Michigan Primary Care Transformation Project Performance Incentive Technical Manual

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1 Michigan Primary Care Transfrmatin Prject 2016 Perfrmance Incentive Technical Manual Fr Physician Organizatins, Physician Hspital Organizatins, Independent Practice Assciatins and Primary Care Practices

2 Michigan Primary Care Transfrmatin Prject (MiPCT) 2016 Perfrmance Incentive Technical Manual Cntents Objectives f the MiPCT Perfrmance Incentive Prgram Summary f 2016 Perfrmance Incentive Metrics Changes frm the 2015 MiPCT Perfrmance Incentive Prgram Data Surces fr 2016 Metrics Submissin f MiPCT Registry/EHR Data Pint Alltment Methdlgy Metric Specificatins Claims - Based Utilizatin Metrics Claims - Based Clinical Quality Metrics Registry/EHR - Based Clinical Quality Metrics Prcess Metrics Perfrmance Incentive Payment Prcess Appendix: Specificatins fr Submissin f Clinical Data Selectin f the 2016 Perfrmance Incentive Metrics The 2016 Perfrmance Incentive metric set, t be used fr the 2016 midyear (54 mnth) and end f year (60 mnth) assessments, was selected and refined by the MiPCT Perfrmance Incentive Subcmmittee during a series f meetings. Perfrmance Incentive Subcmmittee members represented health plans, physician rganizatins and physician hspital rganizatins. Technical assistance was prvided by cnsultants frm the Michigan Data Cllabrative and the MiPCT evaluatin team at the Michigan Public Health Institute. The MiPCT Clinical Subcmmittee and leadership frm physician rganizatins and physician hspital rganizatins reviewed the prpsed metrics and prvided input. MiPCT Perfrmance Incentive Subcmmittee Members: Dr. Paul Pnstein (chair), Ruth Clark, Susan Dlby, Dr. Kimberly Cleman, Dr. Jim Frshee, Christina Hildreth, David Livingstn, Ewa Matuszewski, Dr. Diane Sayers, Alicia Simmer and Betsy Wasilevich Cmmittee Cnsultants: Myrn Hepner, Ellen Bunting, Brian Allisn and Clare Tanner MiPCT Staff: Amanda First and Dana Watt MDC Technical Manual Editrs: Susan Stephan and Brian Allisn Updated 8/15/2016 1

3 2016 MiPCT Perfrmance Incentive Prgram Objectives f the MiPCT Perfrmance Incentive Prgram The MiPCT Perfrmance Incentive Prgram prvides financial rewards t physician rganizatins/ physician hspital rganizatins/independent practice assciatins (POs) and primary care practices fr achievements n MiPCT Perfrmance Incentive Metrics. The Perfrmance Incentive Prgram is designed t transitin ver the three years f the demnstratin frm metrics that reward infrastructure and prcess develpment in 2012 tward thse that reward imprvement in quality and cst utcmes in The prgram is designed t Reward primary care practices fr transfrmatin effrts and fr achieving desired utcmes. Reward/cmpensate POs fr the services prvided t assist MiPCT primary care practices t transfrm care prcesses and achieve desired utcmes. Reward imprvement n ppulatin level indicatrs f patient health care status and decreased r stabilized cst f care Incentive Perids and Payments Perfrmance Incentive perids are identified by the number f mnths since initiatin f the MiPCT Demnstratin Prject perfrmance evaluatins perids are 54 Mnth (midyear) and 60 Mnth (end f year). Payment will be made abut 6 mnths fllwing the clse f the perfrmance perid Perfrmance Incentive Metrics Summary Table 1 lists the 2016 metrics, data surces and the maximum pints t be alltted t each measure fr adult and child ppulatins. The metrics will be used fr bth the 54 Mnth and 60 Mnth assessments. Part I-III Outcme/Imprvement Metrics Utilizatin and clinical quality metrics will make up 90% f the pssible pints. The metrics will be assessed at the PO level fr the ttal applicable ppulatin f adults (> 18 years) and/r children (< 18 years) in the PO and will nt take practice type, e.g. pediatrics, int cnsideratin. Ttal adult and child pints fr Parts I-III will be multiplied by the prprtin f adults t children in the PO (see page 5). Part IV Prcess Metrics Prcess/Practice Capability metrics will make up 10% f the ttal pssible pints. Prcess measures will be assessed at the practice level and pints will be alltted fr the percent f practices in each PO with the prcess/capability in place. Updated 8/15/2016 2

