MY 2020 & 2021 AMP Program Updates...• AMP measure specifications available sooner to participants...

Thien Nguyen, Director, Data Strategy

Edith Fox, Project Manager

Christine Tu, Program Coordinator

January 21, 2021

MY 2020 & 2021 AMP Program Updates

Questions? Submit them via the "Q&A" function!

Today’s webinar will be recorded and posted onhttps://www.iha.org/news-and-events/

• Welcome!

• MY 2019 AMP results update

• What’s new in 2021

• MY 2020 measure set

• MY 2020 data submission & reporting

• Looking ahead: MY 2021 measurement

Agenda

1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.2

MY 2019 results update

Issues surfaced after results were finalized in October 2020 for AMP Commercial HMO.

• Member attribution – Continuous enrollment & anchor date criteria were applied incorrectly for two measures

— Acute Hospital Utilization (AHU) and Emergency Department Utilization (EDU).

– Member attribution was applied at the plan level instead of at the plan and PO level.

• Small PO pooled results for risk adjusted measures – This only impacts POs with less than 5,000 members.

The small PO pooled observed-to-expected (O/E) ratio results were incorrectly calculated using the normalized

results for small POs.

• Geography adjustment factor (GAF) application – The incorrect GAF was applied to generate the geography

and risk adjusted TCOC. Minor adjustments to geography and risk adjusted TCOC results — average PO

change of $1.47 PMPM.

What happened?


Copyright 2021 Integrated Healthcare Association, all rights reserved.1/21/20215

Issues Impacted Measures Use of Measure Results

Member Attribution• Acute Hospital Utilization (AHU)

• Emergency Department Utilization (EDU) • No impact to awards or public

reporting

• Updated results will be

reflected in incentive design

resources for POs and plans

Small PO Pooled

Results(PO results with <5,000 member)

• Acute Hospital Utilization (AHU)

• Emergency Department Utilization (EDU)

• All Cause Readmissions (PCR)

Geography

Adjustment Factor

Application

• Geography & risk adjusted TCOC only

• No impact to awards or

PO incentive eligibility

• Updated results will be used

for public reporting

What’s impacted?

• Updated MY 2019 results

– AMP PO results and benchmarks are available on IHA Analytics Portal.

– Your member-level detail information on Onpoint Member-Level Detail Portal.

• Incentive modeling resources

– PO Worksheets available on IHA Analytics Portal.

– Health Plan Plug and Plays have been distributed to plans utilizing IHA results for incentive payments.

Updated MY 2019 results now available!


https://analytics.iha.org/measures

https://iha-prp.onpointhealthdata.org/users/sign_in


AMP measure generation & reporting process – Onpoint-generated results

Participant Review AMP Final Results

IHA releases

preliminary results to

participants

Participant Questions &

Appeals period

NCQA: certifies

measures for use in

AMP program

Onpoint:data intake,

generate measure

results, QA/ validation

IHA: QA/ validate measure results

Results used for PO

accountability

Measure Generation

Data quality continues to be IHA’s highest priority

• Process improvement

– Planned process improvements with our vendors to deliver timely and accurate results.

– Improve documentation.

• Drive continuous quality improvement

– Quality assurance and validation from data intake to results reporting.

– Expand and improve upon data validation, shift to more upfront validations to identify errors upstream.

• Vendor partnership

– Partner closely with our vendors to review process and mitigate possible points of failure.

– Partner with our vendors to simplify and create a streamlined measure certification process.

Improvements for MY 2020 reporting cycle


MY 2020 AMP program updates

• New health plan participation for AMP Medicare Advantage — Welcome Inter Valley Health Plan!

• Updates to MY 2020 AMP program accountability due to COVID-19

• Updated AMP Technical Specifications release timeline

• New IHA website & brand refresh

New in 2021



The committee members agreed with

Technical Payment Committee

recommended incentive approach to

use the current Attainment Incentive

pathway with updated/relaxed

performance targets.

MY 2020 AMP Incentive

Design Approach

The committee members voted to keep

27 of the 38 measures across clinical

quality, ACI, patient experience,

resource use and cost domains to be

used for awards, public reporting and

incentive design.

MY 2020 AMP

Accountability Measure Set –

“Pandemic Priority”

IHA intends to collect and report all

normally submitted data for MY 2020 to

continue to provide insights from 2020

results including those related to

COVID-19.

