Download Delaware Center for Health Innovation Common Scorecard

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Delaware Center for Health Innovation
Common Scorecard Frequently Asked Questions
Last amended: October, 2016
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Common Scorecard Frequently Asked Questions
General ............................................................................................................................................................................. 3
Where can I find more background information on the Common Scorecard?............................................................ 3
Who can I contact with technical questions about the Common Scorecard? ............................................................. 3
What is required of my practice by enrolling in the Common Scorecard? .................................................................. 3
Will I be held accountable financially for these quality measures? ............................................................................. 3
Do practices need to change billing processes or use new codes to participate in the Common Scorecard? ............ 3
Patient Panels (Attribution) .............................................................................................................................................. 4
How are the patients in my Common Scorecard panel attributed to me? .................................................................. 4
Why is my patient list wrong or missing some of my patients?................................................................................... 4
Data Quality and Availability............................................................................................................................................ 5
Why is data not available for some measures? ........................................................................................................... 5
How often will the Scorecard data be refreshed? ....................................................................................................... 5
What happens if none of my patients are eligible for a certain measure? .................................................................. 5
What do I do if my measure data is missing or inaccurate? ........................................................................................ 5
What testing has been conducted to ensure the data is accurate? ............................................................................ 5
Which payers participate in the Common Scorecard? ................................................................................................. 6
Why is one of my providers not included in my practice? ........................................................................................... 6
Quality and Utilization Measures: General ...................................................................................................................... 7
What is the source of the Common Scorecard quality measures? .............................................................................. 7
How does the Common Scorecard compare to other scorecards used by payers? .................................................... 7
How were the Common Scorecard quality measures chosen? ................................................................................... 7
What are the quality measure goals and how are they determined? ......................................................................... 8
Are the quality and utilization measures adjusted for patient risk? ............................................................................ 8
How are measures updated over time? ....................................................................................................................... 8
Which measures are available by which payer and over what time period(s)? .......................................................... 9
Quality and Utilization Measures: Measure-specific Questions ..................................................................................... 10
What are the known issues with the current Common Scorecard measures? .......................................................... 10
How is the Diabetes: HbA1c measure rate calculated? ............................................................................................. 10
Which reporting rate is used for the Well-Child Care, 0 to 15 Months measure? ..................................................... 10
Which reporting rate is used for the Medication Management for People with Asthma measure? ........................ 10
Which combination rate is used for the Childhood Immunization Status (CIS) measure? ........................................ 11
How is total cost of care (TCC) calculated? ................................................................................................................ 11
How are utilization measures calculated and displayed? .......................................................................................... 11
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GENERAL
Where can I find more background information on the Common Scorecard?
A series of introductory webinars were created to help explain the Common Scorecard, and can be
found by visiting:
http://www.choosehealthde.com/Providers/Common-Scorecard#common-scorecard-webinars
Who can I contact with technical questions about the Common Scorecard?
Please reach out to the DHIN Helpdesk, at [email protected] or 302-480-1770. The helpdesk is
available to help resolve any technical issues you may have with the Common Scorecard.
Furthermore, any questions related to the Common Scorecard measures, patient attribution, or
other non-technical questions may be directed to the DHIN helpdesk, who will connect you with the
appropriate individuals to help answer your questions.
What is required of my practice by enrolling in the Common Scorecard?
Nothing is required of your practice. By enrolling in the Common Scorecard, you are not incurring
any obligations. The Common Scorecard is a free, informational resource made available to you
through the Delaware Center for Health Innovation (DCHI).
Will I be held accountable financially for these quality measures?
You will not become financially accountable for the measures in the Common Scorecard by signing
up for and viewing the Common Scorecard, as the Common Scorecard is an independent resource
that is not tied directly to payment.
However, the Common Scorecard measures were chosen in large part because they are
commonly used in many of Delaware's pay-for-value programs. The Common Scorecard offers
practices a convenient, single view of performance across payers, although providers should
continue to refer to payers’ reports for determination of payment.
Do practices need to change billing processes or use new codes to participate in
the Common Scorecard?
The aspiration of clinicians and payers who provided input into the measures selected for the
Common Scorecard was to focus on measures that could be captured without any additional effort.
