TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Accreditation & Measures Policy DATE: September 19, 2016 RE: Measures for Accreditation Scoring in 2017 This communication gives advance notice about the measures that will be used for accreditation scoring in 2017. As stated in the 2016 Health Plan Accreditation Standards for organizations accredited under the 2015 standards and beyond, NCQA will recalculate accreditation scores annually on the set of measures identified for each new reporting year, instead of on the same measure set for the standards year under which the organization was surveyed. Organizations accredited under the 2014 standards or earlier will continue to be scored on the measure set in effect at the time of their accreditation survey. Appendix 2: and CAHPS Points for Reporting Year 2017 includes the 2017 measures and is attached to this memo. It replaces Appendix 2 for organizations surveyed on the 2016 standards at their annual reevaluation in 2017, and applies to organizations surveyed on the 2017 standards. 1100 13th Street, NW Suite 1000 Washington, DC 20005 www.ncqa.org 202.955.3500 phone 202.955.3599 fax
Effective for Reporting Year 2017
Appendix 2 and CAHPS Points for Reporting Year 2017
Effective for Reporting Year 2017
Appendix 2 and CAHPS Points for Reporting Year 2017 2-1 APPENDIX 2 AND CAHPS POINTS FOR REPORTING YEAR 2017 Key to Reporting Categories Access and Service AS Getting Better GB Qualified Providers QP Living With Illness LWI Staying Healthy SH 2017 Measure Standard Description 2017 HP Points Reporting Categories MEASURES REQUIRED FOR HP ACCREDITATION COMMERCIAL HMO/POS/PPO Adult BMI Assessment 1.3214 SH Antidepressant Medication Management (Both Rates) Appropriate Testing for Children With Pharyngitis 1.3214 GB Appropriate Treatment for Children With Upper Respiratory Infection 1.3214 GB Medication Management for People With Asthma (Medication Compliance 75% Rate only) Asthma Medication Ratio (Total Rate) Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis 1.3214 GB Breast Cancer Screening 1.3214 SH Cervical Cancer Screening 1.3214 SH Childhood Immunization Status (Combination 10) 1.3214 SH Chlamydia Screening in Women (Total Rate) 1.3214 SH Colorectal Cancer Screening 1.3214 SH Comprehensive Diabetes Care (New Rate BP Control [<140/90], New Rate HbA1c Control [<8.0%] HbA1c Poor Control [>9.0%], Medical Attention for Nephropathy, Eye Exam) 2.6429 LWI Controlling High Blood Pressure Flu Vaccinations for Adults Ages 18-64 1.3214 SH Follow-Up After Hospitalization for Mental Illness (7-Day Rate only) Follow-Up for Children Prescribed ADHD Medication (Both Rates) Human Papillomavirus Vaccine for Female Adolescents 1 NA NA For display purposes, all points are rounded to four decimal places. The ISS determines the official score. 1 The HPV vaccination was added to the Immunizations for Adolescents (IMA) measure in 2017. For Accreditation 2017, HPV will be scored NA. Organizations will continue to be scored on the IMA Combination 1 rate. For Accreditation 2018, organizations will be scored on the IMA Combination 2 rate, which includes the HPV vaccination. Effective for Reporting Year 2017
2-2 Appendix 2 and CAHPS Points for 2017 2017 Measure Standard Description 2017 HP Points MEASURES REQUIRED FOR HP ACCREDITATION COMMERCIAL HMO/POS/PPO Reporting Categories Immunizations for Adolescents (Combination 1) 1.3214 SH Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (Engagement of AOD Treatment Rate only) Medical Assistance With Smoking and Tobacco Use Cessation (Advising Smokers and Tobacco Users to Quit Rate only) 1.3214 AS 1.3214 GB Persistence of Beta-Blocker Treatment After a Heart Attack Pharmacotherapy Management of COPD Exacerbation (Both Rates) Plan All-Cause Readmissions 1.3214 GB Prenatal and Postpartum Care (Postpartum Care Rate only) 1.3214 SH Use of Imaging Studies for Low Back Pain 1.3214 GB Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (the total of all ages for each of the 3 rates) Total for Measures 37 1.3214 SH CAHPS 5.0H Getting Care Quickly 1.300 AS CAHPS 5.0H Getting Needed Care 1.300 AS CAHPS 5.0H Claims Processing 1.300 AS CAHPS 5.0H Coordination of Care 1.300 AS CAHPS 5.0H Customer Service 1.300 AS CAHPS 5.0H Rating of Health Plan 2.6000 AS CAHPS 5.0H Rating of All Health Care 1.300 QP CAHPS 5.0H Rating of Personal Doctor 1.300 QP CAHPS 5.0H Rating of Specialist Seen Most Often 1.300 QP Total for CAHPS Measures 13 Total for and CAHPS Measures 50 TOTAL STANDARDS AND MEASURES 100 MEASURES REQUIRED FOR ACCREDITATION MEDICARE HMO/POS/PPO Adult BMI Assessment 2.0556 SH Antidepressant Medication Management (Both Rates) 2.0556 LWI Breast Cancer Screening 2.0556 SH Colorectal Cancer Screening 2.0556 SH Comprehensive Diabetes Care (New Rate BP Control [<140/90], New Rate HbA1c Control [<8.0%] HbA1c Poorly Controlled [>9.0%], Eye Exam, Medical Attention for Nephropathy) 4.1112 LWI Controlling High Blood Pressure 2.0556 LWI Flu Vaccinations for Adults Ages 65 and Older 2.0556 SH Follow-Up After Hospitalization for Mental Illness (7-Day Rate only) 2.0556 LWI For display purposes, all points are rounded to four decimal places. The ISS determines the official score. Effective for Reporting Year 2017
