2015-16 Evaluation 2016-17 Wrap Up

Webinar

Presenters:QIP Team

Audio Instructions

To avoid echoes and feedback, we request that you use the telephone instead of your computer microphone for listening/talking during the webinar.

Agenda

2015-2016 PCP QIP Evaluation

Presenter:Joy Dionisio, MPH

Project Coordinator II

Research Questions

- How engaged were providers in the program?

- How were total points and earnings distributed across provider sites?

- How did providers perform across the measures relative to performance targets?

- What is the quality of care provided to PHC members as measured by the PCP QIP?

Summary Findings- 222 providers participated in the 2015-2016 PCP QIP;

124 in Southern Counties and 98 in Northern Counties

- In 2015-2016, the base rate committed on a per member per month basis was $5.00.

- The total pay-out was $44 million (14-15: $38 million)

- Fixed Pool: - 15 Clinical measures- 8 Non-Clinical Measures

- Unit of Service:- 7 Measures

How engaged were providers?

Provider Experience Survey

Strongly Agree

Agree DisagreeStrongly Disagree

Our providers are aware of the QIP 47% 49% 4% 0%My opinions are heard in various QIP processes, including measure development 30% 60% 10% 0%

In monitoring clinical measures, eReports is useful and easy to use. 36% 53% 8% 4%

In monitoring non-clinical measures, the quarterly non-clinical reports are useful and easy to use. 25% 60% 13% 2%

The QIP measures are actionable. 38% 49% 13% 0%The measures in the QIP are relevant to our organization's QI efforts. 44% 48% 8% 0%

The QIP team responds to my questions and concerns in a timely manner. 64% 32% 4% 0%

The QIP team's response to my questions and concerns is helpful. 62% 36% 2% 0%The QIP led to improved patient care at my provider site. 44% 46% 10% 0%The QIP drives our Quality Improvement agenda. 42% 44% 13% 0%

I am satisfied with the program. 40% 53% 8% 0%

Webinar Participation & Evaluation

Webinar Date No. of Participants

% rating of good and/or excellent

Kick-Off Webinar (Advanced) July 28, 2015 41 29.4% (5/17)

Kick-Off Webinar (Beginner) July 29, 2015 21 80.0% (4/5)

eReports Training Webinar October 6, 2015 24 100.0% (8/8)

Patient Experience Measure: CG-CAHPS October 15, 2015 15 66.7% (6/9)

Q&A with Dr. Glaseroff (Part II of Transforming Primary Care Webinar)*

October 20, 2015 11 100.0% (4/4)

2015-2016 Measure Specifications Webinar

January 27, 2016 31 92.3% (12/13)

2014-2015 QIP Evaluation and 2015-2016 Wrap Up

June 14, 2016 26 90.0% (9/10)

*This webinar was a follow-up to the original webinar by Dr. Glaseroff, where he discussed the empanelment model at his practice. The original webinar was very popular, but unfortunately attendance data cannot be located.

How engaged are providers?

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Uploaded Data Logged In

Percent of Provider Sites Utilizing eReports

2014-15 2015-16

How engaged are providers?

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PCMH Recognition Peer-Led SelfManagement

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Proportion of Providers Participating in Manual Submission Unit of Service Measures - Southern Region

2013-14 2014-15 2015-16

How engaged are providers?

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PCMH Recognition Peer-Led SelfManagement

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Proportion of Providers Participating in Manual Submission Unit of Service Measures - Northern Region

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How were total points and earnings distributed across provider sites?

Clinical Measures - South

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Payment Pools

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Independent Institutional

Practice Types

Member Volume Adult Family Pediatric1-49 50.16 (n = 14) 53.74 (n = 14) N/A (n = 0)

50-199 55.22 (n = 9) 55.02 (n = 15) 55.35 (n = 6)200-749 58.94 (n = 10) 65.93 (n = 44) 73.88 (n = 6)

750-1649 71.25 (n = 2) 65.55 (n = 37) 76.25 (n = 3)1650+ N/A (n = 0) 72.65 (n = 55) 80.06 (n = 4)

Total 55.18 (n = 35) 66.09 (n = 165) 69.70 (n = 19)

Median Score

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2013-2014 2014-2015 2015-2016

South North All

How did providers perform across the

measures relative to performance targets?