4 Table 1: 2016 Perfrmance Incentive Metrics, Data Surces and Maximum Pints MiPCT Perfrmance Incentive Measures I. Utilizatin (assessed at PO level) Scre > PO 50 th percentile r > 1 % imprvement ver baseline** Numeratr Data Surce Denminatr Adults in PO > 18 years 2016 Pints* Children in PO < 18 years Risk-adjusted Overall ED Visit Rate per 1000 attributed members*** Claims Claims Asthma ED Visits fr Previusly Diagnsed Asthma Claims Claims Ambulatry Care Sensitive Hspitalizatins Claims Claims Hspital Readmissins Claims Claims 15 II. Clinical Quality Metrics (assessed at PO level) Scre > PO 50 th percentile r > 1 % imprvement ver baseline** 1. Diabetes: Annual Retinal Eye Exams Claims Claims Breast Cancer Screening Claims Eligibility 5 3. Cervical Cancer Screening Claims Eligibility 5 4. Well Child Visits - 15 mnths Claims Eligibility 5 5. Well Child Visits years Claims Eligibility 5 6. Adlescent Immunizatins MCIR Eligibility 5 7. Childhd Immunizatins/Cmb3*** 5 III. Clinical Quality Metrics (assessed at PO level) Scre > PO 50 th percentile r >1% imprvement ver 2013 scre 1. Diabetes Cntrl AIC < 8 Registry Claims 4 2. Diabetes: Bld Pressure < 140/90 Registry Claims 4 3. CVD: Bld Pressure < 140/90 Registry Claims 4 4. Hypertensin: Bld Pressure < 140/90 Registry Claims Tbacc Use Assessment Registry Eligibility Weight Assessment fr Children & Adlescents Registry Eligibility 10 Part I, II & III Adult and Child Subttals* PO Adult Pints (Adult Subttal x % adults in PO PO Child Pints (Child Subttal x % Children in PO) PO Outcme Measures Subttal (PO Adult Pints + PO Child Pints) 85 Updated 8/15/2016 3

5 Table 1: 2016 Perfrmance Incentive Metrics, Data Surces and Maximum Pints (cntinued) MiPCT Perfrmance Incentive Measures Numeratr Data Surce Denminatr 2016 Pints* IV. Prcess Measures (assessed at practice level) Actual Ptential Depressin Screening fr Patients with Chrnic Health Cnditins Registry Claims 10 PO Prcess Measures Subttal (10) PO Outcme Measures Subttal (frm page 3) (90) Ttal PO Pints (100) * Bld fnt numbers represent the maximum pssible pints available fr the sectin and fr each metric. **Scres will be cmpared against a baseline average f the previus 2-3 year s scres. ***New measure fr Changes frm previus MiPCT Perfrmance Incentive Prgram perids New Measures Added r Retired in 2016: Nne New Measures Added in 2015 Part I: Risk-adjusted Overall ED Visit Rate per 1000 attributed members. This utcme measure replaces Primary Care Sensitive ED Visits. Part II: Childhd Immunizatins/Cmb3. Measures Retired in 2015 Part I: Primary Care Sensitive ED Visits. Part IV: Ntificatin f Hspital Admissins & Discharges. Part IV: Fllw-Up Referrals t a Cmmunity-Based Prgram r Agency Part IV: Self-Management Supprt Offered fr Chrnic Cnditin f Fcus Data Surces fr 2016 Metrics Claims: Claims data will be used t calculate the numeratrs and denminatrs fr Part I utilizatin and Part II clinical quality metrics. Claims data will be used t determine the denminatrs fr the Part III clinical quality metrics and the Part IV depressin screening metric. Data analysis will be delayed until after the 3 mnth run ut perid fr claims submissin is cmpleted. Updated 8/15/2016 4

6 54 Mnths: The measurement year is 7/1/15 thrugh 6/30/16. Sme Part II clinical metrics have an additinal ne r tw year claims lk-back perid. See metric specificatins fr details. 60 Mnths: The measurement year is 1/1/16 thrugh 12/31/16. Sme Clinical Quality metrics have an additinal 1 r 2 year lk-back perid. See metric specificatins fr details. Registry/EHR: Numeratrs fr Part III clinical metrics and the Part IV depressin screening metric will be calculated frm clinical registry/electrnic health recrd data submitted by POs t the Michigan Data Cllabrative. Eligibility Data: Sme Part II and Part III metrics are applicable t the entire MiPCT subppulatin that meets age criteria. Denminatrs fr these metrics will be identified frm health plan eligibility and demgraphic data. Michigan Childhd Immunizatin Registry (MCIR): MCIR scres will be used fr the adlescent immunizatin metric. Submissin f MiPCT Registry/EHR Data Participating POs will submit specified registry/ehr data t the Michigan Data Cllabrative fr all participating MiPCT patients. Optinally, POs may submit data fr all f the patients in the MiPCT practice and MDC will filter the data t identify the prtin applicable t MiPCT patients. Submitted data will be laded int the MiPCT multi-payer database, integrated with claims data, and used t calculate perfrmance metrics fr use in the prject dashbard, reprts and the incentive prgram. Technical dcumentatin fr registry submissins is fund in the Appendix (page 21) and n the MDC Supprt webpage at (Navigate t MiPCT Registry Data Submissin/Specificatins/ Clinical data specs). Fr further infrmatin abut submissin f registry data, the Michigan Data Cllabrative at MichiganDataCllabrative@umich.edu. Pint Alltment Methdlgy Utilizatin, Claims- and Registry-Based Clinical Quality Metrics: Pints will be alltted fr achievement and imprvement. Pints will be added and capped at the maximum pint level. Fr the registry-based clinical quality metrics, POs must submit registry/ehr numeratr data fr 50% r mre f the metric s eligible ppulatin in rder fr the metric t be eligible fr assessment and pints. Achievement. Rates fr each metric will be ranked lwest t highest rate fr utilizatin and highest t lwest rate fr clinical quality. Ranked rates will be divided int percentiles and pints assigned as fllws: 90th percentile = full pints 80th percentile = 80% f pints 70th percentile = 60% f pints 60th percentile = 40% f pints 50th percentile = 20% f pints Updated 8/15/2016 5

