VBP Workgroup Meeting November 29, 2016 November 29, 2016 2 - - PowerPoint PPT Presentation
VBP Workgroup Meeting November 29, 2016 November 29, 2016 2 Agenda I. CAG Update and recommendations: HARP Behavioral Health Chronic Conditions (Utilized in the IPC VBP Arrangement) II. Education & Outreach Update (Post VBP
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CAG Recommended Definition and Quality Measures
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HARP CAG Members Alan Maughan Kamala Green, PhD Alison Flynn Kishor Malavade, MD Amy Jones, LMSW Lloyd Sederer, MD Anne Schettine, RN Loretta B. Willis, RN, BS, CPHQ, CCM Bob Myers, PhD Marleen Radigan, MS, MPH, DrPH Bruce J. Schwartz, MD Mary Richards, LCSW Cathy Saresky, MSW Nanette McLain Chad Shearer, JD, MHA Pam Mattel, LCSW Debbie Pantin Pat Lincourt, MSW, LCSW Edward Amyot, MD Paul Streck Frank Dowling, MD Radhika Vars, MSW Gary Belkin, MD, PhD, MDH Sabina Lim, MD, MPH Greg Allen Stephan Brown, PhD Henry Chung, MD Thomas E. Smith, MD Howard Hitzel, MD Tony Maffia, LCSW/R Jean McCarrick RN, LCSW Tracie Gardner Jeffrey Levine, MD, FACP Valerie Grey Julie Harris Virna Little, PsyD, LCSW-R, SAP
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include employment, education and peer supports services. Tier 2 includes the full array of BH HCBS
HARP plans (including the enhanced benefit package BH HCBS)
Use Disorder (SUD) diagnoses having serious behavioral health issues are eligible to enroll in HARP Plans
Population Included Defined Services
The CAG recommends the following definition for the HARP VBP arrangement.
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The CAG recommends the following quality measures for use in the HARP arrangement.
# Measures Reporting Source State Recommended Category* P4R** 1 Diabetes screening for people with schizophrenia or bipolar disorder using antipsychotic medications State 1 No 2 Follow-up after hospitalization for mental illness (within 7 and 30 days) State 1 No 3 Percentage of members enrolled in a Health Home State 1 No 4 Initiation of pharmacotherapy for opioid dependence within 30 days1
State
1 No 5 Percentage of mental health discharges followed by two or more mental health
State 1 Yes 6 Tobacco use screening and follow-up for people with serious mental illness or alcohol or other drug dependence VBP Contractor 1 Yes 7 Initiation of pharmacotherapy for alcohol use disorder within 30 days2 State 1 Yes
1 – OASAS proposing to work through measure specifications and application of measure as a pay-for-performance measure 2 – A claims-based measure for which OMH/OASAS are seeking additional input from VBP contractors to refine * – P4R entry of ‘Yes’ then State Recommended Category of ‘1’ = Required & ‘2’ = Optional. ** – P4R entry of “No” indicates can be used for performance payment.
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The CAG recommends the following quality measures for use in the HARP arrangement.
# Measures Reporting Source State Recommended Category* P4R** 8 Utilization of pharmacotherapy for alcohol use disorder2 State 1 Yes 9 Utilization of pharmacotherapy for opioid dependence2 State 1 Yes 10 Follow-up after emergency department visit for alcohol and other drug dependence2 State 1 Yes
1 – OASAS proposing to work through measure specifications and application of measure as a pay-for-performance measure 2 – A claims-based measure for which OMH/OASAS are seeking additional input from VBP contractors to refine * – P4R entry of ‘Yes’ then State Recommended Category of ‘1’ = Required & ‘2’ = Optional. ** – P4R entry of “No” indicates can be used for performance payment.
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The CAG recommends the following quality measures for use in the HARP arrangement.
# Measures Reporting Source State Recommended Category* P4R** 11 Rate of readmission to inpatient mental health treatment within 30 days (readmission in any geographic region) State 1 No 12 Continuing engagement of alcohol and other drug dependence treatment (CET)1
State
1 No 13 Continuity of care within 14 days of discharge from any level of SUD inpatient care1
State
1 No 14 Percentage of members who receive PROS or HCBS for at least 3 months in reporting year VBP Contractor 1 Yes 15 Percentage of members who maintained/obtained employment or maintained/improved higher education status (from HCBS Waiver Eligibility Screening) VBP Contractor 1 Yes 16 Percentage of members with maintenance of stable or improved housing status(from HCBS Waiver Eligibility Screening) VBP Contractor 1 Yes 17 Percentage of members with reduced criminal justice involvement(from HCBS Waiver Eligibility Screening) VBP Contractor 1 Yes
1 – OASAS proposing to work through measure specifications and application of measure as a pay-for-performance measure * – P4R entry of ‘Yes’ then State Recommended Category of ‘1’ = Required & ‘2’ = Optional. ** – P4R entry of “No” indicates can be used for performance payment.
