OPWDD Value-Based Destination
NY Alliance Leadership ConferenceDecember 6, 2019
Presenter: Tamika R. Black, PhDDivision of Data Management and Strategy
Value-Based Payment Overview• Value-based payments (VBP) reward health
care and service providers with incentive payments for the quality of care delivered
• The goals of VBP align with the Quadruple Aim• VBP is a payment model that incentivizes
integrated care and rewards providers and plans when quality targets are met or exceeded– Pays for enhanced patient care coordination– Pays for managing the cost of care and
reducing inefficiencies– Pays for the use of evidence-based clinical
practices
Quadruple AimManaging Cost
of Care
Reduce Provider Burden
Improve Quality of Care
Improve Outcomes
VBP Roadmap for I/DD Services and Populations
• The VBP Roadmap indicates that VBP arrangements for I/DD populations are still in development
• To assist with this development, OPWDD and the NYSDOH have engaged a Clinical Advisory Group and stakeholders to:• Assist in defining the “value proposition” for VBP for I/DD services
• Promote future stability in a VBP environment
• Establish feedback loop with stakeholders to identify the best quality measures and Health Information Technology (HIT) that promote interoperability for VBP
• Advance a Roadmap unique to the I/DD community that addresses expansion of access and coverage for enrollees and builds capacity for providers to participate in VBP arrangements
Medicaid Payment Reform: Moving Towards VBPVBP Goal: MCOs required to begin implementing VBP Contracting with providers
VBP Goal: 80% of MCO’s provider payments in VBP
VBP Roadmap: Five-Year plan for Medicaid Payment Reform
Clinical Advisory Groups (CAGs) • I/DD CAG met in 2016
I/DD CAGs
VBP Bootcamps
I/DD Health Home (I/DD HH) Implementation
VBP Pilots
2016 2017 2018 2019 2020
OPWDD Goals for System Transformation
People live and receive services in the most
integrated setting
People have community participation
experiences that are meaningful to them
People have meaningful
relationships with friends, family and
others that are important to them
People experience personal health, safety
and growth opportunities
People exercise choice and decision making in their life and with their daily schedule to the
extent possible
Key Components of a VBP Arrangement
Who and What is Covered?
Which Providers are Responsible? What is Measured? What Risk Do
Providers Assume?What HIT is needed
for VBP?• The members (patients)
covered by a VBP Arrangement
• The services included or excluded in a VBP Arrangement
• The members included (attributed) in a VBP Arrangement
• Quality and outcome measures for each kind VBP Arrangement
• Providers move to risk-based contracting (upside or downside risk) for the cost and quality of care for attributed populations
• Data and systems needed to deliver care, measure performance, and assume risk for services provided to people with I/DD
Quality Measures
Attribution HITBenefit Design
Risk
Initiatives Supporting VBP Readiness
Enhancing I/DD Health
Homes
I/DD CAG Quality
Measure Evaluation
Evaluating the FIDA-IDD Experience
I/DD Clinical Advisory Group (CAG) Scope of Work for 2019 and Beyond
• 2 year commitment• DOH will use feedback from I/DD
CAG but has ultimate authority to select measures and reporting requirements for VBP
• Clinical expertise and industry knowledge of I/DD services and populations
• Geographic diversity • Total care spectrum experience
for the I/DD population
• Attend and actively participate in scheduled CAG workgroup meetings
• Designate an additional individual to act as an alternate
• Present recommendations to the Joint Advisory Council (JAC) prior to the submission of any recommendations to the DOH
• Build upon the work of the 2016 I/DD CAGs
• Review key considerations related to quality measurement from the VBP Roadmap
• Make recommendations and provide feedback for quality measures for I/DD populations
Membership Selection
Roles & Responsibilities
CAG Objective
Scope of Membership
Quality Measures for I/DD VBP Arrangements
The I/DD CAG will focus on the role of quality in a VBP Arrangement by:
• Analyzing potential data sources for I/DD quality measures
• Identifying and reviewing existing quality measures that are appropriate for individuals with I/DD
• Assisting in the prioritization of quality measures that can be incorporated into OPWDD’s delivery system and used for I/DD VBP Arrangements
Domains for HCBS• The National Quality Forum (NQF)
has also been collaborating with multiple organizations to identify additional domains of quality that can be used to measure HCBS
• Many of these measure domains could be used to support I/DD specific quality measures
Domain Examples
NQF HCBS Domains
Choice and Control
Human and Legal Rights
Community Inclusion
WorkforceEquity
Caregiver Support
• Additional work is needed to finalize measure specifications and expand their use for I/DD managed care and VBP
Source: NQF, Quality in Home and Community-Based Services to Support Community Living: Addressing Gaps in Performance Measurement, 2016. Available at: https://www.qualityforum.org/Publications/2016/09/Quality_in_Home_and_Community-Based_Services_to_Support_Community_Living__Addressing_Gaps_in_Performance_Measurement.aspx
2016 I/DD CAG Report: Quality MeasuresI/DD Measures
The Council on Quality and Leadership (CQL) Personal Outcome Measures (POMs®)
People Choose Where and With Whom they Live
People Choose Where they Work
People Use their Environments
People Participate in the Life of the Community
People have the Best Possible Health
People Interact with Other Members of the Community
People Perform Different Social Roles
Clinical Measures
Centers for Medicare &
Medicaid Services (CMS)
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
Proportion of Adults who had blood pressure screened in past 2 years
Diabetes Composite: Aspirin Use
Emergent Care for Improper Medication Administration or Medication Side Effects
National Committee for Quality Assurance
(NCQA)
Annual Dental Visit (ADV)
Colorectal Cancer Screening
Diabetes Composite: Hemoglobin A1c Control (HbA1c) (<8.0%)
Statin Therapy for Patients With Cardiovascular Disease
Diabetes Composite: Blood Pressure (BP) <140/90
Diabetes Composite: Tobacco Non-Use
Quality Measure Domains (2019)• There are multiple domains of quality measurement:
Source: Agency for Healthcare Research and Quality (AHRQ), Types of Health Care Quality Measures. Available at: https://www.ahrq.gov/talkingquality/measures/types.html
Measure Domain Description Required Data Types Example Measures Sets
Access to CareAssesses timely and appropriate health care access for individuals with I/DD.