7 Less than 50 th percentile = 0 pints Percent Imprvement: Imprvement is defined as a psitive percent change fr clinical quality metrics and a negative percent change fr utilizatin metrics. The percent change frmula is (measurement perid rate baseline rate / baseline rate x 100). Significant imprvement > 1% = full pints Nn-significant imprvement > 1% = 50% f pints Imprvement <1% = 0 pints Capability Metrics: Pints fr these measures will be calculated by multiplying the ttal pssible pints fr the measure with the better result between; percent f practices in the PO r calculating verall PO percentage meeting criteria. Methdlgy fr Calculatin f Ttal PO Pints 1. Assess applicable utilizatin and clinical quality metrics at the PO adult and/r child ppulatin levels (see Tables 1 and 2 n pages 4-6). 2. Sum pints fr utilizatin and prcess metrics and recrd Adult and Child Subttals. 3. Multiply Adult Subttal by the percent f adult beneficiaries in the PO t btain PO Adult Pints. Multiply the Child Subttal Scre by the percent f children in the PO t btain PO Child Pints. 4. Add PO Adult Pints and PO Child Pints t btain the PO Outcme Measures Subttal. 5. Assess Prcess Measures and calculate the PO Prcess Measure Subttal. 6. Add PO Outcme Measures Subttal (85 pints pssible) and Prcess Measures Subttal (15 pints pssible) t btain Ttal PO Pints (100 pints pssible). Updated 8/15/2016 6

8 2016 Metric Specificatins Utilizatin Metrics The Michigan Data Cllabrative will use claims data t calculate the PO rates fr the utilizatin metrics. Full pints will be alltted t each metric fr which the 2016 scre exceeds the MiPCT benchmark rate. Variable pints will be assigned t metrics fr which the 2016 rate has imprved in cmparisn t the baseline rate. Cntact the Michigan Data Cllabrative MichiganDataCllabrative@umich.edu fr additinal infrmatin. 1. Risk Adjusted Overall ED Visit Rate per 1000 attributed members Metric Surce: HEDIS 2015 Ambulatry Care definitin f ED events and MPHI risk adjustment methdlgy Definitin: Measures the risk adjusted ED rate based fr (Adult and Pediatric) with three r mre eligible mnths, ppulatins independently measured. Risk adjusted values are determined by calculating predicted visits (Numeratr) fr all eligible members based n the Truven MarketScan nrmalized cncurrent risk scre with a tw part analysis using lgistical and binmial regressin. Numeratr: Observed: Ttal ED visits f eligible member. Predicted: Defined by SPSS risk adjustment analysis f eligible members. Denminatr: Ttal number r patients with 3 r mre mnths f cntinuus enrllment. 2. Asthma Emergency Department (ED) Visits fr Previusly Diagnsed Asthma Metric Surce: Michigan Quality Imprvement Cnsrtium (MQIC) Definitin: Individuals previusly diagnsed with asthma wh have had a visit t an emergency department with a principle diagnsis f asthma. (The measure is reprted per 1000 members with asthma). Numeratr: The number f patients frm the denminatr wh have had a visit t an Emergency Department during the measurement perid with a principal diagnsis f asthma and a service date ccurring after the earliest date f the chrnic cnditin diagnsis. The earliest asthma ED visit date is used. Denminatr: Ttal number f patients with a qualifying asthma diagnsis thrugh the end f the measurement year. Numeratr HEDIS Value Sets: Asthma Methdlgy fr Denminatr Identificatin: HEDIS criteria are used t identify members with persistent asthma. At least ne f the fllwing criteria must be met during bth the measurement year and the year prir t the measurement year. Criteria need nt be the same acrss bth years. At least 1 inpatient r ED visit with principal diagnsis f Asthma Or At least 4 utpatient visits with any diagnsis f asthma Or At least 4 prescriptins fr an asthmatic drug (excluding leuktriene mdifiers). Updated 8/15/2016 7

