VBP Workgroup Meeting August 25, 2016
August 25, 2016 2 Agenda I. VBP Roadmap Update: CMS Feedback II. Clinical Advisory Group Update & Recommendations III. Children’s Health Subcommittee/Clinical Advisory Group IV. Ongoing VBP Implementation: VBP Regulatory Workgroups
August 25, 2016 3 I. VBP Roadmap Update: CMS Feedback
August 25, 2016 4 CMS Roadmap Feedback Feedback on the Year 2: Annual VBP Roadmap Update 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
5 August 25, 2016 Sample Roadmap Comments from CMS Requests for Further Information Page 11 of the Roadmap says that NYS has “prioritized the Maternity Bundle and the Chronic Bundle”. What does the State mean by prioritizing these bundled care services? Page 13 of the Roadmap references “significant trauma care costs”. Could the State elaborate on what it means by “significant trauma care”? Page 50 of the Roadmap mentions the development of Program Integrity workgroup – what will the process be to appoint members? Broader Policy Questions to Review How will quality be measured? How did the State determine the stimulus adjustment amount? What are the contract changes that will be implemented to incorporate VBP? What aspects of the Roadmap have been implemented to date?
August 25, 2016 6 II. Clinical Advisory Group Update & Recommendations 1) Identifying and Categorizing Quality Measures 2) Maternity CAG Report Recommendations 3) HIV/AIDS CAG Report Recommendations
August 25, 2016 7 Identifying and Categorizing Quality Measures
August 25, 2016 8 Starting Points for Selection of Quality Measures 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
9 August 25, 2016 Criteria Used for Selecting Quality Measures CAG members for each VBP arrangement assessed quality measures according to the following criteria: Clinical Relevance Feasibility Validity & Reliability • Focused on key outcomes of • Claims-based measures are • Measure is well established by the total integrated care preferred over non-claims reputable organization process rather than a single based measures (clinical data, • Outcome measures are component of that care surveys) adequately risk-adjusted • Outcome measures are • When clinical data or surveys preferred over process are desirable, existing sources measures, but process should be available (e.g. measures remain crucial statewide registries or where outcome measures are standardized EHR extracts) not (yet) available • Prefer patient-level data • Reflects existing variability in • Data sources must be performance and/or possibility available without significant for improvement delay
August 25, 2016 10 Quality Measure Selection The quality measure selection process began using the following sources: • Relevant DSRIP Domain 2 and 3 measures • Relevant NYS Quality Assurance Reporting Requirements (QARR) measure • Advanced Primary Care measure set (State Heath Innovation Plan – SHIP) • Relevant measures from CMS measure sets • National Quality Forum (NQF) measures • National Committee for Quality Assurance (NCQA) • CAG-specific sets (e.g. NYS AIDS Institute measures for HIV/AIDS CAG) Key starting point: no reinventing of the wheel!
August 25, 2016 11 Categorizing and Prioritizing Quality Measures CATEGORY 1 Approved quality measures that are felt to be both clinically relevant, reliable and valid, and 1 feasible. CATEGORY 2 Measures that are clinically relevant, valid, and probably reliable, but where the feasibility 2 could be problematic. These measures should be investigated during the 2016/2017 pilot program. CATEGORY 3 3 Measures that are insufficiently relevant, valid, reliable and/or feasible.
August 25, 2016 12 Quality Measures – Roadmap Language “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 State accepts or VBP Contractors recommends re-categorizes report on measure measures measures categories These proposals are presented in the following slides for Workgroup comment 1 VBP Roadmap, page 34
August 25, 2016 13 Current Status of CAG Reports 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 HARP Subpopulation Draft under development. Scheduled to Behavioral Health review during October work group meeting. Chronic Heart Disease, Pulmonary, Integrated Primary Care (IPC): Drafts under development. Scheduled Diabetes (Chronic Conditions) Chronic Bundle to review during October work group meeting. Managed Long-Term Care (MLTC) MLTC Subpopulation Draft under development Intellectually/Developmentally Disabled I/DD Subpopulation Draft under development (I/DD) * Website address: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/vbp_final_cag_reports.htm
14 August 25, 2016 Maternity CAG Recommendation Report CAG Recommended Arrangement Definition and Quality Measures
August 25, 2016 15 Maternity VBP CAG The Maternity CAG met over three sessions to discuss the key areas listed below: Maternity CAG Members Howard Minkoff, MD Thomas Havranek, MD Karen Smoler Heller Edmund LaGamma MD • Medicaid Redesign Team (MRT) Overview Valerie Grey Michael Horgan, MD Liz Dears, Esq Timothy Stevens, MD, MPH • Delivery System Reform Incentive Payment Grace Bi, MD, MMS, MS, CPH Edward Kelly Bartels, MD Vinay S. Rane, MD (Monitor) Maria Czerwinski, MD Program (DSRIP) Overview Nalini Krishnan, MD Rachel de Long, MD, MPH Loretta B. Willis, RN, BS, CPHQ, CCM Marilyn Kacica, MD, MPH • Value Based Payments (VBP) Overview Sharmila K Makhija MD, MBA Wendy Shaw Arnold Friedman, MD Eileen Shields Michael Brodman, MD Warria Esmond, MD • Episode and/or Bundle components and triggers Maryanne F. Laffin, RN, FNP, CNM, FACNM Taechin Yu, MD, FACOG Robert Silverman, MD Sharon Deans, MD, FACOG • Data Analytics & Cost Analysis Ephraim Back, MD MPH Lorraine Ryan, RN, Esq. Elie Ward, MSW Foster Gesten, MD • Quality Measure Discussion & Selection 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
16 August 25, 2016 8 Maternity Arrangement Definition: CAG Recommendation Consistent with the CAG recommendations, the State recommends the following bundle definition for the Maternity VBP arrangement. Population Included • Includes all pregnant females, between 12 years and 65 years old, with a qualifying trigger code. • Qualifying trigger code includes vaginal delivery or C-section delivery. Bundle Definition • Pregnancy Care: Includes all services associated with pregnancy care, such as pre-natal care and visits, lab tests, medication, ultrasound, etc. • Delivery & Post Partum Care: Includes all services associated with the delivery, whether vaginal or C-section, up to 60 days post-discharge. Services such as facility costs, professional services, and any associated complications for mother and child are included. • Newborn Care: Includes all services associated with the newborn’s care up to 30 days post-discharge. 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.
August 25, 2016 17 Quality Measures: Data Dictionary Field Description Acceptable Values State (claims-based measures) Reporting Source Entity responsible for the reporting of required data VBP Contractor (e.g. clinical measures) 1 (Must be Reported) State Recommended The Category in which the State proposes to classify the 2 (Optional) Category measure. 3 (Not Recommended) Yes – reporting is key first step towards improved The State recommends to reward the VBP contractor’s Pay for Reporting quality measurement reporting of this measure rather than the VBP contractor’s (P4R) No – measure can be used to compare performance performance
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