DSRIP Achievement Value (AV) Guide Webinar

February 25, 2016

  • Guide also available in Portable Document Format (PDF)

Agenda

  1. Purpose of Webinar
  2. What is an Achievement Value?
  3. How to earn an Achievement Value
    • Earning AVs for Domain 1 measures
    • Earning AVs for Domain 2, 3, or 4 measures
  4. How Achievement Values relate to payments
  5. DSRIP Timelines
  6. Additional Information

1. Purpose of Webinar

Introduction to the AV Guide for PPS

  • DOH published the Achievement Value (AV) Guide for Performing
  • Provider Systems (PPS) on January 29, 2016*.
  • The AV Guide provides information on the processes associated with earning AVs and the associated payments.
  • The AV Guide summarizes information provided in previous guidance and does not contain any policy changes.
  • This webinar introduces the AV Guide by walking through the content of the AV Guide on a high level.
The AV Guide for PPS: Table of Contents

Chapter 1: What are Achievement Values?

  • How AVs relate to PPS payments

Chapter 2: How to Earn Achievement Values

  • Earning AVs in Domain 1
  • Timing of Domain 1 AV awards
  • Organizational Measures
  • Project Specific Measures
  • Earning AVs in Domain 2, 3, and 4
  • Timing of Domain 2, 3, and 4 AV awards
  • Criteria for earning Domain 2, 3, and 4 AVs

Chapter 3: Demonstration Years, Payments and Measurement Period Timelines

Appendices:

  1. Calculation of Payment Amounts per Payment Period
  2. AV Scoring Rules Exceptions
  3. Due Dates for Domain 1 Process Measure Milestones

Disclaimer

  • The AV Guide will be updated when policy changes occur.
  • This webinar will not be updated to reflect policy changes.

*Updated AV Guide – March 9th, 2016 (link)

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2. What is an Achievement Value?

  • Within DSRIP, PPS choose 8 to 11 projects from the DSRIP project menu list.
  • Projects are tracked using process and performance measures.
  • PPS will be paid based on their progress on these measures.
PPS progress on measures is tracked through a system of Achievement Values (AVs)
  • PPS earns an AV if they meet the milestones for process measures or meets the targets for performance measures.
  • Based on the share of earned AVs for a project, PPS then earn incentive payments.
PPS meets milestone(s)
or targets
PPS earns AV associated
to the milestone or target
PPS earns share of
project payments based
on relative share of AVs
obtained for project
Achievement Values are typically scored as either 1 (milestone/target met) or 0 (not met)
  • Some performance measures are composite i.e. they are worth partial AVs (total measure components sum to 1 AV).
  • For example:
    • Antidepressant medication management – effective acute phase treatment: 0.5 AV;
    • Antidepressant medication management – effective continuation phase treatment: 0.5 AV.

Achievement Values are awarded for both Process and Performance Measures

Measures for DSRIP are categorized into 4 Domains

Table 1: Measure Types per Domain
Domain Types of Measures
Domain 1 Process Measures:

Requires PPS progress towards Organizational milestone(s) and Project Specific milestones by specified target dates.
Domains 2, 3 & 4 Performance Measures:

Pay for Reporting (P4R) Measures:
PPS earn incentive payments for successfully and accurately reporting the measures to NYS DOH within the timeframes.*

Pay for Performance (P4P) Measures:

PPS earn incentive payments for results that meet or exceed the annual improvement target.

*Many of the P4R measures are reported by the State (not the PPS). Whether a measure is reported by the State or the PPS, is outlined in the DSRIP Measure Specification and Reporting Manual: Measurement Year 1. February 25, 2016.

Each project is associated with a subset of Domain 1 measures and Domain 2,3 or 4 measures

  • Every project has Domain 1 measures, and;
  • Measures of the Domain from which the project was chosen: Domain 2 3 or 4.

