16 th Annual IHA Stakeholders Meeting Session 1A

Transcription

1 16 th Annual IHA Stakeholders Meeting Session 1A September 19, 2017 Hilton Los Angeles Airport Thank you to our Platinum Sponsor:

2 IHA & PBGH ACO Measurement & Benchmarking Initiative September 19, 2017

3 HMO 3-way agreement (plan, physician organization, hospital) HMO global risk HMO dual risk PPO 3-way agreement (plan, PO, hospital) PPO 2-way agreement (plan and physician organization) PPO 4-way agreement (plan, PO, hospital, employer) All of the above How do you define an ACO? 2017 Integrated Healthcare Association All rights reserved 3

4 How Do ACOs Perform in VBP4P? Average OPA Star Rating (1=POOR, 4=EXCELLENT) Physician organizations with ACO contracts All physician organizations Clinical Quality Patient Experience Total Cost of Care VBP4P physician organizations with ACO contracts tend to be slightly higher cost and higher quality 2017 Integrated Healthcare Association All rights reserved 4

5 Why Measure Commercial ACOs? ACOs are a key new model for integrated care, but performance is unknown or assumed Continued commercial ACO growth will widen emerging measurement and reporting gap Over 80% of California medical groups and IPAs with commercial ACO contracts already participate in Value Based P4P 2017 Integrated Healthcare Association All rights reserved 5

6 The Challenge: Conflicting ACO Measure Sets IHA stakeholders identified 9 key measurement programs particularly relevant for ACO alignment considerations 1-4 Current California health plan ACO sets (4 included) 5 CMS-AHIP ACO & PCMH Core Set (CQMC) 6 Catalyst for Payment Reform ACO Collaborative Core Set 7 NCQA Commercial Health Plan Accreditation 8 CMS Pioneer/MSSP ACO 9 MIPS Quality Payment Program Of 89 measures across the 9 programs sets, only 4 measures were in all sets, while 60 measures were in only in 1 or 2 sets 2017 Integrated Healthcare Association All rights reserved 6

7 IHA-PBGH ACO Measurement Initiative Objective: Establish a highly aligned common statewide measure set and benchmarks for commercial ACOs; broaden IHA s measurement footprint beyond VBP4P; accelerate and influence national measurement priorities Approach: Leverage existing performance measurement infrastructure Provide a common set of performance measures appropriate for ACO measurement Use established IHA data collection processes to collect data and report to participants Rely on existing plan definitions of ACOs and attribution methodologies Measurement & Benchmarking Focused: No intention to include a standard incentive 2017 Integrated Healthcare Association All rights reserved 7

8 Which Measures Should Be Included? VBP4P Measures IHA Stakeholders & VBP4P Committee members Purchaser Priorities IHA purchaser members - CalPERS, Covered CA, Disney, Google Pacific Business Group on Health Catalyst for Payment Reform National Priorities CMS/AHIP Core Quality Measures Collaborative CAPG Targeted Reduction IHA Stakeholders & VBP4P Committee members Proposed ACO Measure Set Endorsed by all named organizations 2017 Integrated Healthcare Association All rights reserved 8

9 Proposed ACO Measure Set YEAR 1 MEASURES (MY 2017) 1 Asthma Medication Ratio 2 Breast Cancer Screening 3 Cervical Cancer Screening 4 Cervical Cancer Overscreening 5 Colorectal Cancer Screening 6 Controlling High Blood Pressure 7 Statin Therapy for Patients w/ Cardiovascular Disease 8 Comprehensive Diabetes Care 9 Statin Therapy for Patients w/ Diabetes 10Use of Imaging for Low Back Pain 11Appropriate Testing for Children w/ Pharyngitis 12Antibiotic Avoidance in Adult Acute Bronchitis 13Childhood Immunization Status 14Chlamydia Screening in Women 15Immunizations for Adolescents 16All Cause Readmissions 17ED Visits 18Total Cost of Care DEVELOPMENTAL MEASURES (MY 2018 & BEYOND) 19 Initiation of Alcohol & Drug Dependence Tx 20 Persistent Beta Blocker After Heart Attack 21 Avoidable ER Visits 22 Prenatal and Postpartum Care 23 Preventative Care & Screening: Tobacco Use 24 AHRQ Prevention Quality Indicator #90: Ambulatory Sensitive Admissions 25 Use of Opioids at High Dose OR Concurrent Use of Opioids & Benzodiazepines 26 Weight Assessment & Counseling for Children/Adolescents 27 CG-CAHPS (ACO) 28 Patient Reported Outcomes 29 Flu Vaccinations for Adults Adult BMI Screening & Follow Up 31 Depression Remission at 6 months 32 Screening for Depression & Follow Up Plan 33 Ischemic Vascular Disease: Aspirin Use 34 Optimal Diabetes Care Combination 35 NTSV C-Section 2017 Integrated Healthcare Association All rights reserved 9

10 What About the Developmental Measures? 18 measures collected using existing VBP4P data flows MY 2017 Year 2 development measures MY 2019 MY 2018 Patient experience (CAHPS) Year 1 developmental measures Developmental measures: Represent crucial priorities for measurement requiring some level of implementation testing and development Approach provides a coordinated and predictable path for advancing these measures Phased in following initial measurement year 2017 Integrated Healthcare Association All rights reserved 10

11 Proposed ACO Measures Are Highly Aligned Participants have indicated alignment across key measure sets is critical to success, and provides an opportunity/pathway to alignment across regional and national ACO measurement Key Measure Set Alignment with Proposed ACO Set Health plan ACO sets 42% CMS-AHIP ACO & PCMH Core Set 73% NCQA Health Plan Accreditation 75% CPR ACO Collaborative Set 100% CMS Pioneer & MSSP ACO (subset) 37% MIPS (subset) 63% 2017 Integrated Healthcare Association All rights reserved 11

12 ACO Initiative Timeline 2017 Integrated Healthcare Association All rights reserved 12

13 Emma Hoo Director, Pay for Value Pacific Business Group on Health Mark Schafer, MD Chief Executive Officer MemorialCare Medical Foundation 2017 Integrated Healthcare Association All rights reserved 13

14 For more information: or 2017 Integrated Healthcare Association All rights reserved 14