9 Denminatr HEDIS Value Sets: Diabetes, Observatin, ED, Nnacute Inpatient, Outpatient, Acute Inpatient. NDC HEDIS set f CDC-A. 3. ACSC Hspitalizatin Rate (Adult and Child) Adult ACSC Hspitalizatin Rate Metric Surce: AHRQ Preventin Quality Indicatrs Descriptin: Percent f adult inpatient discharges that are classified by the AHRQ algrithm as ptentially avidable thrugh early interventin and apprpriate utpatient care. Numeratr: The number f cases flagged with the utcme f interest. Denminatr: The number f inpatient discharges fr individuals ver the age f 18. Cdes: Available frm the Michigan Data Cllabrative Exclusins: Pregnancy, Childbirth and Puerperium ACSC Methdlgy: Definitins fr ACSCs are based n ICD-9 and 10-CM diagnsis and prcedure cdes (ften alng with diagnsis related grup (DRG), majr diagnstic categry (MDC), sex, age, prcedure dates, admissin type, admissin surce, discharge dispsitin). There are 9 chrnic cnditins: Diabetes Shrt Term Cmplicatins; Diabetes Lng Term Cmplicatins; Diabetes Amputatin; Diabetes Uncntrlled; Chrnic Hypertensin; Chrnic Angina n prcedure; Chrnic Heart Failure; Chrnic COPD and Chrnic Asthma in Yung Adults (the nly PQI with an upper limit Age at admissin > 18 AND < 40.) There are 4 Acute Cnditins: Bacterial Pneumnia; Dehydratin; UTI (urinary tract infectin) and Perfrated Appendix. Children/Teen ACSC Hspitalizatin Rate Metric Surce: AHRQ Preventin Quality Indicatrs Descriptin: Percent f ptentially preventable inpatient admissins in children/teens < 18 years f age. Numeratr: Numeratr is defined in five sectins: Pediatric Asthma Admissins, Pediatric Diabetes Shrt Term Cmplicatins, Pediatric Gastrenteritis, Pediatric Perfrated Appendix and Pediatric UTI. Patients are included in the numeratr if they are hspitalized fr any f these numeratr definitins. Denminatr: The number f inpatient discharges fr children (see applicable age grups belw). Methdlgy fr Calculating Numeratrs: PDIs included in the ACSC measure: Asthma Admissin Rate (pediatric members 2 t 17 years), Diabetes Shrt-term Cmplicatins (pediatric members 6 t 17 years), Gastrenteritis Admissin Rate (pediatric members 3 mnths t 17 years) Perfrated Appendix Admissin Rate (pediatric members 1 t 17 years) and Urinary Tract Infectin Admissin Rate (pediatric members 3 mnths t 17 years). Cdes: Available frm Michigan Data Cllabrative Updated 8/15/2016 8

10 Exclusins: Pregnancy, childbirth, puerperium. Additinal exclusins are applied independently based n the five numeratr sectins.. 4. All-Cause Readmissins Metric Surce: 2013 and 2014 HEDIS Definitin: Percent f ttal acute inpatient stays fr adults 18 years f age and lder during the measurement year that was fllwed by an acute readmissin fr any diagnsis within 30 days. Numeratr: The number f acute inpatient stays during the measurement year that was fllwed by an acute readmissin fr any diagnsis within 30 days fr adults 18 years f age and lder. Denminatr: Ttal number f acute inpatient stays during measurement perid. Exclusins: Inpatient stays with discharges fr death and inpatient discharge with a principle diagnsis fr pregnancy r fr any ther cnditin riginating in the perinatal perid. Admissins with identical admissin and discharge dates are excluded. Acute Admissins with a discharge date in the thirty days prir t the Admissin Date are excluded. Exclusin HEDIS Value sets: Pregnancy and Perinatal Cnditins Claims-Based Clinical Quality Metrics The Michigan Data Cllabrative will use claims and eligibility data t calculate rates fr the metrics in this grup. 1. Diabetes: Eye Examinatin Metric Surce: HEDIS 2015 Cmprehensive Diabetes Care Eye Exam Definitin: Percent f patients years f age with diabetes wh had an eye screening fr diabetic retinal disease during the measurement year r a negative retinal eye exam during the prir year. Numeratr: The number f patients frm the denminatr with an eye exam in the measurement year r negative exam in the previus year. Denminatr: Ttal number f patients years ld with diabetes. Diabetes is identified by pharmacy r claims data during the measurement year r prir t the measurement year. Claim/Encunter: Members wh had ne f the diagnsis f diabetes during the measurement year r the year prir t the measurement year; Outpatient r nn-acute inpatient: tw face-t-face encunters n different dates f service with a diagnsis f diabetes, Acute Inpatient r ED: One face-t-face encunter. Pharmacy data: Members wh were dispensed insulin r ral hypglycemics/antihyperglycemics. Updated 8/15/2016 9

