Total Care for General Population (TCGP)/Integrated Primary Care (IPC)
Value Based Payment Quality Measure Set
Measurement Year 2017
- Measure Set is also available in Portable Document Format (PDF)
Updated July 14, 2017 NYS Medicaid Value Based Payment
The 2017 Integrated Primary Care (IPC) quality measure set was created in collaboration with the Diabetes, Chronic Heart Disease, Pulmonary, and Behavioral Health Clinical Advisory Groups (CAGs), as well as the New York State (NYS) Value Based Payment (VBP) Workgroup to align with the Advanced Primary Care measure set put forth by the Integrated Care Workgroup. The IPC measure set is the same set that will be used for the Total Care for the General Population (TCGP) arrangement in 2017. The measure set is closely aligned with existing measures sets used in the Delivery System Reform Incentive Payment (DSRIP) Program and the Quality Assurance Reporting Requirements (QARR) measure set. The IPC measure set is intended to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple settings throughout preventive care, sick care, and priority chronic condition episodes.
The measure set includes measures classified by category based on an assessment of reliability, validity, and feasibility, and according to suggested method of use (either Pay for Reporting (P4R) or Pay for Performance (P4P)).
To increase alignment with the QARR, one measure relating to statin therapy for those with diabetes has been changed since the March 2017 release of the TCGP/IPC VBP Measure Set. The change with updated measure steward is notated in red in the table below.
MEASURE CLASSIFICATION
In September and October of 2016, the CAGs published recommendations to the State on quality measures, data, and support required for providers to be successful. Additionally, the report addressed other implementation details related to a VBP IPC Arrangement. Upon receiving the CAG recommendations, the State conducted further feasibility review and analysis to define a final list of measures for inclusion during the 2017 VBP Measurement Year (MY). Each measure has been designated by the State as Category 1, 2, or 3 with associated recommendations for implementation and testing for future use in VBP arrangements.
Categorizing and Prioritizing Quality Measures
CATEGORY 1
Approved quality measures that are felt to be both clinically relevant, reliable and valid, and feasible.
CATEGORY 2
Measures that are clinically relevant, valid, and probably reliable, but where the feasibility could be problematic. These measures should be investigated during the 2017 pilot program.
CATEGORY 3
Measures that are insufficiently relevant, valid, reliable and/or feasible.
Category 1
Category 1 quality measures as identified by the CAGs and accepted by the State are to be reported by VBP Contractors. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible1.
The State classified each Category 1 measure as either P4P or P4R:
- P4P measures are intended to be used in the determination of shared savings amounts for which VBP Contractors are eligible. Measures can be included in both the determination of the target budget and in the calculation of shared savings for VBP Contractors.
- P4R measures are intended to be used by the Managed Care Organizations (MCOs) to incentivize VBP Contractors for reporting data to monitor quality of care delivered to members under the VBP contract. Incentives for reporting will be based on timeliness, accuracy, and completeness of data. Measures can be reclassified from P4R to P4P through annual CAG and State review or as determined by the MCO and VBP Contractor.
Categories 2 and 3
Category 2 measures have been accepted by the State based on agreement of measure importance, validity, and reliability, but flagged as presenting concerns regarding implementation feasibility. These measures will be further investigated in the VBP pilots. The State requires that VBP Pilots select and report a minimum of two Category 2 measures per VBP arrangement (or have a State and Plan approved alternative). VBP Pilot participants will be expected to share meaningful feedback on the feasibility of Category 2 measures when the CAGs reconvene. The State will discuss measure testing approach, data collection, and reporting requirements with VBP pilots at a future date.
Measures designated as Category 3 were identified as unfeasible at this time or as presenting additional concerns including accuracy or reliability when applied to the attributed member population for the IPC arrangement. Several measures in the original CAG report were removed for this reason and therefore are no longer in the Category 1 or 2 measure list. These measures will not be tested in pilots or included in VBP at this time.
MEASUREMENT YEAR 2017 MEASURE SET
The measures and State determined classifications provided on the following pages are recommendations for MY 2017. Note that measure classification is a State recommendation and implementation is to be determined between the MCO and VBP Contractor.
Measure sets and classifications are considered dynamic and will be reviewed annually. Updates will include additions, deletions, reclassification of measure category, and reclassification from P4R to P4P based on experience with measure implementation in the prior year. During 2017, the CAGs and the VBP Workgroup will re-evaluate measures and provide recommendations for MY 2018.