As a result, the current iteration of the Common Scorecard focuses on core measures that can be
calculated using claims data.
There are some quality measures included in a section at the bottom of the Scorecard entitled,
“Potential Future Measures”. These measures are a priority for Delaware, but can be subject to
data capture challenges (for example, through the use of CPT© or other codes that may not be in
widespread use today). For that reason, these measures will be monitored to assess whether data
capture improves and potentially added to the Scorecard at a later date.
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PATIENT PANELS (ATTRIBUTION)
How are the patients in my Common Scorecard panel attributed to me?
Patient attribution is the process by which healthcare payers determine the patients for which a PCP
is responsible over a defined period of time. Each payer uses its own method of patient attribution
for purposes of the Common Scorecard. This is to ensure Common Scorecard patient attribution
lists are accurate relative to those used by each individual payer. Patients may either be assigned or
attributed using a prospective or retrospective approach.
For additional questions about how each payer conducts patient attribution, please reach out to the
DHIN helpdesk at [email protected] or 302-480-1770.
Why is my patient list wrong or missing some of my patients?
There are several reasons why the list of patients attributed to your practice as part of the Common
Scorecard may appear to be incorrect.
First, the methods used to attribute patients to your practice may vary by payer. If you have
questions about the attribution methodology used by a specific payer, please contact the DHIN
helpdesk (contact information below). The DHIN helpdesk will put you in touch with a contact at the
appropriate payer(s) to help answer your questions.
Second, patients may not appear in an attribution list for an individual measure because patients
must qualify to be included in the measure denominator, based on the measure’s definition. To
examine which patients qualify for a denominator of a particular measure, click on the info button
next to the measure:
There is also a quick reference guide on the Choose Health DE website with a brief overview of the
numerator and denominator definitions for each of the Common Scorecard measures:
http://www.choosehealthde.com/Content/Documents/DCHI/DCHI-Common-Scorecard-2.0-QuickReference.pdf
Third, the Common Scorecard utilizes a practice’s Organization NPI to aggregate members and
display quality and utilization measure performance. If your organization utilizes multiple
Organization NPI numbers, patients may be attributed to the different Organization NPIs used for
your practice in the Scorecard. As a first step, check the “Practice” search bar/drop-down in the
Common Scorecard for other instances of your practice. If your attribution lists are still incorrect
across all Organization NPIs used by your practice, please reach out to the DHIN helpdesk (contact
information below).
Finally, if you believe your attribution list is incorrect or have other questions related to attribution,
please reach out to the DHIN helpdesk at [email protected] or 302-480-1770.
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DATA QUALITY AND AVAILABILITY
Why is data not available for some measures?
There are several reasons why data may be missing from some measures within the Common
Scorecard:
None of your patients may be included in the measure denominator
Quality and utilization measures have specific denominators that define which patients and under
what circumstances those patients should be included in the denominator. It is possible that for
some measures, no patients in your panel for the denominator. If you have questions about which
patients are included in the denominator of a given measure, click the “info” icon to the left of the
quality measure within the Common Scorecard:
Data for a certain time period may be unavailable
Availability of data for the Common Scorecard can vary by the timeframe selected within the
Common Scorecard.
For includes different payers’ data depending on the measure timeframe. See the question below,
“Which measures are available by which payer and over what time period(s)?” for more information.
Data may be missing for some of the measures
Due to limitations in currently available data, some measures may be missing from the Common
Scorecard for certain payers and timeframes. DCHI, DHIN, and the payers are working together to
improve availability of measure data over time. To see a list of the measures available by payer and
timeframe for the Common Scorecard, please see the question, “Which measures are available by
which payer and over what time period(s)?”
How often will the Scorecard data be refreshed?
The Scorecard will be updated on a quarterly basis. Common Scorecard reporting uses a
cumulative methodology that builds up over each quarter of the performance period. For example,
at the end of the second quarter, data included in the Scorecard will reflect cumulative Q1-Q2
performance.
What happens if none of my patients are eligible for a certain measure?
If none of your patients are considered “eligible” for a quality or utilization measure based on the
definition of the measure’s denominator, the measure will not be calculated for your practice and a
“no data” indicator will appear for the measure within the Scorecard.
