VBP Workgroup Meeting August 25, 2016 August 25, 2016 2 Agenda - - PowerPoint PPT Presentation
VBP Workgroup Meeting August 25, 2016 August 25, 2016 2 Agenda I. VBP Roadmap Update: CMS Feedback II. Clinical Advisory Group Update & Recommendations III. Childrens Health Subcommittee/Clinical Advisory Group IV. Ongoing VBP
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CMS response to the Roadmap was positive The majority of comments were requests for further information Additional questions focused on implementation details, which will be reviewed in conversation with CMS and may not result in Roadmap edits
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Requests for Further Information Broader Policy Questions to Review
What does the State mean by prioritizing these bundled care services?
means by “significant trauma care”?
process be to appoint members?
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Alignment with DSRIP (avoidable hospital use) Reduce ‘drowning’ in measures phenomenon: outcome measures have priority Measuring the quality of the total cycle of care of the VBP arrangement Relevance for patients and providers Alignment with Medicare: linking to point of care registration (EHR) Alignment with State Heath Innovation Plan’s Advanced Primary Care measure set Transparency of process, of measures, of outcomes
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Clinical Relevance
the total integrated care process rather than a single component of that care
preferred over process measures, but process measures remain crucial where outcome measures are not (yet) available
performance and/or possibility for improvement
Feasibility
preferred over non-claims based measures (clinical data, surveys)
are desirable, existing sources should be available (e.g. statewide registries or standardized EHR extracts)
available without significant delay
Validity & Reliability
reputable organization
adequately risk-adjusted
CAG members for each VBP arrangement assessed quality measures according to the following criteria:
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The quality measure selection process began using the following sources:
Key starting point: no reinventing of the wheel!
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CATEGORY 1 Approved quality measures that are felt to be both clinically relevant, reliable and valid, and feasible. CATEGORY 2 Measures that are clinically relevant, valid, and probably reliable, but where the feasibility could be problematic. These measures should be investigated during the 2016/2017 pilot program. CATEGORY 3 Measures that are insufficiently relevant, valid, reliable and/or feasible.
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“The Category 1 quality measures recommended by each CAG and accepted by the State are to be reported by the VBP contractors. The measures are also intended to be used to determine the amount of shared savings that VBP contractors are eligible for … “ 1 CAG recommends measure categories State accepts or re-categorizes measures VBP Contractors report on measures
These proposals are presented in the following slides for Workgroup comment
1 VBP Roadmap, page 34
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August 25, 2016 Clinical Advisory Group Associated VBP arrangement Status of Report Maternity Maternity Bundle Published on DOH website* HIV/AIDS HIV/AIDS Subpopulation Published on DOH website* Health and Recovery Plan (HARP) and Behavioral Health HARP Subpopulation Draft under development. Scheduled to review during October work group meeting. Chronic Heart Disease, Pulmonary, Diabetes (Chronic Conditions) Integrated Primary Care (IPC): Chronic Bundle Drafts under development. Scheduled to review during October work group meeting. Managed Long-Term Care (MLTC) MLTC Subpopulation Draft under development Intellectually/Developmentally Disabled (I/DD) I/DD Subpopulation Draft under development
* Website address: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/vbp_final_cag_reports.htm
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CAG Recommended Arrangement Definition and Quality Measures
Program (DSRIP) Overview
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Maternity CAG Members Howard Minkoff, MD Thomas Havranek, MD Karen Smoler Heller Edmund LaGamma MD Valerie Grey Michael Horgan, MD Liz Dears, Esq Timothy Stevens, MD, MPH Grace Bi, MD, MMS, MS, CPH Edward Kelly Bartels, MD Vinay S. Rane, MD (Monitor) Maria Czerwinski, MD Nalini Krishnan, MD Rachel de Long, MD, MPH Loretta B. Willis, RN, BS, CPHQ, CCM Marilyn Kacica, MD, MPH Sharmila K Makhija MD, MBA Wendy Shaw Arnold Friedman, MD Eileen Shields Michael Brodman, MD Warria Esmond, MD Maryanne F. Laffin, RN, FNP, CNM, FACNM Taechin Yu, MD, FACOG Robert Silverman, MD Sharon Deans, MD, FACOG Ephraim Back, MD MPH Lorraine Ryan, RN, Esq. Elie Ward, MSW Foster Gesten, MD Vito Grasso Raina Josberger Donna Montalto, MPP Anne Schettine, RN Renee Samelson, MD, MPH Kathy Ciccone, RN, MPH, ACHE Kevin Kiley, MD Grace Bi, MD, MMS, MS, CPH Chris Glantz, MD Vinay S. Rane, MD (Monitor) Deborah Campbell, MD Nalini Krishnan, MD
The Maternity CAG met over three sessions to discuss the key areas listed below:
1. A qualifying trigger code is a ICD-9/CPT/HCPCS code which, when implicated, will automatically create the maternity bundle. See Appendix 1 (regarding a list of the HCI3 PREGN, CSECT, and VAGDEL ICD-9/CPT/HCPCS qualifying trigger codes). http://www.hci3.org/ecr_descriptions/ecr_description.php?version=5.2.005&name=VAGDEL&submit=Submit 2. The HCI3 data is for the period between January 1, 2012 through December 31, 2013.
