Agenda Items #4 and #5 of Metrics and Scoring Committee Meeting #5 Oregon Metrics and Scoring Committee Michael Bailit October 22, 2012
Meeting Agenda #4 Continue Setting Performance and Improvement Targets #5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #5 Algorithm Design 2
Measures that Require Additional Discussion Regarding Targets 1. CAHPs Composite 2. Rate of PCPCH Enrollment 3. Colorectal Cancer Screening 4. Screening for Clinical Depression and Follow-up Plan 5. EHR Composite 3
CAHPS Composite Measure OHA will present an alternative to the seven-question composite. � Proposed Improvement Target: MN method with 3% floor � Proposed Performance Target: Medicaid 75 th percentile 4
Rate of PCPCH Enrollment � OHA recommends no improvement target for Year One. � OHA recommends selecting a performance target based on a desired Year One distribution of PCPCH enrollment across the three recognition tiers. � Performance target options: Option 1 Option 2a Option 2b Option 3a Option 3b Target .875 .75 .75 .67 .67 Tier 3 (x3) 75% 50% 60% 33.3% 20% Tier 2 (x2) 12.5% 25% 15% 33.3% 70% Tier 1 (x1) 12.5% 25% 14% 33.3% 0% Not 0 0 11% 0 10% certified 5
Colorectal Cancer Screening � Proposed Improvement Target: MN method with 3% floor � Proposed Performance Target: 61.34% or above � 2012 Commercial data 75th percentile: 65.76% � Adjustment factor: -4.42 (average difference between Medicaid measures and commercial measures for adult populations 1 ) Commercial Adjustment Adjusted Benchmark Factor Performance Target 65.76% -4.42 = 61.34% 1: See Excel spreadsheet for calculation of the adjustment factor. 6
Screening for Clinical Depression and Follow-up � OHA recommends no performance targets and data reporting only for Year One. – If the CCO reports data in Year One, it should receive credit for this measure. 7
EHR Composite Measure � OHA continues to await benchmark data from CMS to inform target setting. 8
Meeting Agenda #4 Continue Setting Performance and Improvement Targets #5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #5 Algorithm Design 9
Review Feedback on Structural Elements of the Incentive Pool OHA is responsible for determining the structure of the incentive pool, but would appreciate comments from the Committee. � OHA requested that members submit feedback through email in response to the following questions: – What should happens to eligible incentive funds not earned by a CCO? – How should the amount of incentive funds that are potentially available to the CCOs be determined? – What should be the timing of the distribution of funds? 10
Meeting Agenda #4 Continue Setting Performance and Improvement Targets #5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #5 Algorithm Design 11
How should the incentive pool be divided among the CCOs? Distribution Options: 1.The incentive pool opportunity is apportioned based on CCO enrollment. 2.There is a minimum available amount (floor) established for all CCOs and those CCOs above the floor subsidize those below it (based on enrollment) 3.The incentive pool is available such that smaller CCOs are eligible for a disproportionate share relative to larger CCOs based on a tiering of CCOs by enrollment. 4.The incentive pool is available such that smaller CCOs are eligible for a disproportionate share relative to larger CCOs using a continuous scale adjustment across all CCOs. 12
Assumptions for the Examples The program will receive a 4.4% increase. The Governor has said that 2-3% of this will be allocated based on performance relative to the quality incentive pool measures. Assumptions for options modeling: � The incentive pool is $46 million (2% of the 4.4% increase). � Enrollment for the year is the same as in September 2012. � There are 16 participating CCOs. � Total enrollment is 461,584. 13
Distribution Option 1: Even Distribution 1. The incentive pool opportunity is apportioned based on CCO enrollment. 14
Option 1: Even Distribution Example : � PMPM is $8.30 (same across all CCOs) � Total potential ranges from $560,071 to $11,352,608 � Average potential incentive payment is $2,875,000 � Median potential incentive payment is $2,033,099 � Three of the 16 CCOs are eligible to receive less than $1 million 15
