MY 2020 & 2021 AMP Program Updates - January 21, 2021 Thien Nguyen, Director, Data Strategy Edith Fox, Project Manager Christine Tu, Program ...
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MY 2020 & 2021 AMP Program Updates January 21, 2021 Thien Nguyen, Director, Data Strategy Edith Fox, Project Manager Christine Tu, Program Coordinator
Agenda
• 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
Questions? Submit them via the "Q&A" function!
Today’s webinar will be recorded and posted on
https://www.iha.org/news-and-events/
2 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
MY 2019 results update
What happened?
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.
4 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
What’s impacted?
Issues Impacted Measures Use of Measure Results
• Acute Hospital Utilization (AHU)
Member Attribution • Emergency Department Utilization (EDU) • No impact to awards or public
reporting
Small PO Pooled • Acute Hospital Utilization (AHU) • Updated results will be
Results • Emergency Department Utilization (EDU) reflected in incentive design
(PO results with
Updated MY 2019 results now available!
• 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.
6 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
AMP measure generation & reporting process – Onpoint-generated
results
NCQA:
certifies
measures
for use in
AMP Onpoint:
program data intake, IHA
generate releases
Participant Results used
Questions & for PO
measure preliminary
IHA: QA/ Appeals accountability
results, QA/ results to
validate period
validation participants
measure
results
Measure Generation Participant Review AMP Final Results
7 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
Improvements for MY 2020 reporting cycle
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.
8 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
MY 2020 AMP program updates
New in 2021 • 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 10 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
Measurement Year (MY) 2020 program updates in response to
COVID-19
MY 2020 AMP
MY 2020 Data Collection MY 2020 AMP Incentive
Accountability Measure Set –
& Reporting Design Approach
“Pandemic Priority”
IHA intends to collect and report all The committee members voted to keep The committee members agreed with
normally submitted data for MY 2020 to 27 of the 38 measures across clinical Technical Payment Committee
continue to provide insights from 2020 quality, ACI, patient experience, recommended incentive approach to
results including those related to resource use and cost domains to be use the current Attainment Incentive
COVID-19. used for awards, public reporting and pathway with updated/relaxed
incentive design. performance targets.
11 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 updated accountability measure set
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.
Status MY 2020
Measure Domain
Quo “Pandemic Priority”
Clinical Quality
• Prevention & Screening: childhood and adolescent immunizations
• Diabetes: statin therapy for patients with diabetes; HbA1c control; medication adherence 24 16
• Cardiovascular: controlling blood pressure; statin therapy; medication adherence
• Respiratory: appropriate antibiotic use; appropriate testing for pharyngitis; asthma medication ratio
Advancing Care Information 2 2
Patient Experience 5 4
Appropriate Resource Use
• All-Cause Readmissions (PCR); Acute Hospital Utilization (AHU); Emergency Department Utilization 5 4
(EDU); Generic Prescribing — Overall (GRX)
Cost 1 1
Data Quality 1 0
TOTAL 38 27
Detailed AMP MY 2020 Measure Set can be found here.
12 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 incentive design approach
Use of the current
Attainment Incentive pathway
with updated/relaxed
performance targets
13 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 AMP program cycle
MY20 Onpoint-
MY20 Quality Generated Final MY20 AMP Preparing
Data Collection Reports Release Results
(Jan - June) Reports Release for MY21
(May - Aug) (Aug – Oct) (Oct) Cycle
• Plans: Quarterly • Commercial HMO & • Results from health • Final results available • Jun: MY 2021 AMP
submission to Onpoint MA results from plan member-level data for all AMP programs Technical Specification
• POs & Plans: Audited audited data submission to Onpoint • Results used for PO • Oct: MY 2022 Public
quality submission to submission to (Preliminary & Final) recognition, public Comment
TransUnion TransUnion • Participant Review: reporting, incentive • Dec: MY21 Final AMP
(Preliminary & Final) Questions and Appeals payments Program Guide
• Participant Review: period
Questions and Appeals
period
14 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 AMP measurement updates
2016–2021 measure set strategy
1 2 3
Increase alignment in the Targeted development Support less burdensome
AMP measure set of the AMP measure set data collection and
more timely reporting
16 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.2022–2026 measurement strategy — in development!
Goal Process
• Develop 2022-2026 measurement strategy that • Strategy development will be informed by
reflects consensus-based decisions for IHA AMP stakeholders and approved through
performance measurement programs. IHA Committees.
We want to hear from you — Stakeholder survey coming soon!
17 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.How IHA maintains the AMP measure set
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).
