Medicaid Prime Year 3 Shared Savings Distribution Methodology - - PowerPoint PPT Presentation

▶
medicaid prime year 3
SMART_READER_LITE
LIVE PREVIEW

Medicaid Prime Year 3 Shared Savings Distribution Methodology - - PowerPoint PPT Presentation

Mar 15, 2024 367 likes •489 views

Medicaid Prime Year 3 Shared Savings Distribution Methodology Shared Savings Pool Amount Available is dependent on 1. RMHP Plan Level performance meets contract thresholds 2016 Performance on 3 HEDIS Measures Patient Activation

slide-1
SLIDE 1

Medicaid Prime – Year 3

Shared Savings Distribution Methodology

slide-2
SLIDE 2

2

Shared Savings Pool

Amount Available is dependent on

1. RMHP Plan Level performance meets contract thresholds

– 2016 Performance on 3 HEDIS Measures – Patient Activation Measure (PAM)

2. Medicaid Prime Plan financial performance

– Region Wide

slide-3
SLIDE 3

3

Shared Savings Distribution Criteria

  • 1. Total Cost Relativity (TCR = 25% weighting)
  • 2. Quality Measurement (QM = 75% weighting)

Must meet the QM criteria to be eligible for the TCR portion

slide-4
SLIDE 4

4

Total Cost Relativity Calculation

Risk adjusted average total cost for patients attributed to the practice compared to the average total cost of care for the region wide Medicaid Prime program

*Lower risk adjusted total costs = larger share of available pool *Higher risk adjusted total costs = smaller share of available pool

Performance Period = 1/1/2017 – 12/31/2017 Practices must be eligible for the QM portion to be eligible for the TCR portion Monthly TCR Benchmarking reports will become available 1st Quarter 2017

slide-5
SLIDE 5

5

Practice Feedback – Shared Savings

Core principles:

  • Higher portion of shared savings goes to practices

that:

– Larger attribution volume – Higher risk relativity scores – Lower total cost relativity

  • Entire available pool distributed to practices that meet

quality measurement criteria.

slide-6
SLIDE 6

6

Practice Feedback – Shared Savings

  • Plan level: Program wide pool available at state

contract year end if 1) we beat global budget targets and 2) meet plan level quality targets.

  • Practice level: 75% of shared savings for Quality

Measurement Criteria, 25% for Total Cost Relativity.

  • Practice level: A Payment Multiplier will be calculated

for each practice to distribute shared savings on a weighted basis

slide-7
SLIDE 7

7

Practice Feedback – Shared Savings

slide-8
SLIDE 8

8

Quality Measurement Criteria

  • 1. CQM Reporting and Improvement
  • Performance period 1/1/2017 – 12/31/2017
  • Reported 1st Quarter 2018
  • 2. Patient Activation Measure/Coaching for Activation
  • Performance period 7/1/2016 – 12/31/2017
  • Monitored quarterly by RMHP
  • Final assessment by RMHP 1st Quarter 2018

*Both components must be met to meet the QM portion

  • f the distribution criteria
slide-9
SLIDE 9

9

CQM Reporting and Improvement

Practices meet 2017 performance targets* as demonstrated by reporting 2017 performance via EMR by end of Q1, 2018 *Performance targets = set by one of the following:

  • 1. Practice established targets
  • 2. Prime region targets
slide-10
SLIDE 10

10

Patient Activation Measure/Coaching for Activation

  • Demonstration of ongoing use of PAM

– Continued use in established target population – Added target populations – Repeat PAM

  • Demonstration of utilization of CFA tool

– Open CFA tool at least monthly (9/12 months or 60 times in 6 months)

  • Monitored quarterly by RMHP
  • Performance Period = 7/1/2016 – 12/31/2017
slide-11
SLIDE 11

11

Questions?

Contacts: Lori.Stephenson@rmhp.org Patrick.Gordon@rmhp.org