Total Care for General Population (TCGP)/Integrated Primary Care (IPC)
Value Based Payment Quality Measure Set
Measurement Year 2018
- Measure Set is also available in Portable Document Format (PDF)
October 31, 2017 NYS Medicaid Value Based Payment
INTRODUCTION
The 2018 Total Care for General Population (TCGP)/ 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. The goal is to align with measures sets put forth for the Advanced Primary Care initiative by the Integrated Care Workgroup, the Delivery System Reform Incentive Payment (DSRIP) Program, and for the Quality Assurance Reporting Requirements (QARR). The Measure Set is intended to be the same for both TCGP and IPC Arrangements for Measurement Year (MY) 2018 and was designed to encourage providers to meet high standards of patient–centered clinical care and coordination across multiple settings through preventive care, sick care, and priority chronic condition episodes.
Introduction of Pediatric Measures
The Children´s Health CAG was convened in 2016–2017 and presented its final recommendations to the VBP Workgroup in October of 2017. Based on these recommendations, an additional 14 pediatric measures (8 Category 1 and 6 Category 2 measures) were added to the TCGP/ IPC Measure Set for MY 2018.
MEASURE SELECTION AND FEASIBILITY
During the summer of 2017, the Diabetes, Chronic Heart Disease, Pulmonary, and Behavioral Health CAGs reconvened and made recommendations to the State on quality measures, data collection, data reporting, and support required for providers to be successful in a VBP environment.
Beginning in June of 2017, the State initiated monthly meetings of the VBP Measure Support Task Force and arrangement–level Sub–teams. The goal of the Task Force and Sub–teams is to make recommendations to the State to support and inform the Annual Measure Review Cycle. Members of the Task Force include professionals from various Managed Care Organizations (MCOs), VBP Pilot Contractors, clinical Subject Matter Experts, and State Agencies, along with other professionals who have experience in quality measurement and health information technology. The Task Force provided feedback to DOH on quality measure feasibility, reporting, and calculation.
Upon receiving the CAG recommendations and Task Force feedback, the State defined a final list of measures for inclusion for MY 2018.
MEASURE CLASSIFICATION
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. The measures below are 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)).
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 2018 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.
Not all Category 1 measures will be reportable for the measurement year, as reporting on some of these measures will be phased in over the next 2 years. Please see the 2018 Value Based Payment Reporting Requirements Technical Specifications Manual 2 for details as to which measures must be reported for the measurement year. This manual will be updated annually each fall, in line with the release of the final VBP measure set for the subsequent year.
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 one Category 2 measure per VBP Arrangement for MY 2018 (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 approaches, data collection, and reporting requirements with VBP Pilots as a part of the Measure Support Task Force.
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 an arrangement.
MEASUREMENT YEAR 2018 QUALITY MEASURE SET
The measures and State–determined classifications provided on the following pages are recommendations for MY 2018. 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 2018, the CAGs and the VBP Workgroup will re–evaluate measures and provide recommendations for MY 2019.
Category 1
The table below displays the Category 1 TCGP/ IPC Quality 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–recommended classification for measure use. The measure set is redlined to highlight changes made between MY 2017 and MY 2018. Additions are made in red text while deletions or changes are made with a strikethrough.
| 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 |
| Adolescent Preventive Care– Assessment and Counseling of Adolescents on Sexual Activity, Tobacco Use, Alcohol and Drug Use, Depression | NYS | – | P4R |
| Adolescent Well–Care Visits | NCQA | – | P4R |
| Annual Dental Visit | NCQA | – | P4R |
| Antidepressant Medication Management – Effective Acute Phase Treatment & Effective Continuation Phase Treatment | NCQA | NQF 0105 | P4P |
| Breast Cancer Screening | NCQA | NQF 2372 | P4P |
| Cervical Cancer Screening | NCQA | NQF 0032 | P4P |
| Childhood Immunization Status– Combination 3 | NCQA | NQF 0038 | P4P |
| Chlamydia Screening In 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 |
| Follow–Up Care for Children Prescribed ADHD Medication | NCQA | NQF 0108 | P4R |
| Immunizations for Adolescents, Combination 2 |
National Committee for Quality Assurance (NCQA) | NQF 1407 | P4P |
| Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) | NCQA | NQF 0004 | P4P |
| – | |||
| Initiation of Pharmacotherapy upon New Episode of Opioid Dependence4 | NYS | – | P4P |
| Medication Management for People with Asthma (ages 5 – 64) – 50% and 75% of Treatment Days Covered | NCQA | NQF 1799 | P4P |
| Pediatric Quality Indicator (PDI) #14 Asthma Admission Rate, Ages 2 Through 17 Years | Agency for Healthcare Research and Quality (AHRQ) | NQF 0728 | 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 Alcohol Abuse or Dependence Pharmacotherapy5 | NYS | – | 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 |
| Well–Child Visits in the First 15 Months of Life | NCQA | NQF 1392 | P4P |
| Well–Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life | NCQA | NQF 1516 | P4P |
Category 2
The table below displays the Category 2 TCGP/ IPC Quality 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 2018. The measure set is redlined to highlight changes made between MY 2017 and MY 2018. Additions are made in red text while deletions or changes are made with a strikethrough.
