Total Care for General Population (TCGP)
Value Based Payment Quality Measure Set
Measurement Year 2024
- Measure Set is also available in Portable Document Format (PDF)
February 2024 NYS Medicaid Value Based Payment
INTRODUCTION
The Measurement Year (MY) 2024 Total Care for General Population (TCGP) Quality Measure Set was created in collaboration with the Primary Care (Physical Health), Maternity Care, Behavioral Health/Health and Recovery Plans (HARP), People Living with HIV/AIDs, 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 Healthcare Effectiveness Data and Information Set® (HEDIS)1 Technical Specifications for Health Plans, the Centers for Medicare & Medicaid Services (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
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 Value Based Payment (VBP) Roadmap.
Managed Care Organizations (MCOs) (excluding Managed Long-Term Care) that execute a TCGP VBP arrangement must base shared savings and risk distribution on quality measures that include at least one, Pay-for-Performance (P4P) measure from each of the following domains:
- Primary Care
- Mental Health
- Substance Use Disorder
- HIV/AIDS
- Maternity
- 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.
VBP ARRANGEMENT REQUIREMENTS FOR MY2024 - HEALTH EQUITY
In MY2022, NCQA added race and ethnicity stratification for five HEDIS measures to help promote transparency in health plan performance; another eight were added for MY2023. 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, starting in July 2022, NYS requires payers and providers to incorporate race and ethnicity measure stratification in VBP arrangements. For MY2024, HEDIS added nine additional measures for race and ethnicity stratification, totaling 22 measures spanning numerous domains and VBP arrangement types.
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 MY2024 specifications.2
| 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) | ✓ | ✓ | ✓ | |||
| Cervical Cancer Screening (CCS; CCS-E)* | ✓ | ✓ | ✓ | |||
| Child and Adolescent Well–Care Visits (WCV) | ✓ | ✓ | ||||
| Childhood Immunization Status (CIS; CIS-E)* | ✓ | ✓ | ||||
| Colorectal Cancer Screening (COL-E) | ✓ | ✓ | ✓ | |||
| Controlling High Blood Pressure (CBP) | ✓ | ✓ | ✓ | |||
| Eye Exam for Patients with Diabetes (EED)* | ✓ | ✓ | ✓ | |||
| Follow-Up After Emergency Department Visit for Mental Illness (FUM)* | ✓ | ✓ | ✓ | |||
| Follow–Up After Emergency Department Visit for Substance Use (FUA) | ✓ | ✓ | ||||
| Follow-Up After Hospitalization for Mental Illness (FUH)* | ✓ | ✓ | ||||
| Glycemic Status Assessment for Patients with Diabetes (GSD) (Formerly Hemoglobin A1c - HBD) | ✓ | ✓ | ✓ | |||
| Immunizations for Adolescents - Combo 2 (IMA, IMA-E) | ✓ | ✓ | ||||
| Initiation and Engagement of Substance Use Disorder Treatment (IET) | ✓ | ✓ | ✓ | |||
| Kidney Health Evaluation for Patients with Diabetes (KED)* | ✓ | ✓ | ✓ | |||
| Pharmacotherapy for Opioid Use Disorder (POD) | ✓ | ✓ | ||||
| Postpartum Depression Screening and Follow-Up (PDS-E)* | ✓ | |||||
| Prenatal and Postpartum Care (PPC) | ✓ | ✓ | ||||
| Prenatal Depression Screening and Follow-Up (PND-E)* | ✓ | |||||
| Prenatal Immunization Status (PRS-E)* | ✓ | ✓ | ||||
| Well-Child Visits in the First 30 Months of Life (W30) | ✓ | ✓ | ||||
*Added for MY2024
Stratification Requirements:
- 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. As of April 1, 2023, all other existing contracts were to be updated/amended at the end of the contract's current measurement period and before the contract's next measurement period began.
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 MY2024 the TCGP Measure Set consists of 31 Category 1 measures. The following measure domains were incorporated into the TCGP Measure Set for MY2024: 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.3
For MY2024 the TCGP Measure Set consists of 33 P4P and 3 P4R measures, as defined below.
- P4P measures are intended to be used to determine shared savings amounts for which VBP Contractors are eligible. Measure performance can be considered 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 to report 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 2024 Value-Based Payment Reporting Requirements Technical Specifications Manual (MY2024) for details on which measures must be reported for the measurement year. This manual will be updated annually, in line with the release of the final VBP measure set for the subsequent year.
MY2024 QUALITY MEASURE SET
The measures provided on the following pages are recommendations for MY2024. 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.
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, MY2024 TCGP Quality Measure Set, arranged alphabetically within domains and includes the measure title, measure steward, and State-recommended measure classification. The measure set is redlined to highlight changes made between MY2023 and MY2024, please refer to the key at the end of this table for an explanation of redlined formatting.
| TCGP Measure | Measure Steward | Classification | |
|---|---|---|---|
| 2024 TCGP Primary Care Domain You must choose at least 1 measure from the following domain to be included in the VBP Contract. |
|||
| Adult Immunization Status - Electronic (Influenza)(AIS-E)* | NCQA | P4P | |
| Antidepressant Medication Management - Effective Acute Phase Treatment & Effective Continuation Phase Treatment (AMM)* | NCQA | P4P | |
| Asthma Medication Ratio (AMR) | NCQA | P4P | |
| Breast Cancer Screening (BCS-E)^ | NCQA | P4P | |
| Cervical Cancer Screening (CCS; CCS-E)^ | NCQA | P4P | |
| Chlamydia Screening in Women (CHL) | NCQA | P4P | |
| Colorectal Cancer Screening ( |
NCQA | P4P | |
| Controlling High Blood Pressure (CBP) | NCQA | P4P | |
| COVID-19 Immunization Measure (CVS)^ | NYS | P4P | |
| Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) | NCQA | P4P | |
| Eye Exam for Patients with Diabetes (EED)^ | NCQA | P4P | |
| NCQA | P4P | ||
| Initiation and Engagement of Substance Use Disorder Treatment (IET) | NCQA | P4P | |
| Kidney Health Evaluation for Patients with Diabetes (KED)^ | NCQA | P4P | |
| Social Need Screening and Intervention (SNS-E)^ | NCQA | ||
| 2024 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 (SAA) | CMS | P4P | |
| Depression Remission or Response for Adolescents and Adults (DRR-E) | NCQA | P4P | |
| Follow-Up After Emergency Department Visit for Mental Illness (FUM) | NCQA | P4P | |
| Follow-up After Hospitalization for Mental Illness (FUH) | NCQA | P4P | |
| Potentially Preventable Mental Health Related- Readmission Rate 30 Days (PPR-MH) | NYS | P4P | |
| 2024 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 Substance Use (FUA) | NCQA | P4P | |
| Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) | NCQA | P4P | |
| Initiation of Pharmacotherapy upon New Episode of Opioid Dependence (POD-N) | NYS | P4P | |
| Pharmacotherapy for Opioid Use Disorder (POD) | NCQA | 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. | |||
| 2024 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. |
|||
| HIV Viral Load Suppression (HIV-AD) | HRSA | P4P | |
| 2024 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 (PPC) | NCQA | P4P | |
| Prenatal Immunization Status (PRS-E)* | NCQA | P4P | |
| 2024 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. |
|||
| Child and Adolescent Well-Care Visits (WCV) | NCQA | P4P | |
| Childhood Immunization Status - Combination 3 (CIS; CIS-E) | NCQA | P4P | |
| Developmental Screening Using Standardized Tool, First Three Years of Life (DEV-N)*! | OHSU/NYS | P4R | |
| Immunizations for Adolescents - Combination 2 (IMA, IMA-E) | NCQA | P4P | |
| Oral Evaluation, Dental Services (OED)*! | NCQA | P4R | |
| Topical Fluoride for Children (TFC)*! | NCQA | P4R | |
| Well-Child Visits in the First 30 Months of Life (W30)^ | NCQA | P4P | |
*To Be Retired MY2025-MY2026Retired/Removed for MY2024
*New Measure MY2024
! New P4R measure, may be included in VBP contract, but does not meet P4P measure requirement by domain.
^Measure Revised for MY2024
Appendix A
The tables below identify the changes to the Category 1 measures for the MY2024 TCGP Quality Measure Set.
Category 1 Measure Changes from 2023 to 2024
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder | Steward no longer supports measure. | Measure removed |
| Adult Immunization Status - Electronic (Influenza)(AIS-E) | New | Measure added to VBP list of CAT1 recommended measures |
| Antidepressant Medication Management - Effective Acute Phase Treatment & Effective Continuation Phase Treatment (AMM) | Proposed Retirement | To be retired by NCQA in MY2025 |
| Asthma Admission Rate - PDI #14 | Measure removed | Steward no longer supports measure. |
| Breast Cancer Screening (BCS-E) | Measure reporting specifications revised by NCQA for HEDIS MY2024 | Implemented gender-inclusive language |
| Cervical Cancer Screening (CCS; CCS-E) | Measure reporting specifications revised by NCQA for HEDIS MY2024 | Implemented gender-inclusive language |
| Cervical Cancer Screening (CCS; CCS-E) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures - New for MY2024 |
| Childhood Immunization Status - Combination 3 (CIS; CIS-E) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures - New for MY2024 |
| Colorectal Cancer Screening ( |
Measure reporting specifications revised by NCQA for HEDIS MY2024 | ECDS Reporting only |
| COVID-19 Immunization Measure (CVS) | Measure reporting specifications revised by NYS for MY2024 | Refer to Quality Assurance Reporting Requirements (QARR) Technical Specifications for MY2024. |
| Developmental Screening Using Standardized Tool, First Three Years of Life (DEV-N) | New | Measure added to VBP list of CAT1 recommended measures |
| Eye Exam for Patients with Diabetes (EED) | Measure reporting specifications revised by NCQA for HEDIS MY2024 | Revised diabetes denominator |
| Eye Exam for Patients with Diabetes (EED) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures - New for MY2024 |
| Follow-Up After Emergency Department Visit for Mental Illness (FUM) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures - New for MY2024 |
| Follow-Up After Hospitalization for Mental Illness (FUH) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures - New for MY2024 |
| Hemoglobin A1c Control for Patients with Diabetes (HBD) | Name and specifications revised for MY2024, now: Glycemic Status Assessment for Patients with Diabetes (GSD)^ | Revised diabetes denominator; Inclusion of Glucose Management Indicator (GMI) |
| Kidney Health Evaluation for Patients with Diabetes (KED) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures - New for MY2024 |
| Oral Evaluation, Dental Services (OED) | New | Measure added to NCQA list of required reporting. |
| Prenatal Immunization Status (PRS-E) | New | Measure added to VBP list of CAT1 recommended measures |
| Prenatal Immunization Status (PRS-E) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures - New for MY2024 |
| Social Need Screening and Intervention (SNS-E) | Classification change | Second year measure; changed to P4P. |
| Topical Fluoride for Children (TFC) | New | Measure added to NCQA list of required reporting. |
| Well-Child Visits in the First 30 Months of Life (W30) | Measure specifications revised by NCQA for HEDIS MY2024 | Telehealth component remove |
__________________________________________________________
1. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).1
2. HEDIS® Measurement Year 2024 Volume 2 Technical Specification for Heath Plans, General Guidelines section 31. 2
3. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value-Based Payment: Annual Update, May 2022. (Link) 3
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