11 Numeratr HEDIS Value Sets: Diabetic Retinal Screening, Diabetic Retinal Screening with Eye Care Prfessinal, Diabetic Retinal Screening Negative. Als MDC defined Taxnmy cdes t define an eye care prfessinal. Denminatr HEDIS Value Sets: Diabetes, Observatin, ED, Nnacute Inpatient, Outpatient, Acute Inpatient. NDC HEDIS set f CDC-A. Exclusin HEDIS Value Sets: If nly identified thrugh drug claims, excludes with Diabetes Exclusins r Plycystic Ovaries. Als exclude fr gestatinal diabetes r sterid-induced diabetes. 2. Breast Cancer Screening Metric Surce: HEDIS 2015 Breast Cancer Screening Definitin: Percentage f wmen years f age wh received at least ne mammgram t screen fr breast cancer within the measurement year r tw years prir. Numeratr: The number f patients frm the denminatr with 1 r mre mammgrams any time n r between tw years prir t the measurement year. Denminatr: Ttal number f females years ld n the final day f the measurement year. Numeratr HEDIS Value Sets: Mammgraphy Denminatr Exclusins: Wmen wh had a bilateral mastectmy r fr whm there is evidence f tw unilateral mastectmies. Lk fr evidence f a bilateral mastectmy as far back as pssible in the member s histry thrugh the end f the measurement year. Exclusin HEDIS Value Sets: Bilateral Mastectmy, Histry f Bilateral Mastectmy, Unilateral Mastectmy, r Bilateral, Right r Left Mdifier. 3. Cervical Cancer Screening Metric Surce: HEDIS 2015 Cervical Cancer Screening Definitin: Percent f wmen years f age wh received Cervical cytlgy within 3 years r wmen aged wh received cervical cytlgy r human papillmavirus c-testing within 5 years. Numeratr: Wmen wh had cervical cytlgy during the measurement year r the tw years prir t the measurement year. If nt identified, then wmen years f age wh had cervical cytlgy and a human papillmavirus test during the fur previus years prir t the measurement year. Denminatr: Ttal number f female patients wh were years ld n the last day f the measurement perid. (There is a 3 year lk-back perid.) Numeratr HEDIS Value Sets: Cervical Cytlgy and HPV Tests Exclusins: Wmen wh have had a hysterectmy with n residual cervix, cervical agenesis r acquired absence f cervix, at any time during the member s histry thrugh the end f the measurement year. Updated 8/15/

12 Exclusin HEDIS Value Sets: Absence f Cervix 4. Well-Child Visits in the First 15 Mnths f Life Metric Surce: HEDIS 2015 Well Child Visits in the First 15 Mnths f Life Descriptin: Percent f children wh turned 15 mnths ld during the measurement year and wh had six r mre well-child visits with a PCP during their first 15 mnths f life. Numeratr: Ttal number f patients wh had six r mre well-child visits with a PCP during their first 15 mnths f life. Denminatr: Ttal number f patients wh turned 15 mnths ld during the measurement year. Numeratr HEDIS Value Sets: Well Care. Als includes an MDC custm list f taxnmy cdes t identify that the visits were with a PCP r OB/GYN. 5. Well-Child Visits in the Third, Furth, Fifth and Sixth Years f Life Metric Surce: HEDIS 2015 Well Child Visits in Third, Furth, Fifth and Sixth Years f Life Definitin: Percent f children 3-6 years f age wh had ne r mre well-child visits with a PCP during the measurement year. Numeratr: The number f patients frm the denminatr wh received 1 r mre well-child visits with a PCP during the measurement year. Denminatr: Ttal number f patients wh turned 3-6 years ld during the measurement year. Numeratr HEDIS Value Sets: Well Care. Als includes an MDC custm list f taxnmy cdes t identify that the visits were with a PCP. 6. Adlescent Immunizatins Metric Surce: HEDIS 2015 Immunizatins fr Adlescents Definitin: Percent f yuth 13 years f age wh have received the fllwing a. Meningcccal vaccine n r between the members 11th t 13th birthdays. b. 1 Tdap r 1 Td n r between the members 10th t 13th birthdays. Numeratr: The number f patients frm the denminatr wh by their 13th birthday received ne dse f meningcccal vaccine And ne tetanus, diphtheria txids and acellular pertussis vaccine (Tdap) Or ne tetanus, diphtheria txids vaccine (Td). Denminatr: Ttal number f patients wh turned 13 years ld during the measurement year. Data Surce: Immunizatin data is btained frm the Michigan Childhd Immunizatin Registry (MCIR). 7. Childhd Immunizatins/Cmb3 Metric Surce: HEDIS 2015 Childhd Immunizatin Status CIS Definitin: Percent f yuth 2 years f age wh have received the fllwing Updated 8/15/

