value based pay for performance (vbp4p) results and ... · of the 21 paid clinical quality...

November 2015

Value Based Pay for Performance

(VBP4P) Results and Highlights for

Measurement Year 2014 (MY 2014)

© 2016 Integrated Healthcare Association. All rights reserved.

2

VBP4P MY 2014 Highlights – Quality


3

VBP4P MY 2014 Highlights – Cost and Value


4

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:


5

Physician Organization Participation

Participation in the VBP4P program is voluntary. A total of 205 physician organizations

participated in 2014 measurement – representing the care delivered to 9.3 million

commercial HMO/POS members. This represents over 95% of the commercial HMO/POS

membership in California.


6

Value Based P4P Measurement


7

Performance on Clinical Quality Measures

Of the 21 paid clinical quality measures, 7 measures increased by more than 1 percentage point, 4

measures declined by more than 1 percentage point, and 10 measures saw less than 1 percentage point

change.


8

Impact of Gains in Clinical Quality

Average physician organization performance improved on 13 of the 21 clinical quality measures from

2013 to 2014. Measures with the 6 largest gains are shown below.

+3.3% +2.5%

Data based on observed rates

1,096 more girls received 3 doses of the HPV vaccine by age 13

4,094 more boys received 3 doses of the HPV vaccine by age 13

39,878 more women were appropriately screened for cervical cancer

430 more adults with acute bronchitis didn’t receive unnecessary antibiotics

1,083 more children with pharyngitis received antibiotics and a strep A test

3,582 fewer diabetic patients had poor blood sugar control


9

Measures of Overuse

Several program measures align with the recommendations of Choosing Wisely®, an initiative of the ABIM Foundation

with the goal of advancing a dialog on avoiding wasteful or unnecessary medical tests, treatments and

procedures. Physician organizations have gained ground since 2008 on avoiding unnecessary antibiotics and evidence-

based cervical cancer screening, but there is still much room for improvement.

Data based on observed rates


10

Performance Favorable Against National

Benchmarks

Members served by P4P-participating POs and plans represent over 95% of the commercial HMO/POS population in

California. Of the 14 P4P measures with HEDIS benchmarks, the California HMO/POS average exceeds the national “all

lines of business“ average for 10 measures and exceeds the California PPO average for 12 measures. Below are five

example measures.

Data based on HEDIS benchmarks


11

Patient Experience Ratings Hold Steady

Patient experience results are one of the most challenging performance measurement areas from an improvement

perspective. Four of the six composite measures showed improvement in 2014 – the Overall Ratings of Care composite

most notably increased by 1.3 percentage points to 67.6%. Patient ratings for two composite measures declined – Timely

Care and Service by just under 1 percentage point.

Rates based on Clinician and Group CAHPS survey instrument administered by CHPI, includes case mix adjustment


12

New MUHIT Approach Increases Participation

In 2014, the VBP4P program changed the collection approach for the Meaningful Use of Health IT domain to reduce the

measurement burden on physician organizations (POs). As a result, participation increased from 160 POs in MY 2013 to

191 in MY 2014. The graph below shows the distribution of POs by the percent of their providers participating in the EHR

Incentive Program with CMS or Medi-Cal. On average, 72% of providers within a PO have attested to meeting CMS

Meaningful Use of Health IT requirements.


13

First Look at Ability to Report E-Measures


14

Meaningful Use Not Always Meaningful?

The CMS EHR incentive

program requires that

providers can report selected

e-measures. Several

physician organizations show

a marked disconnect between

the percent of providers in the

EHR incentive program and

the percent of providers the

organization is able to include

in its e-measure reporting for

P4P. The cluster of POs

circled in the graph (right)

have substantial providers

participating in the incentive

program that the POs were

unable to include in the

reported e-measure rate.

Participate in Medi-Cal or CMS EHR Incentive Program (% of Providers in PO) Data based on observed rates


15

Inpatient Use Down, Readmissions & ED Up

The number of non-maternity inpatient bed days and discharges (per thousand member years) continued to decrease in

2014. Inpatient readmissions rose 3.5%, and emergency department visits were up 1.3%. The overall generic prescribing

rate increased 2%.

*Readmissions measure specifications changed from IRN to PCR to align with HEDIS beginning for MY 2013-2014 trend


16

Total Cost of Care Measures


17

Total Cost of Care Varies by Region

The California statewide average Total Cost of Care was $3,794 in MY 2014. Geographic differences

persist despite adjusting for the relative risk of the population and regional differences in wages and

capital costs. The Bay Area and Sacramento region had the highest average per-member cost in 2014 at

$4,106, while the Inland Empire region had the lowest at $3,366.


18

Total Cost of Care Results Over Time

Measurement year 2014 saw expanded health plan participation in TCC measurement. Anthem Blue

Cross, Kaiser Permanente, and Western Health Advantage all participated in measurement for the first

time – bringing the represented population up to 8.4 million* members. From a program perspective, we

see that the average TCC for the participating population increased from $2,973 to $3,794 over the

period from 2008 to 2014.

