Provider Directory Advisory Group Meeting November 18, 2015

Provider Directory Advisory Group Meeting

November 18, 2015

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Welcome!

• Agenda review:– Introductions – welcome Peter Graven!– Breakouts for use refining and prep for larger group

discussion– Group report-outs– Clinical Quality Metrics Registry Presentation– Break– Procurement update– Common Credentialing update– Fees orientation – Wrap up, updates, and next steps for December

Use Cases

Use refining and prep for larger group discussion

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Handouts for group exercises

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• Use case packets• Standards matrix updates

– Network adequacy updates in Oregon start in January 2017

• Updated data element matrix with Common Credentialing practitioner types

• Parking lot

Group discussions

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• Write your name on your assigned use case and worksheet:– Plans - Validation data sets (8)– HIE - Provider searches for DSM addresses (6)– Analytics - Provider data sets for analytics (24)– Delivery - Provider searches (15/16)

• Groups will have 30 minutes to review the use case Select a presenter from your group to walk through/present their priority use to the broader PDAG

Group Presentations

Office of Health AnalyticsOffice of Health Information Technology

Overview of Clinical Quality Metrics Registry

(CQMR)

Crystal Nielson, Lead Policy Analyst

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Discussion Outline

• Oregon’s Quality and Measurement Strategy• Clinical Quality Measure (CQM) Reporting Requirements • Future State

– Vision for HIT Optimized Health Care System– Clinical Quality Metrics Registry (CQMR) Overview

QUALITY AND MEASUREMENT STRATEGY

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Selection of CCO Metrics Set

• Metric set needed to measure Oregon’s Transformation efforts:– CMS to evaluate Oregon’s progress– Oregon to evaluate CCO performance

• Metrics and Scoring Committee is responsible for identifying and adopting metrics

• Committee identified an initial set of 17 CCO metrics• Three measures are based on clinical data (the majority are claims

or hybrid measures) – NQF 0418 Screening for Clinical Depression and Follow-up Plan– NQF 0059 Diabetes Poor Control– NQF 0018 Controlling Hypertension

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Clinical Quality Measures

• Three measures in the initial CCO Metric Set are based on clinical data (the majority are claims or hybrid measures) – NQF 0418 Screening for Clinical Depression and Follow-up Plan– NQF 0059 Diabetes Poor Control– NQF 0018 Controlling Hypertension

• Efforts in place to develop custom measures for:– SBIRT

• OHA reviewed draft federal measures• Completing draft specifications for custom measure in Q4 of 2015• Two rounds of pilots in 2016• Implementation of EHR-based measure reporting beginning with 2017

– Tobacco Prevalence/Cessation• Utilizing data collection process for the Smoking Objective • Submitting “test data”

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Incremental Approach to eReporting

• Reporting clinical data requires new processes and capacity• A key decision point was the plan for collecting CQM data

– Chart review vs. electronic reporting?• Electronic reporting will:

– Enable population-based measurement– Automate the reporting process

• Need to develop technology solution for collecting CQM data while implementing waiver requirements: “working with what we have”

• Desire to meet stakeholders where they were and allow for necessary capacity building

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CQM REPORTING REQUIREMENTS

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Implementing CQM Reporting

• CCOs required to submit:– Pre-Submission Narrative– Data Submission

• Percentage of incentive payment has been payable upon approval of pre-submission documents

• Year Three (2015) is first year that there is no pay-for-reporting component, payment will be performance based

• Incremental increases in reporting requirements over each program year

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Submission Process

• Data is due to OHA on April 1st following the program year (May 1st in Year One)

• CCO manually uploads files to a secure FTP site• In Year Two (2014), most CCOs submitted data:

– Aggregated at the physical location (one CCO submitted patient-level data)

– For the full calendar year – For CCO Medicaid beneficiaries only– From custom query

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THE CQMR AND CQM REPORTING IN FUTURE YEARS

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CQMR Overview

• The Clinical Quality Metrics Registry (CQMR) will electronically collect, aggregate, display, and export clinical quality measure data in order to support an HIT-optimized health system