MY 2020 Data Collection

& Reporting

Measurement Year (MY) 2020 program updates in response to COVID-19


The committee members voted to keep 27 of the 38 measures across clinical quality, advance care information, patient

experience, resource use and cost domains to be used for awards, public reporting and incentive design.

MY 2020 updated accountability measure set

Measure DomainStatus

Quo

MY 2020

“Pandemic Priority”

Clinical Quality

• Prevention & Screening: childhood and adolescent immunizations• Diabetes: statin therapy for patients with diabetes; HbA1c control; medication adherence• Cardiovascular: controlling blood pressure; statin therapy; medication adherence

• Respiratory: appropriate antibiotic use; appropriate testing for pharyngitis; asthma medication ratio

24 16

Advancing Care Information 2 2

Patient Experience 5 4

Appropriate Resource Use

• All-Cause Readmissions (PCR); Acute Hospital Utilization (AHU); Emergency Department Utilization (EDU); Generic Prescribing — Overall (GRX)

5 4

Cost 1 1

Data Quality 1 0

TOTAL 38 27

Detailed AMP MY 2020 Measure Set can be found here.

https://www.iha.org/performance-measurement/amp-program/measure-set/

Use of the current

Attainment Incentive pathway

with updated/relaxed

performance targets

MY 2020 incentive design approach


MY 2020 AMP program cycle


Data Collection (Jan - June)

• Plans: Quarterly submission to Onpoint

• POs & Plans: Audited quality submission to TransUnion

MY20 Quality Reports Release

(May - Aug)

• Commercial HMO & MA results from audited data submission to TransUnion (Preliminary & Final)

• Participant Review: Questions and Appeals period

MY20 Onpoint-Generated

Reports Release(Aug – Oct)

• Results from health plan member-level data submission to Onpoint(Preliminary & Final)

• Participant Review: Questions and Appeals period

Final MY20 AMP Results

(Oct)

• Final results available for all AMP programs

• Results used for PO recognition, public reporting, incentive payments

Preparing for MY21

Cycle

• Jun: MY 2021 AMP Technical Specification

• Oct: MY 2022 Public Comment

• Dec: MY21 Final AMP Program Guide

MY 2020 AMP measurement updates

Support less burdensome

data collection and

more timely reporting

Targeted development

of the AMP measure set

Increase alignment in the

AMP measure set

2016–2021 measure set strategy

1 2 3


2022–2026 measurement strategy — in development!

• Develop 2022-2026 measurement strategy that

reflects consensus-based decisions for IHA

performance measurement programs.

Goal Process

• Strategy development will be informed by

AMP stakeholders and approved through

IHA Committees.

We want to hear from you — Stakeholder survey coming soon!



All IHA stakeholders have the opportunity to influence ongoing development of IHA measure sets.

IHA holds public comment for proposed testing measures (current year) and adoption of validated

measures (upcoming year).

How IHA maintains the AMP measure set

Testing

Tests validity of a new

measure

First-Year

Collected to establish

baseline for use in AMP

programs

Adopted

Ready for program use –

fully validated with ability

to benchmark attainment

and improvement

Retired

No longer meets criteria

for measures included in

AMP measure set

Domain Measure

AMP Product Line

Commercial

HMO

Commercial

ACO

Medicare

Advantage

Medi-Cal

Managed Care

Clinical

Quality

Child and Adolescent Well-Care Visits (WCV) First-Year

Prenatal and Postpartum Care (PPC) Info Only

Weight Assessment & Counseling for Nutrition and

Physical Activity for Children/Adolescents: BMI Percentile Documentation (WCC)

First-Year

Adult BMI Assessment (ABA) Retired

Data QualityEncounter Format (ENFMT) First-Year First-Year First-Year First-Year

Encounter Timeliness (ENLAG) First-Year First-Year First-Year First-Year

Appropriate

Resource Use

Hospital Average Length of Stay (HALOS) First-Year First-Year Info Only

MY 2020 measure set reminders

MY 2020 AMP Measure Set



Summary of MY 2020 Specification Changes

• Cross-cutting changes to multiple HEDIS measures

(please refer to the manual for specific measures):

– Telehealth-related specification changes to HEDIS

measures in response to shifts in care during COVID-19.

– Palliative care added as a required exclusion for some

screening and diabetes HEDIS measures.

• Additional changes to specific measures:

– Child and Adolescent Well-Care Visits (WCV) –

Combines former Well-Child Visits in the Third, Fourth,

Fifth, and Sixth Years of Life (W34) and Adolescent

Well-Care Visits (AWC) HEDIS measures.

