Introduction to NCQA & SNP Assessment June 25 and 27, 2013.
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Transcript of Introduction to NCQA & SNP Assessment June 25 and 27, 2013.
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Introduction to NCQA & SNP Assessment
June 25 and 27, 2013
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2SNP Training – Intro to NCQA & SNP Assessment Program
Purpose of Training
• Provide brief overview of NCQA
• Describe the SNP assessment program NCQA is executing on behalf of CMS
• Give a general understanding of main components of SNP assessment– HEDIS®
measures– Structure &
Process measures
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3SNP Training – Intro to NCQA & SNP Assessment Program
A Brief Introduction to NCQA
• Private, independent non-profit health care quality oversight organization
• Founded in 1990 - Celebrating 23 years
• Committed to measurement, transparency and accountability
• Unites diverse groups around common goal: improving health care quality
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4SNP Training – Intro to NCQA & SNP Assessment Program
NCQA: Mission and Vision
• Mission–To improve the quality of health
care
• Vision–To transform health care
through measurement, transparency and accountability
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5SNP Training – Intro to NCQA & SNP Assessment Program
NCQA: COMMITTED TO MEASUREMENT, TRANSPARENCY,
ACCOUNTABILITYQuality measurement
means:• Use of objective measures
based on evidence• Results that are comparable
across organizations• Impartial third-party
evaluation and audit• Public Reporting
NCQA’s quality programs include:
• Accreditation of health plans using performance data
• HEDIS clinical measures• CAHPS consumer survey• Measurement of quality in
provider groups• Physician Recognition• ACOs
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6SNP Training – Intro to NCQA & SNP Assessment Program
Achieving the Mission• Over 70 percent of all Americans
enrolled in health plans that are accredited by NCQA
• More than 90 percent of managed care organizations report HEDIS® quality data
• 41 states and the federal government rely on NCQA Accreditation and HEDIS
• More than 42,846 clinicians and 5,804 practices* have earned NCQA Recognition; 6 programs form the basis of quality improvement programs and P4P nationwide
*As of 5/31/13
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7SNP Training – Intro to NCQA & SNP Assessment Program
Objectives of SNP Assessment Program
• Develop a robust and comprehensive assessment strategy
• Evaluate the quality of care SNPs provide
• Evaluate how SNPs address the special needs of their beneficiaries
• Provide data to CMS to allow plan-plan and year-year comparisons
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8SNP Training – Intro to NCQA & SNP Assessment Program
SNP Assessment Process
• Year-to-Year Approach– Defining and assessing desirable
structural characteristics– Assessing processes– Assessing outcomes
• Two main components – HEDIS Measures-focus on clinical
performance– Structure & Process measures-focus
on structural characteristics and systems
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9SNP Training – Intro to NCQA & SNP Assessment Program
Year-to-Year Strategy
FY 2008 FY 2009
SNPs Effective as of January 2007 SNPs Effective as of January 2008
HEDIS 2008 HEDIS 2009
Measure Development Measure Development
• 13 existing measures • 13 existing measures
• Introduced 2 new measures
-- Care for Older Adults
-- Medication Reconciliation Post-discharge
Structure & Process Measures Structure & Process Measures
• SNP 1: Complex Case Management • SNP 1-3
• SNP 2: Improving Member Satisfaction • SNP 4: Care Transitions
• SNP 3: Clinical Quality Improvements • SNP 5: Institutional SNP Relationship with Facility
• SNP 6: Coordination of Medicare & Medicaid
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10SNP Training – Intro to NCQA & SNP Assessment Program
Year-to-Year Strategy
FY 2010 FY 2011
SNPs Effective as of January 2009 SNPs Effective as of January 2010
HEDIS 2010 HEDIS 2011
Measure Development Measure Development
Same as 2009 • 15 existing measures
In development for 2011
Plan all-cause readmissions
Introduced 1 new measure
-- Plan all-cause readmissions
Structure & Process Measures Structure & Process Measures
Refinement of existing measures: SNP 4 & 6
Increased focus on evidence of implementation
Clarified requirements Moved analyses to separate elements
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11SNP Training – Intro to NCQA & SNP Assessment Program
Year-to-Year Strategy FY 2012 FY 2013
SNPs Effective as of January 2011 SNPs Effective as of January 2012
HEDIS 2012 HEDIS 2013
Measure Development Measure Development
• 16 existing measures • 16 existing measures Includes 14 Effectiveness of Care Measures plus:
--Plan all-cause readmissions
--Board Certification
Includes 14 Effectiveness of Care Measures plus:
--Plan all-cause readmissions
--Board Certification
• Clarified reporting requirements and methodology
Structure & Process Measures Structure & Process Measures Enhanced documentation requirements Clarified measure language Strengthened focus on quality
improvement and implementing interventions
• Changed requirements for SNP 1 from Case Management to Care Management—focus on assessment and individualized care plans
• Revised some existing requirements for SNP 2, SNP 3 and SNP 4
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12SNP Training – Intro to NCQA & SNP Assessment Program
Project Time Line 2013
• June 17 – HEDIS submissions due to NCQA
• June & July – NCQA Releases 2013 Structure and Process measures in hardcopy and in ISS
• June through September– S&P Training for SNPs
• October 15, 2013 – S&P Measure submissions due to NCQA
• October 15, 2013 to April 30, 2014 - S&P reviews conducted by NCQA and Surveyors
• June 2014– NCQA Delivers Final Report to CMS
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HEDIS 101
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14SNP Training – Intro to NCQA & SNP Assessment Program
What Is HEDIS?
