Value Based Payment Arrangements for Adults with Intellectual or Developmental Disabilities (IDD)
Progress Report of the IDD Value Based Payment Advisory Group
- Report is also available in Portable Document Format (PDF)
NYS Medicaid Value Based Payment
December 2016
| Contents |
|---|
Introduction
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The Intellectually/Developmentally Disabled VBP Advisory Group
|
IDD VBP Arrangement Overview
|
| IDD VBP Advisory Group |
Quality Measure Discussion Summary
|
| Selecting Quality Measures: Criteria Used to Determine Relevance |
| Clinical relevance |
| Reliability and Validity |
| Feasibility |
| Categorizing and Prioritizing Quality Measures |
| Conclusion |
| Intellectually/Developmentally Disabled CAG Recommended Quality Measures – Category 1 and 2 |
CAG Categorization and Discussion of Measures – Category 1 & 2
|
| CAG Categorization and Discussion of Measures – Category 3 |
Appendix A:
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Appendix B:
|
Introduction
Delivery System Reform Incentive Payment (DSRIP) Program & Value–Based Payment (VBP) Overview
The New York State DSRIP program aims to fundamentally restructure New York State´s healthcare delivery system, reducing avoidable hospital use by 25 percent, and improving the financial sustainability of New York State´s safety net.
To further stimulate and sustain this delivery reform, at least 80 – 90 percent of all payments made from Managed Care Organizations (MCOs) to providers will be captured within VBP arrangements by 2020. The goal of converting to VBP arrangements is to develop a sustainable system, which incentivizes value over volume. The Centers for Medicare & Medicaid Services (CMS) has approved the State´s multiyear VBP Roadmap, which details the menu of options and different levels of VBP that the MCOs and providers can select and also outlines how the State sets quality measures per VBP arrangement.
The NYS VBP Roadmap outlines two types of VBP arrangements:
- Population–based VBP arrangements
- Episode–based VBP arrangements
This document describes the population–based IDD VBP arrangement.
|top of page|The Intellectually/Developmentally Disabled VBP Advisory Group
Introduction
New York State´s Office for People With Developmental Disabilities (OPWDD) has launched a comprehensive effort to transform its services in partnership with CMS. The joint goals of the transformation effort include:
- Developing new service options to better meet the needs of individuals and families in a truly person–centered way, including allowing for more self–direction of services;
- Creating a specialized managed care system that recognizes the unique needs of people with disabilities, and is focused on a habilitation model of services and supports;
- Ensuring that people live in the most integrated community settings;
- Increasing the number of individuals who are competitively employed;
- Focusing on a quality system that values personal outcome goals for people, such as an improved life or access to meaningful activities; and
- Working to make funding in the system sustainable and transparent.
As part of the effort, a diverse group of stakeholders was called together by OPWDD to examine the challenges of implementing the Transformation Agenda, which is focused on programmatic goals in the areas of community integration, employment and self–direction, as well as the transition to managed care. The panel was asked to shape clear and actionable recommendations to guide implementation. People with intellectual and developmental disabilities and their families, as well as advocates and providers were engaged throughout the process. A series of public meetings was convened at various locations around the state to gain the input of stakeholders through an unprecedented level of outreach. The results of the
Panel´s work are contained in the Transformation Panel Report, Raising Expectations, Changing Lives, which lays out their process, vision and recommendations.1
One of the key questions posed by the Transformation Panel related to the implementation of managed care and VBP in the OPWDD system was how to use Managed Care and Value–Based Payment models to increase the accountability and flexibility of the system by rewarding providers for good performance. Managed care and VBP were identified as key platforms for change upon which other needed structural changes could be built using tools unavailable through the fee for service Medicaid system. In addition to the establishment of conflict–free Care Coordination Organizations in the OPWDD system, a plan for the transition to managed care is under development. This plan will be thoroughly vetted by stakeholders to ensure it meets the needs of the individuals and families supported by OPWDD. Managed care is the foundation for VBP, and in order to realize the full benefits of VBP for OPWDD services, a timely transition to managed care is essential.
