Agenda & Opening Comments LA Medicaid- Evolution of Value - - PowerPoint PPT Presentation

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Agenda & Opening Comments LA Medicaid- Evolution of Value - - PowerPoint PPT Presentation

May 22, 2023 313 likes •496 views

Agenda & Opening Comments LA Medicaid- Evolution of Value Based Purchasing History New Changes with Contract Extension Old State Models vs. New State Models and Focus Review new State HEDIS measures New

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SLIDE 1

Agenda & Opening Comments

  • LA Medicaid- Evolution of Value Based Purchasing

–

History

–

New Changes with Contract Extension

  • Old State Models vs. New State Models and Focus
  • Review new State HEDIS measures
  • New Alternative Payment Model Structure
  • UHC Focus and Commitment to VBP

–

History

–

Changes with New Contract

–

New Models

»

Examples

–

Other Models

  • Questions
  • Contacts and Resources

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SLIDE 2

LA Medicaid – Evolution of Value Based Purchasing(VBP)

➢Feb 2012- Shared Savings Plans

✓ MCOs to Share with providers as they earn Shared Savings ✓ MCOs picked metrics for Shared Savings gateway ✓ State’s Care Enhance Fee eliminated

➢Full Risk: February 2015

✓ State Requires MCOs to commit to actuarial commitment to providers ✓ No HEDIS or method prescribed for MCOs

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SLIDE 3

LA Medicaid – Evolution of Value Based Purchasing(VBP)

  • State completes Statewide Stakeholder

meetings

✓Providers, MCOs, Hospitals, Lobbyists, Etc… ✓Discussion on Agreement on future execution and best path for Value Based Purchasing.

  • 7 regional “town hall” meetings to solicit input on quality

measure selection

  • Attended by >260 people representing health plans, health

systems, primarily direct care providers

  • 2 rounds of Medicaid Quality Committee/Sub-Committee

meetings to make quality measure recommendations

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SLIDE 4

LA Medicaid – Evolution of Value Based Purchasing(VBP)

  • 23 Month Extension: February 2018
  • State continues to require MCOs to commit to actuarial commitment

to providers

  • State Creates new all MCO guidance on Value Based purchasing

–NEW- At Risk – 2% Withhold on Quality/VBP vs. Penalty model »Significant $$ risk change for MCOS –NEW- 16 Core HEDIS Measures are Core for all MCOs –NEW- MCOs to drive increase use of Alternative Payment Models(APM) –NEW- All MCOs must come to agreement on use of Common Scorecard and Payment frequency on VBP

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SLIDE 5

Continuum of Value Based Purchasing(VBP) Changes for 2018

➢ State Changes Monetary At Risk Model for MCOS: ✓OLD

  • MCOs had 8 Core Quality HEDIS measures At Risk and Penalized

after the year if measures not met

✓ NEW

  • MCOs have 16 Core HEDIS measures + VBP activity At Risk for

2% Withhold. MCOs must hit HEDIS measures and increase VBP activity to Earn Back the 2% Withhold – Earn Back Model

  • 1% on HEDIS
  • 1% on advancing use of VBP on Alternative Payment

Models(APM)

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SLIDE 6

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Proposed LDH Incentive Measures

Identifier

Measure MY18 Target 2017 Statewide Average 2017 United (MY 2016) Proposed Subcommittee Assignment

#01 (PTB) Initiation of Injectable Progesterone for Preterm Birth Prevention TBD 17.27%* 19.42% Maternal #02 (AWC) Adolescent Well Care Visit 50.12% 54.70% 63.88% Pediatric #03 (ADD) Follow-up Care for Children Prescribed ADHD Medication - Initiation Phase 44.80% 44.55% 52.85% Behavioral Health #04 (ADD) Follow-up Care for Children Prescribed ADHD Medication - Continuation Phase 55.90% 56.60% 64.49% Behavioral Health #05 (AMB- ED) Ambulatory Care Emergency Department Visits/1000 MM ** 62.70 73.88 72.49 Emergency Medicine #06 (PPC) Prenatal and Postpartum Care - Timeliness

  • f Prenatal Care

83.56% 80.77% 85.54% Maternal #07 (PPC) Prenatal and Postpartum Care - Postpartum Care 64.38% 63.80% 64.84%-3 Maternal #08 (FUH) Follow-Up After Hospitalization for Mental Illness - Within 30 Days of Discharge 65.42% 49.69% 61.25% Behavioral Health

New Medicaid Quality HEDIS Focus

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SLIDE 7

New Medicaid Quality HEDIS Focus

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Proposed LDH Incentive Measures

