Medicaid Advantage Plus
Value Based Payment Quality Measure Set
Measurement Year 2022
- Measure Set also available in Portable Document Format (PDF)
May 2022 NYS Medicaid Value Based Payment
Please note: Due to COVID-19 and the Department's suspension of Community Health Assessments for of MLTC enrollees reassessment until July 2021, the calculation of the MLTC VBP Category 1 measures, except for the Potentially Avoidable Hospitalization (PAH) measure, may be impacted for 2022.
The measurement year (MY) 2022 value based payment (VBP) quality measure set for Medicaid Advantage Plus (MAP) was created in collaboration with the Managed Long Term Care (MLTC) Clinical Advisory Group (CAG), a Sub-team empaneled by the CAG to discuss VBP approaches and quality measures for Medicaid Advantage Plus (MAP), and Programs of All-Inclusive Care for the Elderly (PACE).
The primary and preventive care measures in Table 1 are currently in the MAP quality frameworks with the Centers for Medicare and Medicaid Services (CMS) and overlap with other VBP measure sets including Integrated Primary Care (IPC) and Total Care for the General Population (TCGP). The classification for these measures for MY 2022 is P4R to incentivize appropriate data collection and establish measure use. Plans are required to report on the P4R measures for plan-provider ("VBP Contractor") combinations.
In addition to the measures listed in Table 1, Table 2 list the recommended Category 1 and Category 2 VBP MLTC measures for MAP Plans for MY 2022 and can be used for VBP contracts for MAP. The MAP Category 1 measures are considered valid and feasible for use in VBP MAP contracts. Category 2 measures, listed in Table 3, are also considered valid but may warrant additional implementation effort stemming from feasibility issues.
MEASURE CLASSIFICATION
Based on Sub-team recommendations and feedback from MAP Plans and PACE Organizations, the State developed quality measure sets specific to MAP and PACE to reflect the unique components of these plans. The measures specifically recommended for use by PACE Organizations are listed in Table 1.
Category 1
Category 1 quality measures as identified by the MLTC CAG and accepted by the State are determined to be clinically relevant, reliable and valid, and also feasible for use by VBP Contractors. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible.1
The State has further 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 MLTC plans to incentivize VBP Contractors to report data on the quality of care delivered to members under a VBP contract. Incentive payments for reporting will be based on the timeliness, accuracy, and completeness of data submitted. Measures can be reclassified from P4R to P4P through annual CAG and State review, or by the MLTC plan and VBP Contractor.
Category 2
Category 2 measures have been accepted by the State based on agreement of measure importance, validity, and reliability, but present implementation feasibility concerns. These measures will be further investigated with VBP program participants.
MEASUREMENT YEAR 2022 MEASURE SET
The measures and classifications provided on the following pages are recommendations for MY 2022. Note that measure classification is a State recommendation. MLTC plans and VBP Contractors can choose the measures they want to link to payment, and how they want to pay them (P4P or P4R) in their specific contracts. However, one measure recommended for VBP must be used as a P4P measure in VBP contracts.
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 2022, the CAGs and the VBP Workgroup may re-evaluate measures and provide recommendations for MY 2022.
VBP Quality Measures for MAP Plans
Table 1 displays the primary and preventive care measures recommended for use by MAP plans and includes measure title, measure steward and/or other measure identifier (where applicable), and State determined classification for measure use. These measures are classified as P4R for MY 2022 and must be reported to the State by the plans for their VBP Contractors.
Table 1: Primary and Preventive Care Measures
| Measures | Measure Source/ Steward | Measure Identifier | Classification |
|---|---|---|---|
| Eye Exam for Patients with Diabetes*1,2 | NCQA/ HEDIS | NQF 0055 | P4R |
| Kidney Health Evaluation for Patients with Diabetes (KED)*1 | NCQA/ HEDIS | P4R | |
| Colorectal Cancer Screening * | NCQA/ HEDIS | NQF 0034 | P4R |
| Antidepressant Medication Management - Effective Acute Phase Treatment & Effective Continuation Phase Treatment* | NCQA/ HEDIS | NQF 0105 | P4R |
| Follow-up After Hospitalization for Mental Illness^ | NCQA/ HEDIS | NQF 0576 | P4R |
| Initiation and Engagement of Substance Use Disorder Treatment *, 2 | NCQA/ HEDIS | NQF 0004 | P4R |
* Included in the TCGP measure set
^ Included in the Health and Recovery Plan (HARP) measure set
Acronyms: NCQA denotes the National Committee for Quality Assurance; HEDIS denotes the Healthcare Effectiveness Data and Information Set; NQF denotes National Quality Forum
Category 1: VBP Quality Measures for MAP Plans
Table 2 displays the complete Category 1 MLTC VBP Measure Set for MAP Plans and includes measure title, measure steward and/or other measure identifier (where applicable), and State determined classification for measure use. All Category 1 measures for use in MAP Plans are classified as P4P for MY 2022.
Table 2: Category 1 VBP Quality Measures for MAP and PACE
| Measures | Measure Source/ Steward | Classification |
|---|---|---|
| Percentage of members who did not have an emergency room visit in the last 90 days | UAS - NY/New York State | P4P |
| Percentage of members who did not experience falls that resulted in major or minor injury in the last 90 days | UAS - NY/New York State | P4P |
| Percentage of members who received an influenza vaccination in the last year* | UAS - NY/ New York State | P4P |
| Percentage of members who did not experience uncontrolled pain | UAS - NY/ New York State | P4P |
| Percentage of members who were not lonely or not distressed | UAS - NY/ New York State | P4P |
| Potentially Avoidable Hospitalizations (PAH) for a primary diagnosis of heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, or urinary tract infection | UAS - NY/ New York State with linkage to SPARCS data | P4P |
* Included in the NYS DOH MLTC Quality Incentive measure set
Acronyms: UAS - NY denotes the Uniform Assessment System for New York for MLTC members; SPARCS denotes the Statewide Planning and Research Cooperative System;
Category 2: VBP Quality Measures for MAP Plans
Table 3 displays the complete Category 2 MLTC VBP Measure set for MAP Plans and includes measure title, measure steward and/or other measure identifier (where applicable), and the recommended measure use classification.
Table 3: Category 2 VBP Quality Measures for MAP and PACE
| Measures | Measure Source/ Steward | Classification |
|---|---|---|
| Care for Older Adults - Medication Review | NCQA | P4R |
| Use of High-Risk Medications in the Elderly | NCQA | P4R |
| Percentage of members who rated the quality of home health aide or personal care aide services within the last 6 months as good or excellent* | MLTC Survey/New York State |
P4R |
| Percentage of members who responded that they were usually or always involved in making decisions about their plan of care* | MLTC Survey/New York State |
P4R |
| Percentage of members who reported that within the last 6 months the home health aide or personal care aide services were always or usually on time* | MLTC Survey/New York State |
P4R |
* Included in the NYS DOH MLTC Quality Incentive measure set
Acronyms: NCQA denotes the National Committee for Quality Assurance
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1. New York State Department of Health, Medicaid Redesign Team, A Path toward Value Based Payment: Annual Update, December 2021 (Link) 1
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