HIV/AIDS Subpopulation

Value Based Payment Quality Measure Set
Measurement Year 2018

  • Measure Set is also available in Portable Document Format (PDF)

October 31, 2017                     NYS Medicaid Value Based Payment


INTRODUCTION

The 2018 HIV/ AIDS Subpopulation Quality Measure Set was created in collaboration with the HIV/ AIDS Subpopulation Clinical Advisory Group (CAG) and the New York State (NYS) Value Based Payment (VBP) Workgroup. The goal is to align with measures sets put forth for the Delivery System Reform Incentive Payment (DSRIP) Program and for the Quality Assurance Reporting Requirements (QARR). The HIV/ AIDS measure set was designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings for the HIV/ AIDS Subpopulation.

MEASURE SELECTION AND FEASIBILITY

During the summer of 2017, the HIV/ AIDS Subpopulation CAG reconvened and made recommendations to the State on quality measures, data collection, data reporting, and support required for providers to be successful in a VBP environment.

Beginning in June of 2017, the State initiated monthly meetings of the VBP Measure Feasibility Task Force and arrangement-level Sub-teams. The goal of the Task Force and Sub–teams is to make recommendations to the State to support and inform the Annual Measure Review Cycle. Members of the Task Force include professionals from various Managed Care Organizations (MCOs), VBP Pilot Contractors, State Agencies, along with other professionals with experience in quality measurement and health information technology. The Task Force provided feedback to DOH on quality measure feasibility, reporting, and calculation.

Upon receiving the CAG recommendations and Task Force feedback, the State defined a final list of measures for inclusion for MY 2018.

MEASURE CLASSIFICATION

Each measure has been designated by the State as Category 1, 2, or 3 with associated recommendations for implementation and testing for future use in VBP Arrangements. The measures below are classified by category based on an assessment of reliability, validity, and feasibility, and according to suggested method of use (either Pay for Reporting (P4R) or Pay for Performance (P4P)).

    Categorizing and Prioritizing Quality Measures

CATEGORY 1
Approved quality measures that are felt to be both clinically relevant, reliable and valid, and feasible.

CATEGORY 2
Measures that are clinically relevant, valid, and probably reliable, but where the feasibility could be problematic. These measures should be investigated during the 2017 pilot program.

CATEGORY 3
Measures that are insufficiently relevant, valid, reliable and/or feasible.

Category 1

Category 1 quality measures as identified by the CAGs and accepted by the State are to be reported by VBP Contractors. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible1.

The State classified each Category 1 measure as either P4P or P4R:

  • P4P measures are intended to be used in the determination of shared savings amounts for which VBP Contractors are eligible. Measures can be included in both the determination of the target budget and in the calculation of shared savings for VBP Contractors.
  • P4R measures are intended to be used by the Managed Care Organizations (MCOs) to incentivize VBP Contractors for reporting data to monitor quality of care delivered to members under the VBP contract. Incentives for reporting will be based on timeliness, accuracy, and completeness of data. Measures can be reclassified from P4R to P4P through annual CAG and State review or as determined by the MCO and VBP Contractor.

Not all Category 1 measures will be reportable for the measurement year, as reporting on some of these measures will be phased in over the next 2 years. Please see the 2018 Value Based Payment Reporting Requirements Technical Specifications Manual 2 for details as to which measures must be reported for the measurement year. This manual will be updated annually each fall, in line with the release of the final VBP measure set for the subsequent year.

Categories 2 and 3

Category 2 measures have been accepted by the State based on agreement of measure importance, validity, and reliability, but flagged as presenting concerns regarding implementation feasibility. These measures will be further investigated in the VBP Pilots. The State requires that VBP Pilots select and report a minimum of one Category 2 measure per VBP Arrangement for MY 2018 (or have a State and Plan approved alternative). VBP Pilot participants will be expected to share meaningful feedback on the feasibility of Category 2 measures when the CAGs reconvene. The State will discuss measure testing approaches, data collection, and reporting requirements with VBP Pilots as a part of the Measure Support Task Force

Measures designated as Category 3 were identified as unfeasible at this time or as presenting additional concerns including accuracy or reliability when applied to the attributed member population for an arrangement.