– Statin Use in Persons with Diabetes (SUPD) – New

exclusions and requirements (refer to AMP Program

Manual).

• The AMP Program aligns with current specifications

from the measure steward whenever possible.

• A full list of MY 2020 specification changes can be

found in Appendix 1 of the MY 2020 AMP Program

Manual.

MY 2020 measure specification changes


https://www.iha.org/wp-content/uploads/2020/11/MY-2020-Align.-Measure.-Perform.-AMP-Manual_2020-12-01_final.pdf


• AMP measure specifications available sooner to participants in preparation for upcoming measurement year.

• MY 2021 AMP Final Technical Specifications will be released on June 1 – 6 months earlier than previous years.

AMP measure specification timeline to align with NCQA HEDIS timeline

Sept. 1: DRAFT MY 2020 & 2021

Manual

Sept 1-30: Public Comment (MY 2020

& MY 2021)

Dec. 1: FINAL MY 2020 manual;

FINAL MY 2020 & 2021 measure sets

June 1: FINAL MY 2022 Technical

Specifications; MY 2022 Prelim.

Program Guide

Oct. 10: DRAFT MY 2023

Technical Specifications

Oct. 10-28: Public Comment

(MY 2023)

Dec. 1: FINAL MY2023 measure set;

MY 2022 Final Program Guide



Program Guide

Oct. 9: DRAFT MY 2024 Technical

Specifications

Oct. 9-27: Public Comment (MY 2024)

Dec. 1: FINAL MY 2024 measure set;


CY 2021

Transition Year (Current)



Program Guide

Oct. 11: DRAFT MY 2022 Technical

Specifications

Oct. 11-29: Public Comment (MY

2022)

Dec. 1: FINAL MY 2022 measure set;


CY 2020

Prior State

CY 2022 CY 2023

MY 2020 AMP data submission & reporting

MY 2020 reporting

Health PlanAMP Product Line

Commercial HMO Commercial ACO Medicare Advantage Medi-Cal Managed Care

Aetna X X

Anthem Blue Cross X X

Blue Shield of California X X X

Blue Shield of California Promise X

Cigna Health Care of California X

Health Net X X X

Inter Valley Health Plan NEW!

Kaiser Permanente X X

LA Care Health Plan X

Oscar Health Plan X

Sharp Health Plan X X

Sutter Health Plus X

UnitedHealthcare X X X

Western Health Advantage X

REMINDER: POs can voluntarily self-report data for any or all the product lines below – either all measures, or a subset of

measures. POs that are self-reporting should include all members for their contract plans listed below.


Measure domains & data sources

Quality Domain

Patient Experience(AMP Commercial HMO & Medi-Cal Managed Care)

Advancing Care Information(AMP Commercial HMO)


• Clinician and Group CAHPS survey

of PO members

• Administered by PBGH

• e-Measures reported by POs

• Not audited

Clinical Quality

• Self-reporting PO audited submission (all product

lines & optional)

• Health plan audited submission (HMO, Medicare

Advantage) & claims submission (ACO, Medi-Cal)

• Not a sample – all members included

Resource Use Domain

Appropriate Resource Use

• Complete member-level data submitted by

health plans

• Calculated by Onpoint Health Data

Total Cost of Care

• Member-level cost data submitted by

health plans

• Calculated by Onpoint Health Data

Data Quality Domain

Encounter Data Metrics

• Encounter data volume by service types from

health plan audited submission

• Encounter Format and Encounter Timeliness

from health plan claims & encounters data

submission. Calculated by Onpoint Health Data


Data submission process

AUDITED CLINICAL

QUALITY SUBMISSION

(TransUnion Healthcare)

PO & Plan

• Generate measure results using data file layout provided by IHA

Auditor

• Audits measure results

• Validates programming

• Locks file

Transunion

• Validates formats

• Consolidates files

IHA

• Reviews and consolidates data

• Creates and distributes reports to HPs and POs

Health Plan

• Eligibility

• Member Identifier

• Claims (Med & Rx)

• Lab results

• Cost

Onpoint

• Intakes, validates, and links data

• Generates measure results

IHA

• Reviews and consolidates data

• Creates and distributes reports to HPs and POs

HEALTH PLAN MEMBER-

LEVEL DATA SUBMISSION

(Onpoint Health Data)

To do now:

Review draft data file layouts. Please email any feedback to [email protected] by January 29.

