Total Care for General Population (TCGP)

Value Based Payment Quality Measure Set
Measurement Year 2022

• Measure Set is also available in Portable Document Format (PDF)

December 30, 2021                     NYS Medicaid Value Based Payment

---

INTRODUCTION

The Measurement Year (MY) 2022 Total Care for General Population (TCGP) Quality Measure Set was created in collaboration with the Primary Care (Physical Health), Maternity Care, Behavioral Health/HARP, People Living with HIV, and Clinical Advisory Groups (CAGs), as well as the New York State Department of Health (NYS DOH) CAG Strategy team. The goal of this measure set is to align with measures put forth in the NYS Quality Assurance Reporting Requirements (QARR), the HEDIS®¹ Technical Specifications for Health Plans, the CMS Core measure set, and the Merit-based Incentive Payment System (MIPS), where applicable. The measure set is designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings.

---

MEASURE SELECTION AND FEASIBILITY

During the spring, summer, and fall of 2021, the Physical Health, Maternity Care, People Living with HIV/AIDS, Behavioral Health, and Children´s 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.

Upon receiving recommendations from the CAGs, the release of guidelines from national measure stewards, such as NCQA/HEDIS©, and in accordance with the NYS VBP Roadmap;² the State defined a final list of measures to be included in the TCGP Measure Set for MY2022.

Beginning in MY2020, to encourage a broader diversity of quality measures, appropriate to member populations being served by a TCGP arrangement, the State recommended all measures in the TCGP measure set be grouped into domains and added the following requirement to the VBP Roadmap.

Managed Care Organizations (MCOs) (excluding MLTC) that execute a TCGP VBP arrangement must base shared savings and risk distribution on quality measures that include at least one, Category 1 P4P measure from each of the following domains:

1. Primary Care
2. Mental Health
3. Substance Use Disorder
4. HIV/AIDS
5. Maternity
6. Children´s

TCGP VBP arrangements that exclude pregnant women, children, or persons living with HIV/AIDS are not required to include quality measures from these respective quality measure set domains. However, TCGP arrangements that carve out HARP members are still required to include quality measures from the primary care, mental health, and substance use disorder quality measure domains, in addition to the maternity, children, and HIV/AIDS domains if these latter populations are included.

These requirements carry through to TCGP Arrangements for MY2022. For MY2022, four measures have been removed/replaced, three measures have been added, and three measures´ specifications have changed, culminating in a total of 29 TCGP Category 1 measures.

---

PROPOSED VBP ARRANGEMENT REQUIREMENTS FOR MY2023 - HEALTH EQUITY

For MY2022, NCQA is adding race and ethnicity stratification for five HEDIS measures to help promote transparency into health plan performance. By doing so, NCQA hopes to better identify where disparities exist, so they can be addressed. They also hope to identify and learn from top performers in areas where disparities don´t exist. To align with this initiative, NYS will require payers and providers to incorporate race and ethnicity measure stratification in Value Based Payment (VBP) arrangements starting in July 2022.

Stratification Specifications:

1. Payers will be required to include at least one of the following measures in all level 1 or higher VBP arrangements and stratify results by race and ethnicity categories as outlined in the HEDIS MY2022 specifications.³ The table below depicts available quality measures by arrangement type.

NQCA Measure Name	Measure Inclusion by Arrangement Type
	TCGP	IPC	HARP/BH	Maternity	HIV/AIDs	Children´s
Colorectal Cancer Screening	✓	✓	✓		✓
Controlling High Blood Pressure	✓	✓	✓		✓
Hemoglobin A1c Control for Patients with Diabetes	✓	✓	✓		✓
Prenatal and Postpartum Care	✓			✓
Child and Adolescent Well–Care Visits	✓	✓				✓

2. Stratification of selected measures will be classified as pay-for-reporting (P4R).
3. Payers will be required to include the following detail in the Provider Contract Statement and Certification form and Contract language:
   1. Indicate what measure(s) will be included for race and ethnicity stratification.
   2. Indicate how the stratified measure results for applicable measures will be shared with the VBP contractor.
4. Plans will be required to include the race and ethnicity data to NYS using the following method:

Race and ethnicity fields will be added to the annual VBP member attribution submission file specifications. This will allow the State to stratify measure performance by race and ethnicity categories for applicable performance measures at the VBP contract and VBP Contractor levels.

