Webinar Transcript

Slide 1

Welcome to the WEBINAR: DSRIP Performance Measures: Annual Improvement Targets and Baseline results.

Slide 2

Today we will be going over Performance Measures, Measurement Specification and Reporting Manual, and the baseline performance measure results file you have received for select Domain 2 and 3 measures.

Slide 3

This presentation will provide PPSs with details about:

  • Baseline measures results and how they are calculated.
  • A detailed explanation on performance goals and the process of annual improvement target setting.
  • A brief overview about how results are used in determining earned achievement values.
  • As well as outlines when a PPS can achieve high performance targets

We also hope to provide an explanation of the information contained in the baseline measure results file that each PPS will receive and how to use and interpret this file.

Answers key questions a PPS may have and explain scenarios when baseline results fall above or below statewide performance goals.

Slide 4

We wanted to take some time to walk you through how the Measurement and Specification Reporting Manual links back to the applicable performance measures that you are responsible for.
For the purpose of this slide we will be limiting our discussion to applicable domain 2 and 3 measures.

Starting in the lower left hand side of the slide: The Measure Specification and Reporting Manual outlines official Domain 1 to 4 performance measures, describes how performance measures will be calculated (Domains 2 and 3), and includes a description of numerators and denominators for each measure. An updated copy of the manual will be released each DSRIP Measurement year.

The DSRIP Measurement year runs from July 1 to June 30. As you can see in the box in the lower right lower hand corner of the Slide. Your baseline data or Measurement year 0 was July 1, 2013 to June 30, 2014. Measurement year 1 is July 1, 2014 to June 30, 2015 and so on.

During the DSRIP measurement year, data is collected for all performance measures associated with the projects the PPS selected, and the PPS result is calculated using this data.

The State will calculate annual improvement target values using the most recent PPS result that will be used for the next measurement year. These results will then be provided to the PPS.

The PPS will need to meet or exceed the annual improvement target to earn the achievement value for measures that are pay-for-performance. Pay-for-reporting measures will earn the achievement value for the PPS result alone.

Each subsequent year the PPS will report data and annual improvement targets will be set.

Slide 5

For all applicable Domain 2 and Domain 3 metrics, a baseline result is calculated for each metric for each PPS.

Measure results are calculated according to the methodology outlined in the Measure Specification and Reporting Manual. This manual is available on the link given in the slide. Make sure you have the Reporting Manual that corresponds with the correct DSRIP Measurement Year.

For measures that are calculated with claims and encounters, data from July 1, 2013 to June 30, 2014 was used for baseline. UAS-NY measure results are based on assessments conducted from January to June 2014.

The baseline results mark the starting point of DSRIP Measurement Year 1 from which PPS will have to demonstrate improvement towards the Statewide Performance Goal on an annual basis. We understand that it is May and that the DSRIP Measurement Year 1 ends on June 30th. Remember that for measurement years 1 and 2, many of these measures are pay for reporting.

A Statewide Performance Goal has been established for each measure using the top decile zip code results for NYS Medicaid managed care for 2013. These Statewide Performance Goals will not change over time.

´Gap to goal´ is the process by which the annual improvement target is set for a specific measurement year. The most current PPS measurement year (MY) result is used to determine the gap between this result and the measure´s performance goal, and then 10% of that gap is added to this result to establish the annual improvement target for the next measurement year. Each subsequent year will continue to be set with an annual improvement target using the most recent year´s result

A High Performance Fund has been established and is comprised of funds available for a PPS when they achieve high performance through two methods: 1) achieving a reduction in gap to goal by 20% or more in any annual measurement period for a high performance eligible measure; or 2) meeting or exceeding the measure´s performance goal for the measurement period for a high performance eligible measure.

The ´Performance Measures Baseline Results´ file (sent out on May 27, 2015) can be used to identify where the PPS begins, what their annual improvement target has been set to, the result a PPS must achieve to access the High Performance Fund, and how the PPS compares to the Statewide Performance Goal.

