Agenda & Opening Comments LA Medicaid- Evolution of Value - PowerPoint PPT Presentation

Agenda & Opening Comments • LA Medicaid- Evolution of Value Based Purchasing – History – New Changes with Contract Extension • Old State Models vs. New State Models and Focus • Review new State HEDIS measures • New Alternative Payment Model Structure • UHC Focus and Commitment to VBP – History – Changes with New Contract – New Models » Examples – Other Models • Questions • Contacts and Resources 2

LA Medicaid – Evolution of Value Based Purchasing(VBP) ➢ Feb 2012- Shared Savings Plans ✓ MCOs to Share with providers as they earn Shared Savings ✓ MCOs picked metrics for Shared Savings gateway ✓ State’s Care Enhance Fee eliminated ➢ Full Risk: February 2015 ✓ State Requires MCOs to commit to actuarial commitment to providers ✓ No HEDIS or method prescribed for MCOs 3

LA Medicaid – Evolution of Value Based Purchasing(VBP) • State completes Statewide Stakeholder meetings ✓ Providers, MCOs, Hospitals, Lobbyists, Etc … ✓ Discussion on Agreement on future execution and best path for Value Based Purchasing. • 7 regional “town hall” meetings to solicit input on quality measure selection • Attended by >260 people representing health plans, health systems, primarily direct care providers • 2 rounds of Medicaid Quality Committee/Sub-Committee meetings to make quality measure recommendations 4

LA Medicaid – Evolution of Value Based Purchasing(VBP) • 23 Month Extension: February 2018 • State continues to require MCOs to commit to actuarial commitment to providers • State Creates new all MCO guidance on Value Based purchasing – NEW- At Risk – 2% Withhold on Quality/VBP vs. Penalty model »Significant $$ risk change for MCOS – NEW- 16 Core HEDIS Measures are Core for all MCOs – NEW- MCOs to drive increase use of Alternative Payment Models(APM) – NEW- All MCOs must come to agreement on use of Common Scorecard and Payment frequency on VBP 5

Continuum of Value Based Purchasing(VBP) Changes for 2018 ➢ State Changes Monetary At Risk Model for MCOS: ✓ OLD • MCOs had 8 Core Quality HEDIS measures At Risk and Penalized after the year if measures not met ✓ NEW • MCOs have 16 Core HEDIS measures + VBP activity At Risk for 2% Withhold. MCOs must hit HEDIS measures and increase VBP activity to Earn Back the 2% Withhold – Earn Back Model • 1% on HEDIS • 1% on advancing use of VBP on Alternative Payment Models(APM) 6

New Medicaid Quality HEDIS Focus Proposed LDH Incentive Measures 2017 2017 Proposed Measure MY18 Target Statewide United Subcommittee Identifier Average (MY 2016) Assignment Initiation of Injectable Progesterone for #01 TBD 17.27%* 19.42% Maternal Preterm Birth Prevention (PTB) Adolescent Well Care Visit #02 (AWC) 50.12% 54.70% 63.88% Pediatric Follow-up Care for Children Prescribed ADHD Medication - Initiation Phase #03 (ADD) 44.80% 44.55% 52.85% Behavioral Health Follow-up Care for Children Prescribed ADHD Medication - Continuation Phase #04 (ADD) 55.90% 56.60% 64.49% Behavioral Health Ambulatory Care Emergency Department #05 (AMB- Visits/1000 MM ** 62.70 73.88 72.49 Emergency Medicine ED) Prenatal and Postpartum Care - Timeliness #06 (PPC) 83.56% 80.77% 85.54% Maternal of Prenatal Care Prenatal and Postpartum Care - Postpartum #07 (PPC) 64.38% 63.80% 64.84%-3 Maternal Care Follow-Up After Hospitalization for Mental Illness - Within 30 Days of Discharge #08 (FUH) 65.42% 49.69% 61.25% Behavioral Health 7