MEASUREMENT YEAR 2018 QUALITY MEASURE SET

The measures and State determined classifications provided on the following pages are recommendations for MY 2018. Note that measure classification is a State recommendation and implementation is to be determined between the MCO and VBP Contractor.

Measure sets and classifications are considered dynamic and will be reviewed annually. Updates will include additions, deletions, reclassification of measure category, and reclassification from P4R to P4P based on experience with measure implementation in the prior year. During 2018, the CAGs and the VBP Workgroup will re–evaluate measures and provide recommendations for MY 2019.

Category 1

The table below displays the Category 1 HIV/ AIDS Quality Measure Set, arranged alphabetically, and includes measure title, measure steward, the National Quality Forum (NQF) number and/or other measure identifier (where applicable), and State determined classification for measure use. The measure set is redlined to highlight changes made between MY 2017 and MY 2018. Additions are made in red text while deletions or changes are made with a strikethrough.

Measure Measure Steward Measure Identifier Classification
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder Centers for Medicare & Medicaid Services (CMS) NQF 1880 P4P
Antidepressant Medication Management – Effective Acute Phase Treatment & Effective Continuation Phase Treatment National Committee for Quality Assurance (NCQA) NQF 0105 P4P
Breast Cancer Screening NCQA NQF 2372 P4P
Cervical Cancer Screening NCQA NQF 0032 P4P
Colorectal Cancer Screening NCQA NQF 0034 P4P
Comprehensive Diabetes Care: All Three Tests (HbA1c, dilated eye exam, and medical attention for nephropathy) NCQA NQF #s 0055, 0062, 0057 P4P
Comprehensive Diabetes Care: Eye Exam (retinal) Performed NCQA NQF 0055 P4P
Comprehensive Diabetes Care: Foot Exam NCQA NQF 0056 P4R
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) NCQA NQF 0575 P4R
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) NCQA NQF 0059 P4P
Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) testing [performed] NCQA NQF 0057 P4P
Comprehensive Diabetes Care: Medical Attention for Nephropathy NCQA NQF 0062 P4P
Controlling High Blood Pressure NCQA NQF 0018 P4P
Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications NCQA NQF 1932 P4P
HIV Viral Load Suppression Health Resources and Services Administration (HRSA) NQF 2082 P4P
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) NCQA NQF 0004 P4P
Initiation of Pharmacotherapy for Alcohol Dependence3 NYS Office of Alcoholism and Substance Abuse Services (OASAS) P4R
Initiation of Pharmacotherapy upon New Episode of Opioid Dependence4 NYS P4P
Linkage to HIV Medical Care5 HRSA P4R
Medication Management for People with Asthma (ages 5 – 64) – 50% and 75% of Treatment Days Covered NCQA NQF 1799 P4P
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow– Up Plan CMS NQF 0421 P4R
Preventive Care and Screening: Influenza Immunization American Medical Association Physician Consortium for Performance Improvement (AMA PCPI) NQF 0041 P4R
Preventive Care and Screening: Screening for Clinical Depression and Follow–Up Plan CMS NQF 0418 P4R
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention AMA PCPI NQF 0028 P4R
Proportion of Patients with HIV/ AIDS that have a Potentially Avoidable Complication during a Calendar Year Altarum Institute (Formerly HCI3) P4R
Sexually Transmitted Diseases: Screening for Chlamydia, Gonorrhea, and Syphilis6 NCQA NQF 0409 P4P
Statin Therapy for Patients with Cardiovascular Disease NCQA P4R
Statin Therapy for Patients with Diabetes NCQA P4R
Substance Abuse Screening7 HRSA, HIV/ AIDS Bureau P4R
Use of Alcohol Abuse or Dependence Pharmacotherapy8 NYS P4R
Use of Spirometry Testing in the Assessment and Diagnosis of COPD NCQA NQF 0577 P4R

Category 2

The table below displays the Category 2 HIV/ AIDS Quality Measure Set and includes measure title, measure steward, and the NQF number and/or other measure identifier (where applicable). All Category 2 measures are classified as P4R in MY 2018. The measure set is redlined to highlight changes made between MY 2017 and MY 2018. Additions are made in red text while deletions or changes are made with a strikethrough.