13 fur diphtheria, tetanus and acellular pertussis (DTaP); three pli (IPV); ne measles, mumps and rubella (MMR); three haemphilus influenza type B (HiB); three hepatitis B (HepB), ne chicken px (VZV); fur pneumcccal cnjugate (PCV); ne hepatitis A (HepA); tw r three rtavirus (RV); tw influenza (flu) vaccines by their secnd birthday Numeratr: The number f patients frm the denminatr receiving vaccine schedule by their 2 nd birthday. Denminatr: Ttal children wh turn 2 years f age during the measurement year, excluding any patient wh had a waiver fr any vaccine. Data Surce: Immunizatin data is btained frm the Michigan Childhd Immunizatin Registry (MCIR). Registry/EHR-Based Clinical Quality Metrics Fr the metrics in this sectin, the Michigan Data Cllabrative will calculate numeratrs frm registry/ehr data submitted by the PO and will calculate denminatrs frm claims and/r eligibility data. A data submissin threshld f 50% applies t each f these metrics. POs must submit registry/ehr numeratr data fr 50% r mre f the metric s eligible ppulatin in rder fr the metric t be eligible fr assessment and pints. Additinal questins regarding the registry frmats and prcess shuld be directed t Michigan Data Cllabrative. 1. Diabetes: HbA1C Cntrl (< 8%) Metric Surce: HEDIS 2015 Cmprehensive Diabetes Care HbA1c Cntrl (<8%) Definitin: Percent f adults aged years with a diagnsis f diabetes wh had a screening HbA1c test in the measurement year with result f HbA1c < 8. Numeratr: The number f patients frm the denminatr with mst recent HbA1c < 8. Denminatr: Ttal number f patients years ld with diabetes and ne r mre HbA1c tests during the measurement year. See denminatr f Diabetes Eye Exam fr diabetes diagnsis criteria. Data fr Numeratr: Identifying data, date, HbA1c levels in standard frmat. Denminatr Cdes (Diabetes): See denminatr cdes fr Diabetes Eye Exams. Exclusins: Plycystic vary disease, sterid induced diabetes and gestatinal diabetes. See Diabetes Eye Exam fr Value Sets. Updated 8/15/

14 2. Diabetes: Bld Pressure Management Metric Surce: HEDIS 2015 Cmprehensive Diabetes Care Definitin: Percent f adults aged years with a diagnsis f diabetes with the mst recent bld pressure during the measurement year recrded as less than 140/90. Numeratr: The number f patients frm the denminatr with mst recent BP <140/90. Denminatr: Ttal number f patients years ld with See denminatr f Diabetes Eye Exam fr diabetes diagnsis criteria. Data fr Numeratr: Identifying data, date and bld pressure in standard frmat. Cdes fr Denminatr (Diabetes): See denminatr cdes fr Diabetes Eye Exams. Exclusins: Plycystic vary disease, sterid induced diabetes and gestatinal diabetes. See Diabetes Eye Exam fr Value Sets. 3. Hypertensin: Cntrlling High Bld Pressure Metric Surce: HEDIS 2015 Cntrlling High Bld Pressure and Essential Hypertensin Definitin: The percent f members years f age wh had a diagnsis f hypertensin (HTN) and whse BP was adequately cntrlled (<140/90) during the measurement year. Numeratr: The number f patients frm the denminatr with mst recent BP<140/90. Denminatr: Ttal number f patients years ld with hypertensin and ne r mre primary care ffice visits during the measurement year. Data fr Numeratr: Identifying data, date and bld pressure in standard frmat. Denminatr HEDIS Value Sets: Outpatient CPT and Essential Hypertensin Exclusins: Evidence during the measurement year f end-stage renal disease (dialysis r renal transplant als meets the criteria), pregnancy, and/r an admissin t a nn-acute inpatient setting. Exclusin HEDIS Value Sets: Kidney Transplant, Pregnancy and ESRD. 4. Cardivascular Disease (CVD): Bld Pressure Management Metric Surce: HEDIS 2013 Chlesterl Management fr Patients with Cardivascular Disease and sme value sets frm HEDIS 2015 fr Crnary artery bypass grafting (CABG), Acute mycardial infarctin (AMI) and Percutaneus crnary interventin (PCI). Definitin: Percent f adults years f age wh have gne thrugh an IVD (Ischemic Vascular Disease) event/treatment r cardiac prcedure and whse mst recent bld pressure is in cntrl <140/90). Numeratr: The number f patients frm the denminatr with mst recent BP<140/90. The lwest systlic and lwest diastlic reading will be used if there are several BP readings recrded n the same date. Denminatr: Ttal number f patients years f age with at least ne ffice visit wh were discharged alive fr AMI, CABG r PCI fr an 11-mnth perid in the year prir t the measurement Updated 8/15/

