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Expansion Counties Training III: PHC’s Pay-For-Performance Program – Quality Improvement Program (QIP) PowerPoint Presentation
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Expansion Counties Training III: PHC’s Pay-For-Performance Program – Quality Improvement Program (QIP). Presenters Antara Aiama (QI/PI Manager) Jess Liu (QIP Project Specialist). Objectives. QIP Overview & Timeline Measures Resources for Providers Q&A session. What is the QIP?.

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expansion counties training iii phc s pay for performance program quality improvement program qip

Expansion Counties Training III:PHC’s Pay-For-Performance Program –Quality Improvement Program (QIP)

Presenters

Antara Aiama (QI/PI Manager)

Jess Liu (QIP Project Specialist)

objectives
Objectives
  • QIP Overview & Timeline
  • Measures
  • Resources for Providers
  • Q&A session
what is the qip
What is the QIP?
  • What is the Quality Improvement Program?
  • Who qualifies for program?
timeline
Timeline

Final payment for QIP 2013-2014 mailed

Measurement period for QIP 2013-2014

Final date for clinical data submission via e-Reports

Final date for non-clinical data submission

resources
Resources

QIP Website:

http://partnershiphp.org/Provider/MC_QIP.htm

QIP Inbox: qip@partnershiphp.org

eReports (monitor performance on CLINICAL measures):

https://qip.partnershiphp.org/

Monthly Reports (monitor performance on NON- CLINICAL measures) – sent out monthly

Monthly Newsletters – sent out monthly

Other non-QIP-related questions: Sharon McFarlin, Provider Relations Rep (smcfarlin@partnershiphp.org; 707-420-7687)

measures
Measures
  • Unit of Service Measurement Set (Optional)
  • Measures and Incentive amounts
  • Fixed Pool PMPM Measurement Set (Required)
  • Measures: Clinical Domain, Appropriate Use of Resources, and Access & Operations,
advance care planning acp
Advance Care Planning (ACP)
  • ACP conversations with medi-medi and medi-cal members 65 years or older and/or have a major life-limiting disease
  • Attestations must be signed by a clinician (physicians, PAs, RN, nurse practitioners)
  • Only one attestation per patient per fiscal year; maximum of 100 per site
pcmh certification
PCMH certification
  • PCP site must have a minimum of 50 PHC members to be eligible for this incentive
  • Submit evidence of certification to PHC by July 31, 2014
  • PCMH recognition can be from NCQA, AAHC or JCAHO
peer led self management group
Peer Led Self Management Group
  • PCP site must have a minimum of 50 PHC members to be eligible for this incentive
  • Incentive for new or existing groups that are open to both PHC and non-PHC members
  • Groups must meet at least 4 times between Sep 1, 2013 – June 30, 2014
  • Must submit evidence of at least 16 PHC member visits
utilization of cair
Utilization of CAIR
  • Providers with 20 or more members ages 0-13 years of age are eligible for this incentive
  • Must submit CAIR registration ID by December 31, 2013
  • Incentive pays for active utilization of registry; payment is based on performance in comparison to PHC network performance
access extended office hours
Access/extended Office Hours
  • Monitored and reported by Provider Relations representative
  • Must be open and additional 8 hours beyond normal business hours of the practice site
cervical cancer screening family internal medicine sites 20 pts
Cervical Cancer Screening – Family & Internal Medicine Sites (20 pts)

Threshold: 69.1%

Denominator: The number of continuously enrolled Medi-Cal women 24-65 years of age as of 06/30/2014.

Numerator: The percentage of continuously enrolled Medi-Cal women 24 –65 years of age who were screened for cervical cancer according to the evidence-based guidelines:

• Women age 24-65 who had a Pap test in the measurement year

or the two years prior (July 1, 2011 – June 30, 2014).

• Women age 35-65 who had a Pap test and an HPV test on the

same date of service in the measurement year or the four years

prior (July 1, 2009 – June 30, 2014).

childhood immunization dtap pediatric medicine sites 20 pts
Childhood Immunization – DTaP – Pediatric Medicine Sites (20 pts)

Threshold: 80.6%

Denominator: Children who turn 2 years of age between July 1, 2013-June 30, 2014.

