Quality Advance Program 2016 Overview- Connecticut Health Services January 1, 2016
QUALITY ADVANCE PROGRAM Introduction Harvard Pilgrim supports the Provider Group s efforts to manage the cost, quality, and patient experience of their patients care by encouraging and rewarding investments and improvements in infrastructure support, health information technology, and HEDIS measure performance. The Quality Advance Program (QAP) consists of the following initiatives: 1. Infrastructure Support Program 2. Health Information Technology 3. Rewards for Excellence By October 1 of each calendar year, the Plan will give written notice to Provider Group, pursuant to the Agreement, of the terms and criteria that will apply to the Quality Advance Program for the subsequent calendar year. I. Infrastructure Support Program (ISP) The Infrastructure Support Program (ISP) provides support to the Provider Group and Medical Director. There are four components to the ISP measure. The Provider group must 1) have a Medical Director, 2) the Medical Director must meet their responsibilities, 3) the Provider Group must implement two Infrastructure Support initiatives- one in the area of Patient Centered Medical Home (PCMH) transformation and one in the area of Efficiency, and 4) conduct a Cultural Competency self-assessment, as more fully described below. Medical Director The Medical Director is the liaison between Harvard Pilgrim and the Provider Group to support collaborative efforts to deliver high quality, cost-efficient, patient centered care to Harvard Pilgrim members through the oversight of the QualityAdvance Program and other initiatives. Responsibilities of the Medical Director include, but are not limited to, the following: Supports Provider Group physicians and promotes the adoption of evidence-based health care delivery Designs and implements provider group-wide population management programs Regularly reviews performance data to identify and manage outlier performance and drivers of practice variation across the provider group Provides regular updates to provider group about Harvard Pilgrim products, policies, performance payment and recognition programs Facilitates local physician recognition and reward programs related to performance on Harvard Pilgrim s quality strategic quality initiatives Assists with the resolution of Harvard Pilgrim care delivery issues and provider-related concerns Ensures compliance with HIPPA requirements and confidentiality of all Harvard Pilgrim proprietary information Attends Harvard Pilgrim Medical Directors meetings, twice annually as scheduled Ensures submission of the an annual Business Plan and 2 updates, detailing 2 initiatives as described below Quality Advance Overview 2016 CT FINAL Page 2 of 16
Infrastructure Support Initiatives: The Provider Group will submit a Business Plan and two (2) updates detailing two (2) improvement initiatives (as more fully described in Appendix 2): 1. one initiative to support the transition of its practices to a Patient Centered Medical Home care delivery model 2. one network-wide initiative to support improved care delivery efficiency (appropriate utilization and reduced total cost of care) Table 1: PCMH Initiative Topic Choices The Provider Group implements one (1) multi-practice initiative aligned with NCQA PCMH standards. Detailed information about PCMH standards is available on the NCQA public website www.ncqa.org/programs/recognition/practices/patientcenteredmedicalhomepcmh.aspx PCMH 1: Patient-Centered Access. The practice provides access to team-based care for both routine and urgent needs of patients/ families/ caregivers at all times. PCMH 2: Team-Based Care. The practice provides continuity of care using culturally and linguistically appropriate, team-based approaches. PCMH 3: Population Health Management. The practice uses a comprehensive health assessment and evidence-based decision support based on complete patient information and clinical data to manage the health of its entire patient population. PCMH 4: Care Management and Support. The practice systematically identifies individual patients and plans, manages and coordinates care, based on need. PCMH 5: Care Coordination and Care Transitions. The practice systematically tracks tests and coordinates care across specialty care, facility-based care and community organizations. PCMH 6: Performance Measurement and Quality Improvement Cultural Competency Self-Assessment: Harvard Pilgrim is committed to achieving health care equity for our members and the communities we serve. Assuring the cultural competency of our provider network is of critical importance in delivering on that commitment. The Provider Group will submit a self-assessment of cultural competency to ensure racial/ethnic sensitivity, language access and attention to health literacy, as further described in Appendix 3. Target: Medical Director Responsibility Measure: The target is met when the Medical Director(s) attend 2 scheduled Medical Directors meetings as scheduled. ISP: The target is met when the Provider Group submits the initial business plan, mid-year update and final report, more fully described in Appendix 2. Cultural Competency Self-Assessment: The target is met when the Provider Group has submitted a Cultural Competency self-assessment further described in Appendix 3. Quality Advance Overview 2016 CT FINAL Page 3 of 16