• Claims data and encounter data• Life Plan data• Eligibility and enrollment data
• NCQA HEDIS
Effectiveness of CareAssesses provision of evidence-based care to ensure proper use of services for individuals with I/DD
• Claims data• Eligibility and enrollment data • NCQA HEDIS
Care ManagementAssesses the coordination of services and care reflective of the person-centered care planning process.
• Claims data and encounter data• Life Plan data• Care management data
• I/DD HH measures
Experience or Perception of Care
Assesses individuals’ with I/DD experience and attitudes about the services and care they receive.
• Survey data• AHRQ CAHPS• CQL POMs• NCI Core Indicators
Administrative and Programmatic
Assesses or evaluates quality performance of health care programs • Program evaluation data • 1915(c) Waiver reporting
Social Determinants of HealthCommunity
Inclusion and Relationships
Employment
Housing Stability
Access to Health Care/ Primary Care
Food Security
TransportationFocus on improved outcomes for people
I/DD CAG 2020 Roadmap
Q1 2020 Q2 2020 Q3 2020 Q4 2020
Final measure evaluation criteria
Chronic conditions or health problems for I/DD
Identify existing measure sets that may address chronic conditions or health problems for I/DD
Prioritization based on feasibility
Environmental scan of other states’ use of quality measure sets
Other operational considerations
Covered services and benefits
Analysis of existing measure sets using evaluation criteria
Review of completed work and recommended measure sets
Discuss annual cycle for reviewing recommended measure sets
Review I/DD CAG scope of work for future meetings
I/DD CAG Meeting #1Select measure evaluation criteria.
I/DD CAG Meeting #2Apply evaluation criteria
I/DD CAG Meeting #4Finalize recommendations
I/DD CAG Meeting #3Prioritize quality measures
Enhancing Capacity for I/DD Health Homes• OPWDD/DOH conduct technical assistance reviews
and designation reviews to ensure Health Homes are providing quality care
Technical Assistance
• OPWDD monitors the performance of CCO Health Homes on key process metrics.
I/DD Health Home Dashboards
• CCOs will share key data elements from finalized Life Plans with OPWDD to assist in the monitoring of Life Plan quality, including the calculation of the I/DD specific health home measures.
Life Plan Data System
Enhancing I/DD Health
Homes
Enabling Readiness through MC-COP
• The Managed Care Community of Practice in I/DD (MC-COP) conducts technical assistance webinars to I/DD providers on managed care laws and regulations, compliance and quality, financing, and infrastructureTechnical Assistance
Webinars
• Regional, in-person training events offer technical assistance on additional topics including contracting and credentialing, finance and billing, claims testing, utilization management, and provider readinessIn-Person Learning
Collaboratives
• MC-COP’s Managed Care Organizational Self-Assessment (MC OSA) assists I/DD providers with assessing their readiness for managed care across 11 domains of processes, practices, and activitiesOrganizational Self-
Assessment
Evaluating Managed Care for I/DD
• OPWDD and PHP collaborate on an ongoing basis to discuss operational considerations and other key elements for serving dually eligible individuals with I/DD through managed careOPWDD and PHP
Collaboration
• PHP is part of the I/DD CAG and has shared their quality measure experience and insight with other CAG members and OPWDD
• Both New York State and CMS are evaluating the outcomes of the FIDA-IDD Demonstration to determine the feasibility of scaling the program
I/DD CAG Participation
Evaluating the FIDA-IDD Experience
Value-based Destination: Building I/DD Provider Capacity
What covered services and care should be measured and what systems and data can be used to measure it?
Quality Measures
Build the HIT to deliver care, assume risk, and measure quality
Supporting HIT
Determine the type and amount of risk providers assume for I/DD VBP Arrangements
Risk
Identify the I/DD Populations and Services in VBP
Benefit Design
Attribution
Determine which providers are accountable for the cost and quality of care for individuals with I/DD
Questions?