Measure Measure Steward Measure Identifier
Asthma: Assessment of Asthma Control – Ambulatory Care Setting The American Academy of Allergy, Asthma & Immunology (AAAAI)
Continuing Engagement in Treatment (CET) Alcohol and Other Drug Dependence NYS OASAS
Continuity of Care from Inpatient Detox to Lower Level of Care9 NYS
Continuity of Care from Inpatient Rehabilitation to Lower Level of Care10 NYS
Diabetes Screening NYS DOH AIDS Institute
Hepatitis C Screening HRSA
Housing Status HRSA
Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse or Dependence11 NYS
Linkage to HIV Medical Care12 NYS DOH AIDS Institute
Lung Function/Spirometry Evaluation (Asthma) AAAAI
Medical Case Management: Care Plan HRSA
Patient Self–Management and Action Plan (Asthma) AAAAI
Prescription of HIV Antiretroviral Therapy HRSA NQF 2083
Sexual History Taking: Anal, Oral, and Genital NYS DOH AIDS Institute
Sexually Transmitted Diseases: Screening for Chlamydia, Gonorrhea, and Syphilis13 NCQA NQF 0409
Use of Imaging Studies for Low Back Pain NCQA NQF 0052
Utilization of Pharmacotherapy for Alcohol Dependence NYS OASAS
Use of Opioid Dependence Pharmacotherapy14 NYS

Appendix A


Updated Measure Name Crosswalk

The following table shows the measure names that were updated for MY 2018.

Measure Name in MY 2018 Measure Name in MY 2017
Continuity of Care from Inpatient Rehabilitation to Lower Level of Care Continuity of Care from Inpatient Detox or Inpatient Care to Lower Level of Care
Continuity of Care from Inpatient Detox to Lower Level of Care Continuity of Care from Inpatient Detox or Inpatient Care to Lower Level of Care
Initiation of Pharmacotherapy upon New Episode of Alcohol Abuse or Dependence Initiation of Pharmacotherapy for Alcohol Dependence
Initiation of Pharmacotherapy upon New Episode of Opioid Dependence Initiation of Pharmacotherapy for Opioid Use Disorder
Substance Abuse Screening Substance Use Screening
Use of Alcohol Abuse or Dependence Pharmacotherapy Utilization of Pharmacotherapy for Alcohol Dependence
Use of Opioid Dependence Pharmacotherapy Utilization of Pharmacotherapy for Opioid Use Disorder

Appendix B


The tables below provide the changes to the Category 1 and Category 2 measures for the MY 2018 HIV/ AIDS Quality Measure Set.

Category 1 Measure Changes from 2017 to 2018

Measure Name Change Rationale for Change
Initiation of Pharmacotherapy for Alcohol Dependence Moved to Category 2 Measure moved to Category 2 because timeframe for measurement is too narrow
Linkage to HIV Medical Care Moved to Category 2 Recommended by HIV Quality Advisory Committee of the AIDS Institute to align with ETE
Sexually Transmitted Diseases: Screening for Chlamydia, Gonorrhea, and Syphilis Moved to Category 2 Recommended by HIV Quality Advisory Committee of the AIDS Institute to align with ETE

Category 2 Measure Changes from 2017 to 2018

Measure Name Change Rationale for Change
Use of Imaging Studies for Low Back Pain Moved to Category 3 Removed due to measure specification change
Utilization of Pharmacotherapy for Alcohol Dependence Moved to Category 1 Measure promoted to Category 1 because timeframe for measurement is sufficiently broad

__________________________________________________________

1. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value Based Payment: Annual Update, June 2016. (Link)  1
2. 2018 Value Based Payment Reporting Requirements; Technical Specifications Manual, Nov 2017, File found in the Quality Measures tab (Link)  2
3. Measure moved to Category 2 for MY 2018.  3
4. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  4
5. Measure moved to Category 2 for MY 2018.  5
6. Ibid.  6
7. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes see the Updated Measure Name Crosswalk table at the end of this document.  7
8. Measure moved from Category 2 for MY 2018. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  8
9. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document. This measure is a component of a measure that was split into two separate measures for MY 2018.  9
10. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  10
11. Measure moved from Category 1 for MY 2018. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  11
12. Measure moved to Category 1 for MY 2018.  12
13. Ibid.  13
14. Measure name changed from MY 2017. No other changes to measure or specification made. For a full listing of measure name changes, see the Updated Measure Name Crosswalk table at the end of this document.  14