Appendix 2 and CAHPS Points for Reporting Year 2017 2-3 2017 Measure Standard Description 2017 HP Points MEASURES REQUIRED FOR ACCREDITATION MEDICARE HMO/POS/PPO Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (Engagement of AOD Treatment Rate only) Medical Assistance With Smoking and Tobacco Use Cessation (Advising Smokers and Tobacco Users to Quit Rate only) Reporting Categories 2.0556 LWI 2.0556 GB Osteoporosis Management in Women Who Had a Fracture 2.0556 LWI Persistence of Beta-Blocker Treatment After a Heart Attack 2.0556 LWI Pharmacotherapy Management of COPD Exacerbation (Both Rates) 2.0556 LWI Plan All-Cause Readmissions 2.0556 GB Pneumococcal Vaccination Status for Older Adults 2.0556 SH Potentially Harmful Drug-Disease Interactions in the Elderly (Total Rate) 2.0556 LWI Use of High-Risk Medications in the Elderly (Rate 1 only) 2.0556 SH Total Measures 37 CAHPS 5.0H Coordination of Care 1.6250 AS CAHPS 5.0H Getting Care Quickly 1.6250 AS CAHPS 5.0H Getting Needed Care 1.6250 AS CAHPS 5.0H Rating of Health Plan 3.2500 AS CAHPS 5.0H Rating of All Health Care 1.6250 QP CAHPS 5.0H Rating of Personal Doctor 1.6250 QP CAHPS 5.0H Rating of Specialist Seen Most Often 1.6250 QP Total for CAHPS Measures 13 Total and CAHPS Measures 50 TOTAL STANDARDS AND MEASURES 100 MEASURES REQUIRED FOR ACCREDITATION MEDICAID HMO/POS/PPO Adult BMI Assessment 1.3214 SH Annual Dental Visits (Total Rate) 1.3214 AS Antidepressant Medication Management (Both Rates) Appropriate Testing for Children With Pharyngitis 1.3214 GB Appropriate Treatment for Children With Upper Respiratory Infection 1.3214 GB Medication Management for People With Asthma (Medication Compliance 75% Rate only) Asthma Medication Ratio (Total Rate) Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis 1.3214 GB Breast Cancer Screening 1.3214 SH Cervical Cancer Screening 1.3214 SH Childhood Immunization Status (Combination 10) 1.3214 SH Chlamydia Screening in Women (Total Rate) 1.3214 SH For display purposes, all points are rounded to four decimal places throughout. The ISS determines the official score. Effective for Reporting Year 2017
2-4 Appendix 2 and CAHPS Points for 2017 2017 Measure Standard Description 2017 HP Points MEASURES REQUIRED FOR ACCREDITATION MEDICARE HMO/POS/PPO Comprehensive Diabetes Care (New Rate BP Control <140/90, New Rate HbA1c Control (<8.0%), HbA1c Poorly Controlled (>9.0%), Eye Examination, Medical Attention for Nephropathy) Reporting Categories 2.6429 LWI Controlling High Blood Pressure Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications Flu Vaccinations for Adults Ages 18-64 1.3214 SH Follow-Up After Hospitalization for Mental Illness (7-Day Rate only) Follow-Up for Children Prescribed ADHD Medication (Both Rates) Frequency of Prenatal Care ( 81 percent of expected visits only) 1.3214 SH Human Papillomavirus Vaccine for Female Adolescents 1 NA NA Immunizations for Adolescents (Combination 1) 1.3214 SH Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (Engagement of AOD Treatment Rate only) Medical Assistance With Smoking and Tobacco Use Cessation (Advising Smokers and Tobacco Users to Quit Rate only) 1.3214 GB Pharmacotherapy Management of COPD Exacerbation (Both Rates) Prenatal and Postpartum Care (Both Rates) 1.3214 SH Use of Imaging Studies for Low Back Pain 1.3214 GB Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (the total of all ages for each of the 3 rates) Total Measures 37 1.3214 SH CAHPS 5.0H Getting Care Quickly 1.4444 AS CAHPS 5.0H Getting Needed Care 1.4444 AS CAHPS 5.0H Coordination of Care 1.4444 AS CAHPS 5.0H Customer Service 1.4444 AS CAHPS 5.0H Rating of Health Plan 2.8889 AS CAHPS 5.0H Rating of All Health Care 1.4444 QP CAHPS 5.0H Rating of Personal Doctor 1.4444 QP CAHPS 5.0H Rating of Specialist Seen Most Often 1.4444 QP Total for CAHPS Measures 13 Total for and CAHPS Measures 50 TOTAL STANDARDS AND MEASURES 100 For display purposes, all points are rounded to four decimal places throughout. The ISS determines the official score. Effective for Reporting Year 2017