For example:

  • Project 2.a.i is associated with 7 Domain 1 measures and 22 Domain 2 measures
  • Project 3.a.iii is associated with 7 Domain 1 measures and 14 Domain 3 measures
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3. How to earn an Achievement Value

Earning AVs for Domain 1 Measures

Domain 1 measures represent the group of Process Measures
  • Domain 1 process measures are divided into Organizational and Project Specific measures.
For each Organizational measure and Project Specific measure one or multiple milestones are defined
  • PPS earns AV if the PPS meets the milestone(s) associated with the measures by the specified target date.
  • PPS have to reach all milestones associated with the measure in order to earn an AV.
Progress on Domain 1 measures is evaluated based on Quarterly Reports supplied by PPS
  • Reports are submitted on a quarterly basis.
  • Payments occur twice* a year: in January and July.
  • Each payment period, the evaluation of whether an AV is earned will be based on the two most recent Quarterly Reports

* With the exception of the first demonstration year when three payments will be made (May 2015, Jan 2016 and July 2016).

Earning Domain 1 Organizational AVs

  • 4 Organizational measures: Governance, Workforce, Cultural Competency / Health Literacy and Financial Sustainability.
  • PPS earns an Organizational AV if PPS meets the associated milestone(s) by the target date.
    • Overview of milestones per Domain 1 measure and the associated target dates is included in the AV Guide.
  • Organizational AVs are carried across all projects: once a PPS earns an Organizational AV, this Organizational AV is awarded for all projects in the PPS portfolio.
  • Organizational AVs are awarded twice a year after Q2 and after Q4 based on the two most recently quarterly reports.
Table 2: Example of Financial Sustainability Measure Overview of Domain 1 Milestones and Target Dates*
Example of Financial Sustainability Measure Overview of Domain 1 Milestones and Target Dates

* The full table is included in the AV Guide (Appendix C).

Earning Domain 1 Project Specific Avs

  • There are 3 Project Specific measures: Reporting, Patient Engagement Speed* and Project Implementation Speed.
  • PPS earns Project Specific AV if PPS meets associated milestone(s) by target date.
  • Project Specific AVs are awarded separately for each project.
  • AVs for Reporting and Patient Engagement Speed are earned twice a year based on two most recent quarterly reports.
  • Project Implementation Speed is different:
    • PPS can earn a maximum of 3 AVs for Project Implementation Speed over the duration of DSRIP.
    • AVs are awarded at the following moments:
      • In the quarter the PPS committed to milestones (Demonstration Year 4, Quarter 4 (DY4, Q4) at the latest) and;
      • In DY2, Q4 and;
      • In DY3, Q4.
    • If the quarter in which a PPS has committed milestones coincides with either DY2, Q4 or DY3, Q4 only one AV will be available for that quarter based on meeting the commitment made by the PPS. In this situation, a PPS can earn a maximum of 2 AVs for Project Implementation Speed over the duration of the DSRIP.

* The Patient Engagement AV does not apply to Project 2.a.i. nor Domain 4 projects. No AV is available for these projects.

Allowable Domain 1 AVs for a project per payment period

Table 3: Total Allowable AVs awarded for Domain 1 for Each Project
Reporting Period DY1* DY2 DY3 DY4 DY5  
AV Category Q2 Q4 Q2 Q4 Q2 Q4 Q2 Q4 Q2 Q4  
Organizational Governance 1 1 1 1 1 1 1 1 1 1 AVs are carried across all projects
Workforce 1 1 1 1 1 1 1 1 1 1
Cultural Competency/ Health Literacy 1 1 1 1 1 1 1 1 1 1
Financial Sustainability 1 1 1 1 1 1 1 1 1 1
Project Specific Reporting
Quarterly Progress, Project Budget and Flow of Funds reporting
1 1 1 1 1 1 1 1 1 1 AVs are evaluated separately for each project
Patient Engagement Speed* 1 1 1 1 1 1 1 1 1 1
Project Implementation Speed ** ** ** 1 ** 1 ** ** N/A N/A
Total possible AVs 6 + 6 + 6 + 7 6 + 7 6 + 6 + 6 6  

* Not applicable to Project 2.a.i and Domain 4 projects: no AVs for Patient Engagement Speed are available.
** An AV is only allowable if a PPS committed to achieving milestones related to Project Implementation Speed in that Quarter, but the latest it can be earned is DY4, Q4.
+ If a PPS commits to achieving milestones related to Project Implementation Speed in this Quarter, the total number of allowable AVs becomes 7 in that Quarter.