• Technology includes:– Database– Web-based Portal

• Emphasis on functionality & standards utilized by ONC certified HIT for reporting of CQM data – CMS eCQM Specifications– Capture, calculate, and report certification criteria (including Quality

Reporting Data Architecture format)• Procurement occurring in coordination with other HIT portfolio

projects (e.g., Common Credentialing, Provider Directory)

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eReporting of CQMs to CQMR

• CCOs, providers, data intermediaries will submit clinical data to meet quality program reporting requirements

• Quality programs will utilize data to determine eligibility for incentive payments– CCO Incentive Metrics Program (Program Year 2016)– EHR Incentive Program (Program Year 2018)– Considering use for other programs

• Improve access to clinical quality measure data and the ability to utilize standardized data for analytics/quality improvement initiatives

• Enable a ‘report once’ strategy to streamline reporting requirements among multiple quality programs

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CQMR & Provider Directory

• OHIT anticipates that CQMR will be a data source for Provider Directory (and perhaps vice versa)

• CQMR will provide account/access management information that includes provider affiliations to CCOs and clinics

• QRDA standard includes a number of data fields related to provider demographics

• Limitation is data “timeliness” – measure data will be submitted to the CQMR annually (some discussion around quarterly submissions)

• As projects develop, additional connections may be identified

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Crystal Nielson, MPA: HALead Analyst – CQMRcrystal.nielson@state.or.us(971) 304-9627

Break

Procurement Updates

Rachel OstroyImplementation Director

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HIT Portfolio Upcoming Milestones

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Fall 2015 (Q4) Winter 2016 (Q1) Spring 2016 (Q2)

Summer 2016 (Q3)

• QA Vendor (CSG) onboard

• System integrator (Harris) contract

• Stage Gate 3 submission• Harris begins planning

phase

• Provider Directory (PD) Market Analysis

• Common Credentialing (CC) RFP

• Provider Directory RFP

• CC vendor selection

• CC Implementation

• PD vendor selection

Common Credentialing Updates

Melissa IsavoranCredentialing Project Director

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Current progress Advisory Committee on Physician Credentialing Information

recommended nonsubstantive form changes to be brought to the CCAG for review on 11/20

Delegation agreements may impact program viability Fee structure development work continues with identifying

logistics for tiered set-up fees Provider data alignment discussions with stakeholders

identified consensus of value in exploring additional data collection through common credentialing – value vs. complexity

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OHPR 8.5.15

Timeline for the Oregon Common Credentialing Program (OCCP)

Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 1st Qtr 2017

Convened the Common Credentialing

Advisory Group

1/17Request for

Information Issued

2/1Report to Legislature

7/1 Developed Rules

10/1 Report to Legislature

Sept 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015

Requirements and Contract

12/31Final Report

2/1Report to Legislature

2/5SB 594 Introduced

Planning and Sub-Vendor

Implementation

Common Credentialing Vendor Contract

Prime Contract Amendment

2/1Report to Legislature

5/29SB 594 Passed

3/1 – 3/31/17Marketing and Outreach

2/8 – 6/30Rulemaking Process

Development & Implementation Plan

10/1Report to Legislature Go Live Date

Common Credentialing Fees

Melissa IsavoranCredentialing Project Director

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Fee Authority

Senate Bill 604 requires OHA to develop rules on the imposition of fees, not to exceed the cost of administering the Oregon Common Credentialing Program (OCCP), on health care practitioners who submit credentialing information to the database and credentialing organizations that access the database.

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Current Fee StructurePractitioners generally do not pay for credentialing, BUT:Privileging is supported by fees and includes credentialingSome credentialing costs are built into provider paymentsPractitioners pay for office staff hours to complete

credentialing paperwork and required follow up

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Fee Structure DevelopmentOHA developed high-level fee structure options by:Consulting subject matter experts and the CCAG on fee

structure principles to use as guidelines and options,Researching market fee structures, and Assessing Request for Information responses to fee

structure questions:◦Not a lot of consistency in responses◦ Total cost ranges varied greatly◦ Some structures conflicted with principles due to inequities (e.g.,

annual Maintenance fees)◦ Some structures (e.g., enterprise fees) not feasible as they

considered number of credentialing organization users, which would actually be small

