Health and Recovery Plan (HARP) Subpopulation

Value Based Payment Quality Measure Set
Measurement Year 2018

  • Measure Set is also available in Portable Document Format (PDF)

October 31, 2017                     NYS Medicaid Value Based Payment


INTRODUCTION

The 2018 Health and Recovery Plan (HARP) Subpopulation Quality Measure Set was created in collaboration with the HARP Subpopulation Clinical Advisory Group (CAG) and the New York State (NYS) Value Based Payment (VBP) Workgroup. The goal is to align with measures sets put forth for the Delivery System Reform Incentive Payment (DSRIP) Program and for the Quality Assurance Reporting Requirements (QARR) measure set. The HARP measure set was designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings for the HARP Subpopulation.

MEASURE SELECTION AND FEASIBILITY

During the summer of 2017, the HARP Subpopulation CAG reconvened and made recommendations to the State on quality measures, data collection, data reporting, and support required for providers to be successful in a VBP environment.

Beginning in June of 2017, the State initiated monthly meetings of the VBP Measure Support Task Force and arrangement–level Sub–teams. The goal of the Task Force and Sub-teams is to make recommendations to the State to support and inform the Annual Measure Review Cycle. Members of the Task Force include professionals from various Managed Care Organizations (MCOs), VBP Pilot Contractors, State Agencies, along with other professionals with experience in quality measurement and health information technology. The Task Force provided feedback to DOH on quality measure feasibility, reporting, and calculation.

Upon receiving the CAG recommendations and Task Force feedback, the State defined a final list of measures for inclusion for MY 2018.

MEASURE CLASSIFICATION

Each measure has been designated by the State as Category 1, 2, or 3 with associated recommendations for implementation and testing for future use in VBP arrangements. The measures below are classified by category based on an assessment of reliability, validity, and feasibility, and according to suggested method of use (either Pay for Reporting (P4R) or Pay for Performance (P4P)).

    Categorizing and Prioritizing Quality Measures

CATEGORY 1
Approved quality measures that are felt to be both clinically relevant, reliable and valid, and feasible.

CATEGORY 2
Measures that are clinically relevant, valid, and probably reliable, but where the feasibility could be problematic. These measures should be investigated during the 2018 pilot program.

CATEGORY 3Measures that are insufficiently relevant, valid, reliable and/or feasible.

Category 1

Category 1 quality measures as identified by the HARP Subpopulation CAG and accepted by the State are to be reported by VBP Contractors. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors would be eligible1.

The State classified each Category 1 measure as either P4P or pay for reporting P4R:

  • P4P measures are intended to be used in the determination of shared savings amounts for which VBP Contractors are eligible. Measures can be included in both the determination of the target budget and in the calculation of shared savings for VBP Contractors.
  • P4R measures are intended to be used by the Managed Care Organizations (MCOs) to incentivize VBP Contractors for reporting data to monitor quality of care delivered to members under the VBP contract. Incentives for reporting will be based on timeliness, accuracy, and completeness of data. Measures can be reclassified from P4R to P4P through annual CAG and State review or as determined by the MCO and VBP Contractor.

Not all Category 1 measures will be reportable for the measurement year, as reporting on some of these measures will be phased in over the next 2 years. Please see the 2018 Value Based Payment Reporting Requirements Technical Specifications Manual 2 for details as to which measures must be reported for the measurement year. This manual will be updated annually each fall, in line with the release of the final VBP measure set for the subsequent year.

Categories 2 and 3

Category 2 measures have been accepted by the State based on agreement of measure importance, validity, and reliability, but flagged as presenting concerns regarding implementation feasibility. These measures will be further investigated in the VBP Pilots. The State requires that VBP Pilots select and report a minimum of one Category 2 measures per VBP Arrangement (or have a State and Plan approved alternative) for MY 2018. VBP Pilot participants will be expected to share meaningful feedback on the feasibility of Category 2 measures when the CAGs reconvene. The State will discuss measure testing approach, data collection, and reporting requirements with VBP Pilots at a future date.

Measures designated as Category 3 were identified as unfeasible at this time or as presenting additional concerns including accuracy or reliability when applied to the attributed member population for an arrangement.

MEASUREMENT YEAR 2018 QUALITY MEASURE SET

The measures and State determined classifications provided on the following pages are recommendations for MY 2018. Note that measure classification is a State recommendation and implementation is to be determined between the MCO and VBP Contractor.

Measure sets and classifications are considered dynamic and will be reviewed annually. Updates will include additions, deletions, reclassification of measure category, and reclassification from P4R to P4P based on experience with measure implementation in the prior year. During 2018, the CAGs and the VBP Workgroup will re-evaluate measures and provide recommendations for MY 2019.

Category 1

The table below displays the complete Category 1 HARP Subpopulation Quality Measure Set, arranged alphabetically, and includes measure title, measure steward, the National Quality Forum (NQF) number and/ or other measure identifier (where applicable), and State determined classification for measure use. The measure set is redlined to highlight changes made between MY 2017 and MY 2018. Additions are made in red text while deletions or changes are made with a strikethrough.

Measure Measure Steward Measure Identifier Classification
Adherence to Antipsychotic Medications for Individuals with Schizophrenia Centers for Medicare & Medicaid Services (CMS) NQF 1879 P4P
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder Centers for Medicare & Medicaid Services (CMS) NQF 1880 P4P
Breast Cancer Screening National Committee for Quality Assurance (NCQA) NQF 2372 P4P
Cervical Cancer Screening NCQA NQF 0032 P4P
Chlamydia Screening In Women NCQA NQF 0033 P4P
Colorectal Cancer Screening NCQA NQF 0034 P4P
Comprehensive Diabetes Care: All Three Tests (HbA1c, dilated eye exam, and medical attention for nephropathy) NCQA NQF #s 0055, 0062, 0057 P4P
Comprehensive Diabetes Care: Eye Exam (retinal) Performed NCQA NQF 0055 P4P
Comprehensive Diabetes Care: Foot Exam NCQA NQF 0056 P4R
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) NCQA NQF 0575 P4R
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) NCQA NQF 0059 P4P
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) testing [performed] NCQA NQF 0057 P4P
Comprehensive Diabetes Care: Medical Attention for Nephropathy NCQA NQF 0062 P4P
Continuity of Care from Inpatient Detox to Lower Level of Care3 NYS P4P
Continuity of Care from Inpatient Rehabilitation to Lower Level of Care4 NYS P4P
Controlling High Blood Pressure NCQA NQF 0018 P4P
Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications NCQA NQF 1932 P4P
Follow–Up After Emergency Department Visit for Alcohol and Other Drug Dependence5 NCQA NQF 2605 P4P
Follow–Up After Emergency Department Visit for Mental Illness6 NCQA NQF 2605 P4P
Follow–Up After Hospitalization for Mental Illness NCQA NQF 0576 P4P
Initiation of Pharmacotherapy for Alcohol Dependence7 NYS OASAS P4R
Initiation of Pharmacotherapy upon New Episode of Opioid Dependence8 NYS P4P
Maintaining/Improving Employment or Higher Education Status9 NYS P4R
Maintenance of Stable or Improved Housing Status10 NYS P4R
Medication Management for People with Asthma (Ages 5 – 64) – 50% and 75% of Treatment Days Covered NCQA NQF 1799 P4P
No or Reduced Criminal Justice Involvement11 NYS P4R
Percentage of Members Enrolled in a Health Home NYS P4R
Percentage of Members who Receive PROS or HCBS for at least 3 Months in Reporting Year12 NYS OMH / OASAS P4R
Potentially Preventable Mental Health Related Readmission Rate 30–Days13 NYS P4P
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow–Up Plan CMS NQF 0421 P4R
Preventive Care and Screening: Influenza Immunization American Medical Association Physician Consortium for Performance Improvement (AMA PCPI) NQF 0041 P4R
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention AMA PCPI NQF 0028 P4R
Statin Therapy for Patients with Cardiovascular Disease NCQA P4R
Statin Therapy for Patients with Diabetes NCQA P4R
Use of Alcohol Abuse or Dependence Pharmacotherapy14 NYS P4R
Use of Spirometry Testing in the Assessment and Diagnosis of COPD NCQA NQF 0577 P4R

Category 2

The table below displays the complete Category 2 HARP Subpopulation Quality Measure Set and includes measure title, measure steward, the NQF number and/or other measure identifier (where applicable). All Category 2 measures are classified as P4R in MY 2018. The measure set is redlined to highlight changes made between MY 2017 and MY 2018. Additions are made in red text while deletions or changes are made with a strikethrough.

