Maternity Care
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 Maternity Care Quality Measure Set was created in collaboration with the Maternity Care, the Primary Care (Physical Health), and the Children's Health 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, and the State’s Vital Statistics maternity care program. The Maternity measure set was designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings throughout the maternity care episode.
MEASURE SELECTION AND FEASIBILITY
Upon receiving recommendations from CAG's, the release of guidelines from national measure stewards, such as 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 Maternity Care Measure Set for MY2023. For MY2023, seveneen measures have remained unchanged, two measures' reporting requirements/specifications were revised and added three measures were added. This culminates in a total of twenty-two Category 1 and 2 Maternity Care 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
| 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, 2023, 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
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.4 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 Managed are Organizations (MCOs) to incentivize VBP Contractors for reporting data to monitor the 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 MCOs and VBP Contractors as part of the 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.
MY 2023 MATERNITY 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 MY2023 Maternity Care Quality Measure Set, arranged alphabetically and includes measure title, measure steward, the National Quality Forum (NQF) number (where applicable), and State-recommended classification for measure use. The measure set is redlined to highlight changes made between MY2022 and MY2023; please refer to the key at the end of these tables for an explanation of redlined formatting.
| Maternity Care Measures | Measure Steward | Measure Identifier | Classification |
|---|---|---|---|
| Contraceptive Care - Postpartum | United States Office of Population Affairs | NQF 2902 | P4R |
| COVID-19 Immunization Measure (CVS)* | NYS | P4P | |
| C-Section for Nulliparous Singleton Term Vertex | The Joint Commission (TJC) | NQF 0471 | P4R |
| Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) | NCQA | P4R | |
| Exclusive Breast Milk Feeding | TJC | NQF 0480 | P4R |
| Incidence of Episiotomy | Christiana Care Health System | NQF 0470 | P4R |
| Initiation and Engagement of Substance Use Disorder Treatment (IET)^ | NCQA | NQF 0004 | P4P |
| Low Birth Weight [Live births weighing less than 2,500 grams (preterm v. full-term)] | Agency for Healthcare Research and Quality (AHRQ) | NQF 0278 | P4R |
| Percentage of Preterm Births | NYS | – | P4R |
| Prenatal and Postpartum Care (PPC)^ | NCQA | NQF 1517 | P4P |
| Prenatal Immunization Status (PRS-E)* | NCQA | NQF 3484 | P4R |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | NCQA | NQF 0028 | P4R |
| Social Need Screening and Intervention (SNS-E)* | NCQA | 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 MY2023 Maternity Care Quality Measure Set and includes the measure title, measure steward, and the NQF number and/or another measure identifier (where applicable). All Category 2 measures are classified as P4R in MY2023. The measure set is redlined to highlight changes made between MY2022 and MY2023; please refer to the key at the end of this table for an explanation of redlined formatting.
| Measure | Measure Steward | Measure Identifier |
|---|---|---|
| Antenatal Steroids | TJC | NQF 0476 |
| Appropriate DVT Prophylaxis in Women Undergoing Cesarean Delivery | Hospital Corporation of America (HCA) | NQF 0473 |
| Experience of Mother with Pregnancy Care | – | – |
| Hepatitis B Vaccine Coverage Among All Live Newborn Infants Prior to Hospital or Birthing Facility Discharge | Centers for Disease Control (CDC) | NQF 0475 |
| Intrapartum Antibiotic Prophylaxis for Group B Streptococcus | Massachusetts General Hospital | NQF 1746 |
| Prenatal Depression Screening and Follow-Up | NCQA | – |
| Postpartum Blood Pressure Monitoring | Texas Maternity Bundle | – |
| Postpartum Depression Screening and Follow-Up | NCQA | – |
| Vaginal Births after Cesarean Section | NYS | – |
Appendix A
The tables below identify the changes to the Category 1 measures for the MY2023 Maternity Care Quality Measure Set. Tere were no changes to the Category 2 measures.
Category 1 Measure Changes from 2022 to 2023
| Measure Name | Change | Rationale for Change |
|---|---|---|
| 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. |
| Prenatal Immunization Status (PRS-E) | New | Measure added to VBP list of CAT1 recommended measures |
| Social Need Screening and Intervention (SNS-E) | New | Measure added to NCQA list of required reporting – New for MY2023. |
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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, May 2022. (Link) 2
3. HEDIS® Measurement Year 2023 Volume 2 Technical Specification for Heath Plans, General Guidelines section 33.3
4. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value-Based Payment: Annual Update, May 2022. (Link) 4
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