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Episode Definitions and Quality Measures Part of the IPC VBP Arrangement
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Behavioral Health Chronic Conditions CAG Members
Alan Maughan Colette Poulin, MSW Jeffrey Levine, MD, FACP Pat Lincourt, MSW, LCSW Alison B. Flynn, CMRP, FACHE David Ackman, MD, MPH John Coppola, MSW Radhika Vars, MSW Alison Burke, Esq Dawn Lambert-Wacey John Kastan Roy Wallach Allegra Schorr Deb Pantin, LCSW Kamala Green, PhD Sabina Lim, MD, MPH Amy Dorin Dianne Kiernan Karen Smoler Heller Sharon Stancliff, MD Amy Jones, LMSW Don Zalucki Kishor Malavade, MD Stephan Brown, PhD Anne Schettine, RN Doug Fish, MD Liz Dears, Esq Stephen Rosenheck, PhD Barbara Zeller, MD Edward Amyot, MD Lloyd Sederer, MD Thomas E. Smith, MD Belinda Greenfield, MA, MEd, PhD Elizabeth Oudens Loretta B. Willis, RN, BS, CPHQ, CCM Tim Feeney, PHD Beth Lawyer Ellen Grabowitz Luke Bergmann Tony Maffia, LCSW/R Bob Myers, PhD Frank Dowling, MD Lynda Hohmann, MD, PhD, MBA Tracie Gardner Brian Johnson, MD Gary Belkin, MD, PhD, MDH Lynne Schaefer, PhD, ABPP-CN Valerie Grey Bruce J. Schwartz, MD Harvey Rosenthal Marleen Radigan, MS, MPH, DrPH Victoria Aufiero, Esq. Bruce Maslack, MD Henry Chung, MD Mary Richards, LCSW Virna Little, PsyD, LCSW-R, SAP Cathy Saresky, MSW Hope Plavin, MPA, MHCDS Monika Taylor, LCSW, CASAC William Streck, MD Chad Shearer, JD, MHA Howard Hitzel, MD Nanette McLain Charlie Morgan, MD, FASAM, FAAFP, DABAM Jean McCarrick RN, LCSW Norman Brier, PhD Charlie Neighbors Jeanna Marraffa, PharmD, DABAT, FAACT Pam Mattel, LCSW
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* A qualifying trigger code is a ICD-9 or 10 /CPT/HCPCS code. See episode definitions here: http://www.hci3.org/programs-efforts/prometheus-payment/evidence_informed_case_rates/ecrs-and-definitions
imaging, medication) associated with the care for the condition (as long as the member remains enrolled)
code* for the specific episode and meet the trigger criteria that is specified for the episode. A confirming trigger claim at east 30 days after the initial trigger claim is also necessary to ensure the episode is appropriate for the member.
Population Included Episodes Definition
The CAG recommends the following Behavioral Health Chronic Conditions definition:
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The CAG recommends the following quality measures for use in the IPC arrangement.
# Measures Reporting Source CAG Recommended Category State Recommended Category* P4R** 1 Screening for Clinical Depression and Follow-Up Plan1 VBP Contractor 1 1 No 2 Antidepressant medication management State 1 1 No 3 Potentially Avoidable Complications State 1 1 No 4 Diagnosis (IMPACT Model) VBP Contractor 2 2 Yes 5 Initiation of Treatment (IMPACT Model) VBP Contractor 1 2 Yes 6 Adjustment of Treatment Based on Outcomes (IMPACT Model) VBP Contractor 2 2 Yes 7 Symptom Reduction (IMPACT Model) VBP Contractor 1 2 Yes 8 Generalized Anxiety Disorder 7-item (GAD 7) Scale VBP Contractor 2 2 Yes
1 – Proposed measure change from pay-for-reporting to pay-for-performance * P4R entry of ‘Yes’ then State Recommended Category of ‘1’ = Required & ‘2’ = Optional. ** P4R entry of “No” indicates can be used for performance payment.
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The CAG recommends the following quality measures for use in the IPC arrangement.