Measure Measure Steward Measure Identifier
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder CMS NQF 1880
Asthma: Assessment of Asthma Control – Ambulatory Care Setting The American Academy of Allergy, Asthma & Immunology (AAAAI)
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis NCQA NQF 0058
Continuing Engagement in Treatment (CET) Alcohol and Other Drug Dependence NYS
Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse or Dependence15 NYS
Lung Function/Spirometry Evaluation (Asthma) AAAAI
Mental Health Engagement in Care 30–Days16 NYS
Patient Self–Management and Action Plan (Asthma)* AAAAI
Percentage of HARP Enrolled Members Who Received Personalized Recovery Oriented Services (PROS) or Home and Community Based Services (HCBS)17 NYS OMH / OASAS
Use of Alcohol Abuse or Dependence Pharmacotherapy18 NYS OASAS
Use of Imaging Studies for Low Back Pain NCQA NQF 0052
Use of Opioid Dependence Pharmacotherapy19 NYS

Appendix A


Updated Measure Name Crosswalk

The following table shows the measure names that were updated for MY 2018.

Measure Name in MY 2018 Measure Name in MY 2017
Continuity of Care from Inpatient Rehabilitation to Lower Level of Care Continuity of Care (CoC) within 14 days of discharge from any level of SUD inpatient care
Continuity of Care from Inpatient Detox to Lower Level of Care Continuity of Care (CoC) within 14 days of discharge from any level of SUD inpatient care
Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse or Dependence Initiation of Pharmacotherapy for Alcohol Dependence
Initiation of Pharmacotherapy upon New Episode of Opioid Dependence Initiation of Pharmacotherapy for Opioid Use Disorder
Maintaining/Improving Employment or Higher Education Status Percentage of members who maintained/obtained employment or maintained/improved higher education status
Maintenance of Stable or Improved Housing Status Percentage of members with maintenance of stable or improved housing status
Mental Health Engagement in Care 30–Days Percentage of Mental Health Discharges Followed by Two or More Mental Health Outpatient Visits within 30–Days
No or Reduced Criminal Justice Involvement Percentage of members with reduced criminal justice involvement
Potentially Preventable Mental Health Related Readmission Rate 30–Days Readmission to mental health inpatient care within 30–days of discharge
Use of Alcohol Abuse or Dependence Pharmacotherapy Utilization of Pharmacotherapy for Alcohol Dependence
Use of Opioid Dependence Pharmacotherapy Utilization of Pharmacotherapy for Opioid Use Disorder

Appendix B


The tables below provide the changes to the Category 1 and Category 2 measures for the MY 2018 HARP Quality Measure Set.

Category 1 Measure Changes from 2017 to 2018

Measure Name Change Rationale for Change
Adherence to Antipsychotic Medications for Individuals with Schizophrenia Added Intended for inclusion in 2017
IPC Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder Moved to Category 2 Intended for Integrated Primary Care
IPC Initiation of Pharmacotherapy for Alcohol Dependence Moved to Category 2 Measure moved to Category 2 because timeframe for measurement is too narrow
Percentage of Members Who Receive PROS or HCBS for At Least 3 Months in Reporting Year Moved to Category 2 Measure demoted and specification is being refined
IPC Utilization of Pharmacotherapy for Alcohol Dependence Moved to Category 1 Measure promoted because timeframe for measurement is sufficiently broad

IPC Measure is also part of TCGP/ IPC Measure Set


Category 2 Measure Changes from 2017 to 2018

Measure Name Change Rationale for Change
IPC Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis Moved to Category 3 Removed due to measure specification change
IPC Use of Imaging Studies for Low Back Pain Moved to Category 3 Removed due to measure specification change

IPC Measure is also part of TCGP/ IPC Measure Set

__________________________________________________________

1. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value Based Payment: Annual Update, June 2016. (Link)  1
2. 2018 Value Based Payment Reporting Requirements; Technical Specifications Manual, Nov 2017, File found in the Quality Measures tab (Link)  2
3. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document. This measure is a component of a measure that was split into two separate measures for MY 2018.  3
4. Ibid.  4
5. This measure is a component of NQF 2605, Follow–Up After Emergency Department Visit for Mental Illness or Alcohol and Other Drug Dependence.  5
6. Ibid.  6
7. Measure Moved to Category 2 for MY 2018.  7
8. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  8
9. Ibid.  9
10. Ibid.  10
11. Ibid.  11
12. Measure moved to Category 2 for MY 2018.  12
13. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  13
14. Measure moved from Category 2 for MY 2018. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  14
15. Measure moved from Category 1 for MY 2018. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  15
16. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  16
17. Measure moved to Category 1 for MY 2018.  17
18. Ibid.  18
19. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  19