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Consistent with the CAG recommendations, the State recommends the following bundle definition for the Maternity VBP arrangement.
medication, ultrasound, etc.
60 days post-discharge. Services such as facility costs, professional services, and any associated complications for mother and child are included.
Population Included Bundle Definition
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August 25, 2016 Field Description Acceptable Values Reporting Source
Entity responsible for the reporting of required data State (claims-based measures) VBP Contractor (e.g. clinical measures)
State Recommended Category
The Category in which the State proposes to classify the measure. 1 (Must be Reported) 2 (Optional) 3 (Not Recommended)
Pay for Reporting (P4R)
The State recommends to reward the VBP contractor’s reporting of this measure rather than the VBP contractor’s performance Yes – reporting is key first step towards improved quality measurement No – measure can be used to compare performance
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No. Category 1 Measure Reporting Source State Recommended Category P4R 1 Frequency of Ongoing Prenatal Care State 1 No 2 Prenatal and Postpartum Care (PPC) State 1 No 3 % of Vaginal Deliveries with Episiotomy VBP Contractor 1 Yes 4 Vaginal Birth After Cesarean (VBAC) Delivery Rate VBP Contractor 1 Yes 5 C-Section for Nulliparous Singleton Term Vertex (NSTV) (risk adjusted) VBP Contractor 1 Yes 6 % of Early Elective Deliveries VBP Contractor 1 Yes
The CAG recommends the following quality measures for use in the Maternity VBP Arrangement.
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The CAG recommends the following quality measures for use in the Maternity VBP Arrangement.
No. Category 2 Measure Reporting Source State Recommended Category P4R
7 Antenatal Steroids VBP Contractor 2 Yes 8 Antenatal Hydroxyl Progesterone VBP Contractor 2 Yes 9 Experience of Mother With Pregnancy Care VBP Contractor 2 Yes 10 Appropriate DVT Prophylaxis in Women Undergoing Cesarean VBP Contractor 2 Yes 11 Intrapartum Antibiotic Prophylaxis for Group B Streptococcus (GBS) VBP Contractor 2 Yes 12 Birth Trauma Rate – Injury to Neonate State 1 No 13 Live Births Weighing Less than 2,500 Grams (risk adjusted) VBP Contractor 1 Yes 14 % Preterm Births VBP Contractor 1 Yes 15 Under 1500g Infant Not Delivered at Appropriate Level of Care State 1 No 16 Postpartum Blood Pressure Monitoring VBP Contractor 2 Yes 17 LARC Uptake VBP Contractor 2 Yes 18 Neonatal Mortality Rate VBP Contractor 3 N/A 19 Hepatitis B Vaccine Coverage Among All Live Newborn Infants Prior to Discharge VBP Contractor 2 Yes 20 % of Babies Who Were Exclusively Fed with Breast Milk During Stay VBP Contractor 1 Yes 21 Monitoring and Reporting of NICU Referral Rates VBP Contractor 2 Yes
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CAG Recommended Arrangement Definition and Quality Measures
Program (DSRIP) Overview
Overview
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The HIV/AIDS CAG met over three sessions to discuss the key areas listed below:
HIV/AIDS CAG Members Christine Kerr, MD Terry Hamilton Sanjiv Shah, MD Clint Koenig, MD Jerry Ernst, MD Joseph McGowan, MD, FACP, FIDSA Peter Gordon, MD David Cohen, MD Jay Dobkin, MD Jack DeHovitz, MD, MPH, FACP Ross Hewitt, MD Peter Meacher, MD William Valenti, MD Anthony Fortenberry, RN David Ferris, MD, MS John Conry, PharmD Bruce Agins, MD, MPH Carlene Zincke Doug Fish, MD Mary-Ann Etiebet, MD Ginny Shubert, Esq. Daniel O'Connell Charles King Johanne E. Morne, MS Agnes Cha, PharmD, AAHIVP, BCACP Ira Feldman, MHA Daniel Young, MD Franklin Laufer, PhD Demetre Daskalakis, MD, MPH Ilena Elevitch Dan Tietz, JD, RN Carmelita Cruz Anne Schettine, RN Farnaz Malik, MPH Eunice Casey, MPH, MIA Janine L. Lloyd Michael Augenbraun, MD Jacqueline T. Treanor, MPA Eli Camhi, LMSW Liz Dears, Esq William Streck, MD Valerie Grey Kathy Ciccone, RN, MPH, ACHE Karen Smoler Heller Sharen Duke, MPH
1. A qualifying trigger code is a ICD-9/CPT/HCPCS code which, when implicated, will automatically create the maternity bundle. See Appendix 1 (regarding a list of the HCI3 PREGN, CSECT, and VAGDEL ICD-9/CPT/HCPCS qualifying trigger codes). http://www.hci3.org/ecr_descriptions/ecr_description.php?version=5.2.005&name=VAGDEL&submit=Submit 2. The HCI3 data is for the period between January 1, 2012 through December 31, 2013.
