Transcript Title

Arkansas Payment Improvement Initiative (APII)
April
Statewide Webinar
April 17, 2013
0
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the
Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public
Information Coordinator – Initiative Update
▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider
Management – Patient Centered Medical Home Update
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager,
BH and ValueOptions Medical Director - Oppositional Defiant
Disorder

Paula Miller, HP Enterprises Analyst - PAP Report Update
Overview
Arkansas aims to create a sustainable patient-centered health system
Objective
Care
delivery
strategies
Enabling
initiatives
Focus of
presentation
Accountability for the Triple Aim
▪ Improving the health of the population
▪ Enhancing the patient experience of care
▪ Reducing or controlling the cost of care
Population-based care delivery
▪ Risk stratified, tailored care delivery
▪ Enhanced access
▪ Evidence-based, shared decision
making
▪ Team-based care coordination
▪ Performance transparency
Episode-based care delivery
▪ Common definition of the
patient journey
▪ Evidence-based, shared
decision making
▪ Team-based care coordination
▪ Performance transparency
Payment improvement initiative
Health care workforce development
Consumer engagement and personal responsibility
Health information technology adoption
SOURCE: State Innovation Plan
Payers recognize the value of working together to improve our system, with close involvement
from other stakeholders…
Coordinated multi-payer leadership…
▪ Creates consistent incentives and standardized reporting
rules and tools
▪ Enables change in practice patterns as program applies to
many patients
▪ Generates enough scale to justify investments in new
infrastructure and operational models
▪ Helps motivate patients to play a larger role in their health
and health care
1 Center for Medicare and Medicaid Services
PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE
Key Design Elements
We have worked closely with providers and patients across Arkansas to
shape an approach and set of initiatives to achieve this goal
▪
Providers, patients, family members, and other
stakeholders who helped shape the new model in public
workgroups
▪
Public workgroup meetings connected to 6-8 sites
across the state through videoconference
▪
Months of research, data analysis, expert interviews
and infrastructure development to design and launch
episode-based payments
▪
Updates with many Arkansas provider associations
(e.g., AHA, AMS, Arkansas Waiver Association,
Developmental Disabilities Provider Association)
1,000+
29
26
Monthly
4
PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE
Population & episode-based delivery systems roll-out: next 3-4 years
Timing
2Q 2012 –- 3Q 2012
1▪ 69 CPC enrolled practices, ~230 providers, 100k+ Arkansans1
3Q 2013 –- 3Q 2014
2▪ Target voluntary enrollment up to 30% of practices (including
“virtual practices,” 2), focusing initially on Pediatrics
3Q 2014 –- 3Q 2015
3▪ Target enrollment of remaining primary care practices
1H 2013 –- 1H 2014
1▪ All adult DD providers (children follow 6-12 months)
2H 2013 –- 2H 2014
2
3Q 2012 –- 4Q 2012
1▪ Multi-payer launch of first 5 episodes (ADHD, URI, CHF, Joint
replacement, Perinatal)
4Q 2012 –- 4Q 2013
2▪ Transition to scale while maintaining momentum: 1-2 sub-waves
of 5-10 episodes
4Q 2013 –- 2Q 2016
3▪ Accelerate scale up: quarterly launch of 5-10 episodes
2H 2013 –- 2H 2014
1 All adult DD and LTSS services (DD kids phase-in 6-12 months
behind adult)
Episode-based models
Approach
Population-based models
A
PCMH
Health
Homes
Episodes:
Retrospective riskbased
Episodes:
Assessment based
Wave (description)
1 CPC practice participation as of March, 2013
2 Virtual aggregation of patient panels to meet scale of 5,000 persons
Source: State Innovation Model Application
Voluntary enrollment for eligible BH providers
5
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the
Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public
Information Coordinator – Initiative Update
▪ Sheena Olson, Assistant Director, Medicaid Programs and
▪

Provider Management – Patient Centered Medical Home
Update
Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager,
BH and ValueOptions Medical Director - Oppositional Defiant
Disorder
Paula Miller, HP Enterprises Analyst - PAP Report Update
PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE
Episodes Update
For Medicaid, work has occurred on 15 Episodes, with 5 having gone live
Reporting Period
Start Date
Wave 1a
1
Upper Respiratory Infection
Spring 2012
July 2012
2
Attention Deficit Hyperactivity Disorder (ADHD)
Spring 2012
July 2012
3
Perinatal
Spring 2012
July 2012
Wave
1b
Seeking clinical input
Legislative
Review
4
Congestive Heart Failure
November 2012
December 2012
5
Total Joint Replacement (Hip & Knee)
November 2012
December 2012
6
Colonoscopy
May 2013
Q2 CY 2013
7
Cholecystectomy (Gallbladder Removal)
May 2013
Q2 CY 2013
8
Tonsillectomy
May 2013
Q2 CY 2013
9
Oppositional Defiance Disorder (ODD)
May 2013
Q2 CY 2013
10
Coronary Artery Bypass Grafting (CABG)
July 2013
Q3 CY 2013
11
Percutaneous Coronary Intervention (PCI)
12
Asthma
July 2013
Q3 CY 2013
13
Chronic Obstructive Pulmonary Disease (COPD)
14
ADHD/ODD Comorbidity
July 2013
Q3 CY 2013
15
Neonatal
Q3 CY 2013
H2 CY 2013
…
Undecided
Q1 2014
…
…
Undecided
Q1 2014
…
…
Undecided
Q1 2014
…
…
Undecided
Q1 2014
…
Wave 2b
Wave 2c
(not started)
Wave 2
Live
Episode
Wave 2a
Wave 1
In Development
1 Participation includes development and rollout of episode
Pending legislative
review
Multipayer
Participation1
7
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the
Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public
Information Coordinator – Initiative Update
▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider
Management – Patient Centered Medical Home Update
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager,
BH and ValueOptions Medical Director - Oppositional Defiant
Disorder