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Fee Structure Principles (at a high level)Fees should be balanced considering benefits and resourcesEnsure that costs are not a barrier to participation Fees should be equitably balanced between provider types

and credentialing organization types and sizes Fees must be efficient and economical to administerFees should be transparent and justifiable in developmentFees should be stable and produce predictable income to

support the costs of operating common credentialing which should include allocations for information technology and operational quality assurance activities and security

Individually requested processes must be borne by those making such requests

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Fee Structure Options

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FEE OPTIONS STRUCTURECredentialing OrganizationsOne-Time Setup Fee Flat Fee

Tiered FeeFlat Fee, + Amortization

Transactional Fee (ongoing operations and maintenance costs)

Flat FeeTiered Fee; based on Practitioner Type

Expedited Credentialing Fee Flat FeeHealth Care PractitionersInitial Application Fee Flat Fee

Tiered Fee; based on Practitioner Type

Delegation Agreements  Capitated Fee? Annual Capitated Fee?Data Users  Data Use Fee Undetermined

Next Steps for Fee Structure DevelopmentDevelopment of Credentialing Organization fee structure tiersRulemaking Advisory Committee◦Develop rules◦Submit Notice of Proposed Rules to Secretary of State ◦Public rules hearing◦Publish final rules

Legislative approval process (2017)

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Provider Directory Fee Principles Discussion

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Principle 1

Fee development for credentialing organizations and providers must be delicately balanced considering the

benefits they may experience and their respective resources

• Questions for the PDAG (potential edits)• Is there a distinction for the provider directory

between orgs and providers?

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Principle 2

Ensure that costs are not a barrier to participation

• Questions for the PDAG:• What about costs that are considered to be

unfair government competition? • Would the PD be in competition?

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Principle 3

Fees should be equitably balanced between different organization types considering their required level of

participation

• Questions for PDAG:• Different organization types – Independent

Physician Associations (IPAs), individual clinics, hospital and health systems, regional HIEs?

• Different uses?• Different levels of access?• Other?39

Principle 4

Fees for health care organizations should be equitably balanced consider the size and types of its health care

organization

• Questions for PDAG:• Different organization types – Independent Physician

Associations (IPAs), individual clinics, hospital and health systems, regional HIEs?

• Different uses?• Different levels of access?• Other?

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Principle 5

A specific portion of the fees should be specifically allocated for information technology and operational quality

assurance activities

• Questions for PDAG:• Specify more here? Enhancements, maintenance, data

management and ongoing operations

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Principle 8

Fees should be stable (not vary considerably year to year) and predictable with changes based only on scope

adjustments, CPI increases, and increases in participants

• Question for PDAG:• Do we want to be this specific? • Are the items specified the ones we’d have?

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Principle 9

Fees should produce a predictable income to support the costs of operating the provider directory which should

include allocations for information technology and operational quality assurance activities and security.

• Questions for PDAG:• Operating, maintaining, and enhancing?• Security?

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Next steps

• Finalize principles• Draft fee structure options and considerations for the provider

directory based on November meeting input– Fee types– Description– Structure– Benefits– Challenges– Consideration

• December meeting – in depth fee structure conversation.– Bring a fee friend

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Updates and next meeting

Karen Hale

PDAG 2016 meeting dates and locations

Date LocationJanuary 13, 2016 Portland – PSOB Room 1A

February 17, 2016 Woodburn

March 16, 2016 Portland – PSOB Room 1E

April 13, 2016 Woodburn

May 18, 2016 Portland – PSOB Room 1E

June 15, 2016 Woodburn

July 13, 2016 Portland – PSOB Room 1E

August 17, 2016 Woodburn

September 14, 2016 Portland – PSOB Room 1E

October 12, 2016 Woodburn

November 16, 2016 Portland – PSOB Room 1E

December 14, 2016 Woodburn46

PDAG/CCAG Nominations

• 3 current vacancies on the Common Credentialing Advisory Group (CCAG) and 1 current vacancy on the PDAG

• OHA will arrange a joint CCAG/PDAG nomination/application process – PDAG is looking for a provider representative– CCAG is looking for a Hospital representative, health

plan representative, and an Independent Physician Association (IPA) representative

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Public Comment and closing

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