Payment: For the first quarterly payment (January 1, 2016 through March 31, 2016), payment will be earned based on the attendance of at least one Provider Group Medical Director at the HPHC Medical Directors meeting as scheduled and on the submission of the IS initiative business plan. For the second quarterly payment (April 1, 2016 through June 30, 2016), payment will be earned based on the submission of the Cultural Competency self-assessment. For the third quarterly payment (July 1, 2016 through September 30, 2016), payment will be earned based on the attendance of at least one Provider Group Medical Director at the HPHC Medical Directors meeting as scheduled and on the submission of the IS initiative mid-year update. For the final quarterly payment (October 1, 2016 through December 30, 2016), payment will be earned based on the submission of the IS initiative final update. To ensure appropriate receipt and tracking, please email all documents to: HPHC_NMM@HPHC.ORG Quality Advance Overview 2016 CT FINAL Page 4 of 16
II. Health Information Technology (HIT) This measure assesses the level of Health Information Technology (HIT) functionality across practices within the Provider Group in the areas of: 1. Recording patient health information 2. Order/entry management 3. Results management 4. Decision support 5. Electronic communication and connectivity 6. Patient supports 7. Administrative processes and reporting 8. Population health management. Providers who participate in any of the following recognition programs (the Recognition Programs ) will be deemed to have HIT functionality for purposes of this measure: CMS Meaningful Use Bridges to Excellence Physician Office Link (POL) Reporting and Measurement: The Provider Group will submit to HPHC by February 1, 2017 a roster of physicians participating in a Recognition Program. The Plan will confirm the physicians status in the Recognition Program using CMS and NCQA data sources. The Plan will calculate the percentage of physicians in the Provider Group participating in a Recognition Program, which will determine the level of payment. The Provider Group must have at least 25 percent of its physicians participating in a Recognition Program be eligible for any payment under this measure. If an LCU achieves this minimum performance level, the payment will be a linear payout based on the percentage of PCPs achieving recognition For example: Provider Group percentage of physicians participating in a Recognition Program Percentage Payout 20% of providers 0% 46% of providers 46% 99% of providers 99% Payment: Payment for this measure will be made by March 31, 2017. Quality Advance Overview 2016 CT FINAL Page 5 of 16
HIT) III. Rewards for Excellence (R4E) This measure rewards Provider Groups that submit all payer performance data to HPHC for select HEDIS measures. Table 2: HEDIS Measures 1. Controlling High Blood Pressure [CBP] 2. Antidepressant Medication Management [AMM] Effective Continuation Phase (6 months) 3. Adolescent Well Care [AWC] 4. Medication Management for People with Asthma [MMA]- Controller med for >= 75% of treatment period 5. Breast Cancer Screening (BCS) 6. Cervical Cancer Screening (CCS) 7. Diabetic Nephropathy testing (CDC) Reporting: By April 2017, the Provider group will submit all payer performance data for above HEDIS measures to HPHC. Payment: Payment is contingent on submission of all payer HEDIS performance data for the 7 HEDIS measures. Quality Advance Overview 2016 CT FINAL Page 6 of 16
APPENDIX 1 QAP 2016 Program Elements Summary The chart below highlights key elements of the Quality Advance Program for 2016 and identifies the schedules that provide more detailed information about the program. Category Payment Frequency Payment Date I. Infrastructure Support Program (ISP) 1. Medical Director Meeting Attendance 2. ISP Initiatives 3. Cultural Competency Self- Assessment Quarterly Q1, by the end of May 2016 Q2, by the end of Aug 2016 Q3, by the end of Nov 2016 Q4, by the end of Mar 2017 II. Health Information Technology Annually By end of March 2017 III. Rewards for Excellence HEDIS Annually By end of May 2017 Please see HPHC Important Dates 2016 posted on www.harvardpilgrim.org/meddir ( Quick Links ) for ISP documentation submission dates. Please email all submissions to: HPHC_NMM@HPHC.ORG Quality Advance Overview 2016 CT FINAL Page 7 of 16
APPENDIX 2 Infrastructure Support Initiatives Business Plan Deliverables Please document using the Infrastructure Support Business Plan & Update form available on www.harvardpilgrim.org/meddir/p4p 1. Business Plan: On or before February 29, 2016, the Provider group will provide the following: For each Initiative please provide the following: a. Please describe any prior work done in the area b. Key activities/components (bullets) c. Project milestones and deliverables during the calendar year d. 2 measures of success 2. Interim Report, due Sept 30, 2016. (HPHC may request a meeting with LCU to discuss progress) a. Interim Progress report (project plan milestones) b. Interim metrics, if available 3. Final Report, due Jan 31, 2017. (HPHC may meet with Provider group to discuss initiative results) a. Final progress report (project plan milestones) b. For each initiative, please answer the following questions: i. What barriers did you address? ii. iii. iv. What aspects of your project went particularly well and were essential to its success? What were the lessons learned in designing and implementing your project? Your next steps? v. Is the initiative transferrable to the HPHC network? Quality Advance Overview 2016 CT FINAL Page 8 of 16