To begin considering the question of how to implement VBP for individuals with IDD, OPWDD and DOH jointly convened an IDD VBP Advisory Group comprised of more than 40 stakeholder representatives including advocates, parents, individuals with IDD, and providers. Over the course of four meetings, the Advisory Group discussed key components of potential VBP arrangements, including the nature of the VBP arrangement for IDD as outlined in the New York State Roadmap, central values and tenets to be upheld in VBP for individuals with IDD, and quality and performance benchmarking and measurement appropriate for OPWDD services. For a full list of meeting dates and agendas, please see Appendix A.
It is important to note that additional meetings will be needed as the transition to managed care progresses. This interim progress report includes quality measures and concepts that are under development. The quality measures in particular should be viewed as conveying the desired direction and are indicative of a system endeavoring to advance more flexible, person–centered and community–oriented options.
Progress Report Content Overview
The Progress Report is contains two sections.
1. A Description of the IDD VBP Arrangement as Envisioned in the NYS Roadmap
This section provides an overview of the VBP arrangement design, which is envisioned as a total cost of care arrangement for designated IDD members.
2. IDD Quality Measure Discussion Summary
This section provides a description of the quality measures discussed by the Advisory Group to date and the initial criteria used to categorize and prioritize them. A preliminary list of measures recommended by the Advisory Group is included.|top of section| |top of page|
A Description of the IDD VBP Arrangement as Envisioned in the NYS Roadmap
IDD VBP Arrangement Overview
New York State´s VBP Roadmap2 describes how the State will transition 80–90% of all payments from Managed Care Organizations to providers from Fee for Service (FFS) to VBP. The Roadmap identifies a range of VBP options and a menu of options for providers and plans seeking to transition to VBP. These include episodes and bundles of care such as maternity and integrated primary care, as well as total cost of care arrangements for designated member populations, called "subpopulation" arrangements. These total cost of care arrangements for designated populations are designed to incentivize maximum gains from care coordination across the multiple care "silos" with whom these members interact. There are four groups identified for this type of VBP arrangement, including IDD members:
- Members diagnosed with HIV/AIDS;
- Members in Health and Recovery Plans (HARP);
- Members in Managed Long–Term Care plans (MLTC); and
- Members with IDD, receiving OPWDD services.
Value based payments are designed to complement a managed care system, and as the timeframe for OPWDD´s transition to managed care is finalized the design for value–based payments will also be finalized.
Members Included in the Total Cost of Care IDD VBP Arrangement
OPWDD is responsible for the provision of services to more than 128,000 New Yorkers with developmental disabilities, including intellectual disabilities, cerebral palsy, Down syndrome, autism spectrum disorders, and other neurological impairments. It provides services directly and through a network of approximately 750 nonprofit service providing agencies, with about 80 percent of services provided by the private nonprofits and 20 percent provided by state–run agencies. Supports and services include Medicaid funded long–term care services such as habilitation and clinical services, as well as residential supports and services, and are primarily provided in community settings across the state. Largely because of intensive treatment needs, about 270 people continue to reside in institutional settings such as developmental centers. OPWDD services are provided to individuals with qualifying intellectual and/or development disabilities who meet eligibility criteria as defined in New York State law.
IDD members to be included in total cost of care IDD VBP arrangements receive OPWDD services funded by Medicaid. Support needs for IDD members and their families vary and conditions such as behavioral health or chronic physical health conditions may also be present and have an impact on lifetime health status. Regardless of the degree of support needed by any individual with developmental disabilities receiving services from OPWDD, the goal of OPWDD and its provider agencies is to maximize the capability of every individual to achieve personal goals, exercise choice, and live a full, meaningful life.
Services to be Included in the IDD VBP Arrangement
The IDD VBP arrangement is envisioned as a total cost of care arrangement. This type of arrangement is designed to maximize care coordination opportunities across multiple care "silos." The individual member forms the center of the arrangement and all the agencies and support services are arrayed around the individual. The total budget allows for maximum opportunity to respond to individual needs in flexible, creative ways and generate shared savings by streamlining services and developing more cost effective care options.
