People Living With HIV/AIDS
Value Based Payment Quality Measure Set
Measurement Year 2023
- Measure Set is also available in Portable Document Format (PDF)
February 16, 2023 NYS Medicaid Value-Based Payment
INTRODUCTION
The Measurement Year (MY) 2023 People Living with HIV/AIDS (HIV/AIDs) Quality Measure Set was created in collaboration with the People Living with HIV/AIDS Quality of Care Clinical Advisory Committee (QAC), the Primary Care (Physical Health), and the Behavioral Health/HARP 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 Healthcare Effectiveness Data and Information Set® (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
Upon receiving recommendations from the QAC & CAGs, the release of guidelines from national measure stewards, such as the National Committee for Quality Assurance (NCQA)/HEDIS©, and in accordance with the NYS VBP Roadmap;2 the State defined a final list of measures to be included in the HIV/AIDs Measure Set for MY2023. For MY2023, thirty-five measures have remained unchanged, two measures were added, and four measures' reporting requirements/specifications were revised. This culminates in a total of forty-one Category 1 and 2 People Living with HIV/AIDS Quality Measures.
VBP ARRANGEMENT REQUIREMENTS FOR MY2023 - HEALTH EQUITY
In MY2022, NCQA added 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 required payers and providers to incorporate race and ethnicity measure stratification in Value-Based Payment (VBP) arrangements starting in July 2022. For MY2023 HEDIS® is adding eight additional measures.
Stratification Specifications:
- Payers are required to include at least one of the following measures in all level 1 or higher VBP contracts and stratify results by race and ethnicity categories as outlined in the HEDIS MY2023 specifications.3 The table below depicts available quality measures by arrangement type.
| NQCA Measure Name | Measure Inclusion by Arrangement Type | |||||
|---|---|---|---|---|---|---|
| TCGP | HARP/BH | Maternity | HIV/AIDs | Children's | ||
| Adult Immunization Status (AIS-E)* | ||||||
| Asthma Medication Ratio (AMR)* | ✓ | ✓ | ✓ | ✓ | ||
| Breast Cancer Screening (BCS-E)* | ✓ | ✓ | ✓ | |||
| Child and Adolescent Well-Care Visits (WCV) | ✓ | ✓ | ||||
| Colorectal Cancer Screening (COL; COL-E) | ✓ | ✓ | ✓ | |||
| Controlling High Blood Pressure (CBP) | ✓ | ✓ | ✓ | |||
| Follow-Up After Emergency Department Visit for Substance Use (FUA)* | ✓ | ✓ | ||||
| Hemoglobin A1c Control for Patients with Diabetes (HBD) | ✓ | ✓ | ✓ | |||
| Immunizations for Adolescents (IMA, IMA-E)* | ✓ | ✓ | ||||
| Initiation and Engagement of Substance Use Disorder Treatment (IET)* | ✓ | ✓ | ✓ | |||
| Pharmacotherapy for Opioid Use Disorder (POD)* | ✓ | ✓ | ||||
| Prenatal and Postpartum Care (PPC) | ✓ | ✓ | ||||
| Well-Child Visits in the First 30 Months of Life (W30)* | ✓ | ✓ | ||||
*Added for MY2023
- Stratification of selected measures will be classified as pay-for-reporting (P4R).
- Payers are required to include the following detail in the Provider Contract Statement and Certification form and Contract language:
- Indicate what measure(s) will be included for race and ethnicity stratification.
- Indicate how the stratified measure results for applicable measures will be shared with the VBP contractor.
- Plans are 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.
All new contracts submitted on or after July 1, 2022, must meet this requirement to be approved by NYS DOH. 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
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)).
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.5 At least one Category 1 P4P measure must be included in a VBP contract.
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 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 few years. Please refer to the 2023-2024 Value Based Payment Reporting Requirements Technical Specifications Manual (MY2023) 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 the agreement of clinical importance, validity, and reliability, but flagged as presenting concerns regarding implementation feasibility. The State has discussed measure testing approaches, data collection, and reporting requirements with VBP CAGs.
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, therefore Category 3 measures are not included in the measure set.
MY 2023 HIV/AIDS QUALITY MEASURE SET
The measures provided on the following pages are recommendations for MY2023. 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.
Category 1
The table below displays the Category 1 HIV/AIDS 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 State-recommended classification for measure use. The measure set is redlined to highlight changes made between MY2022 and MY2023. Additions are marked by red text while deletions are marked by a red strikethrough.
| HIV/AIDS Measure | 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 (AMM) | National Committee for Quality Assurance (NCQA) | NQF 0105 | P4P |
| Asthma Medication Ratio (AMR)^ | NCQA | NQF 1800 | P4P |
| Breast Cancer Screening (BSC-E)^* | NCQA | NQF 2372 | P4P |
| Cervical Cancer Screening (CCS; CCS-E)* | NCQA | NQF 0032 | P4P |
| Colorectal Cancer Screening (COL; COL-E)^ | NCQA | NQF 0034 | P4P |
| Controlling High Blood Pressure (CBP)^ | NCQA | NQF 0018 | P4P |
| COVID-19 Immunization Measure (CVS)* | NYS | P4P | |
| Depression Remission or Response for Adolescents and Adults (DRR-E) | NCQA | P4P | |
| Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) | NCQA | P4R | |
| Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) | NCQA | NQF 1932 | P4P |
| Eye Exam for Patients With Diabetes (EED) | NCQA | P4P | |
| Hemoglobin A1c Control for Patients With Diabetes (HBD)^ | NCQA | P4P | |
| HIV Viral Load Suppression (HVL-AD) | Health Resources and Services Adm (HRSA) | NQF 2082 | P4P |
| Initiation and Engagement of Substance Use Disorder Treatment (IET)^ | NCQA | NQF 0004 | P4P |
| Initiation of Pharmacotherapy upon New Episode of Opioid Dependence | NYS | – | P4P |
| Kidney Health Evaluation for Patients with Diabetes (KED) | NCQA | P4P | |
| Potentially Avoidable Complications in Patients with HIV/AIDS | Altarum Institute | – | P4R |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | CMS | NQF 0421 | P4R |
| Preventive Care and Screening: Influenza Immunization | NCQA | NQF 0041 | P4R |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | NCQA | NQF 0028 | P4R |
| Sexually Transmitted Infections: Screening for Chlamydia, Gonorrhea, and Syphilis | NYS | – | P4R |
| Social Need Screening and Intervention (SNS-E)* | NCQA | – | P4R |
| Statin Therapy for Patients with Cardiovascular Disease (SPC) | NCQA | – | P4R |
| Use of Pharmacotherapy for Alcohol Abuse or Dependence | NYS | – | P4R |
| Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) | NCQA | NQF 0577 | P4R |
Measure removed from HEDIS/NYS 2023 Measure Set
* New Measure for MY2023/Measure revised for 2023
^ HEDIS Stratified Measure – new for MY2023
* Measures' reporting specifications/requirements revised for MY2023
^ HEDIS Stratified Measure
Category 2
The table below displays the Category 2 People Living with HIV/AIDS Quality Measure Set and includes measure title, measure steward, and the NQF number (where applicable). All Category 2 measures are classified as P4R in MY2023. There are no CAT 2 changes between MY2022 and MY2023.
| Measure | Measure Steward | Measure Identifier |
|---|---|---|
| Asthma Action Plan | American Academy of Allergy, Asthma & Immunology (AAAAI) | – |
| Asthma: Assessment of Asthma Control – Ambulatory Care Setting | AAAAI | – |
| Asthma: Spirometry Evaluation | AAAAI | – |
| Continuing Engagement in Treatment Alcohol and Other Drug Dependence | NYS | – |
| Continuity of Care from Inpatient Detox to Lower Level of Care | NYS | – |
| Diabetes Screening | NYS | – |
| Hepatitis C Screening | HRSA | – |
| Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver (asthma) | TJC | NQF 0338 |
| Housing Status | HRSA | – |
| Linkage to HIV Medical Care | NYS | – |
| Continuity of Pharmacotherapy for Opioid Use Disorder | University of Southern California (USC) | NQF 3175 |
| Prescription of HIV Antiretroviral Therapy | HRSA | NQF 2083 |
| Sexual History Taking: Anal, Oral, and Genital (HIV/AIDS) | NYS | – |
| Substance Abuse Screening | HRSA | – |
| Pharmacotherapy for Opioid Use Disorder (POD) | NCQA | – |
Appendix A
The table below identifies the changes to the Category 1 and Category 2 measures for the MY2023 HIV/AIDS Quality Measure Set.
Category 1 & 2 Measure Changes from 2022 to 2023
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Asthma Medication Ratio (AMR) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures – New for MY2023 |
| Breast Cancer Screening (BCS-E) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures – New for MY2023 |
| Breast Cancer Screening (BCS-E) | Measure revised by NCQA for HEDIS MY2023 specifications | Electronic Clinical Data Systems (ECDS) reporting only. |
| Cervical Cancer Screening (CCS)(CCS-E) | Measure revised by NCQA for HEDIS MY2023 specifications | First year using ECDS |
| COVID-19 Immunization Measure (CVS) | New | Measure added to VBP list of CAT1 recommended measures |
| Initiation and Engagement of Substance Use Disorder Treatment (IET) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures – New for MY2023 |
| Social Need Screening and Intervention (SNS-E) | New | Measure added to NCQA list of required reporting. |
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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
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