Identifier

Measure MY18 Target 2017 Statewide Average 2017 United (MY 2016) Proposed Subcommittee Assignment

#09 (CBP) Controlling High Blood Pressure-Total 56.93% 37.07% 37.96% Adult Medicine #10 (CDC) Comprehensive Diabetes Care - Hemoglobin A1c (HBA1c) testing 87.10% 77.35% 73.97% Adult Medicine #11 (CDC) Comprehensive Diabetes Care - Eye exam (retinal) performed 55.17% 46.02%* 40.63% Adult Medicine #12 (CDC) Comprehensive Diabetes Care - Medical attention for nephropathy 90.27% 89.27%* 87.59% Adult Medicine #13 (W15) Well-Child Visits in the First 15 Months of Life - Six or more well-child visits 62.06% 56.06% 57.55% Pediatric #14 (W34) Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life 72.45% 65.68% 68.19% Pediatric #15 (CPA) CAHPS Health Plan Survey 5.0H, Adult (Rating of Health Plan, 8+9+10) 76.40% 76.36% 78.82% Adult Medicine #16 (CPC) CAHPS Health Plan Survey 5.0H, Child (Rating of Health Plan-General Population, 8+9+10) 86.04% 88.10% 90.07% Pediatric

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SLIDE 8

Simplification and Collaboration ✓ LDH is focused on Simplification and expansion of

Value Based Purchasing to drive outcomes and deliver additional $$$ to Providers

✓ All MCOs must come to agreement on use of

Common Scorecard and Payment frequency on VBP

✓ State to focused on Using 16 common Quality

measures

✓ State is focused on Expansion and moving up the

Continuum of Alternative Payment Models

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SLIDE 9

Alternative Payment Model(APM) Framework

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https://hcp-lan.org/groups/apm-framework-refresh-white-paper/

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SLIDE 10

Current Market Coverage:

➢81% of Membership currently covered by VBC ➢Primarily PCP focused ➢Of Medicaid’s core 33 HEDIS measures in MY 2016

✓UHC 1st place on 13 & 66%(1st or 2nd) on all 33 Measures

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UHC Program, Focus and Compliance

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SLIDE 11

➢2018 focus and commitment

  • Utilize all 16 core HEDIS measures in VBC
  • Moving to 100% of Membership covered by

VBP

–All PCP groups added(Peds and GPs) –All Expansion Membership added

  • New GAP Closure Model
  • New Adds of OB, BH and Specialists
  • Shared Savings models continue

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UHC Program, Focus and Compliance

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SLIDE 12

➢2018 New GAP Closure Model

Example:

  • Adolescent Well Care Visit(AWC)

–Target 51% –Population 100 –Payout »$XX(contract agreement) from 1st member to 51st »$2 times $XX from 51st to 100 plus retro to member 1-25 »Equals double on all members once Target is hit

  • 1st Qtr - 25 members get visit

–Payment- 25 Members times $XX

  • 2nd Qtr- additional 26 members get visit

–Payment- Target hit- All 51 Members get $XX times 2(or double)

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UHC Program, Focus and Compliance on VBP

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SLIDE 13

UHC Value Based Purchasing

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➢2018 New GAP Closure Model

  • Applies to all membership

–Plus all Adult Expansion membership –We now have 1yr of HEDIS baseline

  • Paid Quarterly

–Payment- 25 Members times $XX

  • Quality Team Quarterly Mailings with Scorecards

and visits –Quality Gap reports available on Providers membership

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SLIDE 14

UHC Value Based Purchasing

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➢2018 New OB, BH and Specialist Models coming

  • Development in Progress

➢ Shared Savings remains in place for Large Groups

  • Gateway to hit Shared Savings

–8-10 HEDIS measures applicable to your Practice »i.e. Pediatrics focused, GP,IM focused

  • If BCR% targets(Similar to MLR%) hit, Savings are Shared
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SLIDE 15

Questions??? and Contacts

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➢LDH MEDICAID APM Model background info

https://hcp-lan.org/groups/apm-framework-refresh-white-paper/

➢Contacts on Value Based Purchasing for UHC Medicaid

  • Karl Lirette, COO

karl.lirette@uhc.com

  • Angela Olden, Director of Quality

angela_olden@uhc.com

  • Shelonda Agee, Director of VBP Network Contracting

shelonda_agee@uhc.com

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SLIDE 16

Alternative Payment Model(APM) Framework

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https://hcp-lan.org/groups/apm-framework-refresh-white-paper/