Paula Miller, HP Enterprises Analyst– PAP Report Update
PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE
PCMH town hall schedule
Date
Location
Address
April 16
4 – 6 pm
Little Rock
UAMS at I. Dodd Wilson Education Building -- Rooms 126 & 226
4301 W. Markham
Little Rock, AR 72205
April 18
4 – 6 pm
Mountain Home
Arkansas State University-Mountain Home – McMullin Hall
1600 South College Street
Mountain Home, AR 72653
April 22
4 – 6 pm
Fort Smith
Golden Living Building – Rogers Taylor Conference Room
1000 Fianna Way
Fort Smith, AR 72919
April 25
4 – 6 pm
El Dorado
South Arkansas Community College – Library Auditorium
300 S. West Avenue
El Dorado, AR 71730
May 7
4 – 6 pm
Hot Springs
National Park Community College – Auditorium
101 College Drive
Hot Springs, AR 71913
May 9
4 – 6 pm
Bentonville
Northwest Arkansas Community College – Wal-Mart Auditorium
1 College Drive
Bentonville, AR 72712
May 15
4 – 6 pm
Paragould
Arkansas Methodist Medical Center – Auditorium
900 West Kings Highway
Paragould, AR 72451
9
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the
Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public
Information Coordinator – Initiative Update
▪ Sheena Olson, Assistant Director, Medicaid Programs and
Provider Management – Patient Centered Medical Home
Update
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH
and ValueOptions Medical Director - Oppositional Defiant Disorder

Paula Miller, HP Enterprises Analyst - PAP Report Update
Guideline-concordant treatment pathway for clients diagnosed with ODD
PRELIMINARY
Assessment &
Diagnosis
Treatment
Outcomes
▪ Thorough
▪ Initial treatment plan1: 2 visits per
▪ Effectiveness of
week2
assessment is
performed
▪ Licensed clinician
confirms diagnosis
and is responsible
for care
▪
▪ Parent/caregiver
notification
▪
for 12 weeks (based on
evidence based programs)
– ~40% improve3
– Re-assess those that do not
improve
Second treatment plan1: 2 visits per
week2 for 12 weeks (based on
evidence based programs)
– ~30% improve3
– Re-assess those that do not
improve
Medication may be a useful adjunct
(primarily with comorbidities)
– For comorbid ADHD/ODD,
treatment should address ADHD
symptoms first
treatment
▪ Reasons
necessitating
second treatment
plan
▪ Continuing care
1 Evidence Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior; 2 Visits may include client or
parent/caregiver therapy; 3 Expert Interviews
SOURCE: Expert Interviews, Journal of Clinical Child and Adolescent Psychiatry and Clinical Guidelines for treatment of ODD, American
Academy of Child and Adolescent Psychiatry
Distribution of number of non-comorbid ODD clients
treated by individual providers
PRELIMINARY
Episodes ending in SFY 2010 – SFY 2011 (i.e., two years of data), Medicaid only
Provider count
Number of clients treated by individual providers (clients aged 6 – 17, no comorbid conditions)1
# clients
240
50
40
30
20
10
0
1-5
6-10
11-20
21-50
51-100
% of
Providers
54%
9%
12%
13%
7%
5%
% of
Episodes
0.8%
2.4%
6.1%
18.1%
26.5%
46.0%
1.2
1.6
2.0
2.3
2.6
2.5
Average
episodes
per client1
101+
Clients
treated
1 Episode defined as one 90 day program
SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services SFY2010-SFY2011 Claims data (includes pharmacy)
Concordant with evidence-based programs, the most frequent services
PRELIMINARY
provided are non-medical interventions
Episodes ending in SFY 2011 (i.e., one year data), Medicaid only (N = 10,477)
Cost breakdown by service type for ODD episodes (clients aged 6 – 17, no comorbid conditions)
Total cost, ($ millions)
$19 M
$1 M
$1 M
$2 M
$13 M
$2 M
Tota
l
Assessment
% total cost
5%
6%
11%
Nonmedication
3
interventions
68%
% episodes with
occurrence
69%
17%
78%
92%
1
Testing
2
Office
visits
Medicatio
n
9%
39%
1 Represents assessments billed to Medicaid. 58% of spend is from 90885 9 ZZZ, Psychiatric evaluation of hospital records; 42% of spend
from
90801 9 ZZZ Psychiatric diagnostic interview exam
2 90% of spend from uncoded claims (no CPT code); 5% of spend from 90801 9 AR1, Psychological testing; 4% of spend from 96101 9 ZZZ,
Psychological testing (includes psychodiagnostic tests of emotion); 1% other
3 Non-medication interventions includes all psychotherapy, counseling, community support, and therapeutic activities
SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services; Arkansas Department of Human Services (DHS),
Division of Medical Services SFY2011 Claims data (includes pharmacy)
Behavioral Health Providers provide the vast majority of ODD care in
Arkansas
PRELIMINARY
Episodes ending in SFY 2011 (i.e., one year data), