cbi 2021 presentation final testcompressedimages

2021 CARE-BASED INCENTIVES

Kristen Presleigh, MPHDianna Diallo, MD

Sara Forbes, MS

Housekeeping

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TECHNICAL ISSUE? [email protected]

Submit questions via questions pane

Today’s CBI Presenters

Kristen PresleighQuality Improvement Program Advisor

Sara ForbesQuality Improvement Coordinator

Dr. Dianna DialloMedical Director

Agenda

01 Program Overview

02 What’s New?

03 Modified Measures

04 New Era of Preventive Care

05 Exploratory Measures

06 Retired Measures

07 Resources

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Goals for 2021 Program

• Alignment with CMS core measure sets and NCQA HEDIS®

• Encourage best practices guidelines from U.S. Preventive Services Task Force (USPSTF)

• Testing measures as exploratory

• Encourage delivery of high value care

• Improving patient access and utilization of primary care

Fee-for-Service vs Programmatic Pro

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Fee-for-Service

• A single payment incentive paid quarterly

• No rate calculation

• No minimum eligible member requirements

Programmatic

• Payment based on CBI group performance

• Payment occurs annually (end of Q4)

• Quarterly rates for the measures

• Rolling 12-month measurement period

Measure Type Measure Points

Care CoordinationAccess

Developmental Screening in the First Three Years 2

Application of Dental Fluoride Varnish 2

Initial Health Assessment 5

Post-Discharge Care 6

Unhealthy Alcohol Use in Adolescents and Adults 3

Care CoordinationHospital & Outpatient

Plan All-Cause Readmissions 15

Ambulatory Care Sensitive Admissions 10

Preventable Emergency Visits 12

Quality of Care

Asthma Medication Ratio

35 points/number of

measures you qualify for

Antidepressant Medication Management

BMI Assessment: Children & Adolescents

Cervical Cancer Screening

Diabetic HbA1c Poor Control >9.0%

Immunizations: Children (Combo 10)

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Measure Type Measure Points

Quality of Care Continued

Immunization: Adolescents35 points/number of measures

you qualify for

Maternity Care: Prenatal

Maternity Care: Postpartum

Child and Adolescent Well-Care Visits

Well-Child Visits First 15 months of Life

Performance Target Performance Improvement 10

Refer to pg. 3 in the CBI Workbook for additional information

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CBI Timeline

2019 CBI Top Performers Pro

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Santa Cruz County

• Plazita Medical Clinic• Salud Para La Gente• Madhu Raghavan MD

Monterey County

• Costa Central Medical Group• Santa Lucia Medical Group• Ped and Adolescent Med Assoc of the Pacific Coast

Merced County

• Long Thao, MD• Merced Faculty Associates Medical Group• Atwater Medical Group

Agenda

01 Program Overview

02 What’s New?




06 Retired Measures

07 Resources

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Application of Dental Fluoride Varnish

Measure Description:

Payment Frequency

Eligible Codes

• Annual

• CPT – 99188

• CDT – D1206

Percentage of members ages 6 months -5 years who received at least one topical fluoride application within the measurement year


Child and Adolescent Well-Care Visit Wh

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?

Members 3 – 21 years of age who had at least one comprehensive well-care visit with a PCP.

Billing Frequency

CPT• 99382-99385• 99392-99395

IDC-10 Codes

• Z00.00-Z00.01• Z00.121• Z00.129

Measure Description


• 3-17 years: Well-visits payable every 180 days

• 18-21 years: Well-visits payable once every 12 months

Plan All-Cause Readmission

Members 18 years of age and older, the number of acute inpatient and observational stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days

Measure Description

Payment Frequency

Hospital Exclusions

• Annual

• Member expired during the stay• Female members with principal diagnosis of pregnancy, or perinatal• Planned admissions • Potentially planned procedure without a principal acute diagnosis

Wh

at’s N

ew

?


Unhealthy Alcohol Use in Adolescents and Adults

Wh

at’s N

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Members 11 years and older who are screened for unhealthy alcohol use in primary care settings and providing persons 18 years and older engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use.

Measure Description

Payment Frequency• Annual

• G0442: Annual alcohol misuse screening, 15 minutes• G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes• 88037-7 (Men): How often have you had five or more drinks in one day during the

past year• 75889-6 (Women & Older Adults): How often have you had four or more drinks in

one day during the past year

Asynchronous Telehealth: Not “real-time.” Still requires two-way interaction between the member and provider ( i.e. patient portal, secure text messaging or email)

Telephone visitsTelephone visits

Synchronous Telehealth: Real-time interactive audio and video telecommunications

Wh

at’s N

ew

?