New Medicaid Quality HEDIS Focus Proposed LDH Incentive Measures 2017 2017 Proposed Measure MY18 Target Statewide United Subcommittee Identifier Average (MY 2016) Assignment Controlling High Blood Pressure-Total #09 (CBP) 56.93% 37.07% 37.96% Adult Medicine Comprehensive Diabetes Care - Hemoglobin #10 (CDC) 87.10% 77.35% 73.97% Adult Medicine A1c (HBA1c) testing Comprehensive Diabetes Care - Eye exam (retinal) performed #11 (CDC) 55.17% 46.02%* 40.63% Adult Medicine Comprehensive Diabetes Care - Medical #12 attention for nephropathy 90.27% 89.27%* 87.59% Adult Medicine (CDC) Well-Child Visits in the First 15 Months of Life - Six or more well-child visits #13 (W15) 62.06% 56.06% 57.55% Pediatric Well-Child Visits in the Third, Fourth, Fifth #14 (W34) 72.45% 65.68% 68.19% Pediatric and Sixth Years of Life CAHPS Health Plan Survey 5.0H, Adult #15 (CPA) 76.40% 76.36% 78.82% Adult Medicine (Rating of Health Plan, 8+9+10) CAHPS Health Plan Survey 5.0H, Child (Rating of Health Plan-General Population, #16 (CPC) 86.04% 88.10% 90.07% Pediatric 8+9+10) 8

Simplification and Collaboration ✓ LDH is focused on Simplification and expansion of Value Based Purchasing to drive outcomes and deliver additional $$$ to Providers ✓ All MCOs must come to agreement on use of Common Scorecard and Payment frequency on VBP ✓ State to focused on Using 16 common Quality measures ✓ State is focused on Expansion and moving up the Continuum of Alternative Payment Models 9

Alternative Payment Model(APM) Framework 10 https://hcp-lan.org/groups/apm-framework-refresh-white-paper/

UHC Program, Focus and Compliance Current Market Coverage: ➢ 81% of Membership currently covered by VBC ➢ Primarily PCP focused ➢ Of Medicaid’s core 33 HEDIS measures in MY 2016 ✓ UHC 1 st place on 13 & 66%(1 st or 2 nd ) on all 33 Measures 11

UHC Program, Focus and Compliance ➢ 2018 focus and commitment • Utilize all 16 core HEDIS measures in VBC • Moving to 100% of Membership covered by VBP – All PCP groups added(Peds and GPs) – All Expansion Membership added • New GAP Closure Model • New Adds of OB, BH and Specialists • Shared Savings models continue 12

UHC Program, Focus and Compliance on VBP ➢ 2018 New GAP Closure Model Example: • Adolescent Well Care Visit(AWC) – Target 51% – Population 100 – Payout » $XX(contract agreement) from 1 st member to 51 st » $2 times $XX from 51 st to 100 plus retro to member 1-25 » Equals double on all members once Target is hit • 1 st Qtr - 25 members get visit – Payment- 25 Members times $XX • 2 nd Qtr- additional 26 members get visit – Payment- Target hit- All 51 Members get $XX times 2(or double) 13

UHC Value Based Purchasing ➢ 2018 New GAP Closure Model • Applies to all membership – Plus all Adult Expansion membership – We now have 1yr of HEDIS baseline • Paid Quarterly – Payment- 25 Members times $XX • Quality Team Quarterly Mailings with Scorecards and visits – Quality Gap reports available on Providers membership 14

UHC Value Based Purchasing ➢ 2018 New OB, BH and Specialist Models coming • Development in Progress ➢ Shared Savings remains in place for Large Groups • Gateway to hit Shared Savings – 8-10 HEDIS measures applicable to your Practice »i.e. Pediatrics focused, GP,IM focused • If BCR% targets(Similar to MLR%) hit, Savings are Shared 15

Questions??? and Contacts ➢ LDH MEDICAID APM Model background info https://hcp-lan.org/groups/apm-framework-refresh-white-paper/ ➢ Contacts on Value Based Purchasing for UHC Medicaid • Karl Lirette, COO karl.lirette@uhc.com • Angela Olden, Director of Quality angela_olden@uhc.com • Shelonda Agee, Director of VBP Network Contracting shelonda_agee@uhc.com 16

Alternative Payment Model(APM) Framework 17 https://hcp-lan.org/groups/apm-framework-refresh-white-paper/