15 year r wh had a diagnsis f IVD in the measurement year r year prir t the measurement year, r wh had a diagnsis f IVD during the measurement year. Data fr Numeratr: Identifying data, date and bld pressure in standard frmat. Denminatr HEDIS Value Sets: AMI, CABG, PCI, IVD, Acute Inpatient, and Outpatient 5. Tbacc Use Assessment Metric Surce: MiPCT measure adapted frm part a f the 2014 Meaningful Use Clinical Quality Measure CMS138v1 and NQF Age range is extended frm 18 years and lder t 13 years and lder and the measure perid is decreased frm tw years t 1 year. The MiPCT metric des nt assess part b that requires dcumentatin that a smking cessatin interventin was prvided. Definitin: Percent f individuals 13 years f age and lder with an ffice visit during the measurement year fr whm smking status is recrded. Numeratr: The number f patients frm the denminatr fr which smking status is reprted. Denminatr: Ttal number f unique MiPCT patients aged 13 years and lder with a primary care ffice visit during the measurement year. Data fr Numeratr: Identifying patients that had a Tbacc Assessment Denminatr HEDIS Value Sets: Outpatient and als includes an MDC custm list f taxnmy cdes t identify that the visits were with a PCP. 6. Weight Assessment fr Children and Adlescents Metric Surce: MiPCT metric based n the first bullet f 2013 HEDIS, 2014 Meaningful Use Clinical Quality Measure CMS155v1 (first bullet nly) and NQF 0024a. Definitin: Percent f patients 3-17 years f age wh had an utpatient visit with a Primary Care Physician (PCP) during the measure year and wh bdy mass index (BMI) percentile dcumentatin. Numeratr: The number f patients frm the denminatr with BMI percentile recrded. Denminatr: Ttal number f patients aged 3-17 years f age with an utpatient visit with a primary care physician during the measurement year. Data fr Numeratr: Identifying data, date and BMI percentile in standard frmat. Denminatr HEDIS Value Sets: Outpatient and als includes an MDC custm list f taxnmy cdes t identify that the visits were with a PCP. Exclusin: Diagnsis f pregnancy during the measurement perid Exclusin HEDIS Value Sets: Pregnancy Prcess Measures Prcess measures are assessed at the practice & PO levels. T qualify fr measure 1, depressin screening data must be submitted t the Michigan Data Cllabrative using an apprved standard frmat. Updated 8/15/

16 1. Depressin Screening fr Patients with Chrnic Health Cnditins Metric Surce: MiPCT Measure adapted frm the Meaningful Use 2014 Clinical Metric CMS 2v1 (NQF 0418) Preventive Care and Screening: Screening fr Clinical Depressin and Fllw-Up Plan. MiPCT mdificatins are limiting screening t individuals with ne r mre f the qualifying chrnic illnesses in place f universal screening and nt assessing dcumentatin f a fllw-up plan fr psitive screens. Descriptin: Percent f individuals 12 years and lder wh were seen fr an ffice visit during the measurement year and have dcumentatin that a depressin screen was cmpleted using a PHQ-2 r ther age- apprpriate standardized depressin screening tl. Percent f MiPCT practices in the PO, r verall rate f the PO fr this measure. Nte: Care team supprt prcesses need t be in place during implementatin f depressin screening. Prtcls are advised fr prcesses such as using a diagnstic tl (e.g. PHQ-9) t fllw up psitive screens, initiating medicatin treatment fr patients with diagnsed depressin, referral f patients with depressin fr behaviral cunseling and/r initiatin f medicatins, self-management educatin and supprt (including care management services when indicated), and identificatin f referral surces/ prcesses fr patients identified with severe depressin r thse at risk fr suicide. Numeratr: Number f patients frm the denminatr with depressin screening during an ffice. Denminatr: The number f patients aged 12 and lder with a qualifying chrnic illness (Cardivascular Disease, Chrnic Kidney Disease, COPD, Asthma, Diabetes, Heart Failure and ADHD) with at least ne utpatient visit with a PCP. Methdlgy: POs will submit depressin screening data t MDC. MDC will use claims data frm 2010 t current and standard HEDIS methdlgy t identify the ppulatin f individuals with ne r mre f the specified chrnic diseases. Rates will be calculated at the Practice and PO levels, the result qualifying fr the mst pints will be used in the final pint calculatins. Numeratr Data: Identifying data, visit date and depressin screen yes. Nte: Blank screening fields and n respnses are nt added t the numeratr. Denminatr HEDIS Value Sets: All the value sets names are in italics belw Outpatient Cardivascular: CABG, PCI, MI, r custm list f CAD; CKD: Custm list includes any diagnsis f CKD f the stages prir t rutine dialysis; COPD: Patients greater than r equal t 42 with COPD, Chrnic Brnchitis, Emphysema, r COPD and with an Acute Inpatient, ED, r Outpatient visit n the same claim; Asthma: Met ne f these requirements Asthma with ED Visit Asthma with an Acute Inpatient visit Asthma with at least fur Outpatient r Observatin visits Updated 8/15/