Total cost of care for IDD would include primary and acute care, as well as OPWDD specialty services such as supported employment, day services, residential supports, Home and Community Based Services (HCBS), and care coordination. Other services relevant to IDD members and families may be included as the arrangement evolves.
It is also important to note that Medicare is an important potential source of support for IDD members, as nearly half of members are dually eligible for Medicaid and Medicare. Efforts to align New York´s Medicaid VBP program with Medicare are underway, and will continue. For providers to fully realize the potential benefits of avoiding hospitalization and providing better primary care, Medicare participation is essential. In the meantime, however, the State will pursue the development of quality incentive initiatives to reward providers for generating savings that would otherwise accrue to Medicare.
Data limitations for dually eligible IDD members are also a factor, as Medicare data is not yet available in the Medicaid Data Warehouse (MDW). Although efforts are underway to link Medicare data in the MDW, total cost of care budget creation is hampered by the lack of claims data in the near term.
Member Attribution to the IDD VBP Arrangement
For the purposes of VBP, members are "attributed" to a provider group and a managed care plan. The cost of their care collectively then forms the basis for the creation of a VBP budget. Each member is attributed to only one arrangement, and for total cost of care "subpopulation" arrangements, designated members are not included in any other arrangements. The attribution assignment also helps to define which of the care partners will take primary responsibility for organizing or coordinating the care. In principle, the provider group that assumes attribution should also have control over the lion´s share of resources available to provide the necessary care and supports for the member. This helps to align the opportunity for shared savings with the primary contracting provider(s).
Although attribution logic was discussed briefly with the IDD VBP Advisory Group, no decisions were made about how to attribute members. Network development among providers was identified as a key area of concern.
In order to help develop the kinds of provider networks needed to support managed care and total cost of care VBP arrangements, OPWDD is working with the provider community to develop Care Coordination Organizations (CCOs). A primary goal of the CCOs will be to coordinate services across multiple service systems including medical, behavioral health, and long–term support services. In addition to a focus on holistic care, the CCOs will have added information technology capabilities to support pay for performance through value–based payments. CCOs are expected to become a logical nexus for member attribution; their exact role in VBP arrangements will be finalized as they evolve.
|top of section| |top of page|IDD VBP Arrangement Quality Measure Summary
IDD VBP Advisory Group
Quality Measure Discussion Summary
Over the course of four meetings the IDD VBP Advisory Group discussed how to appropriately measure quality for a total cost of care arrangement for members with IDD. One key area of focus for the group was on the potential for nontraditional measures to capture the unique aspects of OPWDD supports and services. Many of the supports and services provided by OWPDD fall outside the realm of healthcare. Clinical treatment and condition improvement measures are also not appropriate in many instances.
In order to identify the quality elements most valued among stakeholders, the group completed a brainstorming exercise. Each member was tasked with articulating a number of important indicators of quality to be upheld across the OPWDD system. The "frequency" of the occurrence of the various words among the lists was then charted. Not surprisingly, the most frequently used words were community, people, choice, relationships, employment, life, and staff. A graphic depiction – a "word cloud" – of the frequency of the words appears on the next page.
The measurement challenge is translating these values into tangible quality indicators while also capturing the important role that high quality traditional healthcare services play in the lives of individuals. One possible alternative source for person–centered measures for persons supported by OPWDD are Personal Outcome Measures®, or POMs.3 POMs focus on a person´s perception of the quality of his or her life, what he or she defines as important, and whether these preferences and goals have been achieved. POMs cover three domains with twenty–one individual measure. The three domains are: My Self, My World, and My Dreams. The My Self domain is captured with nine measures focusing on the individual´s personal identity, experiences, and choices. The My World domain is comprised of seven outcome measures. These explore where the individual works, lives, socializes, and belongs. The third domain, My Dreams, includes five measures that cover the individual´s goals and desires. (A full list of the POMS measures is provide in the Appendix.) The measures are collected through structured interviews by accredited, trained interviewers.
