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 bootcamp outreach activities) III. MACRA Update

3 November 29, 2016 HARP CAG Recommendation Report CAG Recommended Definition and Quality Measures

4 November 29, 2016 HARP CAG 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

5 November 29, 2016 8 HARP Definition: CAG Recommendation The CAG recommends the following definition for the HARP VBP arrangement. Population Included • Adults enrolled in Medicaid and 21 years or older with select Serious Mental Illness (SMI) and/or serious Substance Use Disorder (SUD) diagnoses having serious behavioral health issues are eligible to enroll in HARP Plans Defined Services • The BH HCBS eligibility tool will determine if an individual is eligible for Tier 1 or Tier 2 BH HCBS. Tier I services include employment, education and peer supports services. Tier 2 includes the full array of BH HCBS • The scope of care services included in this VBP arrangement is identical to the scope of services covered by the HARP plans (including the enhanced benefit package BH HCBS)

6 November 29, 2016 8 Quality Measures: HARP CAG Category 1 The CAG recommends the following quality measures for use in the HARP arrangement. State Reporting # Measures Recommended P4R** Source Category* Diabetes screening for people with schizophrenia or bipolar disorder using State 1 1 No antipsychotic medications Follow-up after hospitalization for mental illness (within 7 and 30 days) State 1 2 No 3 Percentage of members enrolled in a Health Home State 1 No Initiation of pharmacotherapy for opioid dependence within 30 days 1 1 4 State No Percentage of mental health discharges followed by two or more mental health State 1 Yes 5 outpatient visits within 30 days 2 Tobacco use screening and follow-up for people with serious mental illness or 6 VBP Contractor 1 Yes alcohol or other drug dependence Initiation of pharmacotherapy for alcohol use disorder within 30 days 2 State 1 Yes 7 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.

7 November 29, 2016 8 Quality Measures: HARP CAG Category 1 (cont.) The CAG recommends the following quality measures for use in the HARP arrangement. State Reporting # Measures Recommended P4R** Source Category* Utilization of pharmacotherapy for alcohol use disorder 2 8 State 1 Yes Utilization of pharmacotherapy for opioid dependence 2 State 1 Yes 9 Follow-up after emergency department visit for alcohol and other drug State 1 Yes 10 dependence 2 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.

8 November 29, 2016 8 Quality Measures: HARP CAG Category 2 The CAG recommends the following quality measures for use in the HARP arrangement. State Reporting # Measures Recommended P4R** Source Category* Rate of readmission to inpatient mental health treatment within 30 days 11 State 1 No (readmission in any geographic region) Continuing engagement of alcohol and other drug dependence treatment (CET) 1 1 12 State No Continuity of care within 14 days of discharge from any level of SUD inpatient 1 13 State No care 1 Percentage of members who receive PROS or HCBS for at least 3 months in VBP Contractor Yes 14 1 reporting year Percentage of members who maintained/obtained employment or maintained/improved higher education status (from HCBS Waiver Eligibility VBP Contractor Yes 15 1 Screening) Percentage of members with maintenance of stable or improved housing VBP Contractor Yes 16 1 status(from HCBS Waiver Eligibility Screening) Percentage of members with reduced criminal justice involvement(from HCBS 17 VBP Contractor 1 Yes Waiver Eligibility Screening) 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.

9 November 29, 2016 Behavioral Health Chronic Conditions CAG Recommendations Episode Definitions and Quality Measures Part of the IPC VBP Arrangement

10 November 29, 2016 Behavioral Health Chronic Conditions CAG 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

11 November 29, 2016 8 Behavioral Health Chronic Conditions Definition: CAG Recommendation The CAG recommends the following Behavioral Health Chronic Conditions definition: • Depression & Anxiety • Substance Use Disorder • Bipolar Disorder • Trauma & Stressor Disorder Population Included • Includes all members, between 12 and 65 years old, with a qualifying trigger code. • Each of the Behavioral Health Chronic Condition episodes are triggered by one or more claims that carry a diagnosis 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. Episodes Definition • The episodes include all services (inpatient admissions, outpatient visits, professional services, laboratory tests, imaging, medication) associated with the care for the condition (as long as the member remains enrolled) • Services for exacerbations, short and long term complications of the condition are included * 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

12 November 29, 2016 Depression & Anxiety – Measures The CAG recommends the following quality measures for use in the IPC arrangement. CAG State Reporting # Measures Recommended Recommended P4R** Source Category Category* Screening for Clinical Depression and Follow-Up Plan 1 No 1 VBP Contractor 1 1 No 2 Antidepressant medication management State 1 1 No 3 Potentially Avoidable Complications State 1 1 Yes 4 Diagnosis (IMPACT Model) VBP Contractor 2 2 5 Initiation of Treatment (IMPACT Model) VBP Contractor 1 2 Yes Yes 6 Adjustment of Treatment Based on Outcomes (IMPACT Model) VBP Contractor 2 2 7 Symptom Reduction (IMPACT Model) VBP Contractor 1 2 Yes Yes 8 Generalized Anxiety Disorder 7-item (GAD 7) Scale VBP Contractor 2 2 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.