What do I do if my measure data is missing or inaccurate?
If you believe data is missing or inaccurate, please reach out to the DHIN helpdesk at
[email protected] or 302-480-1770.
What testing has been conducted to ensure the data is accurate?
Extensive testing is conducted on an ongoing basis by the payers that submit data to the Common
Scorecard. Payers have their own internal controls and conduct internal testing to ensure HEDIS
and other quality measures are accurate. Furthermore, payers conduct quality control and perform
accuracy checks on patient attribution and assignment lists.
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The Common Scorecard was tested extensively over the course of a year with 21 testing practices
to determine sources of inconsistencies. A deep dive into specific patients was conducted to confirm
the accuracy of patient attribution and quality measure performance.
The Common Scorecard is intended to be an accurate and useful resource for providers. If you
believe there are issues with your practice’s data within the Scorecard, please reach out to the
DHIN helpdesk at [email protected] or 302-480-1770.
Which payers participate in the Common Scorecard?
The Common Scorecard currently contains data for three payers and lines of business within the
state of Delaware: Highmark Commercial, Highmark Medicaid, and United Medicaid. Longer-term,
additional payer data feeds may be added to the Common Scorecard, including Medicare or other
healthcare payers. To view a full list of the measures available by payer and over which timeframes,
please see the question in this FAQ, “Which measures are available by which payer and over what
time period(s)?”
Why is one of my providers not included in my practice?
One of the reasons a provider within your practice may not be reflected in the Common Scorecard is
that only primary care practitioners, as defined by the following taxonomies, are included:
Taxonomy
code
207Q00000X
207QA0000X
207QA0505X
208D00000X
207R00000X
207RA0000X
208000000X
2080A0000X
363L00000X
363LA2200X
363LC1500X
363LF0000X
363LP0200X
363LP2300X
363LW0102X
363A00000X
Specialty type
Family Medicine
Adolescent Medicine
Adult Medicine
General Practice
Internal Medicine
Adolescent Medicine
Pediatrics
Adolescent Medicine
Nurse Practitioner
Adult Health
Community Health
Family
Pediatrics
Primary Care
Women's Health
Physician Assistant
Provider specialty group
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
If you believe one of your practice’s practitioners is missing from the Common Scorecard, please
reach out to the DHIN helpdesk at [email protected] or 302-480-1770.
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QUALITY AND UTILIZATION MEASURES: GENERAL
What is the source of the Common Scorecard quality measures?
The 26 measures included in the Common Scorecard were drawn from a group of national,
endorsed measures, choosing measures that were already used in Delaware when possible. The
measures are balanced across populations, representing a spectrum of age, clinical condition and
acuity. They capture quality, utilization, and cost. Measures were prioritized by a group of clinicians
on the DCHI Clinical Committee and adopted by the DCHI Board for purposes of testing the first
version of the scorecard. 19 of the Common Scorecard measures are HEDIS® quality measures. 4
additional measures are not HEDIS®, but are endorsed by the National Quality Forum (NQF). 2
measures are custom to the state of Delaware (fluoride varnish and follow-up within 7 days after
hospital discharge), and one measure is specific to each individual payer (total cost of care).
For a full list of measures and the associated source, please visit:
http://www.choosehealthde.com/Content/Documents/DCHI/DCHI-Common-Scorecard-2.0.pdf
How does the Common Scorecard compare to other scorecards used by payers?
Since one of the goals in identifying measures for the scorecard was to draw from those already in
use, many of the measures are the same or similar to those that are included in other scorecards
that you may already receive.
Many providers have invested a lot of time working within their organizations and with individual
payers to develop other scorecards too. The goal is not to develop many new measures, but rather
to create a simpler process and approach for something many parties are all working on. Over time,
the vision is for the Scorecard to become a resource for sharing a single view across payers to give
practices a view on their performance across all of their patients for measures that serve as a basis
for value-based payment models.
How were the Common Scorecard quality measures chosen?
Common Scorecard measures were chosen through a collaborative, four-step process involving the
DCHI Board, DCHI Clinical Committee, and payers and providers within Delaware.
First, a set of approximately 350 measures were considered because the measures addressed the
Triple Aim of health care (health, cost, and progress toward integrated, coordinated care). These
measures were also selected because they reached across lifespans (pediatrics, adults, and older
adults), conditions (acute, chronic), and payers (Medicare, Medicaid, commercial).
Second, approximately half of the ~350 measures were removed due to overlap among the
measures in addressing similar outcomes.
Third, the list of ~175 measures was narrowed to a core set of 30 measures based on (1) relevance
to Delaware needs, (2) priority for stakeholders, (3) evidence that providers can improve outcomes
for the measures, (4) use of existing claims and billing information to calculate the measures, and
(5) ability to capture outcomes accurately.
Finally, a core set of 26 quality and utilization measures were selected based on most pressing
Delaware needs, as well as which measures were “most actionable.” This reflected input from
payers, providers, and other stakeholders on the importance of inclusion. Six of the final 26
Common Scorecard measures are considered “Potential Future Measures” as they can be difficult
to capture using claims data and whose data collection will be monitored over time.
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What are the quality measure goals and how are they determined?
Quality and utilization measure goals are aspirational objectives for quality measure performance.
There are two types of goals displayed in the Common Scorecard: (1) Statewide goals and (2)
Payer goals. Statewide goals are set by the Delaware Center for Health Innovation (DCHI) and are
based on statewide performance for all Delawareans across healthcare payers. Payer goals are
benchmarks or goals set individually by payers for each individual measure. These goals and
benchmarks are determined independently by each payer and line of business.
Are the quality and utilization measures adjusted for patient risk?
No. Quality measures are generally not risk adjusted. Utilization measures, such as the rate of allcause readmissions, the rate of inpatient hospital visits, and the rate of emergency department
visits, are not risk adjusted for purposes of the Common Scorecard.
How are measures updated over time?
Generally, measures based on HEDIS® are updated each year to reflect changes to the measure
made by the National Committee for Quality Assurance (NCQA). Additional changes may occur
from year to year based on feedback from the DCHI Board and Clinical Committee.
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Which measures are available by which payer and over what time period(s)?
Payers, DHIN, and DCHI are working to include data for as many of the Common Scorecard measures as possible, and measure
coverage/availability will continue to improve over time. As of October, 2016 the following measures are available by payer within the Common
Scorecard:
Measure
Diabetes: medical attention for nephropathy
Adolescent well care
HPV vaccination
High risk medications in the elderly
Colorectal cancer screening
Breast cancer screening
Well child care: 3-6 years
Cervical cancer screening
Avoidance of antibiotics in acute bronchitis
Appropriate treatment of URI in children
Childhood immunization status - combination 10
Medication adherence in diabetes
Medication adherence in high blood pressures: RASAs
Well child care: 0-15 months
Developmental screening in the first three years of life
Medication management for asthma
Adherence to statins in cardiovascular disease
Plan all-cause readmission
Diabetes: HbA1c ≤ 9%
BMI assessment
Screening for clinical depression
Fluoride varnish
Follow-up hospital discharge in 7 days
Inpatient hospital utilization
Emergency department utilization
Total cost of care
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QUALITY AND UTILIZATION MEASURES: MEASURE-SPECIFIC QUESTIONS
What are the known issues with the current Common Scorecard measures?
There are currently several known issues with some of the Common Scorecard measures of which
practices using the Scorecard should be aware:
■
High-risk medications in the elderly: assesses elderly patients enrolled in Medicare, and as
a result the measure is not calculated for United Medicaid or Highmark Medicaid for purposes
of the Common Scorecard.
■
Total cost of care: data is available only for Highmark Commercial at this time. There are
plans to include total cost of care data for other payers and lines of business in future
Scorecard releases.
■
Follow-up within 7 days of hospitalization: patient attribution rosters are unavailable for this
measure for Highmark Commercial data. Furthermore, this measure is not available for
Highmark Medicaid due to data limitations. There are plans to include these data for Highmark
Medicaid in future releases of the Common Scorecard.