APPENDIX 3 Cultural Competency Self-Assessment Required: Submit at least one Cultural Competency Self-Assessment survey to Harvard Pilgrim by June 30, 2016. The survey may be at the Provider group level or for a large practice. The Provider group may use the Harvard Pilgrim brief self-assessment tool in Appendix 4 (also posted on www.harvardpilgrim.org/meddir/p4p) or one of the tools listed below. Send a copy of the completed self-assessment to HPHC_NMM@hphc.org by June 30, 2016. Table 1: Preferred Cultural Competency Self-Assessment Tools Culturally and Linguistically Appropriate Services (CLAS) Assessment Tool (Office of Minority Health, US Dept of Health and Human Services) Cultural Competence Implementation Measure (tool starts on page 29) (RAND; endorsed by National Quality Forum as measure 1919) Communication Climate Assessment Tool for Health Care Organizations (American Medical Association) Cultural and Linguistic Competence Policy Assessment Tool (National Center for Cultural Competence) Cultural Competence Assessment Tool (Boston Public Health Commission) Cultural Competence Self-Assessment (Andrulis, Delbanco, et. al.) Quality Advance Overview 2016 CT FINAL Page 9 of 16
APPENDIX 4 Organizational Cultural Competency Brief Self-Assessment Tool About your organization A. Organization name B. Total number of practice sites C. Number of practice sites serving a racially/ethnically diverse population D. Number of primary care physicians (PCPs) E. Percent of PCPs who have completed cultural competency training F. Number of Primary Care Nurse Practitioners/Physician Assistants G. Percent of these NPs/PAs who have completed cultural competency training H. Number of specialist physicians I. Percent of specialists who have completed cultural competency training I. Diversity Assessment and Initiatives 1. Please describe and quantify the cultural, linguistic, racial and ethnic diversity within your patient population 2. Please provide one (1) example of a policy, project, process or program that you have implemented in the last 12 month to address the cultural or linguistic needs of your patient population. 3. What challenges or resource limitations have you identified in promoting cultural competency? Quality Advance Overview 2016 CT FINAL Page 10 of 16
For questions 1-19 below, please enter an X in the appropriate box and comment. II. Governance, Leadership, and Workforce 1. Our organization ensures that the necessary fiscal and human resources including cultural tools, skills, and ledge are a priority in our organization. Agree Agree Dis Dis Comments 2. Our organization s recruitment, hiring, and retention practices achieve a diverse and culturally competent staff, including senior leadership, reflective of our patient/client population. Agree Agree Dis Dis Comments 3. Our organization requires diversity awareness and cultural competence training at all levels of the organization (i.e., staff, management, providers, etc.). Agree Agree Dis Dis Comments III. Communication and Language Assistance 4. Our organization provides language assistance services at no cost to the patient/client. Agree Agree Dis Dis Comments 5. Our organization posts notification of the right to an interpreter in several languages at various points of contact and by various means (print and multimedia). Agree Dis Comments Quality Advance Overview 2016 CT FINAL Page 11 of 16
6. Our organization does not use family members, friends or minors for providing interpretation for a patient/client appointment. Agree Dis Comments 7. Our staff understands and respects the cultural health and illness beliefs and practices of our patient population, including beliefs about complementary and alternative medicine and medical treatments that may violate cultural and/or religious traditions. Agree Dis Comments 8. Our organization assures that the patient education materials we use are culturally appropriate for our patient populations and are available in their preferred language. Agree Dis Comments 9. We explain technical or specialized terminology and make every effort to assure that our patients fully understand questions, instructions and explanations from our clinical, administrative and other staff. Our staff are expected to assess patients understanding by asking questions or having the patient repeat the information in their own words. Agree Dis Comments 10. Our organization has a designated process for assuring that our printed patient/client materials are written in plain language and adhere to health literacy guidelines. Agree Dis Comments Quality Advance Overview 2016 CT FINAL Page 12 of 16
IV. Engagement, Continuous Improvement, and Accountability 11. Our organization has a strategic plan that incorporates Culturally and Linguistically Appropriate Services (CLAS) goals and activities. Agree Dis Comments 12. Our organization has developed measurable outcome goals regarding cultural and linguistic competence and periodically assesses our progress in meeting those goals. Agree Dis Comments 13. We have identified a CLAS/cultural competency champion from within our staff to monitor our activities and advancement in cultural competency Agree Dis What is the name of this individual? Comments 14. Our organization collects race and ethnicity, preferred language, and disability status for all of our patient/clients. (If you collect 2 out of 3 enter Agree ) Agree Dis Comments 15. Our organization measures clinical quality of care by race/ethnicity and language and identifies disparities in the care received by different population groups. Agree Dis Comments Quality Advance Overview 2016 CT FINAL Page 13 of 16
16. Our organization measures patient experiences by race/ethnicity, language and education to assess access, communication, coordination of care and patient engagement. Agree Dis Comments 17. Our organization works to address identified disparities in care and service and to meet the social and health needs of our community. Agree Dis Comments 18. Our organization has a formal grievance/complaint process that is accessible to all patient/client populations. Agree Dis Comments 19. Our organization regularly provides information to the public through print materials and activities highlighting our efforts to provide culturally responsive care to all patient/clients. Agree Dis Comments Quality Advance Overview 2016 CT FINAL Page 14 of 16
Recommendations for Improving Organizational Cultural Competency The following recommendations provide guidance for meeting the National CLAS Standards. The recommendations are numbered the same as the corresponding questions in the self-assessment. These recommendations are intended to assist organizations that responded Dis, Strongly Dis or Don t Know to the corresponding question. We hope this information will be useful in the development of quality improvement activities, action plans, and strategic designs. II. Governance, Leadership, and Workforce 1. It is leadership that establishes the culture of the organization through setting priorities that include the availability of fiscal and human resources for cultural competence. 2. Identify the patient/client populations in your service area and develop a plan to recruit staff at all levels who reflect those populations. Include recruitment of staff from diverse populations in your strategic plan. 3. Create or identify staff opportunities to attend training on serving diverse patient/client populations (i.e., brown bag lunches, all staff meetings, in-services, conferences, etc.). III. Communication and Language Assistance 4. Review your organization s process for ensuring that a patient/client is never billed for interpreter services. 5. Post a sign in the common areas of your organization offering interpreter services. The sign should provide this offer in all of the languages spoken by at least 1% of your patients. Encourage patient to use this service and inform them it is free of charge. 6. Create a policy that family members, friends or minors should not be utilized as interpreters. The policy should explain that utilization of interpreters who are trained in medical interpretation is critical for providing safe and quality care. 7. All staff who communicate directly with patients should receive cultural competency training, including being made aware of the most common cultural beliefs and traditions of the patients seen in the practice. It should not be assumed that all patients from a particular culture share these beliefs but patients should be asked about them as part of shared decision-making about their treatment options. 8. If the target population for your patient outreach and education materials includes a significant number of racially and ethnically diverse patients, assure that these materials respect the cultural beliefs and practices of those patients while promoting high quality care. These materials should be available in the most common languages spoken by patients seen in the practice. 9. Health literacy awareness training is recommended for all staff who interact with patients. Jargon and acronyms should be avoided and a list of recommended alternatives* for commonly misunderstood words should be made available to staff. 10. Conduct periodic reviews of all patient/client materials used at your organization for reading level and compliance with recommendations for clear communication. Use of a checklist* for assessing written materials for health literacy and cultural appropriateness can be very helpful. Quality Advance Overview 2016 CT FINAL Page 15 of 16
IV. Engagement, Continuous Improvement, and Accountability 11. Identify and incorporate some of the recommended strategies from this self-assessment into your strategic plan. Conduct periodic assessments related to cultural and linguistic services provided by your organization and share results with your staff. 12. Utilize results from this assessment to serve as a measurement tool to determine improvements over time regarding delivery of culturally appropriate care. 13. Having an identified organizational champion for the provision of culturally and linguistically appropriate services can help to assure that this perspective is considered whenever new policies or programs are adopted. The champion should also monitor the organization s ongoing compliance with CLAS standards and recommend improvements as needed. 14. Race, ethnicity, preferred language, and disability status should be collected using an individual self report process. This information should be stored in the patient s medical record in order to facilitate the delivery of culturally appropriate care. 15. When creating patient registries, measuring quality of clinical care and conducting patient experience surveys, include race/ethnicity to enable stratification of results and identification of disparities. 16. When conducting patient experience surveys include items about the respondents race/ethnicity and educational attainment to enable identification of racial/ethnic disparities in communication and service, as well as areas where interventions to improve health literacy may be needed. 17. When disparity reduction strategies require a community-based approach, collaborate with other health care delivery organizations in the community and local community-based groups to identify and implement effective interventions. 18. Review your current complaint/grievance policy to determine if patients/clients with limited English proficiency or other cultural and communication needs would be able to access this process. 19. Create opportunities to inform your community of efforts in cultural and linguistic responsiveness - news articles, ads, health fairs, brochures, community meetings, public speaking engagements, etc. * Harvard Pilgrim has developed tools in the asterisked areas noted above. If you would like to view or use these tools, please contact us at HPHC_NMM@HPHC.ORG Quality Advance Overview 2016 CT FINAL Page 16 of 16