The POMs measures are developed and maintained by The Council on Quality and Leadership (CQL), a nonprofit organization dedicated to helping create "a world of dignity, opportunity, and community inclusion for all people".4 CQL is focused on defining, measuring, and improving the quality of life for older adults, people with disabilities, and people with mental illness and/or substance use disorders. CQL started as an accreditation council of the Joint Commission on Accreditation of Hospitals but now offers its own independent accreditations in quality assurance and person–centered excellence. POMS are fairly widely used by agencies in the OPWDD system and CQL has certified and trained many POMs interviewers in New York. However, the adoption of POMs is not mandatory for OPWDD agencies and additional feasibility studies would be needed in incorporating POMs or other outcome measures in the VBP structure.
In addition to the nontraditional POMs measures the Advisory Group also reviewed and discussed other measure sets in use in the IDD field. These included:
- 33 Medicare ACO measures;
- The quality framework submitted to CMS for the Fully Integrated Duals Advantage (FIDA) IDD demonstration;
- National Quality Forum (NQF); and
- OPWDD system–wide performance and agency measures.
Preventive care was identified as a high priority, as members with IDD may experience difficulty undergoing routine examinations and procedures. Yet these examinations and procedures are essential for maintaining good physical health. Behavioral health needs were also flagged as especially important. Hospitalization and over medication are more common for individuals with IDD, and particularly those with significant communication challenges. Hence the group recommended several medication reconciliation measures.
Although a complete list of recommended measures has not yet been finalized by the Advisory Group, a preliminary list of recommended measures is included in this report.
Figure 1: Results of the Group Exercise – A Word Cloud
The word cloud below is a visual presentation of qualitative data–words with greater prominence are words that were used more frequently in the written submissions from the Advisory Group.
Selecting Quality Measures: Criteria Used to Determine Relevance
The standard criteria for measure selection, used by all CAGs and not specific to I/DD, are presented below along with general examples.
|top of page|Clinical relevance
Focused on key outcomes of integrated care process
- Outcome measures (e.g., postpartum depression) are preferred over process measures (e.g., screening for postpartum depression);
- Outcomes of the total care process are preferred over outcomes of a single component of the care process (e.g., the quality of one type of professional´s care)
For process measures: crucial evidence–based steps in integrated care process that may not be reflected in the patient outcomes measured should be reflected (e.g., focus on postpartum contraceptive care is key but will not be captured in outcomes of current maternity episode).
Existing variability in performance and/or possibility for improvement (e.g., blood pressure measurement during pregnancy is unlikely to be lower than >95% throughout the State).
|top of page|Reliability and Validity
Measure is well established by reputable organization
By focusing on established measures – those collected by the. NYS Office of Patient Quality and Safety (OQPS), endorsed by the National Quality Forum (NQF), part of the Healthcare Effectiveness Data and Information Set (HEDIS) measures, for example – validity and reliability of measures are assumed acceptable.
Outcome measures are adequately risk–adjusted (e.g., measuring ´% preterm births´ without adequate risk adjustment makes it impossible to compare performance among providers).
|top of page|Feasibility
Claims–based measures are preferred over non–claims based measures (e.g. clinical data, surveys)
- Ease of data collection data is an important consideration and measures should not place undue burden on providers.
Existing sources are preferable when clinical data or surveys are required (e.g., the vital statistics repository based on birth certificates).
Patient–level data sources are preferable
- Measures that require random samples (e.g. sampling patient records or using surveys) are not ideal because they do not drill down to the patient level and/or allow for adequate risk adjustment, and may add to the data collection burden. An exception is made for measures that are already part of DSRIP/QARR.
Data must be available without significant delay
- In general, measure data sources should not have a longer lag than claims–based measures (about six months). This is an issue with the vital statistics repository, for example, which has a one–year lag for New York City data.
Meaningful and actionable to provider improvement in general
Measures should not only be related to the goals of care but be usable by the provider to improve care.
|top of page|Categorizing and Prioritizing Quality Measures
Based on the above criteria, the CAG discussed the quality measures in the framework of three categories:
- Category 1 – Category 1 comprises approved quality measures that are felt to be clinically relevant, reliable, valid, and feasible.