Earning AVs for Domain 2, 3, 4 measures

Domain 2, 3, and 4 measures represent the group of performance measures
  • Performance measures are Pay for Reporting (P4R) or Pay for Performance (P4P):
    • All performance measures are P4R in the first demonstration year (DY1);
    • Some of the performance measures transition to P4P in later DYs*.
Explanation of carrying over AVs for Domain 2, 3 and 4
  • Results for P4R and P4P measures are calculated once a year at Quarter 4 (Q4):
    • → Therefore the Independent Assessor evaluates P4R and P4P measures only once a year.
  • Since, payment is made twice a year in January and July, P4R and P4P AVs will be carried over to the following payment period:
    • This means that once a PPS earns a P4R or P4P AV in Q4 (payment July), this P4R of P4P AV is also awarded in Q2 of the following demonstration period (payment January).
    • A visualization and an example will be provided later in this presentation (slides 18 – 19).
Earning P4R AVs
  • AVs are awarded based on the PPS successfully and accurately reporting the required measure information.

* If and when a measure transitions to P4P is outlined in the DSRIP Measure Specification and Reporting Manual: Measurement Year 1. February 25, 2016

Earning P4P AVs
  • AVs are awarded when a PPS closes the gap between their own performance and the statewide performance goal by at least 10% over the duration of the measurement year.
    • Exception: Project 2.d.i performance measures*.
  • If the PPS' own performance score surpasses the statewide goal, the PPS will receive an AV in the following years if their score remains better than the statewide goal:
    • This is regardless of whether there was improvement during the measurement period.
  • No P4P AVs will be awarded for an individual measure if:
    • The PPS' baseline score (initial measurement year results) is at or better than statewide performance goal:
      • No AVs can be earned for the duration of DSRIP.
    • Measure has >30 members/events in the denominator:
      • Measure must display a denominator greater than 30 for two consecutive measurement years to be included in the AV calculations again.
    → In these situations the number of available AVs per associated project is reduced by one.

*For Project 2.d.i, performance measures, there are no statewide performance targets therefore different criteria apply for earning AVs since they cannot be based on a 10% annual closure of gap to goal. Those criteria are specified in the DSRIP Measure Specification and Reporting Manual: Measurement Year 1. February 25, 2016.

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4. How Achievement Values relate to payments

AVs are used to determine payments

PPS earn incentive payments based on the share of AVs achieved
  • Calculation of amount of dollars per project is explained in the AV Guide and in the Forestland example.

Exceptions

Running list with exception in the AV Guide
  • Exceptions to the calculation of amount of dollars per project are described in the AV Guide.
  • The list with exceptions is a running list that will be updated as required.
Example of exception
  • If there is no statewide performance goal for a P4P measure available, the measure will remain a P4R measure.
  • The dollars allocated to the P4P measure will be transitioned to P4R dollars.
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5. DSRIP Timelines

Overview of Demonstration Years (DY), Payments, Reporting periods and Measurement Years (MY)

Figure 1: Timelines: Relating Demonstration Years, Payments, Quarterly Reporting Periods and Measurement Years
Timelines: Relating Demonstration Years, Payments, Quarterly Reporting Periods and Measurement Years

Publication date: January 29 th, 2016. Version 1.
* Quarterly reports are generally due on the last day of the month following the close of the quarter

Snapshot in time: February 2016

In Demonstration Year 1, Quarter 4 (DY1, Q4)
  • Quarterly Reports of Q3 and Q4 drive payment 3 of DY1*.
In Measurement Year 2 (MY2)
  • MY2 drives payment 2 of DY2 and payment 1 of DY3.
Next payment is July 2016
  • July 2016 is payment 3 of DY1.
  • DY1 payment 3 is driven by:
    • Quarterly Reports of DY1, Q3 and DY1, Q4 and;
    • MY1 results.
Figure 2: Snapshot of Figure 1, slide 18
Snapshot of Figure 1, slide 18

* DY1 is the only demonstration year in which three payments occur (May 2015, Jan 2016 and July 2016).

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6. Additional Information

Additional Resources

Additional guidance is available through the following DSRIP Webinars and Presentations, (titles contain embedded links):

General
Domain 1 AVs
Domain 2–4 AVs
Earning Payments

Access to DSRIP information is available on the main DSRIP website (link).

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DSRIP e–mail: dsrip@health.ny.gov

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