Deep Dive – Southern Region sites meeting full-point target

Measure 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016Cervical Cancer Screening 1.00% 15.20% 23.20% 8.70% 7.41%

Child BMI 35.10% 60.90% 60.50% 63.10% 68.60%Well-Child Visits 17.60% 44.40% 30.10% 26.80% 30.95%

Adolescent Immunization 40.00% 31.30% 25.00% 40.00% 35.71%HbA1C Good Control 24.70% 41.10% 56.20% 16.70% 39.00%

Retinal Eye Exams - - 11.20% 20.80% 16.00%Nephropathy Screenings - - 62.90% 55.20% 54.00%

Controlling High Blood Pressure - - - 21.70% 20.83%

MPM - - - 31.80% 45.45%Nutritional Counseling - - - 26.70% 42.86%

Physical Activity Counseling - - - 33.30% 35.71%DTaP - - - 26.70% 15.00%

Colorectal Cancer Screening - - - - 10.28%Asthma Care - - - - 50.00%

Childhood Immunization MMR - - - - 85.71%

Deep Dive – Northern Region sites meeting full-point target

Measure 2014-20151 2015-2016Cervical Cancer Screening 1.16% 4.49%

Child BMI 60.53% 58.44%Well-Child Visits 12.50% 9.21%

Adolescent Immunization 75.00% 50.00%HbA1C Good Control 23.17% 29.89%

Retinal Eye Exams 17.07% 6.90%Nephropathy Screenings 70.73% 63.22%

Controlling High Blood Pressure 0.00% 0.00%MPM 42.86% 25.00%

Nutritional Counseling 25.00% 0.00%Physical Activity Counseling 50.00% 0.00%

DTaP 0.00% 12.68%Colorectal Cancer Screening+ - 2.25%

Asthma Care+ - 66.67%Childhood Immunization MMR+ - 25.00%

1In 2014-2015, Northern Region providers were held against the 50th percentile performance as target for all measures except Cervical Cancer Screening and DTaP. Full point targets were raised to the 90th percentile performance for all measures starting 2015-16.

Southern Region Non-Clinical Measures

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Avoidable ED PCP Office Visits Open Practice*

Percent of Sites Meeting Targets for Non-Clinical Access Measures - Southern Region

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016

Southern Region Non-Clinical Measures

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Pharmacy Readmissions Admissions/1000 Opioid Safety

Percent of Sites Meeting Targets for Non-Clinical Appropriate Use of Resource Measures - Southern Region

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016

Northern Region Non-Clinical Measures

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Avoidable ED Visits PCP Office Visits Open Practice*

Percent of Sites Meeting Targets for Non-Clinical Access Measures -Northern Region

2013-2014 2014-2015 2015-2016

Northern Region Non-Clinical Measures

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Pharmacy Readmissions Admissions/1000 Opiod Safety

Percent of Sites Meeting Targets for Non-Clinical Appropriate Use of Resource Measures - Northern Region

2013-2014 2014-2015 2015-2016

What is the quality of care provided to PHC

members as measured by the PCP QIP?

QIP Denominators as a % of HEDIS Denominators

Northern Region

Southern Region

Total HEDIS Population

Annual Monitoring of Patients on Persistent Medications 2.23% 5.97% 4.84% 16,308

Cervical Cancer Screenings 86.50% 59.08% 67.16% 97,029

Childhood Immunization - DTaP 96.86% 62.27% 71.26% 10,286

Childhood Immunization – MMR 15.33% 4.87% 7.59% 10,286

DM – Retinal Eye Exams 96.54% 64.87% 72.84% 15,756

DM - HbA1C Good Control 96.54% 64.87% 72.84% 15,756

DM - Nephropathy Screenings 96.54% 64.87% 72.84% 15,756

Controlling High Blood Pressure 101.65% 65.14% 74.76% 18,880

Immunizations for Adolescents 11.38% 6.80% 7.89% 9,668

Medication Management for Asthma* (Asthma Care) 3.26% 2.35% 2.64% 3,902

Physical Activity Counseling 14.32% 6.24% 8.17% 107,383

Childhood BMI 90.84% 61.83% 68.78% 107,383

Nutritional Counseling 14.32% 6.24% 8.17% 107,383

Well Child Visits 90.69% 64.10% 70.97% 42,057

Colorectal Cancer Screenings Not reported through HEDIS

* Not reported for HEDIS 2017. The most recent available data is from 11/30/16.

Population Rates for Clinical Measures - South

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Population Rates for Non-Clinical Measures - South

PHC Internal Use Only

Measure 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016

Admissions/1000* n/a n/a n/a n/a 40.18

Readmission rate 9.00% 13.80% 11.80% 15.10% 12.12%

Generic Prescription Rate 85.70% 87.70% 88.10% 88.70% 88.89%

Formulary Prescription Rate 97.50% 97.70% 98.00% 98.40% 98.66%

Avoidable ED Visits 0 39.1 36.9 37.35 21.59

PCP Office visits n/a n/a 2.63 2.51 2.42

Population Rates for Non-Clinical Measures - North

Measure 2013-2014 2014-2015 2015-2016Admissions/1000* n/a n/a 56.51

Readmission rate n/a 13.10% 11.89%Generic Prescription Rate 89.60% 89.40% 89.16

Formulary Prescription Rate 98.20% 98.30% 98.39

Avoidable ED Visits 46.4 33.9 21.14+

PCP Office visits n/a 2.47 2.27+

PCP QIP Wrap Up

Measurement Year 2016 – 2017

Presenter:Tara Fogliasso

Project Manager I

16-17 QIP Timeline

July 1, 2016

June 30, 2017

July 10, 2017

July 17,2017

July 31, 2017

August 1-8, 2017

September 1-8, 2017

Oct 31, 2017

Final Submission Date for:• eReports by 5pm• Unit of Service • Outreach Evidence

Final payment for QIP 2016-2017 mailed

Grace Period QIP 2016-2017

New Enhancements

QIP Payment Dispute Policy

Data category ValidationeReports data, including uploads, administrative data, and exclusions