Distribution Option 2: Floor Subsidized by Others • There is a minimum available amount (floor) established for all CCOs and those CCOs above the floor subsidize those below it on a pro-rata basis. • Those CCOs that would have received less than the floor by an even distribution are subsidized by the rest of the “donor” CCOs. The amount of the donation is distributed among the donor CCOs relative to their enrollment, with the largest CCOs contributing the most. 16
Distribution Option 2: Floor Subsidized by Others Example: Floor of $1 million � All CCOs receive at least $1 million dollars � All donor CCOs “contribute” different amounts: $14,401 to $153,736. � The amount of “donation” relative to total is the same for all: 1.4% � PMPM ranges from $8.19 to $14.83 � Total potential ranges from $1,000,000 to $11,198,871 � Average total amount is $2,875,000 � Median total amount is $2,005,567 � Average PMPM is $8.71 � Median PMPM is $8.19 17
Distribution Option 3: Subsidized Tiered Distribution The CCOs are divided into tiers based on enrollment and each tier gets a set PMPM, with the smaller CCOs receiving a greater PMPM than the larger CCOs. 18
Distribution Option 3: Subsidized Tiered Distribution Example: Four tiers � Tiers based on natural groupings of enrollment Tier 1 Tier 2 Tier 3 Tier 4 Percent of 25%+ 9%-13% 4%-7% 1%-2% enrollment PMPM $6.99 $8.00 $8.99 $9.99 � Total potential ranges from $673,726 to $9,555,358 � Average total amount is $2,875,037 � Median total amount is $2,200,860 � Average PMPM is $9.05 � Median PMPM is $8.99 19
Distribution Option 4: Subsidized Continuous Distribution Each CCO receives variable PMPM based on enrollment with the smaller CCOs receiving a greater PMPM than the larger CCOs 20
Distribution Option 4: Subsidized Continuous Distribution Example: � Each CCO receives an individualized PMPM based on enrollment CCO Name PMPM Health Share/CareOregon $6.73 Willamette Valley $7.50 Community Health Trillium Community Health $7.75 Plan FamilyCare CCO $8.00 … $11.00 Eastern Oregon $11.25 Columbia Pacific $11.50 PrimaryHealth Josephine Co 21
Distribution Option 4: Subsidized Continuous Distribution Example: � Each CCO receives an individualized PMPM based on enrollment � Total potential ranges from $9,199,937 to $775,560 � Average total amount is $2,874,801 � Median total amount is $2,349,356 � Average PMPM is $9.44 � Median PMPM is $9.63 22
Meeting Agenda #4 Continue Setting Performance and Improvement Targets #5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #5 Algorithm Design 23
Review: What happens to incentive funds not earned by CCOs? A. Distribute the remaining funds among all of the CCOs that achieved a minimum level of overall performance. B. Distribute the remaining funds among all of the CCOs that achieved a minimum level of overall performance and did not significantly decline in performance on any measures. C. Distribute the remaining funds among a top-scoring percentage (e.g., 5%, 10%, 15%) of CCOs. D. Distribute the remaining funds among the CCOs that achieve the performance targets for an additional set of “challenge” measures. 24
Meeting Agenda #4 Continue Setting Performance and Improvement Targets #5 Review Email Feedback re: Structural Elements of the Incentive Pool #5 Options for Distribution of Incentive Funds #5 Options for Distribution of “Left Over” Funds #5 Algorithm Design 25
Algorithm Design OHA is responsible for determining the algorithm that will be used to distribute the funds, but would appreciate comments from the Committee. Specifically, OHA is interested in getting comments on the following design elements: – Should each CCO be assessed on both a performance target and an improvement target? – Should performance against target be valued the same as performance improvement? – Should all performance measures be considered to represent equivalent value? – Should CCOs be required to achieve a minimum score in order to receive a quality pool distribution? – Should CCOs only be rewarded through the algorithm, or should they also be penalized? 26
Should each CCO be assessed on both a performance target and an improvement target? OHA Proposal: � CCOs will be assessed against a performance target. If the CCO meets the performance target, it gets full credit for the measure. � If the CCO does not meet the performance target for a given measure, it is assessed against an improvement standard. 27
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