CHASE Board April 2019 Nancy Dolson Department of Health Care - - PowerPoint PPT Presentation

CHASE Board April 2019

Nancy Dolson Department of Health Care Policy and Financing

Hospital Transformation Program

Measure Scoring Summary Proposal

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Background

• CHASE and HCPF to seek CMS approval for a five-year delivery

system reform incentive payment (DSRIP) program

• State will leverage existing supplemental payments to hospitals

as incentives in the statewide Hospital Transformation Program (HTP)

• These hospital supplemental payments will be incentivized to:
• Improve patient outcomes
• Lower Medicaid costs
• Prepare hospitals for value-based payment environments
• Foster a culture of community engagement
• In collaboration with hospitals and key stakeholders, HCPF has
• utlined how hospitals will be evaluated through key measures

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Overview

Five focus areas which the HTP seeks to address

• Reducing avoidable inpatient and outpatient hospital

utilization

• Vulnerable populations
• Behavioral health and substance-use disorder
• Clinical and operational efficiencies
• Population health and total cost of care

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Five-Year Plan

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• Pre-program period sees participating hospitals conducting

community and health neighborhood engagement (CHNE) process to inform their plans for the HTP

• Throughout program years 1 to 5 HCPF will maintain

transparency through public reporting on quality measures and hospital utilization

• Reimbursement structure in program years 1 to 2 will be based
• n pay-for-reporting and pay-for-action
• This will shift to pay-for-quality and pay-for-performance in

program years 3 to 5, with percentage of hospital risk increasing annually

• Value-based payment methods are envisioned post-HTP

Five-Year Plan

• Hospitals will receive supplemental payments based on

meeting program measures

• For each measure and intervention, hospitals will develop

improvement plans informed by CHNE with milestones for years 1-2

• As hospitals enact these plans, years 3-5 will build in measures
• f performance to improve care and health outcomes while

reducing costs

• Hospitals will also produce sustainability plans in year 5
• HCPF is recommending statewide measures, as well as local

measures selected by individual hospitals based on their community’s needs

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Downside Risk

Pay-for-Reporting and Activity, Pay for Achievement, Performance and Improvement HCPF proposes that hospitals’ financial risk increase annually according to the following schedule

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Program Year Plan for Hospital Risk PY1: 5%

• f payments at risk

1.5% for hospital applications 1.5% for implementation plans 2% for timely reporting PY2: 6%

• f payments at risk

2% for timely reporting 4% for meeting proj ect milestones PY3: 15%

• f payments at risk

2% for timely reporting 8% for meeting proj ect milestones 5% for meeting measurement/ improvement thresholds *50%

• f penalties can be earned back by

submitting course-correction plan PY4: 20%

• f payments at risk

2% for timely reporting 18% for meeting measurement/ improvement thresholds PY5: 30%

• f payments at risk

2% for timely reporting 8% for submission and approval of sustainability plan 20% for meeting measurement/ improvement thresholds

• Redistribution of penalty dollars and savings bonuses
• Savings bonuses refer to payments to hospitals based on costs

savings in fee-for-service attributable to HTP efforts

• For program years 2 to 3, the risk will comprise only of a

redistribution of penalty dollars

• For program years 4 to 5, HCPF recommends including savings

bonuses

• E.g., dollars could be redistributed to highest/most improved

performers

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Upside Risk

Redistribution of Penalty Dollars and Medicaid Savings Bonus

Measure Development Process

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Measures evaluated based on key principles:

• Evidenced-based and scientifically acceptable
• Usable and relevant
• Feasible to collect
• Aligned with other measure sets
• Opportunity for quality improvement
• Hospitals could impact
• Representative of the array of services and diversity of

patients served

Measure Development Process

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• Hospital measurement workgroups
• Measurement specification workgroups
• Clinical workgroup

Statewide Measures

At least one statewide measure is included in each of these five focus areas which the HTP seeks to address:

• Reducing avoidable inpatient and outpatient hospital

utilization

• Vulnerable populations
• Behavioral health and substance-use disorder
• Clinical and operational efficiencies
• Population health and total cost of care