# Measures Reporting Source CAG Recommended Category State Recommended Category* P4R** 1 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment State 1 1 No 2 Continuing Engagement in Treatment (CET) 1 State 1 1 No 3 Initiation of MAT for Opioid Dependence1 State 1 1 No 4 Initiation of MAT for Alcohol Dependence Plan2 State 1 1 Yes 5 Potentially Avoidable Complications State 1 1 No 6 Continuity of care within 14 days of discharge from any level of SUD inpatient care (COC) Plan1 State 1 1 No 7 Utilization of MAT for Opioid Dependence Plan2 State 2 1 Yes 8 Utilization of MAT for Alcohol Dependence Plan2 State 2 1 Yes 9 Connection to Community Recovery Supports Plan3 VBP Contractor 2 2 Yes
1 – OASAS proposing to work through measure specifications and application of measure as a pay-for-performance measure 2 – A claims-based measure for which OMH/OASAS are seeking additional input from VBP contractors to refine 3 – A developmental measure for which OASAS seeks to develop an appropriate measurement tool with VBP contracting entities *P4R entry of ‘Yes’ then State Recommended Category of ‘1’ = Required & ‘2’ = Optional. ** P4R entry of “No” indicates can be used for performance payment.
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The CAG recommends the following quality measures for use in the IPC arrangement.
# Measures Reporting Source CAG Recommended Category State Recommended Category* P4R** 1 Cardiovascular Health Screening for People With Schizophrenia
State 1 1 No 2 Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications State 1 1 No 3 Readmission to mental health inpatient care within 30 days of discharge State 1 1 No 4 Potentially Avoidable Complications State 1 1 No 5 Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder State 2 1 No 6 Bipolar disorder: the percentage of patients with Bipolar I Disorder with mania/hypomania, mixed or cycling symptoms and behaviors who have evidence of use of pharmacotherapy agent with antimanic properties during the first 12 weeks of treatment. VBP Contractor 2 2 Yes
* P4R entry of ‘Yes’ then State Recommended Category of ‘1’ = Required & ‘2’ = Optional. ** P4R entry of “No” indicates can be used for performance payment.
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The CAG recommends the following quality measures for use in the IPC arrangement.
# Measures Reporting Source CAG Recommended Category CAG Recommended Category* P4R** 7 Bipolar disorder: percentage of patients with Bipolar I Disorder with depressive symptoms and behaviors who have evidence of use of a mood stabilizing or antimanic agent during the first 12 weeks of pharmacotherapy treatment. VBP Contractor 2 2 Yes 8 Bipolar disorder: the percentage of patients diagnosed with bipolar disorder and treated with lithium who have evidence of a lithium serum medication level with 12 weeks of beginning treatment. VBP Contractor 2 2 Yes 9 Bipolar disorder: the percentage of patients with Bipolar I Disorder symptoms and behaviors who received monotherapy with an antidepressant agent during the first 12 weeks of treatment. VBP Contractor 2 2 Yes 10 Bipolar disorder: the percentage of patients with bipolar disorder who receive a recommendation for an adjunctive psychosocial intervention, including evidence-based therapies, within 12 weeks of initiating treatment. VBP Contractor 2 2 Yes 11 Bipolar disorder: the percentage of patients diagnosed and treated for bipolar disorder who are provided with education and information about their illness and treatment within 12 weeks of initiating treatment. VBP Contractor 2 2 Yes
* P4R entry of ‘Yes’ then State Recommended Category of ‘1’ = Required & ‘2’ = Optional. ** P4R entry of “No” indicates can be used for performance payment.
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The CAG recommends the following quality measures for use in the IPC arrangement.
# Measures Reporting Source CAG Recommended Category State Recommended Category* P4R** 1 Potentially Avoidable Complications State 1 1 No 2 Primary Care PTSD Screen (PC-PTSD) VBP Contractor 2 2 Yes
* P4R entry of ‘Yes’ then State Recommended Category of ‘1’ = Required & ‘2’ = Optional. ** P4R entry of “No” indicates can be used for performance payment.
arrangement no later than December 13.
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November 29, 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* Chronic Heart Disease, Pulmonary, Diabetes (Chronic Conditions) Integrated Primary Care (IPC): Chronic Bundle Published on DOH website* Health and Recovery Plan (HARP) and Behavioral Health Chronic Conditions HARP Subpopulation Being presented at the November VBP 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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Objectives
community that may hinder the transition into VBP.
Agenda
solicit feedback on the presented VEO activities
Time & Location
Auditorium
Feedback from the Town Hall will inform CY 2017 VEO strategy through dialogue between Medicaid provider associations and DOH
VEO Strategy will aim to close the knowledge gap in the plan (MCO) and provider communities to support the transition to VBP. VEO activities include but are not limited to:
DOH Provider associations
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MACRA Quality Payment Program has two tracks:
1. Advanced alternative payment models (APMs)
2. Merit-based incentive payment system (MIPS)
To qualify as an Other Payer advanced APM, the rule establishes three requirements :
performance category under MIPS
to Medical Home Models expanded under the Act. (See Appendix)
DOH Feedback, key themes:
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*Section 1833 (z)(D) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ** Section 1833(z)(2) Other payer includes Medicaid or a commercial payer
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The next VBP Workgroup meeting will be held: