Maternity Care

Value Based Payment Quality Measure Set
Measurement Year 2019

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

December 18, 2018                     NYS Medicaid Value Based Payment

INTRODUCTION

The Measurement Year (MY) 2019 Maternity Care Quality Measure Set was created in collaboration with the Maternity 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 in the Delivery System Reform Incentive Payment (DSRIP) Program, the Quality Assurance Reporting Requirements (QARR), the Merit–based Incentive Payment System (MIPS), where applicable, and for the State´s Vital Statistics maternity care measures. The measure set was designed to encourage providers to meet high standards of patient–centered clinical care and coordination across multiple care settings throughout the maternity care episode.

MEASURE SELECTION AND FEASIBILITY

During the spring and summer of 2018, the Maternity Care 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, 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 2019. For MY 2019, one measure has been removed and two measures have been added, culminating in a total of eighteen Maternity Quality Measures.

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 deemed to be clinically relevant, reliable, valid, and feasible.

CATEGORY 2
Measures that are clinically relevant, valid, and reliable, but where the feasibility could be problematic. These measures were investigated during the 2017 & 2018 pilot programs.

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 and deemed reportable by the State are to be reported by VBP Contractors to the MCOs. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible.1 At least one Category 1 P4P measure must be included in a VBP contract.

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 few years. Please see the 2019 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 sets for the subsequent year.

Categories 2 and 3

Category 2 measures have been accepted by the State based on agreement of clinical 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 2019 (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 2019. 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 measure additions, deletions, recategorizations, and reclassifications from P4R to P4P or vice versa, based on experience with measure implementation in the prior year. During 2019, the CAGs and the VBP Workgroup will re–evaluate measures and provide recommendations for MY 2020. Please see Appendix A for a full list of these changes.

Note: Additional changes have been made to the names for some of the measures presented below to ensure alignment with the naming conventions used by the official measure steward. There have not been any changes to the measure specifications associated with these name changes

Category 1

The table below displays the Category 1 MY 2019 Maternity Care 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 2018 and MY 2019. Additions are made in red text while deletions are made with a strikethrough.

Measure Measure Steward Measure Identifier Classification
Contraceptive Care – Postpartum United States Office of Population Affairs NQF 2902 P4R
C–Section for Nulliparous Singleton Term Vertex (NSTV) The Joint Commission (TJC) NQF 0471 P4R
Exclusive Breast Milk Feeding TJC NQF 0480 P4R
Incidence of Episiotomy Christiana Care Health System NQF 0470 P4R
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment National Committee for Quality Assurance (NCQA) NQF 0004 P4P
Low Birth Weight [Live births weighing less than 2,500 grams (preterm v. full term)] Agency for Healthcare Research and Quality (AHRQ) NQF 0278 (lost endorsement) P4R
Percentage of Preterm Births NYS – P4R
Prenatal and Postpartum Care NCQA NQF 1517 (lost endorsement) P4P
Preventive Care and Screening: Screening for Clinical Depression and Follow–Up Plan Centers for Medicare & Medicaid Services (CMS) NQF 0418 P4R
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention American Medical Association Physician Consortium for Performance Improvement (AMA PCPI) NQF 0028 P4R

Category 2

The table below displays the Category 2 MY 2019 Maternity Care 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 2019. The measure set is redlined to highlight changes made between MY 2018 and MY 2019. Additions are made in red text while deletions are made with a strikethrough.

Measure Measure Steward Measure Identifier
Antenatal Hydroxyprogesterone Texas Maternity Bundle –
Antenatal Steroids TJC NQF 0476
Appropriate DVT Prophylaxis in Women Undergoing Cesarean Delivery Hospital Corporation of America (HCA) NQF 0473
Experience of Mother with Pregnancy Care – –
Hepatitis B Vaccine Coverage Among All Live Newborn Infants Prior to Hospital or Birthing Facility Discharge Centers for Disease Control (CDC) NQF 0475
Intrapartum Antibiotic Prophylaxis for Group B Streptococcus (GBS) Massachusetts General Hospital NQF 1746
Monitoring and Reporting of NICU Referral Rates – –
Postpartum Blood Pressure Monitoring Texas Maternity Bundle –
Vaginal Births after Cesarean Section NYS –

Appendix A

The tables below identify the changes to the Category 1 and Category 2 measures for the MY 2019 Maternity Care Quality Measure Set.

CATEGORY 1 MEASURE CHANGES FROM 2018 TO 2019

Measure Name Change Rationale for Change
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment Added Recommended by NYS Department of Health inter– agency review team
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Added Recommended by NYS Department of Health inter– agency review team

CATEGORY 2 MEASURE CHANGES FROM 2018 TO 2019

Measure Name Change Rationale for Change
Monitoring and Reporting of NICU Referral Rates Removed Recommended by Maternity Care CAG

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1. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value Based Payment: Annual Update, November 2017. (Link)  1
2. 2019 Value Based Payment Reporting Requirements; Technical Specifications Manual, Nov 2018, File found in the Quality Measures tab (Link)  2