Numerator: The number of children with at least four DTaP vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

Evidence:

  • Evidence of the antigen or combination vaccine
pharmacy utilization all sites 40 pts
Pharmacy Utilization – All Sites (40 pts)

Targets:

At least 85% generic rate or 98% formulary compliance rate = full 10 points; Or

83.0-84.9% generic rate or 96.0-97.9% formulary compliance rate = 5 points

avoidable ed visits all sites 10 pts
Avoidable ED Visits – All Sites (10 pts)

Target: At or below site-specific, risk-adjusted threshold

‘Avoidable ED Visits’ identified by using DHCS Statewide Avoidable ED Diagnoses Codes1

To calculate Avoidable Emergency Dept Visits PMPY:

Avoidable ED Visits per 1000 = (Avoidable ED visits / Non-Dual Capitated Member Months) *12,000

1In 2011, a California statewide collaborative Quality Improvement Project published a list of diagnoses for non-emergency conditions to determine avoidable ED visits. This list is available in the detailed specifications manual for PHC’s QIP measures.

practice open to phc members all sites 10 pts
Practice Open to PHC Members – All Sites (10 pts)

Targets:

2.5 points per quarter if site remains open to new PHC patients ; 2.5 points additional points at year end if site remains open for all three quarters (i.e. Oct 2013 – June 2014)

Partial Points: Any age restrictions = 1.25 points per quarter

pcp office visits all sites 10 pts
PCP Office Visits – All Sites (10 pts)

Targets: At or below site specific threshold.

To calculate PCP Office Visits PMPY:

PCP Office Visits PMPY = (# Office Visits/ Non-Dual Capitated Member Months)*12

3na operations data all sites 10 pts
3NA & Operations Data – All Sites (10 pts)

Targets: No targets, pay for reporting

For each quarter, submission must include BOTH third Next Available Appointment (3NA) and one optional measure to be considered complete.

  • Optional measures to choose from are: No Show Rate, Provider/Team Continuity or Call Abandonment rate

• If 2 quarters of data are submitted for 3NA and one optional measure, provider will receive full credit (10 points total).

• If 1 quarter of data is submitted for 3NA and one optional measure, provider will receive partial points (5 out of 10 points).

data sources
Data Sources
  • PHC Administrative Data:
    • Outpatient and Inpatient Claims
    • Pharmacy
    • Radiology/Imaging
    • Lab
  • Provider submitted data:
    • Data uploads into eReports
overview of data validation process qip ereports data
Overview of Data Validation Process – QIP eReports data

Five Key Steps

  • Validate source code for all measures
  • Validate denominators at the provider level
  • Validate numerators at the provider level
  • Validate preliminary rates at the aggregate level
  • Provider validation before release of site
qip ereports
QIP eReports
  • An online system to:
    • Monitor real-time clinical performance rates
    • See drill-down denominator and numerator lists
    • Upload additional data

eReports: https://qip.partnershiphp.org

Register for Training Webinar (12-1pm, Oct 9):https://phpevents.webex.com/phpevents/onstage/g.php?t=a&d=662220095

resources1
Resources

QIP Website:

http://partnershiphp.org/Provider/MC_QIP.htm

QIP Inbox: qip@partnershiphp.org

eReports (monitor performance on CLINICAL measures):

https://qip.partnershiphp.org/

Monthly Reports (monitor performance on NON- CLINICAL measures) – sent out monthly

Monthly Newsletters – sent out monthly

Other non-QIP-related questions: Sharon McFarlin, Provider Relations Rep (smcfarlin@partnershiphp.org; 707-420-7687)

next steps
Next Steps
  • Provide us with updated contact info
  • Clinical Measures (CCS and DTaP) and Pharmacy Utilization
  • Familiarize with Specs
  • Sign up for training sessions
  • Start conversation around potential Unit of Service measures with leadership and staff
  • Form a QI Team and assign responsibilities
slide31

Follow-up post discharge can be a back-up measure for either Acute Bed Days/1000 or Readmission Rate, but not both.