Category 1
The Category 1 table displays the Category 1 TCGP/IPC Measure set, arranged alphabetically, and includes measure title, measure steward, the National Quality Forum (NQF) number and/or other measure identifier (where applicable), and State determined classification for measure use.
| TCGP/IPC Measures | Measure Steward | Measure Identifier | Classification |
|---|---|---|---|
| Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder | Centers for Medicare & Medicaid Services (CMS) | NQF 1880 | P4P |
| Antidepressant Medication Management – Effective Acute Phase Treatment & Effective Continuation Phase Treatment | National Committee for Quality Assurance (NCQA) | NQF 0105 | P4P |
| Breast Cancer Screening | NCQA | NQF 2372 | P4P |
| Cervical Cancer Screening | NCQA | NQF 0032 | P4P |
| Childhood Immunization Status | NCQA | NQF 0038 | P4P |
| Chlamydia Screening for Women | NCQA | NQF 0033 | P4P |
| Colorectal Cancer Screening | NCQA | NQF 0034 | P4P |
| Comprehensive Diabetes Care: All Three Tests (HbA1c, dilated eye exam, and medical attention for nephropathy) | NCQA | NQF #s 0055, 0062, 0057 | P4P |
| Comprehensive Diabetes Care: Eye Exam (retinal) Performed | NCQA | NQF 0055 | P4P |
| Comprehensive Diabetes Care: Foot Exam | NCQA | NQF 0056 | P4R |
| Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) | NCQA | NQF 0575 | P4R |
| Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) | NCQA | NQF 0059 | P4P |
| Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) testing [performed] | NCQA | NQF 0057 | P4P |
| Comprehensive Diabetes Care: Medical Attention for Nephropathy | NCQA | NQF 0062 | P4P |
| Controlling High Blood Pressure | NCQA | NQF 0018 | P4P |
| Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications | NCQA | NQF 1932 | P4P |
| Initiation and Engagement of Alcohol and other Drug Dependence Treatment (IET) | NCQA | NQF 0004 | P4P |
| Initiation of Pharmacotherapy for Alcohol Dependence | NYS Office of Alcoholism and Substance Abuse Services (OASAS) | – | P4R |
| Initiation of Pharmacotherapy for Opioid Use Disorder | NYS OASAS | – | P4P |
| Medication Management for People With Asthma (ages 5 – 64) – 50 % and 75% of Treatment Days Covered | NCQA | NQF 1799 | P4P |
| Potentially Avoidable Complications in routine sick care or chronic care | Altarum Institute (Formerly HCI3) | – | P4R |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow – Up Plan | CMS | NQF 0421 | P4R |
| Preventive Care and Screening: Influenza Immunization | American Medical Association Physician Consortium for Performance Improvement (AMA PCPI) | NQF 0041 | P4R |
| Preventive Care and Screening: Screening for Clinical Depression and Follow–Up Plan | CMS | NQF 0418 | P4R |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | AMA PCPI | NQF 0028 | P4R |
| Statin Therapy for Patients with Cardiovascular Disease | NCQA | – | P4R |
| Statin Therapy for Patients with Diabetes** | NCQA | – | P4R |
| Use of spirometry testing in the assessment and diagnosis of COPD | NCQA | NQF 0577 | P4R |
| Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents | NCQA | NQF 0024 | P4P |
*Measure substituted with NCQA measure ´Statin Therapy for Patients with Diabetes´. See above.
**Measure is part of the 2017 QARR measure set and replaces ´Adherence to Statins for Individuals with Diabetes Mellitus´. See above.
Category 2
The Category 2 table displays the Category 2 TCGP/IPC Measure set and includes measure title, measure steward, and the NQF number and/or other measure identifier (where applicable). All Category 2 measures are classified as P4R in MY 2017.
| Measure | Measure Steward | Measure Identifier |
|---|---|---|
| Asthma: Assessment of Asthma Control – Ambulatory Care Setting* | The American Academy of Allergy, Asthma & Immunology (AAAAI) | – |
| Avoidance of Antibiotic Treatment in adults with acute bronchitis* | NCQA | NQF 0058 |
| Continuing Engagement in Treatment (CET) Alcohol and other Drug Dependence | NYS OASAS | – |
| Continuity of Care (CoC) within 14 Days of Discharge from Any Level of SUD Inpatient Care |
NYS OASAS | – |
| Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver* | The Joint Commission | NQF 0338 |
| Lung Function/Spirometry Evaluation (Asthma) | AAAAI | – |
| Patient Self–Management and Action Plan (Asthma)* | AAAAI | – |
| Topical Fluoride for Children at Elevated Caries Risk, Dental Services | American Dental Association (ADA) | NQF 2528 |
| Use of Imaging Studies for Low Back Pain* | NCQA | NQF 0052 |
| Utilization of Pharmacotherapy for Alcohol Dependence | NYS OASAS | – |
| Utilization of Pharmacotherapy for Opioid Use Disorder | NYS OASAS | – |
* VBP Pilot contractors may include measures as outlined in the VBP Pilot webinar held on February 24, 2017. Five measures were added to the Category 2 list subsequent to that presentation to align with measures in the Advanced Primary Care core set and VBP Workgroup recommendations.
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1. A Path toward Value Based Payment: New York State Roadmap for Medicaid Payment Reform. Annual Update. June 2016. 1
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