TAG June Meeting. Welcome!

Transcription

1 TAG June Meeting Welcome!

2 TAG June Agenda Agenda Item Time Presenter 1. Welcome and introductions 9:00 am Alan Ormsby, HDC member and TAG chair 2. TAG Goals Review 9:05 am Alan Ormsby, HDC member and TAG chair, and Sarah Woolsey, HealthInsight 3. Follow Up from May Meeting a. Physician Quality Metrics (HDC Final decision) 4. Clinic Quality Comparisons a. Status update and feedback on process b. Inform TAG about what is going to be included 9:15 am Brantley Scott, OHCS 9:25 am Brantley Scott, OHCS 5. Total Cost of Care a. Status report and update b. Reminder about event on June 26th. c. Quality Composite Proposal d. Process for making the reports public (review?) 9:40 am Rita Hanover, HealthInsight, and Sarah Woolsey, HealthInsight 6. Develop and Finalize Action Items 9:55 am Everyone Next meeting: Tuesday, July 17th 9a to 10a MDT

3 Goals Review Goal 1: TAG to support the development of a standardized process to ensure community feedback and dissemination of pre-publication medical provider data review for publication by July 1, Goal 2: TAG to assist the community in development of transparent data reports or data availability that can benefit Utah Employers by August 1, Goal 3: TAG will assist communitywide efforts to increase the use of and action on existing controlled substance use and opioid-related reports and provide input on transparency mechanisms of benefit to the community by December 30, Goal 4: TAG to assist OHCS to develop actionable price variation reports for cost by procedure by July 1, 2018 and to assist with assessment of tools to make price/cost information widely available to consumers by December 1, 2018 Goal 5: TAG to assess current local reporting tools targeting price/cost information by April 2, 2018 and provide recommendations on making data and information products available to the public.

4 Clinic Quality Comparison

5 HDC Approved Quality Measures Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB, NQF# 0058) Breast Cancer Screening (BCS, NQF# 2372) Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing (CDC, NQF# 0057) Asthma Medication Ratio (AMR, NQF# 1800) Antidepressant Medication Management (AMM, NQF# 0105) Comprehensive Diabetes Care: Medical Attention for Nephropathy (CDC, NQF# 0062) Chlamydia Screening in Women (CHL, NQF# 0033)

6 OHCS Process per rule OCHS must report by July 1 of each year (see S106.5.html) Prior to publication, the report must be "validated" by a "neutral, non-biased entity with a broad base of support from health care payers and health care providers. see S106.5.html) Third, OHCS must allow "the health care provider to verify the accuracy of the information" for a "reasonable period of time to be established by rule" prior to publication Current guidelines are 15 business days. (see

7 Clinics reported on CY2015 had 184 clinics CY2016 has 160 clinics -9 Primary Taxonomy Code Changes -15 Low Physician Count -13 Low Denominator Count +13 Newly included Clinics due to increase in Physician or Denominator count

8 Comparing 2015 to 2016 results

9 TAG Update on Total Cost of Care Reports in Utah June 19 th, 2018

10 Utah and Total Cost of Care 2016-Spring 2017 Funded by Robert Wood Johnson Foundation(RWJF) and Network for Regional Health Improvement (NRHI) Collaboration organizations in CO, MD, ME, MN, MO and OR Utah produced 123 clinical reports using 2014 data and disseminated to primary care practices for review Spring 2017-present Two National Total Cost of Care Benchmark Reports on five states published Utah produced and disseminated 92 clinical reports using 2015 data

11 2015 Total Cost of Care Report Overview for Utah

12 Utah 2015 Report Data Contribution 2.5 million commercial insured members; over 15,000 inpatient claims, 300,000 outpatient claims, 2 million professional claims Select Health Cigna U of U DMBA UHC Regence Aetna Altius APCD contributors: 20 product lines Quality Assurance Process: Data validation included stability, consistency, evaluation of distributions by type of service, orphan claims, standardized MS- DRGs, evaluation of diagnosis code fields 92 Primary Care Practices (58 Adult and 34 Pediatric Reports) 351,083 eligible members; 228,401 attributed to a PCP; 191,750 patients attributed to a PCP with >50 members

13 Initial Learning from Two Years of Utah TCoC Reports Improved completion of APCD claims submissions Improved attribution to clinics High correlations between 2014 and 2015 indices at the clinic level Risk Scores (r = 0.86) $PMPM (r = 0.83)

14 Attribution Process 1. Patient attributed to a primary care provider (PCP) E&M visits: - Total visits - Most recent 2. Providers are attributed to PCP groups HealthInsight/OHCS Master Provider List

15 Master Provider List Elements used to facilitate provider-to-group attribution: National Provider ID (NPI) SK&A National Plan and Provider Enumeration System (NPPES) List provided by clinics List provided by plans Verification by phone

16 Year Over Year Changes % Change Patient Panel Avg Age %Male %Female Inpatient Adm/ ER Visit/ Risk Adj. IP PMPM $71.54* $ Risk Adj. OP PMPM $ $ Risk Adj. Prof PMPM $ $ Risk Adj. Rx PMPM $96.00 $ Risk Adj. Overall PMPM $ $ Total members eligible 635, , Total attributed 212, , *Denotes corrected value

17 Next Steps Production of 2016 TCoC reports (Summer 2018) Review of private TCoC report (late Summer 2018) Community-wide review of quality measures and potential composite result (late Summer 2018) Community-wide discussion on public reporting of TCoC/Quality Composite Reports (Fall 2018)

18 Quality Component Development Important to a true value report Current All Payer Claims Data is potential source data available Measures for Adults: Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing, Breast Cancer Screening, Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis, Lower Back Pain and Medication (75%) for clinics with five or more physicians. Measures for Pediatrics: Management for People with Asthma ( 5 years and up)

19 Mock Template for Public Reporting

20 Reminder Event Discussion of the TCoC Reports June 26 th in Partnership with UPIQ In person or virtual attendance for invite to the event

21 Discussion/Questions