- Category 2 – Category 2 quality measures were felt to be clinically relevant, valid, and probably reliable, but the feasibility could be problematic. These quality measures will likely be investigated during pilots but will likely not be implementable in the immediate future.
- Category 3 – Category 3 measures were decided to be insufficiently relevant, valid, reliable, and/or feasible.
Conclusion
Members of the IDD VBP Advisory Group participated in a broad ranging discussion of the key values and quality opportunities within the OPWDD system, and developed a preliminary list of quality measures. As the transition to managed care for OPWDD services begins to gain momentum, the group will likely need to be reassembled to make final recommendations.
|top of page|Intellectually/Developmentally Disabled CAG Recommended Quality Measures – Category 1 and 2
It should be noted that the POMs measures included below reflect potential measures within the domains considered in the deliberations of the IDD VBP CAG to date in establishing priority outcomes for the OPWDD system. However, as OPWDD advances the use of outcome measures for VBP it may be necessary to substitute process measures to facilitate service providers´ adoption of the performance measure subsets ultimately decided upon in the finalization of the VBP framework.
| No. | Measure | Measure Steward/Source | |
|---|---|---|---|
| Category 1 | 1 | People Choose Where and With Whom they Live | POMs® |
| 2 | People Choose Where they Work | POMs® | |
| 3 | People Use their Environments ( has maximum access to each physical environment s/he frequents) | POMs® | |
| 4 | People Participate in the Life of the Community | POMs® | |
| 5 | People have the Best Possible Health | POMs® | |
| 6 | People Interact with Other Members of the Community | POMs® | |
| 7 | People Perform Different Social Roles | POMs® | |
| 8 | Annual Dental Visit (ADV) | NCQA | |
| 9 | Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up | CMS | |
| 10 | Proportion of Adults who had blood pressure screened in past 2 years | CMS | |
| 11 | Colorectal Cancer Screening | NCQA | |
| 12 | Diabetes Composite: Hemoglobin A1c Control (HbA1c) (<8 percent) | NCQA | |
| 13 | Statin Therapy for Patients With Cardiovascular Disease | NCQA | |
| 14 | Diabetes Composite: Blood Pressure (BP) < 140/90 | NCQA | |
| 15 | Diabetes Composite: Tobacco Non Use | NCQA | |
| 16 | Diabetes Composite: Aspirin Use | CMS | |
| 17 | Emergent Care for Improper Medication Administration or Medication Side Effects | CMS | |
| Category 2 | 18 | Antipsychotic Polypharmacy Monitoring of three or more agents | OPWDD – Under Development |
| 19 | Psychotropic polypharmacy Monitoring | OPWDD – Under Development |
CAG Categorization and Discussion of Measures – Category 1 & 2
| Topic | # | Quality Measure (* = NQF Endorsed) | Type of Measure | Measure Steward/ Source | Data Required | Quality Measure Categorization & Notes | ||
|---|---|---|---|---|---|---|---|---|
| Medicaid Claims Data | Clinical Data | Category | Notes | |||||
| POMs® | 1 | People choose where and with whom they live | Process | POMs® | No | Yes | 1 | This measure scores high on all criteria. |
| 2 | People choose where they work | Process | POMs® | No | Yes | 1 | This measure scores high on all criteria. | |
| 3 | People use their environments | Process | POMs® | No | Yes | 1 | This measure scores high on all criteria. | |
| 4 | People participate in the life of the community | Process | POMs® | No | Yes | 1 | This measure scores high on all criteria. | |
| 5 | People have the best possible health | Process | POMs® | No | Yes | 1 | This measure scores high on all criteria. | |
| 6 | People interact with other members of the community | Process | POMs® | No | Yes | 1 | This measure scores high on all criteria. | |
| 7 | People perform different social roles | Process | POMs® | No | Yes | 1 | This measure scores high on all criteria. | |
