Questions and Answers
Q & A Topics
General | Billing and Payment | Chronic Illness Demonstration Project (CIDP) | Health Home Design | Health Home Development Funds | Health Home Letter of Intent/Applications/Provider Enrollment/Application Form | Health Home Network | Health Information Technology | Managed Care | Member Forms | Population Assignment/ Eligibility (Patient Tracking System) | Quality Metrics and Evaluation (CMART) | Spend Down | Targeted Case Management (TCM) |
Quality Metrics and Evaluation (CMART)
- What is meant by ´clinical risk groups´?
- What data base/metrics will be used to determine the effectiveness of Health Homes? Who will receive this information?
- Will providers be required to adhere to HEDIS standards?
- What is the nature and frequency of required reporting?
- Will patients enrolled in a Health Home be excluded from calculation of readmission rates for a hospital if that hospital is not the health home?
- Will there be regional Health Home advisory committees comprised of stakeholders including consumers and families?
- What will happen to Health Homes that are not meeting the expectation of the consumers?
- Will DOH provide a toll–free number and web site in which stakeholders can voice concerns about underperforming Health Homes?
- We understood that the Health Homes were expected to provide a call–center service 24/7. Is that correct or has there been a change in this expectation?
- Is there a proposed standardized risk assessment for Health Homes to use with members upon enrollment into a Health Home? If there is not a standardized risk assessment tool, is there guidance for what Health Homes should include in their assessment?
- The Inpatient Utilization General Hospital Quality Measure Specification includes the rate of utilization of acute inpatient care per 1,000 member months. Data is reported by age for categories: Medicine, Surgery, Maternity (emphasis added) and Total Inpatient" Since Pregnancy is not one of the medical conditions in the Health Home program, how are we to interpret this?
- What is the purpose of the Health Home Care Management Assessment Reporting Tool?
- How can Health Homes contact the Department about questions and updates?
- Is the HH–CMART reporting data collected by the Health Home rather than the case management provider?
- Is there a central location with more HH–CMART information?
- Will the designated Health Home provider be responsible for quality reporting?
Archived Questions
1. What is meant by ´clinical risk groups´?
Clinical Risk Groups ™ (CRG) are a 3M product to place patients in clinical and severity levels based on diagnostic acuity. CRG™ is used in development of the Departments suggested Health Home assignments.
|top of page|2. What data base/metrics will be used to determine the effectiveness of Health Homes? Who will receive this information?
As part of DOH´s responsibility to CMS we will be collecting data as outlined in the SPA and the Core Set of Quality Measures for Medicaid Health Homes. In addition, DOH will collect data for measures identified in the Health Home Service Children Application and NYS DOH developed CMART process measures. Clinical measure data will be extracted from existing sources and process measure data will be extracted from Health Home CMART submissions. DOH has also outlined in the SPA the evaluation mechanisms for determining the effectiveness of Health Homes. Measures will be reported to NYS Health Homes, NYS Agency Partners and Managed Care Organizations. More information by clicking here.
|top of page|3. Will providers be required to adhere to HEDIS standards?
Health Home providers will be required to meet/adhere to the Health Home clinical measures, many of which are based on HEDIS standards. Based on provider type and other programs´ requirements (e.g., MCO), many Health Homes may be required to meet all HEDIS standards.
|top of page|4. What is the nature and frequency of required reporting?
Most of the data will be extracted from claims and encounters data. See chart below for reporting time periods
| Measure | Description | Report time period | Month – Responsible party |
|---|---|---|---|
| Clinical Measures | All subset clinical measures except for ABA (BMI) and Skilled NH (SNH) | Bi–annual Jan–June 2017 (6 m lag) |
January 15, 2018 and annually thereafter |
| Clinical Measures | ABA (BMI) and Skilled Nursing Home (SNH) only | Annual Jan – Dec 2017 (6 m lag) |
July 15 2017 and annually thereafter DOH Data Analyst &– send via email |
| Process Measures | All subset process measures | Quarterly (monthly look–back) | July 15, 2017 and monthly thereafter |
5. Will patients enrolled in a Health Home be excluded from calculation of readmission rates for a hospital if that hospital is not the health home?
All hospitalizations will continue to be factored into the readmission rate calculations but Health Homes can be reported separately for comparison purposes.
|top of page|6. Will there be regional Health Home advisory committees comprised of stakeholders including consumers and families?
Several Health Homes have implemented regional advisory committees with members who represent care management agencies, providers, plans, peers and members.
