thinc’s p4p project in the hudson valley: quality metrics and the medical home susan stuard...
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THINC’S P4P PROJECT IN THE HUDSON VALLEY: QUALITY METRICS AND THE MEDICAL HOME
Susan StuardExecutive Director, THINC
Agenda
Susan Stuard will talk about the project design
John Blair, MD will discuss the specifics of the medical home transformation work
Project Design
THINC’s P4P Project
In 2007, THINC was awarded a P4P grant from the NYS Department of Health
The request for grant applications sought projects implementing quality metrics, quality report cards, and health plan incentives THINC, MedAllies and the Taconic IPA
decided to leverage this project and add a significant medical home component
EHR Install Base
Key component to the Hudson Valley project is the existing physician EHR install base
THINC has a HEAL 1 grant from NYS DOH to implement 1,000 EHRs in physician’s offices Quarter of the way through that work As a result, THINC and its vendor, MedAllies, have a
strong understanding of EHR implementations and the associated workflow and change management issues
Combine these 250 EHRs with existing EHRs at larger practices and we a good group to work with for medical home
Project Participants
500 primary care physicians in Hudson Valley 250 in quality metrics group only 250 in quality metrics and medical home group
Six health plans Provide claims data for metrics to data aggregator Pay incentives after second quality report card Participate actively in project design via the
THINC Quality Committee
Project Management
THINC Manage grant and deliverables Work with health plans to determine payment process and
triggers Use THINC Quality Committee to ensure collaborative process
for development of project goals and implementation
MedAllies Enable development of quality reporting with ViPS and from
EHR Intensive planning for medical home transformation initiative
Taconic IPA Intensive planning for medical home transformation initiative Physician recruitment
Cornell Conduct evaluation, data gathering, analysis, etc.
Budget
NYS DOH grant award is almost $1.8 million
20% for project management and evaluation
80% to match health plan incentives ~ $1.4 million
Great majority of costs for medical home transformation are being underwritten by the Taconic IPA and MedAllies
Quality Reports
Q1 2009 Report 2007 data HEDIS Measures
Q4 2009 Report 2008 data HEDIS Measures EMR Measures NCQA Medical Home
Recognize the limitations of using 2007 and 2008 in a 2009 implementation – but this is a grant requirement
THINC Taconic Health Information Network and Community
HEDIS Measures
Required to pick from among 34 measures selected by the NYS Pay for Performance Workgroup
Our claims-based project measures are: Breast Cancer Screening Colorectal Cancer Screening Chlamydia Screening Rates HbA1C Testing Lipid Measurement in Diabetics Eye Exam in Diabetics Urine Protein Screening Asthma: Pharmacologic Therapy Appropriate Treatment for Children with Upper Respiratory Infection Appropriate Testing for Children with Pharyngitis
EMR Measures
Also will add EHR-based clinical measures in the second report card
Will pull four from among these six: Controlling High Blood Pressure HbA1C Poorly Controlled Blood Pressure Control/Management in Diabetics LDL Cholesterol Level in Diabetics <130 Eye Exam in Diabetics Urine Protein Screening
In subsequent report cards, starting in 2010, will add more EHR-based clinical metrics
THINC Taconic Health Information Network and Community
Incentive Payments
Incentive payments will be issued after 2nd quality metrics report card in Q4 2009
20% of incentive payments goes to scoring on quality metrics and 80% goes to achievement of NCQA PPC-PCMH Medical Home Level 2 certification Approximate breakdown ~ $1000 on quality
metrics and ~ $10,000 for medical home level 2
Health Plan
Data Aggregator
Claims Data
Claims Data
Summary HEDIS
Measures
Summary HEDIS
Measures
Using claims data and attribution logic, aggregator generates summary measures
MedAllies Reporting Engine
From spec, health plan generates data file for Hudson Valley
Physician
Health Plan
Letter and Report Card
Letter and Report Card
Report Card and Data
File
Report Card and Data
File
Physician EHRSummary EHR/Clinic
al Measures Data from Physician
EHR
Summary EHR/Clinic
al Measures Data from Physician
EHR
THINC
Report Card (with Medical Home Status in Q4
2009)
Report Card (with Medical Home Status in Q4
2009)
Incentive PaymentIncentive Payment
MH Status
MH Status
THINC P4P Project High-Level Data Flow
Evaluation
Working with Rainu Kaushal, MD, MPH, and Lisa Kern, MD, MPH, at Weill Cornell Medical College to conduct a robust academic evaluation of project
Goal is to determine incremental effects of P4P incentives and medical home implementation on quality and costs
Design should allow isolation of the separate effects of EHRs, P4P, and the medical home
Evaluation design should produce results rigorous enough to inform policy debate as well as participant health plans’ designs for future incentive programs
Challenges
Setting aside the huge challenge of moving 250 physicians with EHRs to medical home level 2 within 12 months (John will address)
Coordinating among six health plans who all have different ideas about what should trigger an incentive payments and how attribution methodology should be applied
Tremendous effort to undertake this type of evaluation IRB approvals, participant agreements, control
group recruitment, baseline data gathering, etc. Unknown effort to be expended to implement
the EHR-based clinical measures
Questions
Please feel free to reach out to me with questions
Susan S. StuardExecutive DirectorTHINC RHIOPhone: 845-896-4726 [email protected]