Balancing Incentive Program National Call January 15th, 2014 CMS in collaboration with Mission Analytics Group and New Editions Consulting
Presentation Outline • CMS Updates • Mission Analytics Updates • Disseminating Quality Data • State Updates
Medicaid Adult Core Set • Core Set of 26 measures identified through multi-stakeholder 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: • 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) • Develop staff capacity to report, analyze, and use data for monitoring and improving access and the quality of care in Medicaid • 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 provider-specific 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.
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: • email@example.com • Email Mission Analytics: • firstname.lastname@example.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