Adopted
Ready for program use –
fully validated with ability
First-Year to benchmark attainment
Collected to establish and improvement
baseline for use in AMP
Testing programs
Tests validity of a new Retired
measure
No longer meets criteria
for measures included in
AMP measure set
18 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 measure set reminders
AMP Product Line
Domain Measure Commercial Commercial Medicare Medi-Cal
HMO ACO Advantage Managed Care
Child and Adolescent Well-Care Visits (WCV) First-Year
Prenatal and Postpartum Care (PPC) Info Only
Clinical Weight Assessment & Counseling for Nutrition and
Quality Physical Activity for Children/Adolescents: BMI First-Year
Percentile Documentation (WCC)
Adult BMI Assessment (ABA) Retired
Encounter Format (ENFMT) First-Year First-Year First-Year First-Year
Data Quality
Encounter Timeliness (ENLAG) First-Year First-Year First-Year First-Year
Appropriate
Resource Hospital Average Length of Stay (HALOS) First-Year First-Year Info Only
Use
MY 2020 AMP Measure Set
19 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 measure specification changes
• The AMP Program aligns with current specifications Summary of MY 2020 Specification Changes
from the measure steward whenever possible.
• Cross-cutting changes to multiple HEDIS measures
• A full list of MY 2020 specification changes can be (please refer to the manual for specific measures):
found in Appendix 1 of the MY 2020 AMP Program – Telehealth-related specification changes to HEDIS
Manual. 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).
20 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.AMP measure specification timeline to align with
NCQA HEDIS timeline
• 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.
CY 2020 CY 2021 CY 2022 CY 2023
Prior State Transition Year (Current)
Sept. 1: DRAFT MY 2020 & 2021 June 1: FINAL MY 2021 Technical June 1: FINAL MY 2022 Technical June 1: FINAL MY 2023 Technical
Manual Specifications; MY 2021 Prelim. Specifications; MY 2022 Prelim. Specifications; MY 2023 Prelim.
Program Guide Program Guide Program Guide
Sept 1-30: Public Comment (MY 2020
& MY 2021) Oct. 11: DRAFT MY 2022 Technical Oct. 10: DRAFT MY 2023 Oct. 9: DRAFT MY 2024 Technical
Specifications Technical Specifications Specifications
Dec. 1: FINAL MY 2020 manual;
FINAL MY 2020 & 2021 measure sets Oct. 11-29: Public Comment (MY Oct. 10-28: Public Comment Oct. 9-27: Public Comment (MY 2024)
2022) (MY 2023)
Dec. 1: FINAL MY 2024 measure set;
Dec. 1: FINAL MY 2022 measure set; Dec. 1: FINAL MY2023 measure set; MY 2023 Final Program Guide
MY 2021 Final Program Guide MY 2022 Final Program Guide
21 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 AMP data submission & reporting
MY 2020 reporting
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.
AMP Product Line
Health Plan
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
23 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.Measure domains & data sources
Quality Domain
Clinical Quality Patient Experience Advancing Care Information
(AMP Commercial HMO & Medi-Cal Managed Care) (AMP Commercial HMO)
• Self-reporting PO audited submission (all product • Clinician and Group CAHPS survey • e-Measures reported by POs
lines & optional) of PO members • Not audited
• Health plan audited submission (HMO, Medicare • Administered by PBGH
Advantage) & claims submission (ACO, Medi-Cal)
• Not a sample – all members included
Resource Use Domain Data Quality Domain
Appropriate Resource Use Total Cost of Care Encounter Data Metrics
• Complete member-level data submitted by • Member-level cost data submitted by • Encounter data volume by service types from
health plans health plans health plan audited submission
• Calculated by Onpoint Health Data • Calculated by Onpoint Health Data • Encounter Format and Encounter Timeliness
from health plan claims & encounters data
submission. Calculated by Onpoint Health Data
24 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.Data submission process
AUDITED CLINICAL
QUALITY SUBMISSION PO & Plan Auditor Transunion IHA
(TransUnion Healthcare)
• Generate measure • Audits measure • Reviews and
• Validates formats
results using data results consolidates data
file layout provided • Consolidates files
• Validates • Creates and
by IHA distributes reports
programming
to HPs and POs
• Locks file
HEALTH PLAN MEMBER-
LEVEL DATA SUBMISSION Health Plan Onpoint IHA
(Onpoint Health Data)
• Eligibility • Intakes, validates, • Reviews and
• Member Identifier and links data consolidates data
• Claims (Med & Rx) • Generates • Creates and
measure results distributes reports
• Lab results
to HPs and POs
• Cost
25 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 audited submission data file layouts
For health plan and PO data submission to TransUnion Healthcare
To do now:
Review draft data file layouts. Please email any feedback to amp@iha.org 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.