■
Highmark Medicaid measure limitations: due to data limitations, certain quality or utilization
measures are not included in the Highmark Medicaid data set, including Breast Cancer
Screening, Colorectal Cancer Screening, Follow-up within 7 Days After Hospitalization, and
Total Cost of Care. These measures are missing due to a lack of historical data or certain data
elements needed to calculate the measures and will be added to the Common Scorecard at a
later date once enough data is available.
■
United Medicaid measure limitations: due to data limitations, certain quality or utilization
measures are not included in the United Medicaid data set, including high-risk medications in
the elderly and total cost of care. For Q1 2016 and Q1-Q4 2015 data, the Medication
adherence in diabetes, medication adherence in high blood pressures: RASAs, and diabetes:
HbA1c ≤ 9% measures are also not included in the Common Scorecard.
How is the Diabetes: HbA1c measure rate calculated?
The Diabetes: HbA1c measure is defined as the percentage of members 18 - 75 years of age with
diabetes (type 1 and type 2) whose most recent HbA1c level is ≤ 9.0%* during the measurement
year.
*Note: the official HEDIS specifications display this measures as the percentage of members with
poor control (e.g., HbA1c > 9%). Based on feedback from the DCHI Clinical Committee, this
measure is inverted for purposes of the Common Scorecard and is displayed as HbA1c ≤ 9.0%.
Which reporting rate is used for the Well-Child Care, 0 to 15 Months measure?
The reporting rate for well-child care is 6 or more well-child visits within the first 15 months of age.
Which reporting rate is used for the Medication Management for People with
Asthma measure?
The reporting rate for this measure is the number of members who achieved a proportion of days
covered (PDC) of at least 50% for their asthma controller medications during the measurement
year.
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Which combination rate is used for the Childhood Immunization Status (CIS)
measure?
The reporting rate for this measure is Combination 10, which is the percentage of children age 2
who received the following immunizations by their second birthday:
– four diphtheria, tetanus and acellular pertussis (DTaP) vaccines
– three polio (IPV) vaccines
– one measles, mumps and rubella (MMR) vaccines
– three haemophilus influenza type B (HiB) vaccines
– three hepatitis B (HepB) vaccines
– one chicken pox (VZV) vaccines
– four pneumococcal conjugate (PCV) vaccines
– one hepatitis A (HepA) vaccines
– two or three rotavirus (RV) vaccines
– two influenza (flu) vaccines
How is total cost of care (TCC) calculated?
Total cost of care (TCC) is a measure of healthcare expenditures over a defined period of time. TCC
typically includes total medical and pharmacy spending for a given patient. For purposes of the
Delaware Common Scorecard, TCC is expressed on a per-patient-per-month (PMPM) basis and is
risk-adjusted to adjust costs based on differences in patient severity.
Generally, total cost of care includes all medical and pharmacy spending for a given patient. Each
payer that contributes data to the Common Scorecard is responsible for determining its own TCC
methodology. As a result, the specific spending included, risk-adjustment methodology applied, and
other adjustments made may vary by payer.
As of the October, 2016 launch of the Common Scorecard, TCC data is available only for Highmark
Commercial, due to data availability limitations. However, there are plans to add total cost of care in
the future for additional payers as the data becomes available.
If you have specific questions about how total cost of care is calculated, please reach out to the
DHIN helpdesk at [email protected] or 302-480-1770.
How are utilization measures calculated and displayed?
Utilization measures, including the rate of ED visits and rate of inpatient hospitalizations, are
expressed as a rate per 1,000 annualized members (i.e., member years). This rate is calculated as
follows:
𝑅𝑎𝑡𝑒 𝑝𝑒𝑟 1,000 𝑎𝑛𝑛𝑢𝑎𝑙𝑖𝑧𝑒𝑑 𝑚𝑒𝑚𝑏𝑒𝑟𝑠 =
(12,000 ∗ 𝑒𝑣𝑒𝑛𝑡𝑠)
𝑀𝑒𝑚𝑏𝑒𝑟 𝑀𝑜𝑛𝑡ℎ𝑠
Where the number of events and member months reflect the figures during the time period selected
in the report (e.g., Q1 only, or Q1-Q4).
All-cause readmission rates are calculated as the ratio of unplanned acute readmissions for any
reason within 30 days following an acute admission, divided by the number of acute inpatient stays
during the time period.