As of now, there is a Learning Collaborative series facilitated by the Center for Health Care Strategies in close partnership with DOH and will be open to invited representatives from Health Homes. Findings that emerge from this forum will help guide ongoing development efforts and inform state policy decisions around this significant delivery system reform effort.
Health Homes and Managed Care Organizations have formed a consolidated work group (replacing two earlier work groups) to address and guide policy and operational development related to Health Home.
|top of page|7. What will happen to Health Homes that are not meeting the expectation of the consumers?
DOH and Managed Care Plans will be closely monitoring the quality of the health homes. DOH and Plans have broad latitude in deciding where to assign members and will only assign members to Health Homes meeting quality measures. Plans can also move their members out of Health Homes that are not meeting the needs of members.
|top of page|8. Will DOH provide a toll–free number and web site in which stakeholders can voice concerns about underperforming Health Homes?
Members can communicate concerns about Health Homes with their Health Home team and their managed care plan and if that does not resolve the concern, contact the Medicaid Helpline at 1–800–541–2831or NYS DOH Health Home at 1–518–473–5569
|top of page|9. We understood that the Health Homes were expected to provide a call–center service 24/7. Is that correct or has there been a change in this expectation?
Per the Health Home Standards and Requirements for Health Homes, Care Management Providers and Managed Care Organizations, the Health Home provider must ensure 24 hours/seven days a week availability to a care manager to provide information and emergency consultation services. Several Health Homes have established hotlines managed by medical personnel/nurses to assist with any immediate medical concerns. The Medicaid Helpline operates only during business hours and will address general questions or concerns. Complaints can be reported to the Medicaid Helpline at 1–800–541–2831.
|top of page|10. Is there a proposed standardized risk assessment for Health Homes to use with members upon enrollment into a Health Home? If there is not a standardized risk assessment tool, is there guidance for what Health Homes should include in their assessment?
No, Health Homes should follow the Comprehensive Assessment Policy effective July 1, 2017 which includes guidance on the inclusion of risk screening. The care manager should use all resources that are available for that member to ensure the most appropriate care management plan is formulated including information from previous care management. We would also expect care managers to use validated assessment tools most appropriate to the member´s situation. There are a number of tools such as the DLA Assessment and SBIRT that are available for use.
|top of page|11. The Inpatient Utilization General Hospital Quality Measure Specification includes the rate of utilization of acute inpatient care per 1,000 member months. Data is reported by age for categories: Medicine, Surgery, Maternity (emphasis added) and Total Inpatient" Since Pregnancy is not one of the medical conditions in the Health Home program, how are we to interpret this?
While pregnancy is not a qualifying condition for Health Homes, if members have maternity stays, the stays are included in the inpatient utilization measure. Inpatient utilization is not limited to specific conditions; it is inclusive of all stays just like the HEDIS measure for the Medicaid membership.
|top of page|12. What is the purpose of the Health Home Care Management Assessment Reporting Tool?
The Health Home Care Management Assessment Reporting Tool is a database tool developed by the Office of Quality and Patient Safety in conjunction with the OHIP Health Home Program to collect process metrics. The tool collects data for the intake and intervention phases of care management services for members involved in Health Homes.
The HH–CMART database tool is used for the collection of standardized care management data for members assigned to Health Homes. The data will provide the NYS Department of Health with information about care management services provided to members, in order to evaluate the volume and type of interventions and the impact care management services have on outcomes for people receiving these services.
The data collected in the HH–CMART will be used in conjunction with Medicaid claims data to evaluate impact to utilization and quality of care for members involved in Health Homes.
|top of page|13. How can Health Homes contact the Department about questions and updates?
For questions about Quality Measures, CMART or general reporting guidelines, E–mail the Health Home Team with the subject of Performance Measurement via the Health Home website or call the Health Home Provider line at 518–473–5569.
|top of page|14. Is the HH–CMART reporting data collected by the Health Home rather than the case management provider?
The Health Homes will submit a single file that is a compilation of Health Home CMART data from all care management partners on each Health Home member. The Health Home and Care Management partners must develop a process for the Health Home to collect the Health Home CMART data. Several Health Homes have incorporated CMART data collection within the EHR.
|top of page|15. Is there a central location with more HH–CMART information?
All information regarding HH–CMART and Performance Management can be found by clicking here. This includes a Technical Specifications Manual, user guide, reporting schedule, and additional frequently asked questions specific to the Health Home Care Management Assessment Reporting Tool.
|top of page|16. Will the designated Health Home provider be responsible for quality reporting?
Health Homes must have the capability to submit required data to DOH including CMART data when required. Currently, quality measures are collected from existing data sources and Health Homes are not required to submit additional data.
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