• Removes exclusion of telehealth visits for all well-visit measures

• Removes restrictions of telehealth visits in capturing diagnoses of chronic conditions

Telehealth Guidelines

Measure Additions: Telephone visits, E-visits, Virtual check-in to event diagnosis

Antidepressant Medication Management

Maternity Care: Prenatal

Asthma Medication Ratio Breast Cancer Screening (Exploratory Measure)

Diabetic HbA1c Poor Control Controlling Blood Pressure (Exploratory Measure)

CBI Payment Adjustment

• Plan Do Study Act (PDSA)

• Sanctions

• Corrective Action Plans (CAPs)

CBI Payment Adjustment impacts Quality of Care metrics that can be met throughtelemedicine and/or in person patient visits brief encounters, in addition to regular

patient visits.

Managed Care Plans (MCP) must meet:

• DHCS’s Minimum Performance Level (MPL) for their Managed Care Accountability Set (MCAS)

• MPL = the national Medicaid 50th percentile

MCPs that fail to meet MPLs are subject to:


For Quality of Care metric performance above the 50th percentile, payments remain the same as current

Quality of Care Percentile Points above the 50th Percentile

90th Full

75-90th 75%

50-75th 50%


For Quality of Care measures below the 50th percentile, payment will be adjusted as follows

Tier Performance <50th PercentileCBI Programmatic Payment

Adjustment

1 1-3 metrics >25th and <50th and no metrics <25th Programmatic Total x .75

2 >4 metrics >25th and <50th and no metrics <25th Programmatic Total x .50

3 1-3 metrics <25th Programmatic Total x .25

4 4 or more metrics <25th No CBI Payment

Tier 4 will have Corrective Action Plan (CAP)

Agenda

01 Program Overview

02 What’s New?




06 Retired Measures

07 Resources

Preventable Emergency Visits Mo

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Rate of preventable ED and urgent visits per 1,000 members per year. This measure is derived from the Statewide Collaborative Quality Improvement Project: Reducing Avoidable Emergency Room Visits.

Measure Description

Measure update: Urgent Visits count as half the value as ED visits

Best Practices

• Educate members to use the Alliance’s Nurse Advice Line:1 (844) 971-8907

• Monitor Provider Portal Linked Member ED Visit

Agenda

01 Program Overview

02 What’s New?




06 Retired Measures

07 Resources

Reduction in preventive care visits in children secondary to Covid-19

• Parental fear of contracting the virus

• Restriction of in-person access

• Drop in medical claims in March and April

• Vaccines For Children (VFC) order reduction in Mid March to Mid April 2020

• Immunization rate drop of 40% after Shelter in Place (SIP) order

Local Statistics for Vaccines

Monterey County• 52.85% of 2-year-olds up-to-date • 62% of-13 year-olds up-to-date

Santa Cruz County• 50.14% of 2-year-olds up-to-date• 56.64% of 13-year-olds up-to-date

Merced County• 19.44% of 2-year-olds up-to-date• 38.84% of 13-year-olds up-to-date

National Average: 35.4% of 2-year-olds and 35.3 % of 13-year-olds are up-to-date

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Increased Injuries in Children Identified with SIP

• Increased parental stress -financial, social isolation, lack of adequate childcare

• Decreased parental supervision

• Increased severe physical abuse identified in Emergency Departments

• 1 in 4 young adults surveyed by the CDC in June reported seriously contemplating suicide in the previous 30 days

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Important Role of Preventive Care for Children

• Vaccines to avoid vaccine preventable illnesses

• Monitoring the health of safety of children (ex. lead screening)

• Monitoring growth and development

• Addressing social determinants of health

• Addressing mental health concerns

Importance of Preventive Care for Adults

• Detect and prevent hidden illness early (cancer screenings, monitor BP)

• Maintain optimal health – monitor weight, lifestyle, social determinants of health

• Vaccinations to prevent vaccine preventable illnesses

• Management of Chronic Disease – which untreated may lead to much more concerning health consequences (Asthma, Diabetes, etc)

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Time to Resume Care

• We are encouraging our members to contact their PCP to resume Preventive Care

• Telehealth options to reduce in person contact time

• Keep up all the very important work you do everyday!

Agenda

01 Program Overview

02 What’s New?




06 Retired Measures

07 Resources

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Tuberculosis (TB) Risk AssessmentMeasure Description

Payment Frequency• No payment in 2021


The percentage of members ages 12 months to 21 years (up to before their 21st

birthday) who have been screened for latent tuberculosis infection (LTBI) risk factors by staff at the PCP office during the measurement year.