– AMP Participant Resources webpage under the “Data Collection and Submission Resources” tab

In the future:

Download final data file layouts once they are available on February 15.

For health plan and PO data submission to TransUnion Healthcare

MY 2020 audited submission data file layouts

Data File Layout AuditedCommercial

HMO

Commercial

ACO

Medicare

Advantage

Medi-Cal

Managed Care

Health Plan Clinical Measures X X X X

PO Clinical Measures X X X X

Non-SRPO e-Measures X

ACO Clinical Measures X


mailto:[email protected]

https://www.iha.org/performance-measurement/amp-program/amp-participant-resources/

What are e-measures?

E-measures are electronic clinical quality measures voluntarily reported by provider organizations participating in AMP Commercial

HMO only as part of the Advancing Care Information (ACI) measure domain. They are intended to encourage EHR adoption and use.

Why should my organization report e-measures?

The ACI domain is part of a PO’s Quality Composite Score, which is used in the value-based incentive design as an eligibility gate and

adjuster. Provider organizations who do not report e-measures do not earn points that can increase their quality composite score and

help them earn incentive payments from health plans.

How does my organization report e-measures?

POs report e-measure results to TransUnion healthcare using a data file layout provided by IHA. For each e-measure, POs report two

rates:

• Rate 1: the percentage of providers in your PO who can report the e-Measure (i.e., denominator = total physicians in your PO,

numerator = total physicians who can report the measure from the EHR).

• Rate 2: the aggregated patient numerator and denominator for those providers who can report the e-Measure.

POs are only scored on Rate 1: the percent of providers in the PO who can report the e-Measures.

To receive credit, POs must submit both rates for each e-Measure, with rates >0.

e-Measures: A quick primer


• We encourage supplemental data sharing between POs and health

plans to help ensure accurate and comprehensive reporting of AMP

results.

• POs and health plans are expected to work together to establish

processes and requirements for sharing and using supplemental data.

Data sharing is crucial to complete & accurate results!


Encounter data matters. A lot. For all IHA stakeholders:

• Complete encounter data are strongly tied to risk scores

• Most common cause of appeal of AMP results during annual appeals periods

Encounter Rate by Service Type (ENRST) in AMP:

• Rates and benchmarking for all product lines

What POs can do:

• Monitoryour encounter data submission to plans

• Mind encounter data deadlines for AMP reporting

• Review ENRST results when available in May

To support successful encounter data submission, IHA reports

additional metrics of encounter data timeliness (ENLAG) and format (ENFMT).

Encounter data is especially important


0.0

0.5

1.0

1.5

2.0

2.5

0 2 4 6 8 10 12 14 16 18

Ave

rage R

isk S

core

(A

CG

)

Encounter Volume (rate per member per year for professional services)

Non-Self Reporting Provider Organizations

❑ Feb. 15: Download & program Non-SRPO e-

Measure data file layout

❑ Mar. 22 - May 3: send completed Non-SRPO e-

Measure test file to TransUnion; resend until no

errors are found

❑ May 7: send passing Non-SRPO e-Measure test

file to TransUnion

Self-Reporting Provider Organizations

❑ Feb. 15: Download & program PO clinical measure

data file layout

❑ Mar. 22 - May 3: Send PO clinical measure test file

to TransUnion; resend until no errors are found

❑ Apr. 30: Send passing PO clinical measure file to

auditor

❑ May 7: Send auditor-locked PO clinical measure

file to TransUnion for use in AMP reporting

[audit not required for AMP commercial ACO]

Provider Organizations – data submission checklist

Detailed data collection timeline provided in AMP Program Manual (pages 8-9)



Audited Clinical Submission to TransUnion

❑ Feb. 15: Download & program HP clinical

measure data file layout

❑ Mar. 22 - May 3: Send HP clinical measure test

file to TransUnion; resend until no errors are

found

❑ Apr. 30: Send passing HP clinical measure file to

auditor

❑ May 7: Send auditor-locked HP clinical measure

file to TransUnion for use in AMP reporting

Health Plans – data submission checklist

Detailed data collection timeline provided in AMP Program Manual (pages 8-9).

Member-Level Data Submission to Onpoint

❑ Jan. 31: Q4 2020 data submission

❑ Mar. 1: Plan validation & sign off – Eligibility &

Pharmacy Claims

❑ May 28: Plan validation & sign off – Medical Claims

& Member Identifier

❑ Jun. 4: Plan validation & sign off – Cost



Health Plans – Onpoint quarterly data submission dashboard

Health Plans transitioning to Quarterly Data Submission.