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Statewide Measures: Examples

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Reducing Avoidable Hospital Utilization Behavioral Health and Substance Use Disorders Vulnerable Populations Clinical and Operational Efficiencies Population Health and Total Cost of Care

• 30-day all cause risk

adj usted readmission rate (adult CMS specification - pediatric spec AHRQ)

• RAE follow-up after

discharge from IP or ED with MH covered diagnosis

• RAE follow-up after

discharge from IP or ED with S UD covered diagnosis

• Using ALTOs in ED
• Opioid prescriptions in ED
• Opioid prescribing

guidelines for post- surgical and chronic pain in out years

• S
• cial Determinant s of

Health S creening and Referral To the RAE

• Hospital

Index

• Health Waste

Calculator

• Risk Adj usted Length
• f S

tay (adult CMS specification - pediatric specification to be determined )

Local Measures

• Hospitals will select from an array of local measures to comprise

the remainder of their measurement score

• There is a local measures menu within each of the five focus

areas

• It is recommended that there be no required number of local

measures per focus area but rather the mix of local measure selections should reflect community needs identified in CHNE

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Local Measures: Examples

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Reducing Avoidable Hospital Utilization Behavioral Health and Substance Use Disorders Vulnerable Populations Clinical and Operational Efficiencies

• Connection to PCP prior to

discharge and follow-up appointment made

• ED visits for which the

member received follow-up within 30 days of the ED visit (HEDIS )

• Home Management Plan of

Care (HMPC) Document Given to Pediatric Asthma Patient/ Caregiver (eCQM)

• Percentage of patients with

ischemic stroke who are discharged on statin medication (eCQM)

• 3 Item Care Transitions

Patient S urvey Measure (CMS )

• Initiation of S

UD treatment within 14 days

• f new diagnosis of S

UD (AHRQ)

• S

creening for depression and suicide risk in IP and ED

• S

BIRT in the Emergency Room

• Use of Prescription Drug

Monitoring Program prior to opioid prescription for ED patients

• Initiation of MAT in

Emergency Room

• Utilization of MAT for

perinatal/ postpart um women presenting S UD

• 7-day readmission rate for a high

frequency chronic condition

• Implementation/ expansion of

telehealth visits

• S

creening for transitions of care supports in adults with disabilities

• Opportunity Days –

APR-DRG actual

• vs. expected days
• Increased

utilization of telehealth

• Energy S

tar Certification

State Priorities

• Statewide priority opportunities listed below be weighted more

heavily to incentivize hospitals to undertake these efforts

• Conversion of hospital-owned free-standing

emergency departments (FSED) to address community needs

• Dual-track emergency departments
• Participation in a global budget or other arrangement

for certain rural hospitals, if available

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Complementary Statewide Efforts

• Discussion of hospital inventory and capacity as part of the

CHNE

• Engagement with a multi-provider consensus quality measure

and alternative payment methodology (APM) collaborative

• Use of the Advanced Care Plan Repository and Education Tools
• Use of the Medication (Rx) Prescribing Tool
• Where capacity/need align, provide beds for residential and

inpatient SUD services consistent with SUD Waiver

• Real time Data Sharing and ADT Standards
• Defining and identifying Centers of Excellence

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Discussion

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Hospital Quality Incentive Payment

Proposed Changes for Board Decision

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HQIP

• Behavioral Health Measures
• Follow-up appointments within 7 days after hospital

discharge

• Emergency department utilization for mental health and

substance use conditions

• Subcommittee recommendation
• Revert to the 2018 RCCO/BHO measures

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HQIP

• Hospital Index Measure
• Development timeline for Hospital Index
• Subcommittee recommendation
• Revise the requirements of the Hospital Index measure to a

process measure demonstrating ability to use the tool and extract basic information

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Board Decision

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Thank You

Nancy Dolson Special Financing Division Director Department of Health Care Policy & Financing nancy.dolson@state.co.us