HealthcareEffectivenessData &InformationSet
HEDIS is an evolving set of standard specifications for measuring health plan performance
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15SNP Training – Intro to NCQA & SNP Assessment Program
Where Did HEDIS Come From?• Originally developed by employers and the HMO group in 1991; NCQA took charge of HEDIS in 1992
• Expanded in 1996 to cover all three product lines: commercial, Medicare and Medicaid
• Addresses the leading causesof death and morbidity
• Includes information on quality, utilization and cost
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16SNP Training – Intro to NCQA & SNP Assessment Program
How Are HEDIS Data Used?
• Federal, state and other regulatory requirements
• Performance-based accreditation
• Health plans use for RFP/RFI preparation
• Quality improvement activities and health plan operations
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17SNP Training – Intro to NCQA & SNP Assessment Program
Data Reporting
• Data are reported to NCQA in June of the reporting year
• Data reflect events that occurred during the measurement year(calendar year)
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18SNP Training – Intro to NCQA & SNP Assessment Program
Data Reporting
• Example:–HEDIS 2013 data are
reported in June 2013
–Data reflects events that occurred January–December 2012 (per specs)
–HEDIS 2013 = 2012 data
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19SNP Training – Intro to NCQA & SNP Assessment Program
Effectiveness of Care Measures
• Clinical quality of care Focus – Preventive care– Up-to-date treatments for acute episodes of
illness – Chronic disease care– Appropriate medication treatment
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Collecting HEDIS Data
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21SNP Training – Intro to NCQA & SNP Assessment Program
Three HEDIS Data SourcesAdministrative
Medical Records
Surveys
Claims Encounter Eligibility Provider
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22SNP Training – Intro to NCQA & SNP Assessment Program
Selecting an Eligible Population
• Member ID • Age (DOB)• Enrollment date and type• Dates of service• Diagnosis and procedure
codes• Provider specialty• Pharmacy
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23SNP Training – Intro to NCQA & SNP Assessment Program
• Defining the denominator is critical
• Administrative: Claims and encounter data– Denominator: Based on all eligible
members of the population
Clinical Measures Data Collection
Clinical Measures Data Collection
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Structure & Process Measures
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25SNP Training – Intro to NCQA & SNP Assessment Program
What is a S&P Measure?
• A statement about acceptable performance or results
• Assesses a plan’s ability to comply with specific requirements
• Focus on systems necessary for quality care– Policies & procedures, reports,
materials
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26SNP Training – Intro to NCQA & SNP Assessment Program
How are S&P Measures Developed
• Similar to HEDIS measure development
• Initial literature review and evidence
• Geriatric Measurement Advisory Panel (GMAP)– Diverse set of expert
stakeholders– Technical expert panels
also formed, if necessary
• Pilot Tests/Public Comment– Determine
feasibility/burden– Input from
stakeholders
• Final approval from GMAP and CMS
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27SNP Training – Intro to NCQA & SNP Assessment Program
Components of the S&P Measure
Components of the S&P Measure
• Standard Statement A statement about acceptable
performance or results
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28SNP Training – Intro to NCQA & SNP Assessment Program
Components of the S&P Measure
Intent Statement A sentence that describes the importance of the S&P measure
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29SNP Training – Intro to NCQA & SNP Assessment Program
Components of the S&P MeasuresComponents of an S&P Measure
ELEMENT
FACTORS
SCORING
DATA SOURCES
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30SNP Training – Intro to NCQA & SNP Assessment Program
Components of an S&P Measure
The period of time for which NCQA evaluates the SNPs documentation to assess performance against an element
The extent of the organization’s services evaluated during an NCQA survey.
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31SNP Training – Intro to NCQA & SNP Assessment Program
Components of an S&P Measure
Descriptive information illustrating performance against an element’s requirements. Examples are for guidance and are not intended to be all-inclusive
Guidance for demonstrating performance against the element
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32SNP Training – Intro to NCQA & SNP Assessment Program
Data Source Types
Documented Process
Reports
Materials
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33SNP Training – Intro to NCQA & SNP Assessment Program
Data Source Types--Process
This policy applies to all ABC Health staff unless otherwise noted.
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Documented Process
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34SNP Training – Intro to NCQA & SNP Assessment Program
Data Source Types--Reports
Report
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35SNP Training – Intro to NCQA & SNP Assessment Program
Data Source Types—Reports (cont’d)
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36SNP Training – Intro to NCQA & SNP Assessment Program
Data Source Types--Materials
Materials
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2013 Assessment Against S&P Measures
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38SNP Training – Intro to NCQA & SNP Assessment Program
SNP Assessment Process
• S&P Measures assessment– Data collection through Web-based
Interactive Survey System (ISS) survey tool.
• Several levels of review:– Off-site Review (Level 1)
– Executive Review/Plan Comment (Level 2)
– Final Eyes (Level 3)
– Final Stage Review (Level 4)
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39SNP Training – Intro to NCQA & SNP Assessment Program
S&P Assessment
• Plan Comment Period– Plans will have an opportunity to
provide additional information to clarify issues from original submission materials
– Quick turnaround: Plans will have to respond to NCQA requests for more information rapidly
– One-time opportunity: Only chance plans have to provide additional documentation before data is finalized and sent to CMS
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40SNP Training – Intro to NCQA & SNP Assessment Program
S&P Assessment
• Plan Comment Period (continued)
– If you have questions, please contact a SNP team member immediately
– Please ensure additional data submitted is within the look-back period or it will not meet the requirements
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41SNP Training – Intro to NCQA & SNP Assessment Program
Final Stage Review
• Occurs after plans receive preliminary final scores
• One last opportunity for review• Only for scoring inconsistencies
– Radio buttons and support text language differ
– Different scores for similar SNP PBPs • No new documentation will be
reviewed
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42SNP Training – Intro to NCQA & SNP Assessment Program
Look-Back Period
• What is the Look-Back Period & how does it work?– The look-back period is the six-month period
prior to survey submission – April 15, 2013 to October 15, 2013. All documentation must be current as of the look-back period but it could have been developed before that time.
– Data used for reports can go back up to 1 year prior to submission, unless the explanation indicates otherwise.
– For evidence consisting of a policy, an organization that did not have one in place can develop and incorporate it into its operations during the look-back period.
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43SNP Training – Intro to NCQA & SNP Assessment Program
Who Reports
• HEDIS measures– All SNP plan benefit packages with 30+
members as of February 2012 Comprehensive Report (CMS website)
• S&P measures– All SNP plan benefit packages– Plans with zero enrollment are exempt
for certain elements
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44SNP Training – Intro to NCQA & SNP Assessment Program
SNP Reporting
• Returning SNPs— all SNPs that were operational as of January 1, 2012 AND renewed for 2013 AND have previously submitted.– SNP 1-6
• New SNPs — all SNPs operational as of January 1, 2012 AND renewed for 2013 AND are reporting for the first time.– SNP 1 A-D, SNP 2, SNP 4-6
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45SNP Training – Intro to NCQA & SNP Assessment Program
2013 S&P Measures• SNP 1: Care Management – Major
changes to measure to align with MOC requirements– All SNP Types– Focus on assessment, individualized care
plans, how SNPs coordinate services and manage care for members
• SNP 2: Member Satisfaction – Added examples
– All SNP Types
– Focus on monitoring member satisfaction to identify areas for improvement & take action
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46SNP Training – Intro to NCQA & SNP Assessment Program
S&P Measures: What’s New for 2013
• SNP 3: Clinical Quality Improvement – revised methodology for calculating significant improvement to address small numbers– All SNP types
– Focus on demonstrating quality improvement
• SNP 4: Care Transitions – Added new factor in Element E– All SNP Types– Focus on how SNPs manage and support
members through planned and unplanned transitions in care
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47SNP Training – Intro to NCQA & SNP Assessment Program
S&P Measures: What’s New for 2013• SNP 5: Institutional SNP Relationship
With Facility – No major changes– I-SNPs only – Focus on how SNPs communicate with
facilities to monitor services and members’ needs
• SNP 6: Coordination of Medicare and Medicaid Coverage – No major changes
– Different requirements for Duals and I & C SNPs
– Focus on coordination and administration of benefits for Duals
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SNP Data & Reporting
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49SNP Training – Intro to NCQA & SNP Assessment Program
Data Submissions
• S&P measures– Submission date: October 15, 2013– ISS data collection tool– No Fees required to submit
– All SNPs that were operational as of January 1, 2012, AND renewed in 2013.
– Plans with zero enrollment are exempt for certain elements
NCQA will verify enrollment using CMS Comprehensive Report—publicly available enrollment data
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50SNP Training – Intro to NCQA & SNP Assessment Program
What happens after submission?
• NCQA Analysis of HEDIS and S&P measures– Comparison to MA plans (HEDIS) and to
other SNPs– Demographic (size, type, region)– Statistical significance
• Deliver report to CMS– CMS will make all decisions regarding the
use of the data– NCQA will not publicly report any of the
SNP data
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51SNP Training – Intro to NCQA & SNP Assessment Program
And now…
Questions?
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52SNP Training – Intro to NCQA & SNP Assessment Program
ContactsBrett KayAssistant Vice President, SNP [email protected]
Casandra MonroeAssistant Director, SNP [email protected]
Sandra JonesAssistant Director, SNP [email protected]
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53SNP Training – Intro to NCQA & SNP Assessment Program
Contacts
Anthony DavisAccreditation Manager, SNP Assessment [email protected]
Nidhi DalwadiAccreditation Manager, SNP Assessment [email protected]
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54SNP Training – Intro to NCQA & SNP Assessment Program
Contacts
Priyanka OberoiAccreditation Manager, SNP [email protected]
Ling Chen Accreditation Manager, SNP Assessment 202-955-3548 [email protected]
Delia PonceCoordinator, SNP [email protected]
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55SNP Training – Intro to NCQA & SNP Assessment Program
Additional Resources• NCQA SNP Webpage:
http://www.ncqa.org/snp• FAQs
– Training descriptions & schedule– Final HEDIS and S&P measures
• NCQA Policy Clarification Support (PCS)http://ncqa.force.com/pcs/login
• HEDIS Audit informationhttp://www.ncqa.org/tabid/204/
Default.aspx
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56SNP Training – Intro to NCQA & SNP Assessment Program
Additional Information• HEDIS 2013 Volume 2 Publication
http://www.ncqa.org/Publications
• Specifications Update
http://www.ncqa.org/Publications
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57SNP Training – Intro to NCQA & SNP Assessment Program
Additional SNP Trainings
• Introduction to NCQA & SNP Assessment– June 25 ~ 2-4:00 pm– June 27 ~ 2-4:00 pm
• Structure and Process Measures (S&P 1-3)– July 9 ~ 2-4:00 pm– July 11 ~ 2-4:00 pm– July 16 ~ 2-4:00 pm
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58SNP Training – Intro to NCQA & SNP Assessment Program
Additional SNP Trainings
• Structure and Process Measures (S&P 4-6)– July 18 ~ 2-4:00 pm– July 24 ~ 2-4:00 pm– July 30 ~ 2-4:00 pm
• Interactive Survey System (ISS)– August 6 ~ 2-3:30 pm– August 13 ~ 2-3:30 pm– September 12 ~ 2-3:30 pm
![Page 59: Introduction to NCQA & SNP Assessment June 25 and 27, 2013.](https://reader038.fdocuments.us/reader038/viewer/2022110209/56649e045503460f94af01ae/html5/thumbnails/59.jpg)
59SNP Training – Intro to NCQA & SNP Assessment Program
Additional SNP Seminars
• Open Door Forums– August 15 ~ 2-3:00 pm – September 10 ~ 2-3:00 pm – September 25 ~ 2-3:00 pm