Presenters Antara Aiama (QI/PI Manager) Jess Liu (QIP Project Specialist)

1. 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)

2. Objectives • QIP Overview & Timeline • Measures • Resources for Providers • Q&A session

3. What is the QIP? • What is the Quality Improvement Program? • Who qualifies for program?

4. 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

5. 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)

7. 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,

8. Unit of Service Measures

9. 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

10. 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

11. 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

12. 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

13. 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

14. Fixed Pool Measures

15. 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).

16. 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

17. 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

18. 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.

19. 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

20. 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

21. 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).

22. Data Sources • PHC Administrative Data: • Outpatient and Inpatient Claims • Pharmacy • Radiology/Imaging • Lab • Provider submitted data: • Data uploads into eReports

23. 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

24. Fixed Pool Measures – Tracking Systems

25. 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

26. Monthly Reports

27. Submission Templates

28. 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)

29. 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

30. Comprehensive Measurement Set

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

33. Q&A