| Preventive Health | 8 | Annual Dental Visit (ADV) | Process | NCQA | Yes | Yes | 1 | This measure scores high on all criteria. |
| 9 | Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up | Process | CMS | Yes | Yes | 1 | This measure scores high on all criteria. | |
| 10 | Proportion of Adults who had blood pressure screened in past 2 years | Process | CMS | Yes | Yes | 1 | This measure scores high on all criteria. | |
| 11 | Colorectal Cancer Screening | Process | NCQA | Yes | Yes | 1 | This measure scores high on all criteria. | |
| Diabetes Composite | 12 | Hemoglobin A1c Control (HbA1c) (<8 percent) | Process | NCQA | Yes | Yes | 1 | The advisory group felt that a diabetes composite was a valuable quality measure framework. |
| 13 | Statin Therapy for Patients With Cardiovascular Disease | Process | NCQA | Yes | Yes | 1 | The advisory group felt that a diabetes composite was a valuable quality measure framework. | |
| 14 | Blood Pressure (BP) < 140/90 | Process | NCQA | Yes | Yes | 1 | The advisory group felt that a diabetes composite was a valuable quality measure framework. | |
| 15 | Tobacco Non Use | Process | NCQA | Yes | Yes | 1 | The advisory group felt that a diabetes composite was a valuable quality measure framework. | |
| 16 | Aspirin Use | Process | CMS | Yes | Yes | 1 | The advisory group felt that a diabetes composite was a valuable quality measure framework. | |
| Medication | 17 | Emergent Care for Improper Medication Administration or Medication Side Effects | Process | CMS | No | Yes | 1 | This measure scores high on all criteria. |
| 18 | Antipsychotic Polypharmacy Monitoring of three or more agents | OPWDD – Under Development | 2 | Will need to work with OPWDD to define numerator & denominator to be vetted during pilots. | ||||
| 19 | Psychotropic Polypharmacy Monitoring | OPWDD – Under Development | 2 | Will need to work with OPWDD to define numerator & denominator to be vetted during pilots. | ||||
Additional CAG Requested Measures
During the quality measure, selection discussion the CAG identified additional measurement domains to be reviewed for consideration in a VBP Pilot arrangement.
| Quality Measure (* = NQF Endorsed) | Measure Description | Type of Measure | Measure Steward/ Source | Data Required | Quality Measure Categorization & Notes | ||
|---|---|---|---|---|---|---|---|
| Medicaid Claims Data | Clinical Data | Category | Notes | ||||
| Medication Reconciliation | Measure would need development | ||||||
| Medication Reconciliation: Number of Unintentional Medication Discrepancies per Patient | This measure assesses the actual quality of the medication reconciliation process by identifying errors in admission and discharge medication orders due to problems with the medication reconciliation process. The target population is any hospitalized adult patient. The time frame is the hospitalization period. | Outcome | Brigham and Women´s Hospital | No | Yes | NQF # 2456 | |
| Medication Reconciliation Post–Discharge | The percentage of discharges for patients 18 years of age and older for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record by a prescribing practitioner, clinical pharmacist or registered nurse. | Process | NCQA | Yes | Yes | NQF # 0097 This measure could be adapted to the I/DD population in the pilot phase. | |
| Avoidable Hospitalization w/BH diagnosis | Measure would need development | ||||||
| Hospital–Wide All–Cause Unplanned Readmission Measure | The measure estimates a hospital–level risk–standardized readmission rate (RSRR) of unplanned, all–cause readmission after admission for any eligible condition within 30 days of hospital discharge. | Outcome | CMS | Yes | No | NQF # 1789 | |
| Care Coordination | Measures connectivity among servicing providers would need development | ||||||
CAG Categorization and Discussion of Measures – Category 3
The following quality measures were considered to be insufficiently relevant, valid, reliable, and/or feasible.