Grace period: ends at 5pm on 7/31/2017

Validation period: 8/1/2017 – 8/8/2017Manually-tracked measures, including Patient Experience and Unit of Service measures

Validation period: 9/1/2017 – 9/8/2017

Practice type and payment pool designations

Requests must be submitted during measurement year and reviewed on a case-by-case basis

Fixed Pool Measures – Clinical DomainMeasures Family Internal Pediatric Data

SourceDue Date

Monitoring Patients on Persistent Medications 5 10 --

eReports

Upload data on

eReportsuntil

July 31, 2017 by

5pm

Well Child Visits (3-6 years) 5 -- 10

Childhood Immunization – DTaP (2 years) 5 -- 10

Cervical Cancer Screening 5 5 --

Colorectal Cancer Screening (51-75 years) 5 5 --

Controlling High Blood Pressure (18-85 years) 5 10 --

Retinal Eye Exam (18-75 years) 5 5 --

HbA1C Control (18-75 years) 5 5 --

Nephropathy (18-75 years) 5 5 --

Childhood Immunization – MMR (2 years) -- -- 10

Asthma Care (5-18 years) -- -- 5

Nutrition Counseling (3-17 years) -- -- 10

Physical Activity Counseling (3-17 years) -- -- 10

Adolescent Immunizations (13 years) -- -- 10Total Points: 45 45 65

Fixed Pool Measures – Appropriate Use of Resources

Measures Family Internal Pediatric Data Source Due Date

Admissions/1000 7.5 7.5 n/a Claims n/a

Readmission Rate 7.5 7.5 n/a Claims n/a

Follow-Up Post Discharge n/a Claims September 2017*if applicable

Pharmacy Utilization 10 10 10 Claims n/a

Opioid Safety 5 5 n/a Claims September 2017*if applicable

Total Points: 30 30 10

Follow-up post discharge can be a back-up measure for either Acute Bed Days/1000 or Readmission Rate, but not both.

Fixed Pool Measures – Access and Operations

Measures Family Internal Pediatric Data Source Due Date

Avoidable ED Visits 5 5 5

Claims n/aPractice Open to PHC Members

5 5 5

PCP Office Visits 5 5 5

Total Points: 15 15 15

Fixed Pool Measures – Patient Experience

Measures Family Internal Pediatric Data Source Due Date

CAHPS Survey for sites that meet the member volume threshold

Or

10 10 10 3rd party vendor

n/a

Survey/ Training Option for all other sites

10 10 10 SubmissionTemplate

Part II due July 31, 2017

**no exceptions**

Total Points: 10 10 10

Fixed Pool Measures – Tracking SystemsUnit of Service

MeasureIncentive amount

Data Source Due Date

Advance Care Planning $100 per attestation/$100 per POLST/AD Submission Template

July 31, 2017**no exceptions**

PCMH Certification Level 1: $2000 Level 2: $3000 Level 3: $3500 - one time payment

Submission Template

July 31, 2017**no exceptions**

Peer-Led Self MgmtSupport Groups

$1000 per group per year Submission Template

July 31, 2017**no exceptions**

Utilization of CAIR Based on RI in utilization Submission Template

July 31, 2017**no exceptions**

Access/Extended Office Hours

Equivalent payment of 10% cap Provider Relations

n/a

BuprenorphineQualified Providers

$500 per credential prescriber (max. 5 persite)

ProviderRelations

n/a

SBIRT $5 per screening Claims n/a

Health InformationExchange

$2500 for participating in local HIE –one time payment

SubmissionTemplate

July 31, 2017**no exceptions**

Measurement Year Transition• There will be no impact on the 2016-2017 measurement year.

• Six month measurement period July 1, 2017 – December 31, 2017

• Will use 2016-2017 measurement set

• Partnership Quality Dashboard in 2018

July 1, 2016

June 30, 2017

July 1, 2017

Dec 31,2017

January 1, 2018

Calendar Year Cycle Begins

Measurement year for QIP 2016-2017

Transitional Measurement

Period

Resources

QIP Website: http://www.partnershiphp.org/Providers/Quality/Pages/PCPQIPLandingPage.aspx

QIP Inbox: qip@partnershiphp.org

eReports (CLINICAL measures):https://qip.partnershiphp.org/

Non-Clinical Reports– sent out every other month

Monthly Newsletters

Questions?