BALANCING INCENTIVE PROGRAM
NATIONAL CALL
January 15th,
2014
CMS in collaboration with Mission Analytics Group
and New Editions Consulting
Presentation Outline
1.
2.
3.
4.
CMS Updates
Mission Analytics Updates
Disseminating Quality Data
State Updates
Medicaid Adult Core Set


Core Set of 26 measures identified through multistakeholder process and publicly released in 2012
Voluntary reporting





Began December 2013
CMS updates technical specifications manual annually
Technical Assistance and Analytic Support Program for states
Improvements to Core Sets are required (first update released Dec 2013)
Core measure data feeds into information loop


CMS collects, analyzes, and make publicly available the information
reported by the states (Annual Secretary’s Reports, Reports to Congress)
States use data to drive quality improvement
Adult Medicaid Quality Grant
Program


25 states participating in a two-year grant program
that began December 2012
Three grant program goals:
1.
Collect and report Adult Core Set measures in varying delivery care
settings (e.g. managed care, fee-for-service, long term care settings
such as nursing homes and intermediate care facilities)
2.
Develop staff capacity to report, analyze, and use data for monitoring
and improving access and the quality of care in Medicaid
3.
Conduct at least two Medicaid quality improvement projects relating to
Adult Core Set measures
Adult Medicaid Quality Grant
Program

Grantees’ quality improvement topics relevant to
BIP grantees:
Care transitions from nursing facilities
 Initiation and treatment of substance use
 Integration of physical and behavioral health
 Follow-up care for mental health hospitalizations
 Chronic conditions (diabetes, adult asthma, cardiovascular
health)

States must report to CMS the
methodology for collecting…



Service data: Reports all community long-term
services and supports individuals receive at the
individual level
Quality data: Captures the extent to which providers
are supplying comprehensive, quality care
Outcomes data: Assesses beneficiary and family
caregiver experience and satisfaction with providers
Methods for Collecting Quality Data


Clinical measures

Medicaid Adult Health Care Quality Measures (6)

Healthcare Effectiveness Data and Information Set (HEDIS) (6)

Waiver performance measures (5)
Other mechanisms

Money Follows the Person (MFP) Quality of Life survey (4)

State-specific surveys and reports (4)

Assessment data (1)
Analyzing and Disseminating Findings

Identifies systemic and plan- or providerspecific issues

Encourages quality improvements

Engages stakeholders
Method 1: Discussions with Case
Managers and Providers
Georgia:
 State
data quality and measures group reviews
Healthcare Effectiveness Data and Information Set
(HEDIS) measures and identifies trends within each
waiver program
 Data
group meets monthly or quarterly with
providers and case managers to:
 Discuss
source of identified trends.
 Suggest
best practices to remedy trends.
Georgia Performance Improvement
Plan
Method 2: Provider-Specific Reports
and Follow Up
Maryland:
 Waiver reports with provider-specific data
are mailed to providers
 Corrective and preventive action plans are
required
Method 2: Provider-Specific Reports
and Follow Up
New York:

Plan-specific quality data are distributed to the respective
managed care plans

Plans will be soon be able to access crude quality indicator
(HCQI) reports directly from the state’s Uniform Assessment
System (UAS-NY)*

The UAS-NY will include features that allow:


Automatic production of the crude HCQI reports.
The NYS Office of Quality and Patient Safety to review and
“approve” the reports before they can be accessed by plans.
* The crude reports are not risk adjusted nor do they represent all of the information on quality data
that will be available to plans.
Method 3: Online Report



Makes plan- and provider-level
performance public
Encourages plans and providers to
improve performance to attract clients
Augments transparency and accessibility
Method 4: Collaborate with the
state EQRO
Illinois:
The Illinois Department of Healthcare & Family Services,
State Medicaid Agency, contracts with the Health Services
Advisory Group (HSAG) to serve as the External Quality
Review Organization (EQRO) for the state’s Managed Care
Organizations (MCOs).
 The EQRO performs external oversight, monitoring, and
evaluation of the quality assurance component of managed
care.
 The EQRO process includes review of MCO compliance with
State standards for access to care, structure and operations,
and quality measurement and improvement.
 Validation of Performance Measures & PIPs
 Monitoring of Corrective Action Plans

Method 4: Collaborate with the
state EQRO (continued)
Illinois:

HSAG findings are communicated to the MCO’s and
stakeholders via:

Monthly conference calls

Written report following the EQRO’s on-site record review for the
MCOs

Quarterly face to face meetings

EQR Technical Report: aggregated information on quality, timeliness,
and access to health care services that the MCOs furnish to Medicaid
recipients

Development of a Performance Tracking Tool (PTT) to be used by
each MCO to monitor and trend results for each performance
measure

Stakeholder meetings
Program Resources




Approved State applications and Work Plans
Revised Implementation Manual, FAQs, State
Summaries, State Profiles, and other resources
Email CMS:
 balancing-incentive-program@cms.hhs.gov
Email Mission Analytics:
 info@balancingincentiveprogram.org
Quality Data Resources


Adult Core Set Measures
CMCS Informational Bulletin outlining 2014 update to
Adult Core Set

2013 Technical Specifications and Resource Manual

Adult Medicaid Quality Grant Program

States can submit measurement questions to:
MACqualityTA@cms.hhs.gov
2014 Adult Core Measure Set
NQF #
Measure Name
Measure Steward
0039
Flu Shots for Adults Ages 50-64
NCQA
n/a
Adult BMI Assessment
NCQA
0031
Breast Cancer Screening
NCQA
0032
Cervical Cancer Screening
NCQA
0027
Medical Assistance with Smoking and Tobacco Use Cessation
NCQA
0418
Screening for Clinical Depression and Follow-Up Plan
CMS
1768
Plan All-Cause Readmission
NCQA
0272
PQI 01: Diabetes, Short-Term Complications Admission Rate
AHRQ
0275
PQI 05: Chronic Obstructive Pulmonary Disease (COPD) Admission
Rate
AHRQ
0277
PQI 08: Congestive Heart Failure (CHF) Admission Rate
AHRQ
0283
PQI 15: Adult Asthma Admission Rate
AHRQ
0033
Chlamydia Screening in Women Ages 21-24
NCQA
2014 Adult Core Measure Set (continued)
NQF #
Measure Name
Measure Steward
0576
Follow-Up After Hospitalization for Mental Illness
NCQA
0469
PC–01: Elective Delivery
Joint Commission
0476
PC–03 Antenatal Steroids
Joint Commission
2082
Viral Load Suppression
HRSA
0018
Controlling High Blood Pressure
NCQA
0063
Comprehensive Diabetes Care: LDL–C Screening
NCQA
0057
Comprehensive Diabetes Care: Hemoglobin A1c Testing
NCQA
0105
Antidepressant Medication Management
NCQA
1879
Adherence to Antipsychotics for Individuals with Schizophrenia
CMS
0021
Annual Monitoring for Patients on Persistent Medications
NCQA
0006/000
7
CAHPS Health Plan Survey v 4.0—Adult Questionnaire with
CAHPS Health Plan Survey v 4.0H—NCQA Supplemental
AHRQ, NCQA
0648
Care Transition—Transition Record Transmitted to Health Care
Professional
AMA-PCPI
0004
Initiation and Engagement of Alcohol and Other Drug
Dependence Treatment
NCQA
1391
Prenatal and Postpartum Care: Postpartum Care Rate
NCQA
19