value based p4p 201: shared savings calculation · 3/9/2015 · © 2016 integrated healthcare...
TRANSCRIPT
March 9, 2015
Value Based P4P 201:
Shared Savings Calculation
© 2016 Integrated Healthcare Association. All rights reserved. 2
Today’s session is the third in a series and focuses on
Performance Gates and TCC Specifications:
101: Value Based P4P 101
102: Worksheet Review
103: Performance Gates and TCC Specifications
201: Shared Savings Calculation
202: Resource Use Measure and Specifications
203: Full Risk Organization Methodology
Did you miss a previous webinar?
Slides and recording are available on the IHA website at www.iha.org
Value Based P4P – Webinar Series
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• Background
• Calculating improvement
• Quality and optional adjustments
• Recap with PO worksheet
• Questions
Agenda
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Value Based P4P Overview
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Value Based P4P Design
• Performance gates
- Quality
- Total Cost of Care Trend
• Calculate share of savings
based on resource use
• Adjust share of savings for
Quality
• Sum adjusted shared
savings
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Measures are Not Risk-Adjusted
• “MORE is better”
• % Outpatient Procedures in Preferred Facility
• Generic Prescribing Overall (or Therapeutic Areas)
Risk-Adjusted Measures
• “LESS is better”
• Inpatient Bed Days (or Inpatient Discharges)
• All-Cause Readmissions
• ED Visits
Appropriate Resource Use Measures
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Shared Savings Calculation
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Units of Improvement Calculation
• Compares measurement year and prior year ARU
performance and translates to utilization improvement
• Compared to own prior year performance:
• How many fewer bed days, ED visits, and readmissions?
• How many more prescriptions were generic? How many more
outpatient services were performed in a preferred facility?
• Ultimately, the methodology:
• Accounts for the health risk of your PO’s members
• Reflects the size of your membership
• Calculation included in P4P ARU reports, pages 15-20
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MATH: from result to improvement
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MATH: from result to improvement
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MATH: from result to improvement
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MATH: from result to improvement
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MATH: from result to improvement
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Unit Costs
• Cost of a bed day, ED visit, readmission; cost differential between
brand and generic (GRX) or between preferred and non-preferred
outpatient facilities (OSU)
• Specific methodology for calculating unit costs determined by the
health plan
• P4P recommendation:
• Use actual experience for PO members
• Set prospectively
• Base on prior period
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Shared Savings Calculation
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Two Special Considerations
1. Adjustment to target for Generic Prescribing measures
2. Use of small PO weighted results for POs with fewer
than 1,500 member years with a health plan
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Shared Savings Calculation
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VBP4P Design: How Much is the PO’s Incentive
Payment?
Step 3 – Adjust Share of
Savings for Quality
• Same Quality Score as
used for Quality Gate
• High quality increases
share of savings
• Low quality decreases
share of savings
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Optional Adjustments
ARU Attainment Adjustment
An up or down adjustment based on PO’s baseline performance on a
measure
HIGH baseline attainment INCREASES share of savings; LOW
baseline attainment DECREASES share of savings
ARU Improvement Adjustment
A “bonus” for POs that can only increase your incentive based on
how much you improved
INCREASES share of savings for GREATER improvement
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Shared Savings Calculation
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How Much is the PO’s Incentive Payment?
Step 4 – Sum Shared
Savings Across Measures
• Each measure’s shared
savings can be positive or
negative
• Negative amounts offset
positive amounts
• If sum of all measures >$0,
PO earns incentive
• If sum of all measures <$0,
PO earns no incentive
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• Units of improvement calculations are available in ARU
reports, as well as the PO Value Based P4P worksheets
• Summary of recommended values available in the
Appendix of the Design Document on the IHA website at
www.iha.org
Resources
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Review the Worksheet from VBP4P 102
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Two Special Considerations
1. Adjustment to target for Generic Prescribing measures
2. Use of small PO weighted results for POs with fewer
than 1,500 member years with a health plan
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Generic Prescribing Measures
• Recommendation to adjust the target using the 25th
percentile of actual improvement observed in P4P
• Accounts for the effect of patent expirations on generic
prescribing rates
• Only applied to therapeutic areas with major patent
expirations or newly released blockbuster brands
GRX Target = PO’s Baseline Year Generic Prescribing Rate
+ 25th Percentile of PO Performance for Plan
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Small PO Pooled (aka Weighted) Results
• Additional metric included in ARU reports for POs with less
than 1,500 member years per plan
• Weighted average of your own result and the result for all
small POs for the plan
• As membership increases more weight placed on own
result
• More reliable result intended for use in payment
• For example, substitute pooled result for
measurement year or baseline year result, where
applicable
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Small PO Pooled Results
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• PO reports and worksheets available on the Value Based
P4P Analytics Portal
• Value Based P4P Issue Brief, Design Document, and
Participant Resources available on IHA website at
www.iha.org
• Questions may be directed to [email protected]
• Thank you!
Additional Resources