introduction to value based pay for performance...introduction to value based pay for performance...
TRANSCRIPT
September 23, 2016
Lindsay Erickson, Director – Value Based P4P
Thien Nguyen, Senior Project Analyst – Value Based P4P
Ginamarie Gianandrea, Program Coordinator – Value Based P4P
Introduction to Value Based Pay for Performance
© 2016 Integrated Healthcare Association. All rights reserved.
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About IHA
• Organization: California multi-sector healthcare leadership group
• Mission: Improve quality and lower costs of healthcare
• Approach: Multi-stakeholder collaboration incorporating performance measurement & incentive alignment
• Projects: Value Based P4P, clinical data sharing, encounter data, bundled payment, resource use measurement, and California Regional Cost and Quality Atlas
© 2016 Integrated Healthcare Association. All rights reserved.
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Co
lore
ctal
Can
cer
Scre
enin
g R
ate
(%)
Physician organizations contracting with more than one health plan
Aggregated and Plan-Specific Rates for Colorectal Cancer Screening
Aggregated Rate Min Plan Specific Rate Max Plan Specific Rate
Aggregation Strengthens Signal
For example, the identified PO has aggregated performance across contracted plans of 61.08. On a plan-specific basis the PO’s performance ranges from 41.28 to 62.57 – the plan-specific results are more sensitive to variation in small numbers and reflect uncertainty about the PO’s actual performance.
© 2016 Integrated Healthcare Association. All rights reserved.
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Program Evolution
2003 2009 2012 2013 2014 2015 2016
First year
measurement –
quality only
Appropriate
Resource Use
measures added
Total Cost of Care
measure added
Value Based P4P
– quality and
resource use
integrated into a
single incentive
program
First payments
for Value Based
P4P
Attainment
pathway
added to
VBP4P design
Total Cost of
Care publicly
reported
© 2016 Integrated Healthcare Association. All rights reserved.
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IHA Staff
Program Governance
Partners
Committee Structure for Health Plan & Physician Organization
Involvement
Governance Committee
Technical Measurement Committee Clinical and Data Reporting Experts
Technical Payment Committee Contracting, Actuarial, and Medical Economics Experts
© 2016 Integrated Healthcare Association. All rights reserved.
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Core Program Elements
A Public Report Card Public Recognition Awards
Health Plan Incentive Payments A Common Set of Measures
The California VBP4P program is one of the largest advanced alternative payments models
in the country and aims to create a compelling set of incentives that will drive improvements
in clinical quality, resource use, and patient experience through:
© 2016 Integrated Healthcare Association. All rights reserved.
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Value Based P4P Measures (MY 2016)
Process and outcomes measures focused on six priority clinical areas
Cardiovascular (5)
Diabetes (7)
Musculoskeletal (1)
Prevention (10)
Respiratory (4)
Behavioral Health (1)
Clinical (60%)
Patient ratings of five components, including care overall:
Communicating with Patients
Coordinating Care
Helpful Office Staff
Overall Rating of Care
Timely Care and Service
Patient Experience (30%)
Ability to report selected e-measures (2)
Meaningful Use of Health IT (10%)
Utilization metrics spanning:
Inpatient stays
Readmissions
ED visits
Outpatient procedures
Generic prescribing
Appropriate Resource Use
Average health plan and member payments associated with care for a member for the year, adjusted for risk and geography
Total Cost of Care
Measure Set: http://www.iha.org/our-work/accountability/value-based-p4p/measure-set
© 2016 Integrated Healthcare Association. All rights reserved.
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Public Reporting
OPA Report Card: http://www.opa.ca.gov/
© 2016 Integrated Healthcare Association. All rights reserved.
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The Excellence in Healthcare
Award recognizes physician
organizations who achieve
strong quality and patient
experience results while
effectively managing costs.
Excellence In Healthcare & Bangasser Most
Improved Awards
The Ronald P. Bangasser Award for
Quality Improvement is awarded to the
physician organization in each of the eight
P4P regions with the highest relative
improvement score for overall quality
performance is recognized as the most
improved physician organization in that
region.
© 2016 Integrated Healthcare Association. All rights reserved.
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Value Based P4P Incentive Overview
Quality Gate TCC Trend Gate
Does the PO qualify?
Resource use compared to prior year Selected inpatient, outpatient, ED, and
prescribing measures
Did the PO improve?
Net savings for all ARU measures Quality performance determines share of
savings
How much is the PO’s incentive payment?
Incentive Design Document: http://www.iha.org/our-work/accountability/value-based-p4p/incentives
© 2016 Integrated Healthcare Association. All rights reserved.
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Data Collection & Reporting Timeline
We are
here
VBP4P Manual: http://www.iha.org/our-work/accountability/value-based-p4p/participant-resources/program-manual Value Based P4P Newsletters: http://www.iha.org/news-events/newsletters
© 2016 Integrated Healthcare Association. All rights reserved.
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• If you have any questions after today’s session
contact us at [email protected]
Thank you!
Questions?