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

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 Measure (PAM) 2. Medicaid Prime Plan financial performance – Region Wide 2

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 3

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 1 st Quarter 2017 4

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. 5

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 6

Practice Feedback – Shared Savings 7

Quality Measurement Criteria 1. CQM Reporting and Improvement Performance period 1/1/2017 – 12/31/2017  Reported 1 st 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 1 st Quarter 2018  *Both components must be met to meet the QM portion of the distribution criteria 8

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 9

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 10

Questions? Contacts: Lori.Stephenson@rmhp.org Patrick.Gordon@rmhp.org 11