TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Accreditation & Measures Policy DATE: May 15 2017 (Updated on October 18, 2017) RE: Measures for Accreditation Scoring in 2018 This communication gives advance notice about the measures that will be used for accreditation scoring in 2018. As stated in the 2017 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 2018 includes the 2018 measures and is attached to this memo. October 2017 Update: The Frequency of Prenatal Care (FPC) measure was removed from 2018 with the release of the Volume 2 Technical Update memo on October 1, 2017. For Accreditation 2018, organizations will be given an NA, which does not count toward the maximum number of NAs an organization can receive. 1100 13th Street, NW Suite 1000 Washington, DC 20005 www.ncqa.org 202.955.3500 phone 202.955.3599 fax
Appendix 2 and CAHPS Points for Reporting Year 2018
Appendix 2 and CAHPS Points for Reporting Year 2018 2-1 APPENDIX 2 AND CAHPS POINTS FOR REPORTING YEAR 2018 Key to Reporting Categories Access and Service AS Getting Better GB Qualified Providers QP Living With Illness LWI Staying Healthy SH 2018 Measure Standard Description 2018 HP Points MEASURES REQUIRED FOR HP ACCREDITATION COMMERCIAL HMO/POS/PPO Reporting Categories Adult BMI Assessment 1.2759 SH Antidepressant Medication Management (Both Rates) 1.2759 LWI Appropriate Testing for Children With Pharyngitis 1.2759 GB Appropriate Treatment for Children With Upper Respiratory Infection 1.2759 GB Medication Management for People With Asthma (Medication Compliance 75% Rate only) 1.2759 LWI Asthma Medication Ratio (Total Rate) 1.2759 LWI Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis 1.2759 GB Breast Cancer Screening 1.2759 SH Cervical Cancer Screening 1.2759 SH Childhood Immunization Status (Combination 10) 1.2759 SH Chlamydia Screening in Women (Total Rate) 1.2759 SH Colorectal Cancer Screening 1.2759 SH Comprehensive Diabetes Care (BP Control [<140/90], HbA1c Control [<8.0%], Eye Exam) 2.5518 LWI Controlling High Blood Pressure 1.2759 LWI Emergency Department Utilization *New Measure 1.2759 AS Flu Vaccinations for Adults Ages 18-64 1.2759 SH Follow-Up After Hospitalization for Mental Illness (7-Day Rate only) 1.2759 LWI Follow-Up for Children Prescribed ADHD Medication (Both Rates) 1.2759 LWI For display purposes, all points are rounded to four decimal places. The ISS determines the official score. Effective for Reporting Year 2018
2-2 Appendix 2 and CAHPS Points for Reporting Year 2018 2018 Measure Standard Description 2018 HP Points MEASURES REQUIRED FOR HP ACCREDITATION COMMERCIAL HMO/POS/PPO Reporting Categories Immunizations for Adolescents (Combination 2) *New Rate 1.2759 SH Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (Both Rates) *New Rate 1.2759 AS Persistence of Beta-Blocker Treatment After a Heart Attack 1.2759 LWI Pharmacotherapy Management of COPD Exacerbation (Both Rates) 1.2759 LWI Plan All-Cause Readmissions 1.2759 GB Prenatal and Postpartum Care (Postpartum Care Rate only) 1.2759 SH Statin Therapy for Patients With Cardiovascular Disease (Both Rates) *New Measure 1.2759 LWI Statin Therapy for Patients With Diabetes (Both Rates) *New Measure 1.2759 LWI Use of Imaging Studies for Low Back Pain 1.2759 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 1.2759 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 Antidepressant Medication Management (Both Rates) 1.7619 LWI Breast Cancer Screening 1.7619 SH Colorectal Cancer Screening 1.7619 SH Comprehensive Diabetes Care (BP Control [<140/90], HbA1c Control [<8.0%], Eye Exam) 3.5238 LWI Controlling High Blood Pressure 1.7619 LWI Emergency Department Utilization *New Measure 1.7619 AS Flu Vaccinations for Adults Ages 65 and Older 1.7619 SH Follow-Up After Hospitalization for Mental Illness (7-Day Rate only) 1.7619 LWI For display purposes, all points are rounded to four decimal places. The ISS determines the official score. Effective for Reporting Year 2018
Appendix 2 and CAHPS Points for Reporting Year 2018 2-3 2018 Measure Standard Description 2018 HP Points Reporting Categories MEASURES REQUIRED FOR ACCREDITATION MEDICARE HMO/POS/PPO Initiation and Engagement of Alcohol and Other Drug Dependence 1.7619 AS Treatment (Both Rates) *New Rate Medical Assistance With Smoking and Tobacco Use Cessation 1.7619 GB (Advising Smokers and Tobacco Users to Quit Rate only) Non-Recommended PSA-Based Screening in Older Men *New 1.7619 SH Measure But Osteoporosis Management in Women Who Had a Fracture 1.7619 LWI Persistence of Beta-Blocker Treatment After a Heart Attack 1.7619 LWI Pharmacotherapy Management of COPD Exacerbation (Both Rates) 1.7619 LWI Plan All-Cause Readmissions 1.7619 GB Pneumococcal Vaccination Status for Older Adults 1.7619 SH Potentially Harmful Drug-Disease Interactions in the Elderly 1.7619 LWI (Total Rate) Statin Therapy for Patients With Cardiovascular Disease (Both Rates) 1.7619 LWI *New Measure Statin Therapy for Patients With Diabetes (Both Rates) 1.7619 LWI *New Measure Use of High-Risk Medications in the Elderly (Rate 1 only) 1.7619 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 Adherence to Antipsychotic Medications for Individuals With Schizophrenia *New Measure Adult BMI Assessment 1.2333 SH Annual Dental Visits (Total Rate) 1.2333 AS Antidepressant Medication Management (Both Rates) Appropriate Testing for Children With Pharyngitis 1.2333 GB Appropriate Treatment for Children With Upper Respiratory Infection 1.2333 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 1.2333 GB Breast Cancer Screening 1.2333 SH Cervical Cancer Screening 1.2333 SH Childhood Immunization Status (Combination 10) 1.2333 SH For display purposes, all points are rounded to four decimal places throughout. The ISS determines the official score. Effective for Reporting Year 2018
2-4 Appendix 2 and CAHPS Points for Reporting Year 2018 2018 Measure Standard Description 2018 HP Points MEASURES REQUIRED FOR ACCREDITATION MEDICAID HMO/POS/PPO Reporting Categories Chlamydia Screening in Women (Total Rate) 1.2333 SH Comprehensive Diabetes Care (BP Control [<140/90], HbA1c Control [<8.0%], Eye Exam) 2.4666 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 1.2333 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 NA NA Immunizations for Adolescents (Combination 2) *New Rate 1.2333 SH Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (Both Rates) *New Rate Medical Assistance With Smoking and Tobacco Use Cessation (Advising Smokers and Tobacco Users to Quit Rate only) 1.2333 GB Pharmacotherapy Management of COPD Exacerbation (Both Rates) Prenatal and Postpartum Care (Both Rates) 1.2333 SH Statin Therapy for Patients With Cardiovascular Disease (Both Rates) *New Measure Statin Therapy for Patients With Diabetes (Both Rates) *New Measure Use of Imaging Studies for Low Back Pain 1.2333 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 1.2333 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. 1 The Frequency of Prenatal Care (FPC) measure was removed from 2018 with the release of the Volume 2 Technical Update memo on October 1, 2017. For Accreditation 2018, organizations will be given an NA, which does not count toward the maximum number of NAs an organization can receive. Effective for Reporting Year 2018