The DOH recognizes that MCOs and providers are in the process of negotiating VBP arrangements to meet Statewide VBP goals. Therefore, all new contracts submitted on or after July 1, 2022, must meet this requirement. All other existing contracts must be updated at the end of the contract´s current measurement period and before the contract´s next measurement period begins, or no later than April 1, 2023.

---

MEASURE CLASSIFICATION

In previous years, measures have been designated by the State as Category 1, 2, or 3 with associated recommendations for implementation and testing for future use in VBP Arrangements.

For MY2022 the TCGP Measure Set consists only of Category 1 measures. The following measure domains were incorporated into the TCGP Measure Set for MY2022: Primary Care, Mental Health, Substance Use Disorder, HIV/AIDS, Maternity, and Children´s.

Category 1

Category 1 quality measures as identified by the CAGs and accepted and deemed reportable by the State are to be reported by VBP Contractors to the MCOs. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible.⁴

For MY2022 the TCGP Measure Set consists of 29 P4P measures, as defined below.

• 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 the quality of care delivered to members under a VBP contract. Incentives for reporting should be based on timeliness, accuracy, and completeness of data.

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 few years. Please refer to the Value Based Payment Reporting Requirements Technical Specifications Manual (MY2022) 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.

MY2022 QUALITY MEASURE SET

The measures provided on the following pages are recommendations for MY2022. 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 measure additions, deletions, recategorizations, and/or reclassifications from P4R to P4P or vice versa, based on experience with measure implementation in the prior year. Please see Appendix A for a full list of these changes. In 2022, the CAGs and the VBP Workgroup will re-evaluate measures and provide recommendations for MY2022.

Note: Additional changes have been made to the names for some of the measures presented below to ensure alignment with the naming conventions used by the official measure steward. There have not been any changes to the measure specifications associated with these name changes.

---

Category 1

The table below displays the Category 1 MY2022 TCGP Quality Measure Set, arranged alphabetically and includes measure title, measure steward, the National Quality Forum (NQF) number and/or another measure identifier (where applicable), and the measure classification. The measure set is redlined to highlight changes made between MY2020 and MY2022, please refer to the key at the end of this table for an explanation of redlined formatting.

