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Welcome to the AMP newsletter!
The goal of the monthly newsletter is to keep stakeholders up to date about program changes and deadlines. The newsletter has three main content areas:
- Need to Do, which will alert stakeholders to information and requirements for successful program participation, such as upcoming deadlines.
- In Other News, which will share other program-related news, such as upcoming industry webinars or conferences.
- In the Pipeline, which will provide a longer term view of upcoming key program dates.
All newsletters are archived in the Newsletters section of the IHA website, so you can easily find and share the latest program information.
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Measurement Year (MY) 2018 Data Collection Deadline: Test Data Files to TransUnion March 21 - May 2
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Between March 21 and May 2, 2019, self-reporting physician organizations (POs) and health plans should submit test data files to TransUnion Healthcare. Test data files support clean final file submission to TransUnion for use in the AMP programs.
As a reminder, the MY 2018 data file layouts for self-reporting POs include commercial HMO, Medicare Advantage, and Medi-Cal managed care product lines. PO self-reporting is voluntary; however, POs submitting the self-reporting data file layout are required to populate all 117 DTL records in the file, even if your organization is not reporting for a specific measure or product line. This includes one record for each of the 53 clinical measure IDs for the Commercial HMO product, one record for each of the 15 clinical measure IDs for the Medicare Advantage product and one record for each of the 49 clinical measure IDs for the Medi-Cal Managed Care product. If your physician organization chooses not to self-report a measure or measures within a specific product line,
you must populate those fields with "NR" in the rate column, and with 0 (zero) in the denominator and numerator columns. Detailed instructions for populating and submitting data files are located in the first tab of the data file layout.
Additionally, please note updates made to the following data file layouts:
- Self-Reporting PO Clinical Measure Data File Layout (updated March 15, 2019)
- e-Measure Data File Layout for Non-Self Reporting POs (updated March 7, 2019)
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MY 2017 AMP Commercial HMO Results Final & Incentive Resources Available
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Your organization's MY 2017 appropriate resource use (ARU) and total cost of care (TCOC) results were finalized March 22, 2019, marking the end of the MY 2017 reporting period. All MY 2017 AMP Commercial HMO results are now final and will allow participating health plans to make incentive payments to eligible contracted POs. The following value based incentive resources are also available for participants:
- MY 2017 Intended Health Plan Incentive Design Summary: This summary indicates how participating health plans will apply the standard incentive design or otherwise pay incentives to contracted POs.
- Standard Value Based Incentive Design Technical Document: A comprehensive, step-by-step guide meant to walk participants through the standard value based incentive design.
- AMP Worksheets: AMP worksheets are used to model the standard value based design using your organization's results for each of your contracted health plans. Your MY 2017 worksheet will be available for download in the "Downloads" section of the IHA Reporting Portal next week. An overview and demonstration of how to use the worksheet is available here.
- Member-Level Detail Portal: For those of you who have opted to receive member- level detail through the new Member-Level Detail Portal, member-level information has been refreshed with final MY 2017 data.
- Health Plan Plug & Plays: Incentive modeling workbooks will be provided to plans within the next two weeks.
Note: Calculation Revision for Value Based Payments
The AMP value based incentive design requires that physician organizations do not exceed a certain Total Cost of Care Trend in order to be eligible for shared savings. To ensure that the trend determination is based on true performance and not chance, the payment methodology includes an 85% lower confidence interval. An error was identified in the calculation of the lower confidence level that was displayed alongside your final MY 2017 results. This has been corrected in the information displayed on the reporting portal and in the downloads, as well as the PO worksheets that will be available next week. If you have any questions about the change, email us at
[email protected].
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Connect with IHA at America's Physician Groups (APG) Annual Conference April 11-13
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Don't miss Jeff Rideout, IHA CEO, and Dolores Yanagihara, VP, Analytics and Performance Information, who will present updated findings from the California Regional Health Care Cost & Quality Atlas at the APG Annual Conference Friday, April 12. Stop by the IHA booth, take a guided tour of the Atlas (
https://atlas.iha.org) and connect with IHA staff. Learn more and register for the conference
here.
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Join Us on April 26! Workgroup on Advancing Patient-Reported Outcome Measurement for Depression
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The growing number of commercial and other accountable care organizations (ACOs) and integrated delivery systems in California presents an opportunity to advance implementation of high-value, innovative measures, such as patient-reported outcome measures (PROMs). IHA, the Pacific Business Group on Health and the California Quality Collaborative are hosting a free half-day workshop that will convene purchasers, health plans, POs and other stakeholders to discuss how these organizations can collaborate to improve measurement and outcomes for depression care.
Workgroup on Advancing Depression Patient Reported Outcomes Measurement
April 26, 2019 | 10 a.m.-3 p.m. | Oakland, CA
Key topics include:
- Development efforts to date, including identification of depression screening and remission as the first clinical priority area for PROM development
- A summary of the current state of depression measurement and care integration among commercial ACOs and other organizations in California
- A panel discussion among attendees and representatives from medical groups and independent practice associations who have successfully implemented care models to support depression screening and care management for their commercial ACO population and beyond
- An interactive session on proposed approaches to care redesign and data collection as well as potential challenges
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Upcoming
MY 2018 Data Collection Deadlines
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Data collection is well underway for MY 2018! To ensure timely, complete and valid reporting for MY 2018, please note upcoming data collection deadlines for the AMP programs.
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Activity
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Due
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Self-reporting PO review period: POs that self-report AMP results are encouraged to thoroughly review their clinical quality submission for accuracy and completeness before sending it to auditors for review and locking. As a reminder, self-reported PO results cannot be amended during the annual appeals period unless errors on the part of IHA or TransUnion are identified; errors in PO or vendor programming are not grounds for appeal.
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April 18-30
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Submit files to auditor: Self-reporting POs and health plans send submission files to auditors.
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May 1
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Submit auditor-locked files to TransUnion: Self-reporting POs and health plans submit auditor-locked clinical results to TransUnion HealthCare. (Audit not required for AMP Commercial ACO)
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May 9
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National Committee for Quality Assurance (NCQA) Measure Certification Requirements Changing for Health Plan & Self-Reporting PO Participants
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NCQA is updating measure certification and audit program requirements to increase consistency and validity of measure results reported by health plans and POs participating in the AMP programs. Beginning with MY 2019, health plans and POs that choose to use vendors to calculate their AMP program results must use NCQA-certified vendors. Also beginning with MY 2019, health plans and POs that run their own measure results (without using a vendor) have two options to report results:
- Health plans and POs may continue to program and run their own measure results through uncertified measure logic. Such organizations will continue to undergo the required Manual Source Code Review (MSCR) by an NCQA-certified HEDIS Compliance Auditor for their AMP program submissions.
- Alternatively, health plans and POs that run their own measure results may contract directly with NCQA and use NCQA's test-deck process to certify their measure logic (termed Automated Source Code Review [ASCR]) in lieu of using uncertified logic and undergoing MSCR.
Please note that NCQA plans to discontinue MSCR as part of the HEDIS Compliance Audit (and AMP program) in MY 2021. Beginning with MY 2021 (for reporting year 2022), all health plans and POs must either transition to an NCQA-certified vendor or contract directly with NCQA for certification of their software via the ASCR process. Please see updated MY 2018 FAQs for details, and submit any questions to NCQA through their Policy Clarification Support System.
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