17 At least 4 asthma medicatins prescriptins (ASM-C). If all prescriptins are Leuktriene mdifiers, als requires a diagnsis f Asthma. Diabetes: met ne f these requirements At least 2 visits defined by Outpatient, Observatin, ED r Nnacute Inpatient with Diabetes An Acute Inpatient visit with Diabetes At least 1 insulin r Hypglycemic/Antihyperglycemics prescriptin (CDC-A) Exclude Diabetes Exclusins and Plycystic Ovaries Heart Failure: met any ne f these requirements: At least 1 ED visit and AHRQ defined Heart Failure At least 1 Acute Inpatient stay and AHRQ defined Heart Failure At least 2 Outpatient visits and AHRQ defined Heart Failure ADHD: custm set f cdes indicating a diagnsis f ADHD r ADHD medicatin (ADD-A) Exclusins: An active diagnsis f Depressin r Biplar Disrder. Exclusin HEDIS Value Sets: Majr Depressin r Biplar Disrder Perfrmance Incentive Payment Prcess 1. Medicaid and Medicare cntribute $3.00 per member per mnth t the incentive prgram pl. Nnparticipating health plans may prvide additinal incentive funds thrugh separate incentive prgrams. 2. Perfrmance incentive metrics will be assessed every six mnths f the calendar year and all funds accumulated during that 6-mnth perid will be awarded. a. The Michigan Data Cllabrative will calculate a perfrmance incentive scre fr each PO. Prcess/infrastructure metrics will be assessed at the practice level and rlled up t the PO level. Other metrics will be assessed at the PO level n all MiPCT beneficiaries in the PO. b. The Michigan Data Cllabrative will calculate the payment due each PO based n the ttal perfrmance incentive scre received and the number f MiPCT beneficiaries. PO pints will be ranked frm high t lw and then placed int 10 payment grups such that each payment grup represents ne tenth f MiPCT beneficiaries. Payment grups will be assigned a dllar value ranging frm 82% t 118% f the mean payment. The number f payment grups may be adjusted t accmmdate natural clusters f scres. Calculatin f MiPCT Perfrmance Incentive Payments The calculatin f perfrmance incentive payments is based n a decile ranking methdlgy. Payment amunts will range frm 82% t 118% f the mean f $18.00 per member which is $3.00 per member Updated 8/15/

18 per mnth times six mnths. An example f the payment calculatin methdlgy is prvided n the fllwing page. The steps fr calculating payments are shwn belw. 1. Attribute dllar amunts t the deciles. Decile Frmula $ Per Beneficiary Decile Frmula $ Per Beneficiary 1 118% x $18.00 $ % x $18.00 $ % x $18.00 $ % x $18.00 $ % x $18.00 $ % x $18.00 $ % x $18.00 $ % x $18.00 $ % x $18.00 $ % x $18.00 $ Calculate the ttal perfrmance incentive scre fr each PO and identify the number f MiPCT beneficiaries attributed t each PO. 3. Rank POs by scre frm high t lw. If tw r mre POs receive the same scre d a secndary ranking based n number f beneficiaries, listing the PO with the largest number first. 4. Divide the ttal number f MiPCT beneficiaries* by 10 t determine the number f beneficiaries t be attributed t each decile. Example: 450,000 Beneficiaries/10 = 45,000 beneficiaries per decile 5. Fill decile 1 with the number f beneficiaries frm the tp scring PO. If this is fewer than the ttal beneficiaries alltted t decile 1 (ne tenth), add the beneficiaries frm the next highest ranking PO and repeat until decile 1 is cmplete. Any remaining beneficiaries frm the last PO will then begin filling decile 2 and the prcess cntinues until all beneficiaries have been assigned. 6. The amunt t be paid t each PO is the amunt f beneficiaries attributed t the decile x the payment amunt fr the decile. If a PO s beneficiaries are assigned t 2 r mre deciles, the amunt fr each decile is calculated and the ttals summed. The fictitius example belw shws hw payment wuld be calculated fr the 7 POs with the highest scres. Example: Calculatin f Perfrmance Incentive Payments frm Ranked Scres PO Rank % Ttal Scre # MiPCT members Decile* Decile breakdwn Payment 1 Payment 2 Ttal Payment 1 98% 11,031 1 $21.24 x 11,031 $ 234,298 Updated 8/15/

19 2 96% 54, ,969 15,307 $21.24 x 33,969 $721,501 $20.52 x 15,307 $314,100 $ 1,035, % 4,732 2 $20.52 x 4732 $ 97, % 30, ,962 5,757 $20.52 x 24, ,220 $19.80 x 5,757 $113,988 $ 626, % 3, % 35, % 15,161 4 *Each decile represents 45,000 beneficiaries $19.80 x 3361 $19.80 x 35,882 $19.08 x 15,161 $ 66,548 $ 710,463 $ 289,272 Cntinue the prcess fr the remaining POs thrugh Decile 10. POs in Decile 10 will receive $14.75 x the number f beneficiaries. Distributin f Perfrmance Incentive Payments The Michigan Data Cllabrative will determine the amunt t be paid by participating health plans based n beneficiary enrllment numbers. 1. Payments will be made abut 6 mnths after the clse f each perfrmance measurement perid. 2. POs will retain the apprved prtin specified in the MiPCT implementatin Plan (nt t exceed 20%) t reward/cmpensate their cntributin t primary care practice transfrmatin effrts. The remaining funds are t be distributed t the participating primary care practices. Health systems are encuraged t implement prcesses t ensure incentive funds are passed n t the primary care practice unit level. 3. Funds retained by Physician Organizatins are t be used t supprt primary care practice transfrmatin activities thrugh prvisin f ne r mre f the fllwing: a. clinical leadership supprt b. implementatin f tls and care prcesses that enable the primary care practices t achieve practice transfrmatin, and c. analytic supprt with generatin f reprts t measure transfrmatin prgress. Updated 8/15/

20 T cntact MDC abut submissin f data frm yur registry, MichiganDataCllabrative@umich.edu t discuss yur questins and needs. Updated 8/15/

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