Total Care for General Population (TCGP)/Integrated Primary Care (IPC)

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 Total Care for General Population (TCGP)/ Integrated Primary Care (IPC) Quality Measure Set was created in collaboration with the Diabetes, Chronic Heart Disease, Pulmonary, and Behavioral Health Clinical Advisory Groups (CAGs), as well as the New York State (NYS) Value Based Payment (VBP) Workgroup. The goal is to align with measures sets put forth for the Advanced Primary Care initiative by the Integrated Care Workgroup, the Delivery System Reform Incentive Payment (DSRIP) Program, and for the Quality Assurance Reporting Requirements (QARR). The Measure Set is intended to be the same for both TCGP and IPC Arrangements for Measurement Year (MY) 2018 and was designed to encourage providers to meet high standards of patient–centered clinical care and coordination across multiple settings through preventive care, sick care, and priority chronic condition episodes.

Introduction of Pediatric Measures

The Children´s Health CAG was convened in 2016–2017 and presented its final recommendations to the VBP Workgroup in October of 2017. Based on these recommendations, an additional 14 pediatric measures (8 Category 1 and 6 Category 2 measures) were added to the TCGP/ IPC Measure Set for MY 2018.

MEASURE SELECTION AND FEASIBILITY

During the summer of 2017, the Diabetes, Chronic Heart Disease, Pulmonary, and Behavioral Health CAGs 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, clinical Subject Matter Experts, and State Agencies, along with other professionals who have 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 3
Measures that are insufficiently relevant, valid, reliable and/or feasible.

Category 1

Category 1 quality measures as identified by the CAGs 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 are eligible1.

The State classified each Category 1 measure as either P4P or 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 measure per VBP Arrangement for MY 2018 (or have a State and Plan approved alternative). 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 approaches, data collection, and reporting requirements with VBP Pilots as a part of the Measure Support Task Force.

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 Category 1 TCGP/ IPC 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–recommended 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.

TCGP/IPC Measures Measure Steward Measure Identifier Classification
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder Centers for Medicare & Medicaid Services (CMS) NQF 1880 P4P
Adolescent Preventive Care– Assessment and Counseling of Adolescents on Sexual Activity, Tobacco Use, Alcohol and Drug Use, Depression NYS P4R
Adolescent Well–Care Visits NCQA P4R
Annual Dental Visit NCQA P4R
Antidepressant Medication Management – Effective Acute Phase Treatment & Effective Continuation Phase Treatment NCQA NQF 0105 P4P
Breast Cancer Screening NCQA NQF 2372 P4P
Cervical Cancer Screening NCQA NQF 0032 P4P
Childhood Immunization Status– Combination 3 NCQA NQF 0038 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
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 Care for Children Prescribed ADHD Medication NCQA NQF 0108 P4R
Immunizations for Adolescents,
Combination 2
National Committee for Quality Assurance (NCQA) NQF 1407 P4P
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) NCQA NQF 0004 P4P
Initiation of Pharmacotherapy for Alcohol Dependence3 NYS Office of Alcoholism and Substance Abuse Services (OASAS) P4R
Initiation of Pharmacotherapy upon New Episode of Opioid Dependence4 NYS P4P
Medication Management for People with Asthma (ages 5 – 64) – 50% and 75% of Treatment Days Covered NCQA NQF 1799 P4P
Pediatric Quality Indicator (PDI) #14 Asthma Admission Rate, Ages 2 Through 17 Years Agency for Healthcare Research and Quality (AHRQ) NQF 0728 P4P
Potentially Avoidable Complications in Routine Sick Care or Chronic Care Altarum Institute (Formerly HCI3) P4R
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: Screening for Clinical Depression and Follow–Up Plan CMS NQF 0418 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 Pharmacotherapy5 NYS P4R
Use of Spirometry Testing in the Assessment and Diagnosis of COPD NCQA NQF 0577 P4R
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents NCQA NQF 0024 P4P
Well–Child Visits in the First 15 Months of Life NCQA NQF 1392 P4P
Well–Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life NCQA NQF 1516 P4P

Category 2

The table below displays the Category 2 TCGP/ IPC Quality Measure Set and includes measure title, measure steward, and 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
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 OASAS
Continuity of Care from Inpatient Detox to Lower Level of Care6 NYS
Continuity of Care from Inpatient Rehabilitation to Lower Level of Care7 NYS
Developmental Screening Using Standardized Tool, First 36 Months of Life Oregon Health &amp; Science University NQF 1448
Follow–Up After ED Visit for Alcohol and Other Drug Dependence, Ages 13 and Older NCQA
Follow–Up After ED Visit for Mental Illness, Ages 6 and Older NCQA
Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver The Joint Commission NQF 0338
Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse or Dependence8 NYS
Lung Function/Spirometry Evaluation (Asthma) AAAAI
Maternal Depression Screen Done During Child´s First 6 Months of Life NCQA
Patient Self–Management and Action Plan (Asthma) AAAAI
Screening for Reduced Visual Acuity and Referral in Children (Approved for trial use) CMS NQF 2721
Topical Fluoride for Children at Elevated Caries Risk, Dental Services American Dental Association (ADA) NQF 2528
Use of First–Line Psychosocial Care for Children and Adolescents on Antipsychotics NCQA NQF 2801
Use of Imaging Studies for Low Back Pain NCQA NQF 0052
Utilization of Pharmacotherapy for Alcohol Dependence9 NYS OASAS
Use of Opioid Dependence Pharmacotherapy10 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
Two measures: Continuity of Care from Inpatient Rehabilitation to Lower Level of Care & Continuity of Care from Inpatient Detox to Lower Level of Care Continuity of Care from Inpatient Detox or Inpatient Care to Lower Level of 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
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 TCGP/ IPC Quality Measure Set.

Category 1 Measure Changes from 2017 to 2018

Measure Name Change Rationale for Change
Adolescent Well–Care visits Added Recommended by Children´s Health CAG
Adolescent Preventive Care– Assessment and counseling of adolescents on sexual activity, tobacco use, alcohol and drug use, depression (four–part measure) Added Recommended by Children´s Health CAG
Annual Dental Visit Added Recommended by Children´s Health CAG
Follow–up Care for Children Prescribed ADHD Medication (NQF 0108): Added Recommended by Children´s Health CAG
Immunizations for Adolescents– Combination 2 (NQF 1407) Added Recommended by Children´s Health CAG
Initiation of Pharmacotherapy for Alcohol Dependence Moved to Category 2 Measure moved to Category 2 because timeframe for measurement is too narrow
PDI #14 Asthma Admission Rate, ages 2 through 17 years Added Recommended by Children´s Health CAG
Well–Child Visits in the First 15 Months of Life (NQF 1516) Added Recommended by Children´s Health CAG
Well–Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life (NQF 1392) Added Recommended by Children´s Health CAG

Category 2 Measure Changes from 2017 to 2018

Measure Name Change Rationale for Change
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis Moved to Category 3 Removed due to measure specification change
Developmental Screening In the First Three Years of Life (NQF 1448) Added Recommended by Children´s Health CAG
Follow–up after ED visit for alcohol and other drug dependence Added Recommended by Children´s Health CAG
Follow–up after ED visit for mental illness Added Recommended by Children´s Health CAG
Maternal depression screen done during child´s first 6 months of life Added Recommended by Children´s Health CAG
Screening for Reduced Visual Acuity and Referral in Children (NQF 2721—approved for trial use) Added Recommended by Children´s Health CAG
Use of first–line psychosocial care for children and adolescents on antipsychotics Added Recommended by Children´s Health CAG
Use of Imaging Studies for Low Back Pain Moved to Category 3 Removed due to measure specification change
Utilization of Pharmacotherapy for Alcohol Dependence Moved to Category 1 Measure promoted to Category 1 because timeframe for measurement is sufficiently broad

__________________________________________________________

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 moved to Category 2.  3
4. 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.  4
5. Measure moved to Category 1 from Category 2.  5
6. 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.  6
7. Ibid.  7
8. Measure moved from Category 1. 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. Measure moved to Category 1.  9
10. 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.  10