THINC’S P4P PROJECT IN THE HUDSON VALLEY: QUALITY METRICS AND THE MEDICAL HOME

Susan StuardExecutive Director, THINC

Agenda

Susan Stuard will talk about the project design

John Blair, MD will discuss the specifics of the medical home transformation work

Project Design

THINC’s P4P Project

In 2007, THINC was awarded a P4P grant from the NYS Department of Health

The request for grant applications sought projects implementing quality metrics, quality report cards, and health plan incentives THINC, MedAllies and the Taconic IPA

decided to leverage this project and add a significant medical home component

EHR Install Base

Key component to the Hudson Valley project is the existing physician EHR install base

THINC has a HEAL 1 grant from NYS DOH to implement 1,000 EHRs in physician’s offices Quarter of the way through that work As a result, THINC and its vendor, MedAllies, have a

strong understanding of EHR implementations and the associated workflow and change management issues

Combine these 250 EHRs with existing EHRs at larger practices and we a good group to work with for medical home

Project Participants

500 primary care physicians in Hudson Valley 250 in quality metrics group only 250 in quality metrics and medical home group

Six health plans Provide claims data for metrics to data aggregator Pay incentives after second quality report card Participate actively in project design via the

THINC Quality Committee

Project Management

THINC Manage grant and deliverables Work with health plans to determine payment process and

triggers Use THINC Quality Committee to ensure collaborative process

for development of project goals and implementation

MedAllies Enable development of quality reporting with ViPS and from

EHR Intensive planning for medical home transformation initiative

Taconic IPA Intensive planning for medical home transformation initiative Physician recruitment

Cornell Conduct evaluation, data gathering, analysis, etc.

Budget

NYS DOH grant award is almost $1.8 million

20% for project management and evaluation

80% to match health plan incentives ~ $1.4 million

Great majority of costs for medical home transformation are being underwritten by the Taconic IPA and MedAllies

Quality Reports

Q1 2009 Report 2007 data HEDIS Measures

Q4 2009 Report 2008 data HEDIS Measures EMR Measures NCQA Medical Home

Recognize the limitations of using 2007 and 2008 in a 2009 implementation – but this is a grant requirement

THINC Taconic Health Information Network and Community

HEDIS Measures

Required to pick from among 34 measures selected by the NYS Pay for Performance Workgroup

Our claims-based project measures are: Breast Cancer Screening Colorectal Cancer Screening Chlamydia Screening Rates HbA1C Testing Lipid Measurement in Diabetics Eye Exam in Diabetics Urine Protein Screening Asthma: Pharmacologic Therapy Appropriate Treatment for Children with Upper Respiratory Infection Appropriate Testing for Children with Pharyngitis

EMR Measures

Also will add EHR-based clinical measures in the second report card

Will pull four from among these six: Controlling High Blood Pressure HbA1C Poorly Controlled Blood Pressure Control/Management in Diabetics LDL Cholesterol Level in Diabetics <130 Eye Exam in Diabetics Urine Protein Screening

In subsequent report cards, starting in 2010, will add more EHR-based clinical metrics

THINC Taconic Health Information Network and Community

Incentive Payments

Incentive payments will be issued after 2nd quality metrics report card in Q4 2009

20% of incentive payments goes to scoring on quality metrics and 80% goes to achievement of NCQA PPC-PCMH Medical Home Level 2 certification Approximate breakdown ~ $1000 on quality

metrics and ~ $10,000 for medical home level 2

Health Plan

Data Aggregator

Claims Data

Claims Data

Summary HEDIS

Measures

Summary HEDIS

Measures

Using claims data and attribution logic, aggregator generates summary measures

MedAllies Reporting Engine

From spec, health plan generates data file for Hudson Valley

Physician

Health Plan

Letter and Report Card

Letter and Report Card

Report Card and Data

File

Report Card and Data

File

Physician EHRSummary EHR/Clinic

al Measures Data from Physician

EHR

Summary EHR/Clinic

al Measures Data from Physician

EHR

THINC

Report Card (with Medical Home Status in Q4

2009)

Report Card (with Medical Home Status in Q4

2009)

Incentive PaymentIncentive Payment

MH Status

MH Status

THINC P4P Project High-Level Data Flow

Evaluation

Working with Rainu Kaushal, MD, MPH, and Lisa Kern, MD, MPH, at Weill Cornell Medical College to conduct a robust academic evaluation of project

Goal is to determine incremental effects of P4P incentives and medical home implementation on quality and costs

Design should allow isolation of the separate effects of EHRs, P4P, and the medical home

Evaluation design should produce results rigorous enough to inform policy debate as well as participant health plans’ designs for future incentive programs

Challenges

Setting aside the huge challenge of moving 250 physicians with EHRs to medical home level 2 within 12 months (John will address)

Coordinating among six health plans who all have different ideas about what should trigger an incentive payments and how attribution methodology should be applied

Tremendous effort to undertake this type of evaluation IRB approvals, participant agreements, control

group recruitment, baseline data gathering, etc. Unknown effort to be expended to implement

the EHR-based clinical measures

Questions

Please feel free to reach out to me with questions

Susan S. StuardExecutive DirectorTHINC RHIOPhone: 845-896-4726 x.3018sstuard@thincrhio.org