*Excludes any members that do not have a pharmacy coverage through the health plan; Aetna data unavailable at time of reporting.


19

Total Cost of Care Decreased For First Time in MY

2014 The expansion of TCC measurement in 2014 makes assessing the trend between years difficult.

However, looking at the subset of health plans with results for both 2013 and 2014 – approximately 2.3 M

members – the average TCC declined 1.2%. These results may be impacted by market factors, such as

a decreases in inpatient utilization, increases in HMO enrollee cost sharing, and enrollment in Covered

CA, which features distinct benefit and network designs.

*Data represents population from five health plans: Blue Shield of CA, Cigna, Health Net, Sharp, & UnitedHealthcare

10.9%

7.3% 6.7%

4.9%

2.7%

-1.2%

-2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

-$500

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

20094 plans2.6M

20104 plans2.4M

20114 plans2.3M

20125 plans2.6M

2013*5 plans2.3M

2014*5 plans2.3M

Ave

rage

TC

C (

$P

MP

Y)

Average TCC PMPY TCC Annual Percent Change


20

Value Based P4P Awards


21

Excellence in Healthcare Winners Are Top

Performers in Quality and Cost To earn the Excellence in Healthcare Award, physician organizations must perform in the top 50% for clinical quality and

patient experience and Total Cost of Care performance. Out of over 200 participating physician organizations, only 23 met

this criteria for MY 2014 – the stars in the graph below.


22

2015 Excellence in Healthcare Award Winners

The following physician organizations were recognized for their MY 2014 performance at an awards ceremony luncheon at

the annual IHA Stakeholders meeting.


23

2015 Bangasser Memorial Award Winners

The following physician organizations were recognized for their MY 2014 performance at an awards ceremony luncheon at

the annual IHA Stakeholders meeting.


24

OPA Online Report Card

In early 2016, Total Cost of Care results will be publicly reported for the first time at the physician organization level

alongside clinical quality and patient experience ratings on the Office of the Patient Advocate website. The initial 2015-

2016 edition of the quality report cards was released in October 2015. http://reportcard.opa.ca.gov

http://reportcard.opa.ca.gov/


25

Value Based P4P Design

• Performance gates

- Quality

- Total Cost of Care Trend

• Calculate share of savings

based on resource use

• Adjust share of savings for

Quality

• Sum adjusted shared

savings

Additional information available in VBP4P Design Overview

http://www.iha.org/pdfs_documents/p4p_california/Value-Based-Pay-for-Performance-Issue-Brief-September-2013.pdf


26

Most POs Meet Quality & TCC Trend Gates

To earn any VBP4P shared savings, physician organizations must first demonstrate that they meet a minimum level of

quality and do not have an excessive TCC trend. Most PO contracts (84%) met both requirements and would be eligible

for any shared savings earned. Of the 16% of PO contracts that didn’t pass the performance gates, 14% missed the TCC

trend gate and 4% missed the quality gate.

12% Missed TCC Trend

Gate

2% Missed Both Gates

16 % Did Not Pass

Gates

84% Passed Both

Gates


27

95% of POs Met the Quality Gate

Physician organizations must achieve a Quality Composite Score of 10 or higher in order to be eligible for incentives in the

VBP4P program. This is the equivalent of earning one point for attainment or improvement on each measure. Ninety-five

percent of organizations * met the threshold for 2014.

overall score < 10 overall score > 10

*Representing ninety-six percent of PO contracts

Quality Gate = 10


28

Most Pass the Cost Trend Gate

The recommended Total Cost of Care (TCC) Trend Gate threshold for 2014 of 4.7% is based on a rolling three-year

average of CPI plus 3 percentage points. Using this threshold and including an 85% confidence interval, 86% of physician

organizations met the Value Based P4P TCC Trend Gate in 2014.

2014 TCC Trend Gate = 4.7%


29

Positive Net Shared Savings for 49% of POs

Net improvement across resource use measures is the basis for Value Based P4P shared savings payments. The graph

below displays the distribution of PO incentives using the recommended design, from left to right: those that would earn an

incentive (49%), those that do not pass the gates (16%), and those with estimated losses that earn nothing (35%).

Did not pass the gates ($0 incentive)

The graph above assumes the following unit savings: inpatient bed day $4,000, ED visits $750, readmit $14,000, preferred outpatient procedures $1,500, and generic prescriptions $75. Includes adjustments.


30

Bed Days Drive PO Net Share of Savings

The following graph shows the same distribution for the quality-adjusted net positive shared savings from the previous

slide broken down by relative resource use contribution. The green, which represents bed days, is clearly the main

contributor.

-10

-5

0

5

10

15

20

$ P

MP

M

ED Visits Generic Prescribing Bed Days

Outpatient Procedures Readmissions Estimated PO Shared Savings


31

• Value Based P4P Issue Brief, Design Document, and

Participant Resources available on IHA website at

www.iha.org

• Questions may be directed to [email protected]

Additional Resources

http://www.iha.org/

mailto:[email protected]

value based pay for performance (vbp4p) results and ... · of the 21 paid clinical quality...

Documents