TCGP Measure	Measure Steward	Measure Identifier	Classification
2022 TCGP Primary Care Domain You must choose at least 1 measure from the following domain to be included in the VBP Contract.
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder	CMS	NQF 1880	P4P
Antidepressant Medication Management - Effective Acute Phase Treatment & Effective Continuation Phase Treatment	NCQA	NQF 0105	P4P
Asthma Medication Ratio	NCQA	NQF 1800	P4P
Breast Cancer Screening	NCQA	NQF 2372	P4P
Cervical Cancer Screening	NCQA	NQF 0032	P4P
Chlamydia Screening in Women	NCQA	NQF 0033	P4P
Colorectal Cancer Screening**	NCQA	NQF 0034	P4P
Comprehensive Diabetes Care: Eye Exam (retinal) Performed*	NCQA	NQF 0055	P4P
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)*	NCQA	NQF 0059	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
Eye Exam for Patients with Diabetes^	NCQA	NQF 0055	P4P
Hemoglobin A1c Control for Patients with Diabetes^ **	NCQA	NQF 0059	P4P
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment*	NCQA	NQF 0004	P4P
Initiation and Engagement of Substance Use Disorder Treatment*	NCQA	NQF 0004	P4P
Kidney Health Evaluation for Patients with Diabetes (KED)	NCQA		P4P
2022 TCGP Mental Health Domain You must choose at least 1 measure from the following domain to be included in the VBP Contract.
Adherence to Antipsychotic Medications for Individuals with Schizophrenia	CMS	NQF 1879	P4P
Depression Remission or Response for Adolescents and Adults	NCQA		P4P
Follow-Up After Emergency Department Visit for Mental Illness	NCQA	NQF 2605	P4P
Follow-up After Hospitalization for Mental Illness	NCQA	NQF 0576	P4P
Potentially Preventable Mental Health Related Readmission Rate 30 Days	NYS		P4P
2022 TCGP Substance Use Domain You must choose at least 1 measure from the following domain to be included in the VBP Contract.
Follow–Up After Emergency Department Visit for Alcohol and Other Drug Dependence*	NCQA	NQF 2605	P4P
Follow–Up After Emergency Department Visit for Substance Use^	NCQA	NQF 3488	P4P
Follow-Up After High-Intensity Care for Substance Use Disorder	NCQA		P4P
Initiation of Pharmacotherapy upon New Episode of Opioid Dependence	NYS		P4P
Pharmacotherapy for Opioid Use Disorder	NCQA	NQF 3175	P4P
Unless you are excluding or carving out HIV+ individuals, pregnant women, and/or child members in your TCGP arrangement, you must choose at least one Category 1 P4P measure from each of the applicable domains below.
2022 TCGP HIV/AIDS Domain You must choose at least 1 measure from the following domain to be included in the VBP Contract, if including HIV+ individuals in the contract.
Viral Load Suppression	HRSA	NQF 2082	P4P
2022 TCGP Maternity Domain You must choose at least 1 measure from the following domain to be included in the VBP Contract, if including pregnant women in the contract.
Prenatal & Postpartum Care**	NCQA	NQF 1517 (lost endorsement)	P4P
2022 TCGP Children´s Domain You must choose at least 1 measure from the following domain to be included in the VBP Contract, if including children in the contract.
Asthma Admission Rate - PDI #14	AHRQ	NQF 0728	P4P
Child and Adolescent Well-Care Visits**	NCQA		P4P
Childhood Immunization Status – Combination 3	NCQA	NQF 0038	P4P
Immunizations for Adolescents – Combination 2	NCQA	NQF 1407	P4P
Well-Child Visits in the First 30 Months of Life	NCQA	NQF 1516	P4P

* Measure removed from HEDIS 2022 Measure Set
* Measure specifications/name revised by NCQA/NYS for 2022 HEDIS Measure set
^ Replacement HEDIS measure
** HEDIS Stratified Measure

---

Appendix A

---

The tables below identify the changes to the Category 1 measures for the MY2022 TCGP Quality Measure Set.

Category 1 Measure Changes from 2021 to 2022

Measure Name	Change	Rationale for Change
Comprehensive Diabetes Care: Eye Exam (retinal) Performed	Replaced	Measure name and specifications revised by NCQA for 2022 Measure set
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)	Replaced	Measure name and specifications revised by NCQA for 2022 Measure set
Eye Exam for Patients with Diabetes	Added	Measure added by NCQA for HEDIS MY2022 – replaced CDC measure
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence	Replaced	Measure name and specifications revised by NCQA for 2022 Measure set
Follow–Up After Emergency Department Visit for Substance Use	Added	Measure name and specifications revised by NCQA for 2022 Measure set
Hemoglobin A1c Control for Patients with Diabetes	Added	Measure added by NCQA for HEDIS MY2022 – replaced CDC measure
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment	Changed/Replaced	Measure name and specifications revised by NCQA for 2022 Measure set
Initiation and Engagement of Substance Use Disorder Treatment	Changed/Added	Measure added by NCQA for HEDIS MY2022 – replaced IET measure.

__________________________________________________________

<sup>1. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). 1
2. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value Based Payment: Annual Update, September 2019. (Link) 2
3. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). 3
4. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value Based Payment: Annual Update, September 2019. (Link) 4</sup>