Slide 6

Let´s recap the process of setting annual improvement targets and high performance
Remember the Statewide performance goals are fixed throughout DSRIP measurement years.

  • Each year, an annual improvement target is set for each PPS for all P4P measures in Domain 2 and 3.With the following exception. There are three measures associated with the Patient Activation for Uninsured project (2.d.i) and the PPS will achieve the value for these measures based on ratio or trending as noted in the manual.
  • As you can see in the example provided you first subtract the PPS result (in this case 62.4) from the Performance goal (88.6) giving a gap from the most recent measurement year result to the performance goal of 26.2 percentage points.
  • The annual improvement target is established by determining a small percentage (10%) of the difference between the PPS' most recent result and the performance goal, and then adding that value to the most recent performance PPS result. In the example provided the 26.2 is multiplied by 10% and that 2.62 percentage points is added to the 62.4 giving an annual improvement target of 65.
  • Annual improvement targets are created for each measure at the beginning of the DSRIP measurement year.
  • The PPS must meet or exceed the annual improvement target by the end of the measurement year to achieve the value associated with the measure and the overall percentage of achievement values drives payment. When a PPS achieves the annual improvement target (PPS recent result + 10%) + (PPS recent result) the Independent Assessor will assign an achievement value and the state will distribute DSRIP dollars.
  • When a PPS achieves 'High Performance' or PPS recent result + 20% for one of the 10 measures eligible for High Performance Fund, the PPS would receive additional payment.

Slide 7

This slide recaps the Annual Measurement Cycle Timeline.
The DSRIP Measurement year runs from July 1 to June 30th as shown in the table on the right hand side of this slide.
Several measures are collected through medical record review or from a satisfaction survey. These data are collected after the measurement year, but the services or experience being captured through this collection are occurring in the measurement year.
The State Department of Health will be sending the random sample of patients to the PPS for Medical Record Review beginning in August of each measurement year.
The PPS will be expected to collect medical record data for the selected measures from August to December. For a list of these measures see page 49 of the Measurement Specification and Reporting Manual.

The NYS DOH will calculate the final measure results for each measurement year in January and February and the independent assessor will release the measurement year results in March.

Slide 8

Now let´s talk about the Performance measure baseline results file that you have all received.
Performance measure baseline results have been calculated for each applicable measure for a PPS. Baseline results have been calculated using the methodology outlined in the Measurement Specification and Reporting Manual. Each PPS should reference the Measurement Specification and Reporting Manual to understand how a measure was calculated. Several measures in the reports do not have results or improvement targets because the data is not available; Measurement year 1 results will be used as the baseline for these measures.

In addition to the performance measure results, this file also includes the annual improvement target for Measurement Year 1.

Slide 9

When reviewing your performance measure baseline result file we have outlined in this slide what each of the columns mean. You will see the name of your PPS, the Project number and name of the DSRIP project selected. In addition you will see the name of the performance measure, the baseline numerator, denominator and result. Many measures are calculated by taking the numerator divided by the denominator and then multiplying by 100, but there are also several measures that have different units and the unit label will help to ascertain how those measures were calculated.
For instance whether it is a rate per 100,000 persons or simply a percentage.

You will also see an annual improvement target and high performance goals for relevant measures, as well as, the statewide performance goal for each measure. Refer to the table in the Measurement Specification and Reporting Manual if you have questions about missing high performance goals. There are only a few measure´s that are eligible for the high performance payment.

Slide 10

Now let´s go over how to interpret the baseline results and answer some key questions you may have as you review your results.

First what is the high performance fund? When will I be eligible? Performing Provider Systems who have achieved results more than the high performance goal or above the Statewide Performance Goal, for a measure eligible for high performance, will be eligible for additional payment from the DSRIP high performance fund. This fund will not exceed 30 percent of a PPS´s DSRIP project value.

The High Performance Funds (HPF) are divided into Tier 1 and Tier 2 money: 50% is dedicated to Tier 1 payments, and 50% to Tier 2 payments.

  • Tier 1 payments are reserved for providers whose performance closes the gap between their current performance and the high performance level by at least 20 percent
  • Tier 2 payments are for providers whose performance meets or exceeds the Statewide Performance Goal.

What do missing values mean in the baseline results file? When a baseline target has not been set, there will be no numeric value and the cell will be empty. In these instances, baseline results cannot be set, because there is insufficient information or the data has not been collected yet (i.e., measures obtained from medical record review or from the Clinician & Group Consumer Assessment of Healthcare Providers and Systems (C & G CAHPS) survey).

Slide 11

What if my denominator is less than 30 for baseline? Certain measures may have a denominator less than 30. The file will contain the PPS denominator, numerator and results, but caution should be used in comparing this result to the performance goal. Results based on less than 30 are considered insufficient to determine a statistically sound result. In order to provide as much information to the PPS, the actual measure data is provided.
Results for measures with insufficient denominators will not be included in achievement values.

For measures with denominators >30:

  • The PPS result will be shown in the baseline file. The annual improvement target and high performance goal (if eligible) will also be included for information purposes. If the PPS denominator for the current measurement year remains less than 30, the result will not be used for achievement value determination
  • The minimum denominator size for all metrics is 30. This limit has been set using academic journals and AHRQ materials.
  • For any measure, there must be 2 consecutive years in which the denominator is 30 or more in order for the PPS to obtain the achievement value and receive payment.
  • The achievement values associated with the measure are removed from the base of the achievement values. The PPS is not penalized by having denominators less than 30.

What happens if there is a change in the measure specifications? When a measure´s specifications change (numerator and denominator criteria) for example, these changes will not affect a PPS´s achievements in the past. For future calculations the impact of measurement changes on performance will be evaluated. If it is significant, the use of the baselines and the assignment of Achievement Values will be re-evaluated.

Slide 12

Now I am going to walk you through a few scenarios.
Scenario number 1: What if my baseline result is equal to or higher than statewide performance goal? How is my annual improvement target determined?
While this is not typical in some cases we do have PPS results that are above the performance goal.

Since there is no gap between the PPS result and the Performance Goal for the measure, the annual improvement target will be the same as the baseline result.
In P4P years, the PPS will receive the achievement value for results as long as the result remains above the Performance Goal.
For example, X1 shows no change between years but since the PPS result is higher than the statewide performance goal and the achievement value is awarded.
X2 shows an increase above the current PPS result and as such the achievement value is also awarded.
X3 shows a decrease but the PPS result still stays above the performance goal and again the achievement value is awarded.
X4 shows a decrease and the PPS result slips below the performance goal. When this happens there is no achievement value awarded. For the following year the PPS must move at least 10% from their current result back towards the performance goal in order to be eligible for an achievement value.

Slide 13

Scenario number 2: What if my Measurement Year 3 result is lower than statewide performance goal?
This is where the majority of the PPS results will be.

If the PPS result from one year to the next does not change (X1 as denoted in the chart) no achievement value will be awarded.
Similarly if the PPS result decreases from one year to the next (X2) no achievement value will be awarded.
If the PPS result improves from one year to the next (X3) but does not meet the annual improvement target no achievement value will be awarded.

If as demonstrated by X4, the PPS result increases from one year to the next, and they meet their annual improvement target, the achievement value will be awarded.
IF the increase is greater than 20% of the gap to goal as shown by X5 the achievement value will be awarded, and if the measure is eligible for high performance, additional payment will be awarded.
If the PPS results increase to above the performance goal the achievement value will be awarded and the PPS receives the payment associated with the achievement. The PPS should now refer to the previous slide to understand how results above the performance goal will be handled for payment.

Slide 14

That´s all we have for today. Any questions or comments on the content of this webinar or in the interpretation of baselines results should be directed to the DSRIP e-mail.
Thank you very much.