OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership...

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OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019 Presenter: Tamika R. Black, PhD Division of Data Management and Strategy

Transcript of OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership...

Page 1: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

OPWDD Value-Based Destination

NY Alliance Leadership ConferenceDecember 6, 2019

Presenter: Tamika R. Black, PhDDivision of Data Management and Strategy

Page 2: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Value-Based Payment Overview• Value-based payments (VBP) reward health

care and service providers with incentive payments for the quality of care delivered

• The goals of VBP align with the Quadruple Aim• VBP is a payment model that incentivizes

integrated care and rewards providers and plans when quality targets are met or exceeded– Pays for enhanced patient care coordination– Pays for managing the cost of care and

reducing inefficiencies– Pays for the use of evidence-based clinical

practices

Quadruple AimManaging Cost

of Care

Reduce Provider Burden

Improve Quality of Care

Improve Outcomes

Page 3: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

VBP Roadmap for I/DD Services and Populations

• The VBP Roadmap indicates that VBP arrangements for I/DD populations are still in development

• To assist with this development, OPWDD and the NYSDOH have engaged a Clinical Advisory Group and stakeholders to:• Assist in defining the “value proposition” for VBP for I/DD services

• Promote future stability in a VBP environment

• Establish feedback loop with stakeholders to identify the best quality measures and Health Information Technology (HIT) that promote interoperability for VBP

• Advance a Roadmap unique to the I/DD community that addresses expansion of access and coverage for enrollees and builds capacity for providers to participate in VBP arrangements

Page 4: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Medicaid Payment Reform: Moving Towards VBPVBP Goal: MCOs required to begin implementing VBP Contracting with providers

VBP Goal: 80% of MCO’s provider payments in VBP

VBP Roadmap: Five-Year plan for Medicaid Payment Reform

Clinical Advisory Groups (CAGs) • I/DD CAG met in 2016

I/DD CAGs

VBP Bootcamps

I/DD Health Home (I/DD HH) Implementation

VBP Pilots

2016 2017 2018 2019 2020

Page 5: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

OPWDD Goals for System Transformation

People live and receive services in the most

integrated setting

People have community participation

experiences that are meaningful to them

People have meaningful

relationships with friends, family and

others that are important to them

People experience personal health, safety

and growth opportunities

People exercise choice and decision making in their life and with their daily schedule to the

extent possible

Page 6: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Key Components of a VBP Arrangement

Who and What is Covered?

Which Providers are Responsible? What is Measured? What Risk Do

Providers Assume?What HIT is needed

for VBP?• The members (patients)

covered by a VBP Arrangement

• The services included or excluded in a VBP Arrangement

• The members included (attributed) in a VBP Arrangement

• Quality and outcome measures for each kind VBP Arrangement

• Providers move to risk-based contracting (upside or downside risk) for the cost and quality of care for attributed populations

• Data and systems needed to deliver care, measure performance, and assume risk for services provided to people with I/DD

Quality Measures

Attribution HITBenefit Design

Risk

Page 7: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Initiatives Supporting VBP Readiness

Enhancing I/DD Health

Homes

I/DD CAG Quality

Measure Evaluation

Evaluating the FIDA-IDD Experience

Page 8: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

I/DD Clinical Advisory Group (CAG) Scope of Work for 2019 and Beyond

• 2 year commitment• DOH will use feedback from I/DD

CAG but has ultimate authority to select measures and reporting requirements for VBP

• Clinical expertise and industry knowledge of I/DD services and populations

• Geographic diversity • Total care spectrum experience

for the I/DD population

• Attend and actively participate in scheduled CAG workgroup meetings

• Designate an additional individual to act as an alternate

• Present recommendations to the Joint Advisory Council (JAC) prior to the submission of any recommendations to the DOH

• Build upon the work of the 2016 I/DD CAGs

• Review key considerations related to quality measurement from the VBP Roadmap

• Make recommendations and provide feedback for quality measures for I/DD populations

Membership Selection

Roles & Responsibilities

CAG Objective

Scope of Membership

Page 9: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Quality Measures for I/DD VBP Arrangements

The I/DD CAG will focus on the role of quality in a VBP Arrangement by:

• Analyzing potential data sources for I/DD quality measures

• Identifying and reviewing existing quality measures that are appropriate for individuals with I/DD

• Assisting in the prioritization of quality measures that can be incorporated into OPWDD’s delivery system and used for I/DD VBP Arrangements

Page 10: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Domains for HCBS• The National Quality Forum (NQF)

has also been collaborating with multiple organizations to identify additional domains of quality that can be used to measure HCBS

• Many of these measure domains could be used to support I/DD specific quality measures

Domain Examples

NQF HCBS Domains

Choice and Control

Human and Legal Rights

Community Inclusion

WorkforceEquity

Caregiver Support

• Additional work is needed to finalize measure specifications and expand their use for I/DD managed care and VBP

Source: NQF, Quality in Home and Community-Based Services to Support Community Living: Addressing Gaps in Performance Measurement, 2016. Available at: https://www.qualityforum.org/Publications/2016/09/Quality_in_Home_and_Community-Based_Services_to_Support_Community_Living__Addressing_Gaps_in_Performance_Measurement.aspx

Page 11: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

2016 I/DD CAG Report: Quality MeasuresI/DD Measures

The Council on Quality and Leadership (CQL) Personal Outcome Measures (POMs®)

People Choose Where and With Whom they Live

People Choose Where they Work

People Use their Environments

People Participate in the Life of the Community

People have the Best Possible Health

People Interact with Other Members of the Community

People Perform Different Social Roles

Clinical Measures

Centers for Medicare &

Medicaid Services (CMS)

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

Proportion of Adults who had blood pressure screened in past 2 years

Diabetes Composite: Aspirin Use

Emergent Care for Improper Medication Administration or Medication Side Effects

National Committee for Quality Assurance

(NCQA)

Annual Dental Visit (ADV)

Colorectal Cancer Screening

Diabetes Composite: Hemoglobin A1c Control (HbA1c) (<8.0%)

Statin Therapy for Patients With Cardiovascular Disease

Diabetes Composite: Blood Pressure (BP) <140/90

Diabetes Composite: Tobacco Non-Use

Page 12: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Quality Measure Domains (2019)• There are multiple domains of quality measurement:

Source: Agency for Healthcare Research and Quality (AHRQ), Types of Health Care Quality Measures. Available at: https://www.ahrq.gov/talkingquality/measures/types.html

Measure Domain Description Required Data Types Example Measures Sets

Access to CareAssesses timely and appropriate health care access for individuals with I/DD.

• Claims data and encounter data• Life Plan data• Eligibility and enrollment data

• NCQA HEDIS

Effectiveness of CareAssesses provision of evidence-based care to ensure proper use of services for individuals with I/DD

• Claims data• Eligibility and enrollment data • NCQA HEDIS

Care ManagementAssesses the coordination of services and care reflective of the person-centered care planning process.

• Claims data and encounter data• Life Plan data• Care management data

• I/DD HH measures

Experience or Perception of Care

Assesses individuals’ with I/DD experience and attitudes about the services and care they receive.

• Survey data• AHRQ CAHPS• CQL POMs• NCI Core Indicators

Administrative and Programmatic

Assesses or evaluates quality performance of health care programs • Program evaluation data • 1915(c) Waiver reporting

Page 13: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Social Determinants of HealthCommunity

Inclusion and Relationships

Employment

Housing Stability

Access to Health Care/ Primary Care

Food Security

TransportationFocus on improved outcomes for people

Page 14: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

I/DD CAG 2020 Roadmap

Q1 2020 Q2 2020 Q3 2020 Q4 2020

Final measure evaluation criteria

Chronic conditions or health problems for I/DD

Identify existing measure sets that may address chronic conditions or health problems for I/DD

Prioritization based on feasibility

Environmental scan of other states’ use of quality measure sets

Other operational considerations

Covered services and benefits

Analysis of existing measure sets using evaluation criteria

Review of completed work and recommended measure sets

Discuss annual cycle for reviewing recommended measure sets

Review I/DD CAG scope of work for future meetings

I/DD CAG Meeting #1Select measure evaluation criteria.

I/DD CAG Meeting #2Apply evaluation criteria

I/DD CAG Meeting #4Finalize recommendations

I/DD CAG Meeting #3Prioritize quality measures

Page 15: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Enhancing Capacity for I/DD Health Homes• OPWDD/DOH conduct technical assistance reviews

and designation reviews to ensure Health Homes are providing quality care

Technical Assistance

• OPWDD monitors the performance of CCO Health Homes on key process metrics.

I/DD Health Home Dashboards

• CCOs will share key data elements from finalized Life Plans with OPWDD to assist in the monitoring of Life Plan quality, including the calculation of the I/DD specific health home measures.

Life Plan Data System

Enhancing I/DD Health

Homes

Page 16: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Enabling Readiness through MC-COP

• The Managed Care Community of Practice in I/DD (MC-COP) conducts technical assistance webinars to I/DD providers on managed care laws and regulations, compliance and quality, financing, and infrastructureTechnical Assistance

Webinars

• Regional, in-person training events offer technical assistance on additional topics including contracting and credentialing, finance and billing, claims testing, utilization management, and provider readinessIn-Person Learning

Collaboratives

• MC-COP’s Managed Care Organizational Self-Assessment (MC OSA) assists I/DD providers with assessing their readiness for managed care across 11 domains of processes, practices, and activitiesOrganizational Self-

Assessment

Page 17: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Evaluating Managed Care for I/DD

• OPWDD and PHP collaborate on an ongoing basis to discuss operational considerations and other key elements for serving dually eligible individuals with I/DD through managed careOPWDD and PHP

Collaboration

• PHP is part of the I/DD CAG and has shared their quality measure experience and insight with other CAG members and OPWDD

• Both New York State and CMS are evaluating the outcomes of the FIDA-IDD Demonstration to determine the feasibility of scaling the program

I/DD CAG Participation

Evaluating the FIDA-IDD Experience

Page 18: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Value-based Destination: Building I/DD Provider Capacity

What covered services and care should be measured and what systems and data can be used to measure it?

Quality Measures

Build the HIT to deliver care, assume risk, and measure quality

Supporting HIT

Determine the type and amount of risk providers assume for I/DD VBP Arrangements

Risk

Identify the I/DD Populations and Services in VBP

Benefit Design

Attribution

Determine which providers are accountable for the cost and quality of care for individuals with I/DD

Page 19: OPWDD Value-Based Destination - StarChapter · OPWDD Value-Based Destination NY Alliance Leadership Conference December 6, 2019. Presenter: Tamika R. Black, PhD. Division of Data

Questions?