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Consistent with the CAG recommendations, the State recommends the following bundle definition for the HIV/AIDS VBP arrangement.
York State (EtE).
Population Included HIV/AIDS Subpopulation Services
Exclusions
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No. Category 1 Measure Reporting Source State Recommended Category P4R 1 HIV Viral Load Suppression
VBP Contractor
1 Yes 2 Proportion of Patients with HIV/AIDS that have a Potentially Avoidable Complication during a Calendar Year
State
1 No 3 Sexually Transmitted Diseases: Screening for Chlamydia, Gonorrhea, and Syphilis
VBP Contractor
1 Yes 4 CD4 Cell Count or Percentage Performed
VBP Contractor
1 Yes 5 Preventive Care and Screening: Screening for Clinical Depression and Follow- Up Plan
VBP Contractor
1 Yes 6 Substance Use Screening
VBP Contractor
1 Yes 7 HIV Medical Visit Frequency State 1 No 8 Linkage to HIV Medical Care
VBP Contractor
1 Yes
The CAG recommends the following quality measures for use in the HIV/AIDS VBP Arrangement.
* HIV/AIDS specific measures. Standard primary care measures may also apply.
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No. Category 2 Measure Reporting Source State Recommended Category P4R 9 Sexual History Taking: Anal, Oral, and Genital
VBP Contractor
1 Yes 10 Diabetes Screening State 1 No 11 Hepatitis C Screening
VBP Contractor
2 Yes 12 Housing Status
VBP Contractor
2 Yes 13 Prescription of HIV Antiretroviral Therapy
VBP Contractor
2 Yes 14 Medical Case Management: Care Plan
VBP Contractor
2 Yes
The CAG recommends the following quality measures for use in the HIV/AIDS VBP Arrangement.
* HIV/AIDS specific measures. Standard primary care measures may also apply.
measures and episode definitions from the VBP Workgroup.
arrangement no later than September 9.
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DOH Sponsor: Lana Earle Co-Chairs: Kate Breslin and Dr. Jeanne Alicandro Proposed Scope:
addressed in a VBP environment Proposed Timeline
August September/October October/November November Subcommittee Planning Hold 1st Session Hold Sessions 2 and 3 Submit recommendations prior to finalization of budget
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Co-Chairs:
(HANYS)
(Barclay Damon) Jon Bick
(OHIP Representative)
Meeting Schedule:
Current Status:
Policy T
1) Encounter Data Submission 2) Fraud, Waste, and Abuse 3) VBP Policy Design
Program Integrity
Co-Chairs:
(MSSNY)
(Housing Works)
Carlos Cuevas (OHIP Representative)
Meeting Schedule:
Current Status:
Policy T
1) RHIO and SHIN-NY Data 2) Care Management 3) Vital Statistics (VS)
Patient Confidentiality
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Encounter Data Submission Fraud, Waste, and Abuse Policy Question How does New York State ensure that quality and encounter data is timely, accurate, and complete upon submission? How does VBP impact the role of the OMIG, DOH and other interested parties with regard to fraud, waste and abuse? 1 2 Topic VBP Policy Design 3 What safeguards should be enacted related to access and quality of care to ensure that the transition to VBP does not create incentives that are not in the spirit of the program? 30 August 25, 2016
RHIO and SHIN-NY Data Care Management Policy Question How does New York State address NYS patient confidentiality laws and minor consent laws that limit provider-to-provider access in order to ensure the RHIO and SHIN-NY are complete? How does NYS clarify the application of State Confidentiality laws to Care Management Organizations, which may neither be covered entities nor providers, but still have a need to access patient information in order to coordinate care? 1 2 Topic Vital Statistics (VS) 3 Will NYS create an exception process by which Vital Statistics data can be accessed in order to supplement certain medical records and support VBP? Medicaid Consent How can New York State clarify the scope of the Medicaid Consent Form to providers, in order to minimize delays in data reporting? 4 DSRIP Opt-Out and DEAA Processes How can NYS create exceptions or clarify policy, so upstream or non-State provided data can easily be transmitted for purposes of VBP? 5 31 August 25, 2016
The next VBP Workgroup meeting will be held on October 12 from 1:00 – 3:00 The agenda will be as follows:
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