Attribution Update: Results from Round #2 of Initial Attribution

Greg Allen, Director of Policy
Office of Health Insurance Programs
NYS Department of Health

  • Slides are also available in Portable Document Format (PDF, 647KB)

PRESENTATION OVERVIEW

  • Attribution Concepts
    • Attribution Key Concepts & Terms
    • Attribution Differences
      • Initial Attribution vs. Final Attribution for Valuation
    • Attribution Loyalty Logic (Swim Lanes & Buckets)
  • Attribution Statistics as of 10/27/14 (Round 2 Results)
  • PPS Specific Reports
  • Next Steps
  • Timeline
  • Attribution Tools & Aides

ATTRIBUTION KEY CONCEPTS PART 1

  • DSRIP attribution is driven by matching Medicaid members to providers in PPS Networks based on claims and encounters data
  • Attribution looks at meaningful connections. Excludes the following claims:
    • Capitation, pharmacy, transportation, DME and lab claims
  • 50% Rule ("Meaningful Connection"): To be attributed in DSRIP, Medicaid members must have more than 50% of their claims with providers in any PPS Network.
  • Attribution Time Period: Data from the past years with a built in 6 month lag -rolling timeframe (Round two attribution used 3/13 - 2/14)
  • PCP Connectivity based on 24 months of claims.

ATTRIBUTION KEY TERMS

  • Non-Utilizer (NU): Member enrolled in Medicaid that does not have PCP claim or encounter over 24 month period and no claims within 12 month period.
  • Low utilizer (LU): Members with low visits (3 or fewer now but may change) and no PCP visit within 24 month period.
  • Attributed Through Loyalty: Members attributed through swim lane logic.
  • Attributed Outside Loyalty: Utilizing Medicaid members (those members not meeting LU or NU criteria) attributed geographically to sole PPS (not attributed through 4 swim lane service categories).
  • Non-Attributed: Utilizing Medicaid members in a Multi-PPS county where members don´t have a meaningful connection to a PPS partner network (50% rule or are receiving only non-swim lane service [e.g., Early Intervention])

DIFFERENCES BETWEEN INITIAL ATTRIBUTION VS. FINAL ATTRIBUTION FOR VALUATION

Rule Initial Attribution
(Round2)		 Final Attribution for Valuation: 11/24
50% Rule Rule applied to all allowed claims Rule applied to only meaningful connection claims (Swim Lane Logic Claims)
Attributed Through "Other Claims" (e.g., Early Intervention): Members with claims not captured through swim lanes Not Implemented: Members Currently Fall into Non-attributed Attributed to PPS if more than 50% of "other claims" are with providers in PPS network

DSRIP ATTRIBUTION LOYALTY LOGIC FOR VALUATION

INITIAL ATTRIBUTION RESULTS (RD 2 VS. RD 1)

Attribution Run Date 10/27/2014 10/14/2014 Change
Low Utilizing Medicaid Members 535,540 534,704 836
Non Utilizing Medicaid Members 921,628 1,124,054 (202,426)
Utilizing Medicaid Members, Attributed Outside Network Loyalty (single PPS Counties) 313,133 316,964 (3,831)
Utilizing Medicaid Members, Attributed Through Loyalty 3,559,103 2,655,552 903,551
Non-Attributed Members 1,038,877 1,709,404 (670,527)
Grand Total 6,368,281 6,340,678 27,603

INITIAL MEMBER ATTRIBUTION RESULTS (ROUND #2 -10/27/14)

Level Developmental Disabilities Long Term Care Behavioral Health All Others Total Member Count
Level 1 3,845 90,684 56,268 82,116 232,913
Level 2 7,339   15,322 1,047,985 1,070,646
Level 3 1,700   198,838 1,945,193 2,145,731
Level 4 4,539   11,838 72,122 88,499
Level 5 338   6,485 14,491 21,314
Total 17,761 90,684 288,751 3,161,907 3,559,103

 

PPS SPECIFIC REPORTS REVIEW

 

NEXT STEPS

  • Review the Non-Attributed Provider Report and make sure that all appropriate and newly affiliated Providers and NPIs/MMIS #s are included in the provider Network Tool
  • Include all NPIs of the servicing practitioners within your PPS in the Network Tool, even if they are salaried within the partner organization

TIMELINE

Date Activity
10/17/2014 1st Round Initial Attribution Results provided to PPS
10/31/2014 2nd Round Initial Attribution Results provided to PPSs (& Made Public)
11/11/2014 Provider Network Locked for 3rd Round of Attribution at 4PM EST
11/14/2014 3rd Round Initial Attribution Results provided to PPSs (& Made Public)
11/24/2014 Final Partner List due in Network Tool for Final Attribution at 4PM EST
12/10/2014 Final Attribution Results provided to PPSs (& Made Public)

USEFUL LINKS AND MORE INFORMATION

Salient Public Facing Dashboards

MAPP Analytics Performance Portal (MAPP)

We want to hear from you!

DSRIP e-mail:
dsrip@health.ny.gov

´Like´ the MRT on Facebook:
http://www.facebook.com/NewYorkMRT

Follow the MRT on Twitter:
@NewYorkMRT

Subscribe to our listserv:
http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm