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Sample - Integrated Healthcare Association · If your PO had fewer than 1,500 member years with the...
1
Integrated Healthcare Association (9999999) Gate Threshold Your Results Quality 6 Total Cost of Care (TCC) Trend 4 3.0% MY 2016 Result 1 MY 2015 Result 1 Change in Rate Normalized Expected Rate 6 (MY 2015) Denominator Denominator Units Resource Use Saved/ (Increased) Cost per Resource Use Estimated Savings/ (Additional Cost) b c d = ∆(b,c) e f g h = d*e*f i j=h*i All-Cause Readmissions (PCR) 0.00 Admissions 0.0 $14,000.00 $0.00 Inpatient Bed Days (IPBD) 0.00 NA 1,000 Member Years 0.0 $4,000.00 $0.00 Emergency Department Visits (EDV) 0.00 NA 1,000 Member Years 0.0 $750.00 $0.00 Outpatient Procedures in Pref. Facility (OSU) 0.00 NA O/P procedures 0.0 $1,500.00 $0.00 Generic Prescribing (GRX) - Overall 0.00 NA # Prescriptions 0.0 $70.00 $0.00 LEGEND $0 No $0 0 MY 2016 Result 1 MY 2016 Attainment Benchmark MY 2016 Attainment Threshold MY 2015 Result 1 MY 2015 Attainment Benchmark MY 2015 Attainment Threshold Attainment Reached? (Y-Threshold; Y- Benchmark; No) Incentive ($ PMPY) y x w v u t s r All-Cause Readmissions (PCR) 7.23 No $0.00 Inpatient Bed Days (IPBD) 84.40 No $0.00 Emergency Department Visits (EDV) 139.31 No $0.00 Outpatient Procedures in Pref. Facility (OSU) TBD NA NA Generic Prescribing (GRX) - Overall 86.65 No $0.00 - $ 0 All-Cause Readmissions (PCR) $1.03 $0.34 - $ Inpatient Bed Days (IPBD) $10.14 $3.38 Emergency Department Visits (EDV) $3.14 $1.05 0 Outpatient Procedures in Pref. Facility (OSU) NA NA 0.00 Generic Prescribing (GRX) - Overall $2.29 $0.76 -1.00 $0 Value Score for Full-Risk POs Cost Multiplier Calculation 0.00 MY 2015 TCC 345 TCC_GEO_RISK_ADJ Cost Multiplier* Footnotes 1 2 3 4 5 6 7 8 Measures a Attainement Benchmark Incentive ($ PMPY) Attainment Treshold Incentive ($ PMPY) Measures Pass (Y/N) ? Value Based P4P Incentive Worksheet - Measurement Year 2016 IHA Plan Value Based P4P Incentive Design for Shared Risk POs Performance Gates Measure No QCS Available TCC Trend with 85% CI No TCC Trend Available Quality Multiplier Shared Savings based on Appropriate Resource Use Measures Total Cost of Care (TCC) Amount MY2015 TCC ($PMPY) 90th Percentile MY2016 TCC ($PMPY) No TCC Amount Available Quality Composite Score 2 Net Estimated Savings/Additional Cost Net Savings? (Y/N) PO Share of Net Savings or (Attainment Incentived Needed to Offset Net Add'l Cost) (50%) VBP4P INCENTIVE PAYMENT ($ PMPM) Combined Shared Savings & Attainment Attainment Incentive based on Appropriate Resource Use Measures Measures 7 z Base Attainment Incentive ($ PMPY) MY2015 Member Years Total Attainment Incentive Quality Multiplier Quality Adjustment VBP4P INCENTIVE PAYMENT Health Plan Values - Your PO can update these cells to reflect your own assumptions and understanding of health plan VBP4P incentive programs. The Total Value Based P4P Incentive Payment for your PO is not intended to reflect the actual payments that you will receive from participating health plans. The worksheets are provided for illustration of the general design. The recommended Value Based P4P methodology includes several optional design elements, including thresholds and values. As a result, participating health plans’ programs and your incentive amounts may vary accordingly. Quality Composite Score Cost Multiplier Value Score (cost-adjusted quality) If your PO had fewer than 1,500 member years with the health plan, your PO's result would be a weighted average of your own result and the result for all small POs for the plan. As membership increases, more weight is placed on your own result. Quality Composite Score is 50% Clinical, 30% MUHIT, 20% PAS. See QCS tab for domain specific scoring Share of Savings is estimated based on prior year quality results; final Share of Savings will be based on current year quality results Trend gate is CPI+3% for most POs and CPI+1% for high cost POs. CPI is the average change in the national CPI over three years, such that the last year of the three years is the measurement year. Final CPI for current measurement year not available until first quarter of the following year. High cost POs are POs whose geography & risk-adjusted total cost of care was above the 90th percentile with a given health plan for both the previous year and the current year. Normalized Expected Rate = (Expected Rate)/(Pop Observed/Expected Rate) All Attainment Incentive measures are geography- and risk-adjusted The cost performance adjustment varies based on a continuous linear scale from a decrease of 20% to an increase of 20% based on the PO’s geography- and risk-adjusted Total Cost of Care for the measurement year and specific plan. The maximum and minimum adjustments correspond with the 10th and 90th percentiles of P4P PO performance on TCC (including geography- and risk-adjustment). Sample
Transcript of Sample - Integrated Healthcare Association · If your PO had fewer than 1,500 member years with the...
Integrated Healthcare Association (9999999)
Gate Threshold Your ResultsQuality 6
Total Cost of Care (TCC) Trend4 3.0%
MY 2016 Result 1
MY 2015 Result 1 Change in Rate
Normalized Expected Rate6
(MY 2015)Denominator Denominator Units
Resource Use
Saved/ (Increased)
Cost per
Resource Use
Estimated Savings/
(Additional Cost)
b c d = ∆(b,c) e f g h = d*e*f i j=h*i
All-Cause Readmissions (PCR) 0.00 Admissions 0.0 $14,000.00 $0.00
Inpatient Bed Days (IPBD) 0.00 NA 1,000 Member Years 0.0 $4,000.00 $0.00
Emergency Department Visits (EDV) 0.00 NA 1,000 Member Years 0.0 $750.00 $0.00
Outpatient Procedures in Pref. Facility (OSU) 0.00 NA O/P procedures 0.0 $1,500.00 $0.00
Generic Prescribing (GRX) - Overall 0.00 NA # Prescriptions 0.0 $70.00 $0.00
LEGEND $0
No
$0 0
MY 2016 Result 1 MY 2016 Attainment Benchmark
MY 2016
Attainment
ThresholdMY 2015 Result 1 MY 2015 Attainment Benchmark
MY 2015 Attainment
Threshold
Attainment Reached?
(Y-Threshold; Y-
Benchmark; No)
Incentive ($ PMPY)
y x w v u t s r
All-Cause Readmissions (PCR) 7.23 No $0.00
Inpatient Bed Days (IPBD) 84.40 No $0.00
Emergency Department Visits (EDV) 139.31 No $0.00
Outpatient Procedures in Pref. Facility (OSU) TBD NA NA
Generic Prescribing (GRX) - Overall 86.65 No $0.00
-$
0All-Cause Readmissions (PCR) $1.03 $0.34 -$
Inpatient Bed Days (IPBD) $10.14 $3.38
Emergency Department Visits (EDV) $3.14 $1.05 0Outpatient Procedures in Pref. Facility (OSU) NA NA 0.00Generic Prescribing (GRX) - Overall $2.29 $0.76 -1.00
$0
Value Score for Full-Risk POs
Cost Multiplier Calculation
0.00 MY 2015 TCC 345 TCC_GEO_RISK_ADJ
Cost Multiplier*
Footnotes1
2
3
4
5
6
7
8
Measures
a
Attainement Benchmark Incentive ($
PMPY)
Attainment Treshold Incentive ($
PMPY)Measures
Pass (Y/N) ?
Value Based P4P Incentive Worksheet - Measurement Year 2016
IHA Plan
Value Based P4P Incentive Design for Shared Risk POs
Performance Gates
MeasureNo QCS Available
TCC Trend with 85% CI No TCC Trend Available
Quality Multiplier
Shared Savings based on Appropriate Resource Use Measures
Total Cost of Care (TCC) AmountMY2015 TCC ($PMPY)
90th PercentileMY2016 TCC ($PMPY)
No TCC Amount Available
Quality Composite Score2
Net Estimated Savings/Additional Cost
Net Savings? (Y/N)PO Share of Net Savings or (Attainment Incentived
Needed to Offset Net Add'l Cost) (50%)
VBP4P INCENTIVE PAYMENT ($ PMPM)
Combined Shared Savings & Attainment
Attainment Incentive based on Appropriate Resource Use Measures
Measures7
z
Base Attainment Incentive ($ PMPY)
MY2015 Member Years
Total Attainment Incentive
Quality Multiplier
Quality Adjustment
VBP4P INCENTIVE PAYMENT
Health Plan Values - Your PO can update these cells to reflect your own assumptions and
understanding of health plan VBP4P incentive programs.
The Total Value Based P4P Incentive Payment for your PO is not intended to reflect the actual payments that you will receive from participating health plans. The worksheets are provided for illustration of the general design. The recommended Value Based P4P methodology includes several optional design elements, including thresholds and
values. As a result, participating health plans’ programs and your incentive amounts may vary accordingly.
Quality Composite Score2
Cost Multiplier
Value Score (cost-adjusted quality)
If your PO had fewer than 1,500 member years with the health plan, your PO's result would be a weighted average of your own result and the result for all small POs for the plan. As membership increases, more weight is placed on your own result.
Quality Composite Score is 50% Clinical, 30% MUHIT, 20% PAS. See QCS tab for domain specific scoring
Share of Savings is estimated based on prior year quality results; final Share of Savings will be based on current year quality results
Trend gate is CPI+3% for most POs and CPI+1% for high cost POs. CPI is the average change in the national CPI over three years, such that the last year of the three years is the measurement year. Final CPI for current measurement year not available until first quarter of the following year.
High cost POs are POs whose geography & risk-adjusted total cost of care was above the 90th percentile with a given health plan for both the previous year and the current year.
Normalized Expected Rate = (Expected Rate)/(Pop Observed/Expected Rate)
All Attainment Incentive measures are geography- and risk-adjusted
The cost performance adjustment varies based on a continuous linear scale from a decrease of 20% to an increase of 20% based on the PO’s geography- and risk-adjusted Total Cost of Care for the measurement year and specific plan. The maximum and minimum adjustments correspond with the 10th and 90th percentiles of P4P PO
performance on TCC (including geography- and risk-adjustment).
Sample