| Measure | Measure Steward | Measure Identifier |
|---|---|---|
| Asthma: Assessment of Asthma Control – Ambulatory Care Setting | The American Academy of Allergy, Asthma & Immunology (AAAAI) | – |
| Continuing Engagement in Treatment (CET) Alcohol and Other Drug Dependence | NYS OASAS | – |
| Continuity of Care from Inpatient Detox to Lower Level of Care6 | NYS | – |
| Continuity of Care from Inpatient Rehabilitation to Lower Level of Care7 | NYS | – |
| Developmental Screening Using Standardized Tool, First 36 Months of Life | Oregon Health & Science University | NQF 1448 |
| Follow–Up After ED Visit for Alcohol and Other Drug Dependence, Ages 13 and Older | NCQA | – |
| Follow–Up After ED Visit for Mental Illness, Ages 6 and Older | NCQA | – |
| Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver | The Joint Commission | NQF 0338 |
| Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse or Dependence8 | NYS | – |
| Lung Function/Spirometry Evaluation (Asthma) | AAAAI | – |
| Maternal Depression Screen Done During Child´s First 6 Months of Life | NCQA | – |
| Patient Self–Management and Action Plan (Asthma) | AAAAI | – |
| Screening for Reduced Visual Acuity and Referral in Children (Approved for trial use) | CMS | NQF 2721 |
| Topical Fluoride for Children at Elevated Caries Risk, Dental Services | American Dental Association (ADA) | NQF 2528 |
| Use of First–Line Psychosocial Care for Children and Adolescents on Antipsychotics | NCQA | NQF 2801 |
| Use of Opioid Dependence Pharmacotherapy10 | NYS | – |
Appendix A
Updated Measure Name Crosswalk
The following table shows the measure names that were updated for MY 2018.
| Measure Name in MY 2018 | Measure Name in MY 2017 |
|---|---|
| Two measures: Continuity of Care from Inpatient Rehabilitation to Lower Level of Care & Continuity of Care from Inpatient Detox to Lower Level of Care | Continuity of Care from Inpatient Detox or Inpatient Care to Lower Level of Care |
| Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse or Dependence | Initiation of Pharmacotherapy for Alcohol Dependence |
| Initiation of Pharmacotherapy upon New Episode of Opioid Dependence | Initiation of Pharmacotherapy for Opioid Use Disorder |
| Use of Alcohol Abuse or Dependence Pharmacotherapy | Utilization of Pharmacotherapy for Alcohol Dependence |
| Use of Opioid Dependence Pharmacotherapy | Utilization of Pharmacotherapy for Opioid Use Disorder |
Appendix B
The tables below provide the changes to the Category 1 and Category 2 measures for the MY 2018 TCGP/ IPC Quality Measure Set.
Category 1 Measure Changes from 2017 to 2018
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Adolescent Well–Care visits | Added | Recommended by Children´s Health CAG |
| Adolescent Preventive Care– Assessment and counseling of adolescents on sexual activity, tobacco use, alcohol and drug use, depression (four–part measure) | Added | Recommended by Children´s Health CAG |
| Annual Dental Visit | Added | Recommended by Children´s Health CAG |
| Follow–up Care for Children Prescribed ADHD Medication (NQF 0108): | Added | Recommended by Children´s Health CAG |
| Immunizations for Adolescents– Combination 2 (NQF 1407) | Added | Recommended by Children´s Health CAG |
| Initiation of Pharmacotherapy for Alcohol Dependence | Moved to Category 2 | Measure moved to Category 2 because timeframe for measurement is too narrow |
| PDI #14 Asthma Admission Rate, ages 2 through 17 years | Added | Recommended by Children´s Health CAG |
| Well–Child Visits in the First 15 Months of Life (NQF 1516) | Added | Recommended by Children´s Health CAG |
| Well–Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life (NQF 1392) | Added | Recommended by Children´s Health CAG |
Category 2 Measure Changes from 2017 to 2018
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis | Moved to Category 3 | Removed due to measure specification change |
| Developmental Screening In the First Three Years of Life (NQF 1448) | Added | Recommended by Children´s Health CAG |
| Follow–up after ED visit for alcohol and other drug dependence | Added | Recommended by Children´s Health CAG |
| Follow–up after ED visit for mental illness | Added | Recommended by Children´s Health CAG |
| Maternal depression screen done during child´s first 6 months of life | Added | Recommended by Children´s Health CAG |
| Screening for Reduced Visual Acuity and Referral in Children (NQF 2721—approved for trial use) | Added | Recommended by Children´s Health CAG |
| Use of first–line psychosocial care for children and adolescents on antipsychotics | Added | Recommended by Children´s Health CAG |
| Use of Imaging Studies for Low Back Pain | Moved to Category 3 | Removed due to measure specification change |
| Utilization of Pharmacotherapy for Alcohol Dependence | Moved to Category 1 | Measure promoted to Category 1 because timeframe for measurement is sufficiently broad |
__________________________________________________________
1. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value Based Payment: Annual Update, June 2016. (Link) 1
2. 2018 Value Based Payment Reporting Requirements; Technical Specifications Manual, Nov 2017, File found in the Quality Measures tab (Link) 2
3. Measure moved to Category 2. 3
4. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document. 4
5. Measure moved to Category 1 from Category 2. 5
6. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document. This measure is a component of a measure that was split into two separate measures for MY 2018. 6
7. Ibid. 7
8. Measure moved from Category 1. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document. 8
9. Measure moved to Category 1. 9
10. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document. 10
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