remaining funds among a top-scoring

percentage (e.g., 5%, 10%, 15%) of CCOs.

• D. Distribute the remaining funds among the CCOs that

achieve the performance targets for an additional set

• f “challenge” measures.

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Meeting Agenda

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#5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Algorithm Design #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #4 Continue Setting Performance and Improvement Targets

Algorithm Design

OHA is responsible for determining the algorithm that will be used to distribute the funds, but would appreciate comments from the Committee. Specifically, OHA is interested in getting comments on the following design elements:

– Should each CCO be assessed on both a performance target and an improvement target? – Should performance against target be valued the same as performance improvement? – Should all performance measures be considered to represent equivalent value? – Should CCOs be required to achieve a minimum score in

• rder to receive a quality pool distribution?

– Should CCOs only be rewarded through the algorithm, or should they also be penalized?

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Should each CCO be assessed on both a performance target and an improvement target?

OHA Proposal: CCOs will be assessed against a performance target. If the CCO meets the performance target, it gets full credit for the measure. If the CCO does not meet the performance target for a given measure, it is assessed against an improvement standard.

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Should performance against target be valued the same as performance improvement?

OHA Proposal: The value assigned to meeting a performance target is the same as for demonstrating improvement

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Should all performance measures be considered to represent equivalent value?

Proposed Options: The CCO must meet expectations for a minimum # of measures (i.e., each measured activity treated as of equivalent value).

• r

The CCO must earn a minimum # of points (i.e., measured activities assigned varying weights to reflect their relative value).

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Should CCOs be required to achieve a minimum score in order to receive a quality pool distribution?

Proposed Options:

• Yes. Only those CCOs with a qualifying score can

receive any distribution.

• r
• No. All CCOs can receive a distribution so long as they

report required information/reports.

• r
• No. All CCOs can receive a distribution if performance
• n specific measures warrants it regardless of overall

performance.

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Should CCOs only be rewarded through the algorithm, or should they also be penalized?

Proposed Options: CCOs are only rewarded for attaining targets or improving performance.

• r

CCOs are rewarded for attaining targets or improving performance, but also penalized:

– when performance does not meet minimum expectations for all measures;

• r

– when performance does not meet minimum expectations for certain measures that represent basic performance expectations;

an/or

– when performance significantly declines over the prior period.

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