Characteristics of Tuberculosis

• TB Granulomas may persist (latent tuberculosis infection) or may break down to produce TB disease

• Healthy immune systems are able to stop the multiplication of bacilli

• Most people never develop active pulmonary (infectious) disease.

• LTBI is not a contagious state, persons with the infection are not able to spread organisms to others

TB screening here is defined as asking the member/parent about for any TB risk factor (Z11.1 Screening for pulmonary TB)

TB testing should only be completed if the screening questions are positive (affirmative)

Tuberculosis (TB) Screening

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/TB_Provider_Resources.aspx

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Risk Assessment for TB

Who should be assessed?

• People who spend time in places where TB is more common (homeless shelters, correctional facility staff)

• Infants and children

• Patients from countries where TB disease is common

• Patients who have spent time with someone who has TB disease https://tinyurl.com/y57p7ocx

PERCENT OF PEDIATRIC AGE GROUP SCREENED FOR TB BY AGE GROUP AND COUNTY, 2019

7%

2% 2%3% 3%

8%

4%

10%

2% 2% 2%

5%

8%

5%

12%

6% 6% 6%

10%10%

9%

0%

2%

4%

6%

8%

10%

12%

14%

0‐3 3‐6 6‐9 9‐12 12‐15 15‐18 18‐21

Percen

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Scree

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B

Age in Years

Santa Cruz Monterey Merced

What about School?• TB Risk Assessment is

required

• TB Testing is only required if there is a documented risk for TB

https://www.dhcs.ca.gov/formsandpubs/forms/Forms/ChildMedSvcForms/pm171a(bi).pdf

Do not test if there is no risk!

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Lead Screening in Children Exp

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The percentage of members who had one or more capillary or venous lead blood test for lead poisoning by their second birthday

Initial Screen• Point of care testing

Confirmatory Testing• Venous sample

Measure Description

Payment Frequency

• No payment until 2021

Children 36-72 months must also have a screening blood test if one was not conducted at 12 and 24 months.


Webinar with the California Department of Public Health

Coming Next Week!Oct. 28th – 12 noon

Register at: https://attendee.gotowebinar.com/register/8086352079056968208

Lead Screening in Children

Agenda

01 Program Overview

02 What’s New?




06 Retired Measures

07 Resources

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Retired Measures

Refer to your CBI Workbook for additional information

• Body Mass Index Assessment: Adult

• Member Satisfaction

Agenda

01 Program Overview

02 What’s New?




06 Retired Measures

07 Resources

Provider Portal – New and Updated CBI Reports

New Quality Reports

New Quality Report Feature

Updated CBI Reports

Updated Diabetes Report

Provider Portal Updates

New feature added to each quality report to display performance compared to 25th, 50th, and 75th percentile

DST Updates

New Measure Types• Well-Child Visits 0-15 Months• Chlamydia Screening for Women• Fluoride Varnish• Bilateral Mastectomies

Discontinued DST Measure Types• Depression Screening• Diabetic Retinal Exams

Accepted File Types• Only .csv• No longer accepting .txt

Data Submission Tool

HbA1c Results

Cervical Cancer

Screenings

Alcohol Misuse

Screening and Counseling

(AMSC)

ImmunizationsInitial Health Assessment

(IHA)

Hysterectomy Codes

2017 2018

Data Submission Tool

Body Mass Index (BMI)

Controlling Blood

Pressure

Well-Child Visit 0-15 Months

New!

Chlamydia Screening in

Women

New!

Bilateral Mastectomies

New!

Fluoride Varnish

New!

2019 2020

Data Submission Tool and Archive Re

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February 28, 2021

Best Practice: Submit data monthly or quarterly to track progress

Other Resources

Provider Webpage• Incentive Summary• Tip sheets• Technical

Specifications• Tool Kits• Benchmarks• Recorded Trainings

Quality Improvement & Population Health Team• Practice Coaching• CBI Forensics• CBI@ccah-

alliance.org

Provider Portal

• CBI Dashboard• CBI Forensics

Report• Quality Reports• Data Submission

Tool

Care Management • Care Management

Website

Key Points & Takeaways

• Utilize the CBI Incentive Summary as a guide to measures

• Review new measure tip sheets available in workbook

• Schedule virtual CBI Forensics to review your current trends and performance

• Curious about Practice Coaching? Reach out to [email protected]

CBI Contact Information

CBI [email protected]

Kristen Presleigh, MPHQuality Improvement Program Advisor(831) 430 – [email protected]

Sara Forbes, MSQuality Improvement Coordinator(209) 381 – [email protected]

Re

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Questions &Answ

ers

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