THINCs P4P Project in the Hudson Valley: Quality Metrics and The Medical Home

1
THINCs P4P Project in the Hudson Valley Quality
Metrics and The Medical Home

• Susan Stuard
• Executive Director, THINC

2
Agenda

• Susan Stuard will talk about the project design
• John Blair, MD will discuss the specifics of the
  medical home transformation work

3
Project Design
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THINCs P4P Project

• In 2007, THINC was awarded a P4P grant from the
  NYS Department of Health
• The request for grant applications sought
  projects implementing quality metrics, quality
  report cards, and health plan incentives
• THINC, MedAllies and the Taconic IPA decided to
  leverage this project and add a significant
  medical home component

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EHR Install Base

• Key component to the Hudson Valley project is the
  existing physician EHR install base
• THINC has a HEAL 1 grant from NYS DOH to
  implement 1,000 EHRs in physicians offices
• Quarter of the way through that work
• As a result, THINC and its vendor, MedAllies,
  have a strong understanding of EHR
  implementations and the associated workflow and
  change management issues
• Combine these 250 EHRs with existing EHRs at
  larger practices and we a good group to work with
  for medical home

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Project Participants

• 500 primary care physicians in Hudson Valley
• 250 in quality metrics group only
• 250 in quality metrics and medical home group
• Six health plans
• Provide claims data for metrics to data
  aggregator
• Pay incentives after second quality report card
• Participate actively in project design via the
  THINC Quality Committee

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Project Management

• THINC
• Manage grant and deliverables
• Work with health plans to determine payment
  process and triggers
• Use THINC Quality Committee to ensure
  collaborative process for development of project
  goals and implementation
• MedAllies
• Enable development of quality reporting with ViPS
  and from EHR
• Intensive planning for medical home
  transformation initiative
• Taconic IPA
• Intensive planning for medical home
  transformation initiative
• Physician recruitment
• Cornell
• Conduct evaluation, data gathering, analysis, etc.

8
Budget

• NYS DOH grant award is almost 1.8 million
• 20 for project management and evaluation
• 80 to match health plan incentives 1.4
  million
• Great majority of costs for medical home
  transformation are being underwritten by the
  Taconic IPA and MedAllies

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Quality Reports

• Q1 2009 Report
• 2007 data
• HEDIS Measures
• Q4 2009 Report
• 2008 data
• HEDIS Measures
• EMR Measures
• NCQA Medical Home
• Recognize the limitations of using 2007 and 2008
  in a 2009 implementation but this is a grant
  requirement

THINC Taconic Health Information Network and
Community
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HEDIS Measures

• Required to pick from among 34 measures selected
  by the NYS Pay for Performance Workgroup
• Our claims-based project measures are
• Breast Cancer Screening
• Colorectal Cancer Screening
• Chlamydia Screening Rates
• HbA1C Testing
• Lipid Measurement in Diabetics
• Eye Exam in Diabetics
• Urine Protein Screening
• Asthma Pharmacologic Therapy
• Appropriate Treatment for Children with Upper
  Respiratory Infection
• Appropriate Testing for Children with Pharyngitis

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EMR Measures

• Also will add EHR-based clinical measures in the
  second report card
• Will pull four from among these six
• Controlling High Blood Pressure
• HbA1C Poorly Controlled
• Blood Pressure Control/Management in Diabetics
• LDL Cholesterol Level in Diabetics lt130
• Eye Exam in Diabetics
• Urine Protein Screening
• In subsequent report cards, starting in 2010,
  will add more EHR-based clinical metrics

THINC Taconic Health Information Network and
Community
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Incentive Payments

• Incentive payments will be issued after 2nd
  quality metrics report card in Q4 2009
• 20 of incentive payments goes to scoring on
  quality metrics and 80 goes to achievement of
  NCQA PPC-PCMH Medical Home Level 2 certification
• Approximate breakdown 1000 on quality metrics
  and 10,000 for medical home level 2

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THINC P4P Project High-Level Data Flow
From spec, health plan generates data file for
Hudson Valley
Physician EHR
Health Plan
Summary EHR/Clinical Measures Data from Physician
EHR
Claims Data
Using claims data and attribution logic,
aggregator generates summary measures
Data Aggregator
Summary HEDIS Measures
MH Status
MedAllies Reporting Engine
Report Card (with Medical Home Status in Q4 2009)
THINC
Letter and Report Card
Report Card and Data File
Incentive Payment
Physician
Health Plan
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Evaluation

• Working with Rainu Kaushal, MD, MPH, and Lisa
  Kern, MD, MPH, at Weill Cornell Medical College
  to conduct a robust academic evaluation of
  project
• Goal is to determine incremental effects of P4P
  incentives and medical home implementation on
  quality and costs
• Design should allow isolation of the separate
  effects of EHRs, P4P, and the medical home
• Evaluation design should produce results rigorous
  enough to inform policy debate as well as
  participant health plans designs for future
  incentive programs

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Challenges

• Setting aside the huge challenge of moving 250
  physicians with EHRs to medical home level 2
  within 12 months (John will address)
• Coordinating among six health plans who all have
  different ideas about what should trigger an
  incentive payments and how attribution
  methodology should be applied
• Tremendous effort to undertake this type of
  evaluation
• IRB approvals, participant agreements, control
  group recruitment, baseline data gathering, etc.
• Unknown effort to be expended to implement the
  EHR-based clinical measures

16
Questions

• Please feel free to reach out to me with
  questions
• Susan S. Stuard
• Executive Director
• THINC RHIO
• Phone [phone] x.3018
• sstuard_at_thincrhio.org