Health Plans transitioning to Quarterly Data Submission.

Eligibility Medical Pharmacy Eligibility Medical Pharmacy Eligibility Medical Pharmacy Eligibility Medical Pharmacy

Q1 2020 Q2 2020 Q3 2020 Q4 2020

4/30 7/31 10/31 1/31/21

Aetna

Anthem

Blue Shield

BSCA Promise

Cigna

Health Net

KP

LA Care

Oscar (Off-

Cycle)

Sharp

Sutter Health

United

WHA

In Progress On Track Complete


Audited Clinical Submission (via TransUnion) Date

Preliminary Quality Reports (Commercial HMO & MA) May 28

Questions & Appeals Period May 28-June 18

Final Quality Reports (Commercial HMO & MA) August 10

MY 2020 AMP reporting timeline

Detailed reporting timeline provided in the AMP Program Manual (pg. 10).


Health Plan Member-Level Data Submission (via Onpoint) Date

Preliminary Onpoint-Generated Reports August 10

Questions & Appeals Period August 10-31

Final MY 2020 AMP Reports (All AMP Programs) October 15


Looking ahead: MY 2021 AMP measurement

MeasureCommercial

HMO

Commercial

ACO

Medicare

Advantage

Medi-Cal

Managed Care

Testing

Measures

Depression Care: Preventive Care and Screening: Screening for

Depression and Follow‐Up Plan (PREV‐12)X

Depression Care: Depression Screening and Follow‐Up for

Adolescents and Adults (DSF‐E)X

Depression Care: Utilization of the PHQ‐9 to Monitor Depression

Symptoms for Adolescents and Adults (DMS‐E)X

Depression Care: Depression Remission or Response for

Adolescents and Adults (DRR‐E)X

First-Year

MeasuresPrenatal and Postpartum Care (PPC) X

Adopted

Measures

Child and Adolescents Well-Care Visits (WCV) X

Weight Assessment & Counseling for Nutrition and Physical

Activity for Children/Adolescents: BMI Percentile Documentation

(WCC)

X

Encounter Format (ENFMT) X X X X

Encounter Timeliness (ENLAG) X X X X

Hospital Average Length of Stay (HALOS) X X Info Only

MY 2021 measure set highlights


The new iha.org


A quick reminder: revisiting the old iha.org


Our brand identity at work: the new iha.org

AMP resources


• Performance Measurement – Showcases our work surrounding the AMP programs and the Cost & Quality Atlas

• Align. Measure. Perform. – Page with information on AMP, details on the value of the program, and links to additional program pages (incentive design, awards, public

reporting, and public comment)

• AMP Participant Resources – Page where AMP participants can get what they need in one place, including the program manual, measure set, data collection & submission

resources, and public comment information

• MY 2020 AMP Program Manual

• AMP Measure Sets

• 2016-2021 Measure Set Strategy

• NCQA Vendor Certification Requirements

• NCQA-Certified HEDIS Compliance Auditors

• Draft Data File Layouts (Audited Quality) available under “Data Collection and Submission Resources” section.

• Additional pages

– Incentive Design

– IHA Portals

– AMP Newsletters

• AMP Fact Sheets: AMP Product Lines, Total Cost of Care, and Incentive Design

Key pages for the AMP program

https://www.iha.org/performance-measurement/

https://www.iha.org/performance-measurement/amp-program/




https://www.iha.org/wp-content/uploads/2020/10/2016-2021_vbp4p_measure_set_strategy_1.pdf

https://www.iha.org/wp-content/uploads/2020/10/INFORM1.pdf

https://www.ncqa.org/wp-content/uploads/2019/09/Certified_Hedis_Compliance_Auditors.pdf


https://www.iha.org/performance-measurement/amp-program/incentive-design/

https://www.iha.org/customer-login/

https://www.iha.org/news-and-events/

https://www.iha.org/performance-measurement/amp-program/amp-program-descriptions/

https://www.iha.org/wp-content/uploads/2020/10/Fact-Sheet-Total-Cost-of-Care.pdf

https://www.iha.org/wp-content/uploads/2020/10/Fact-Sheet-Value-Based-Pay-for-Performance-for-Physician-Groups-Key-Pay-for-Performance-Design-Decisions%E2%80%8B.pdf

Questions on the new website?

Need assistance locating a resource?

Email [email protected] so we can assist!

mailto:[email protected]

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