| Topic | # | Quality Measure (* = NQF Endorsed) | Type of Measure | Measure Steward/ Source | Data Required | Quality Measure Categorization & Notes | ||
|---|---|---|---|---|---|---|---|---|
| Medicaid Claims Data | Clinical Data | Category | Notes | |||||
| POMs® | 20 | People are connected to support networks | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. |
| 21 | People have intimate relationships | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 22 | People are safe | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 23 | People exercise rights | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 24 | People are treated fairly | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 25 | People are free from abuse and neglect | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 26 | People experience continuity and security | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 27 | People decide when to share personal information | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 28 | People choose personal goals | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 29 | People realize personal goals | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 30 | People have friends | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 31 | People are respected | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 32 | People live in integrated environments | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| 33 | People choose services | Process | POMs® | No | Yes | 3 | The advisory group selected a subset of POMs® that they felt correlated with better overall care. | |
| Avoidable Hospitalization | 34 | Acute Care Hospitalization | Outcome | CMS | Yes | No | 3 | The advisory group selected an Emergent Care measure and would like to look into a broad avoidable hospitalization measure |
| 35 | Emergency Department Use without Hospitalization | Outcome | CMS | No | Yes | 3 | The advisory group selected an Emergent Care measure and would like to look into a broad avoidable hospitalization measure | |
| 36 | Emergency Department Use with Hospitalization | Outcome | CMS | No | Yes | 3 | The advisory group selected an Emergent Care measure and would like to look into a broad avoidable hospitalization measure | |
| 37 | Potentially Avoidable Hospitalizations: Primary Diagnosis: respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection | Outcome | CMS/NYS DOH | Yes | No | 3 | The advisory group selected an Emergent Care measure and would like to look into a broad avoidable hospitalization measure | |
| Other At–Risk population measures | 38 | Percent of beneficiaries with hypertension whose BP < 140/90 | Process | CMS/NCQA | Yes | Yes | 3 | The advisory group selected a diabetes composite measure set. |
| 39 | Percent of beneficiaries with IVD with complete lipid profile and LDL control < 100mg/dl | Process | CMS/NCQA | Yes | Yes | 3 | The advisory group selected a diabetes composite measure set. | |
| 40 | Percent of beneficiaries with IVD who use Aspirin or other antithrombotic | Process | CMS/NCQA | Yes | Yes | 3 | The advisory group selected a diabetes composite measure set. | |
| 41 | Beta–Blocker Therapy for LVSD | Process | CMS/NCQA | Yes | Yes | 3 | The advisory group selected a diabetes composite measure set. | |
| 42 | ACE Inhibitor or ARB Therapy for Patients with CAD and Diabetes and/or LVSD | Process | CMS/NCQA | Yes | Yes | 3 | The advisory group selected a diabetes composite measure set. | |
| Medical | 43 | Development of Urinary Tract Infection | Outcome | CMS | No | Yes | 3 | |
| 44 | Increase in Number of Pressure Ulcers | Outcome | CMS | No | Yes | 3 | ||
| Dental | 45 | Oral Evaluation, Dental Services | Process | American Dental Association on behalf of the Dental Quality Alliance | Yes | No | 3 | The advisory group selected Annual Dental Visit (ADV) as the quality measure for dental care. |
| 46 | Children Who Have Dental Decay or Cavities | Process | The Child and Adolescent Health Measurement Initiative | Yes | No | 3 | The advisory group selected Annual Dental Visit (ADV) as the quality measure for dental care. | |
| 47 | Children Who Received Preventive Dental Care | Process | The Child and Adolescent Health Measurement Initiative | Yes | No | 3 | The advisory group selected Annual Dental Visit (ADV) as the quality measure for dental care. | |
| Seizures | 48 | Seizure Type(s) and Current Seizure Frequency(ies) | Process | American Academy of Neurology | Yes | No | 3 | The CAG determined this measure should be category 3. |
| Feeding/Choking | 49 | Improvement in Eating | Outcome | CMS | No | Yes | 3 | The CAG determined this measure should be category 3. |
| Preventive Health | 50 | Pneumococcal Vaccination | Process | CMS/NCQA | Yes | Yes | 3 | The CAG determined this measure should be category 3. |