Commercial Commercial Medicare Medi-Cal
Data File Layout Audited
HMO ACO Advantage 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
26 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.e-Measures: A quick primer 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. 27 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
Data sharing is crucial to complete & accurate results! • 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. 28 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
Encounter data is especially important
2.5
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
2.0
appeals periods
Average Risk Score (ACG)
Encounter Rate by Service Type (ENRST) in AMP:
1.5
• Rates and benchmarking for all product lines
What POs can do: 1.0
• Monitor your encounter data submission to plans
• Mind encounter data deadlines for AMP reporting
• Review ENRST results when available in May 0.5
To support successful encounter data submission, IHA reports
additional metrics of encounter data timeliness (ENLAG) and 0.0
0 2 4 6 8 10 12 14 16 18
format (ENFMT).
Encounter Volume (rate per member per year for professional services)
29 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.Provider Organizations – data submission checklist
Self-Reporting Provider Organizations Non-Self Reporting Provider Organizations
❑ Feb. 15: Download & program PO clinical measure ❑ Feb. 15: Download & program Non-SRPO e-
data file layout Measure data file layout
❑ Mar. 22 - May 3: Send PO clinical measure test file ❑ Mar. 22 - May 3: send completed Non-SRPO e-
to TransUnion; resend until no errors are found Measure test file to TransUnion; resend until no
❑ Apr. 30: Send passing PO clinical measure file to errors are found
auditor ❑ May 7: send passing Non-SRPO e-Measure test
❑ May 7: Send auditor-locked PO clinical measure file to TransUnion
file to TransUnion for use in AMP reporting
[audit not required for AMP commercial ACO]
Detailed data collection timeline provided in AMP Program Manual (pages 8-9)
30 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.Health Plans – data submission checklist
Audited Clinical Submission to TransUnion Member-Level Data Submission to Onpoint
❑ Feb. 15: Download & program HP clinical ❑ Jan. 31: Q4 2020 data submission
measure data file layout ❑ Mar. 1: Plan validation & sign off – Eligibility &
❑ Mar. 22 - May 3: Send HP clinical measure test Pharmacy Claims
file to TransUnion; resend until no errors are ❑ May 28: Plan validation & sign off – Medical Claims
found & Member Identifier
❑ Apr. 30: Send passing HP clinical measure file to ❑ Jun. 4: Plan validation & sign off – Cost
auditor
❑ May 7: Send auditor-locked HP clinical measure
file to TransUnion for use in AMP reporting
Detailed data collection timeline provided in AMP Program Manual (pages 8-9).
31 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.Health Plans – Onpoint quarterly data submission dashboard
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
Health Plans transitioning to Quarterly Data Submission.
WHA
Health Plans transitioning to Quarterly Data Submission.
In Progress On Track Complete
32 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.MY 2020 AMP reporting timeline
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
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
Detailed reporting timeline provided in the AMP Program Manual (pg. 10).
34 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.Looking ahead: MY 2021 AMP measurement
MY 2021 measure set highlights
Commercial Commercial Medicare Medi-Cal
Measure
HMO ACO Advantage Managed Care
Depression Care: Preventive Care and Screening: Screening for
X
Depression and Follow‐Up Plan (PREV‐12)
Depression Care: Depression Screening and Follow‐Up for
X
Testing Adolescents and Adults (DSF‐E)
Measures Depression Care: Utilization of the PHQ‐9 to Monitor Depression
X
Symptoms for Adolescents and Adults (DMS‐E)
Depression Care: Depression Remission or Response for
X
Adolescents and Adults (DRR‐E)
First-Year
Prenatal and Postpartum Care (PPC) X
Measures
Child and Adolescents Well-Care Visits (WCV) X
Weight Assessment & Counseling for Nutrition and Physical
Activity for Children/Adolescents: BMI Percentile Documentation X
(WCC)
Adopted
Measures Encounter Format (ENFMT) X X X X
Encounter Timeliness (ENLAG) X X X X
Hospital Average Length of Stay (HALOS) X X Info Only
36 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.The new iha.org
A quick reminder: revisiting the old iha.org 38 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
Our brand identity at work: the new iha.org 39 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.
AMP resources
Key pages for the AMP program
• 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
41 1/21/2021 Copyright 2021 Integrated Healthcare Association, all rights reserved.Questions on the new website? Need assistance locating a resource? Email amp@iha.org so we can assist!
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