Fully-Integrated Duals Advantage (FIDA) Stakeholder Workgroup Plan Qualifications / Quality Metrics

Monday, October 22, 2012
9:00 a.m. - 10:15 a.m.

Call summary

On Monday October 22, 2012, NYSDOH held its third and last planned meeting of the FIDA Plan Qualifications/ Quality Metrics Workgroup meeting for stakeholders. Following is a summary of the meeting discussion.

I. Review of September 24 Meeting Summary

Workgroup participants had no comments/feedback on the previous meeting summary.

II. Overview of Identified Quality Measures and Subgroup Recommendations

Raina Josberger from NYSDOH provided an overview of identified quality measures for the workgroup to discuss. Trilby de Jung provided a summary of overarching principals and specific recommendations developed by a subgroup of workgroup members including Joe Baker, Elisabeth Benjamin, Susan Dooha and Leah Farrell (Attached to this summary).

III. Discussion of Measures

Factors discussed by the group concerning the measures included:

  • General considerations for measure selection. NYSDOH highlighted for the group that all aspects should be weighed when selecting measures, which-in addition to the quality and performance aspects of the program-include:
    • Is there an existing data source and data collection method available?
    • Are the measures nationally accepted?
    • Are the measures tested/ validated by a third party (e.g. NCQA, NQF)?
    Measures that are not validated and/or have existing data sources can still be considered; however, it will take more time to establish them and therefore data collection and reporting time will be lost over the three year demonstration (i.e. only report at the end of the demonstration period rather than throughout). Quality measures 1- 43 in the Excel document are measures that NYS had already committed to producing/collecting for other evaluation projects and can easily expand to the FIDA population (1-27 are HEDIS measures, 28-43 are SAAM). Processes are already in place to collect and report data and will be generated by NYS directly. Capacity to validate and field test new measures in the demonstration timeframe is a concern of NYSDOH, a suggestion was made to treat the demo as a "field test" for the measures. This would have to be checked with the external evaluator (RTI). Melissa Seeley from CMS will see if any measures have been developed by RTI for other states that could be shared with NY.
  • Measures and relationship with ombudsman function. Joe Baker stated that the term measures might be too formal for some elements, which may be better suited to be monitored as part of the ombudsman program. Carla Williams from NYSDOH agreed with the distinction of performance standard versus formal measure. Joe volunteered to draft thoughts on distinctions and share with NYSDOH to distribute to the workgroup.
  • Anticipated developments that can affect measure consideration. SAAM will be transitioning to UAS -NY (which is a web based tool) in the future, which could enable different data collection methods (and potentially measures as well). The survey period of every 6 months will not be affected by the transition. NCQA will be releasing new measures in January 2013 that will be relevant to the FIDA population.
  • Data collection methods (CAPHS).For measure 72, Trilby de Jung recommended that NYS modify the CAPHS survey, and suggested that the state consider use of focus groups because the rate of survey return is low, particularly among high-risk members. Linda Iatrou suggested exploring the possibility of adding NYS-specific questions to annual CAPHS survey required by CMS, taking into consideration timing (survey done between February and June). CMS is checking if there will be a duals-specific demonstration project CAPHS survey in response to a question regarding if the CAPHS survey will go to participants in the demo.
  • Data collection methods (general). A participant asked if the NQF core set was obtained primarily by survey of members (NYSDOH: yes, and tends to be a sample of members unless the plan is very small). Davy Diongson suggested that the IPRO satisfaction survey could be source of data for measures 72-95. In general, Trilby suggested using more frequent, shorter surveys rather than less frequent, longer surveys (NYSDOH: concern about surveying same members if the sample is small).
  • Sample size. A participant asked how measures will be adjusted if the relevant population is small (<30 members). Trilby stated that even though the population is small the numbers may still be important. NYS DOH indicated that the population could also grow as the program matures. Since this is a demonstration, members thought it would make sense to be more, rather than less, inclusive.
  • Other comments. Leah Farrell endorsed the inclusion of measures 72-95, as they have not been traditionally collected by NYS. Davy Diongson noted that the measures provided in the Excel spreadsheet are very focused on screening (which is a focus of NCQA/NQF) and that the workgroup should focus on adding measures related to quality of life and care coordination. Trilby de Jung suggested that monthly member grievances/appeals and associated measures (timeframes, etc.) be added, citing research out of George Washington regarding their relevance to member satisfaction.

IV. Summary / Next Steps

NYSDOH thanked the members for participating in the workgroup. Additional materials should be sent to NYSDOH as well as any suggestions going forward. The measures list was revised according to the discussion (see attached).

Workgroup members were interested in continuing the workgroup, mentioning that there were items that were part of the workgroup charge that were not fully addressed by the group (e.g. plan selection, requirements for integrated services, credentialing, consensus on plan procurement). NYSDOH informed the group that these sessions provided valuable input on issues in advance of negotiation with CMS. It is the intent of NYSDOH to reconvene the workgroups after January 1st, after negotiation with CMS begins (anticipated post- Thanksgiving). NYSDOH welcomes input directly in the meantime.