| 51 | Tobacco Use Assessment and Cessation Intervention | Process | CMS | Yes | Yes | 3 | The CAG determined this measure should be category 3. | |
| 52 | Depression Screening | Process | CMS/NCQA | Yes | Yes | 3 | The CAG determined this measure should be category 3. | |
| Weight Control/BMI | 53 | Body Mass Index (BMI) in adults > 18 years of age | Process | City of New York Department of Health and Mental Hygiene | No | Yes | 3 | The CAG determined this measure should be category 3. |
| OB/GYN | 54 | Mammography Screening | Process | NCQA | Yes | Yes | 3 | The CAG determined this measure should be category 3. |
| 55 | Annual cervical cancer screening or follow– up in high–risk women | Process | Resolution Health, Inc. | Yes | Yes | 3 | The CAG determined this measure should be category 3. | |
| Medication | 56 | Drug Education On All Medications Provided To Patient/Caregiver | Process | CMS | No | Yes | 3 | The CAG determined this measure should be category 3. |
| 57 | Potential Medication Issues Identified And Timely Physician Contact | Process | CMS | No | Yes | 3 | The CAG determined this measure should be category 3. | |
| Care Coordination | 58 | Care Transition Record Transmitted to Health Care Professional | Process | AMA–PCPI | No | Yes | 3 | The CAG determined this measure should be category 3. |
| 59 | Real Time Hospital Admission Notifications | Process | CMS/State defined measure | No | Yes | 3 | The CAG determined this measure should be category 3. | |
| 60 | Risk stratification based on LTSS or other factors | Process | CMS/State defined measure | No | Yes | 3 | The CAG determined this measure should be category 3. | |
| 61 | Discharge follow –up | Process | CMS/State defined measure | No | Yes | 3 | The CAG determined this measure should be category 3. | |
| 62 | Long Term Care Overall Balance Measure | Process | State–specified measure | No | Yes | 3 | The CAG determined this measure should be category 3. | |
| 63 | Nursing Facility Diversion Measure | Process | CMS | No | Yes | 3 | The CAG determined this measure should be category 3. | |
| 64 | Long Term Care Rebalancing Measure | Process | State–specified measure | No | Yes | 3 | The CAG determined this measure should be category 3. | |
Appendix A:
Meeting Schedule
| Date | Agenda | |
|---|---|---|
| CAG #1 | January 21, 2016 | A. Intellectually/Developmentally Disabled VBP Advisory Group Overview
B. The Role of VBP in Achieving Quality, Cost Effective Care C. I/DD Services in Transition – The Transformation Agenda D. System Platforms – Total care, total population models E. Questions / Open Discussion |
| CAG #2 | March 23, 2016 | A. Review themes from first meeting
B. Introducing new themes C. Exercise: Reflections on Value D. Special considerations for measuring quality E. Previewing Quality Measures |
| CAG #3 | May 17, 2016 | A. VBP Overview
B. Group Exercise – Recap and Reflections C. I/DD VBP–––the larger picture D. Quality Measures E. The IDD–FIDA framework |
| CAG #4 | July 6, 2016 | A. CAG objectives review
B. Value opportunities/pathways discussion C. Quality Measure review & selection |
Appendix B:
Full List of CQL POMs
My Self | Who I am as a result of my unique heredity, life experiences and decisions.
- People are connected to natural support networks
- People have intimate relationships
- People are safe
- People have the best possible health
- People exercise rights
- People are treated fairly
- People are free from abuse and neglect
- People experience continuity and security
- People decide when to share personal information
My World | Where I work, live, socialize, belong or connect.
- People choose where and with whom they live
- People choose where they work
- People use their environments
- People live in integrated environments
- People interact with other members of the community
- People perform different social roles
- People choose services
My Dreams | How I want my life (self and world) to be.
- People choose personal goals
- People realize personal goals
- People participate in the life of the community
- People have friends
- People are respected
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1. The full report is available at https://opwdd.ny.gov/sites/default/files/documents/TransformationPanelReport-RaisingExpectationsChangingLives.pdf. 1
2. https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/vbp_roadmap_final.pdf 2
3. POMs are a version of the Patient Reported Outcome Measures, which are key outcome measures because they put the member´s perspective as a central information source to define outcomes of care. See the Roadmap. 3
4. http://www.thecouncil.org/about/cql–history 4
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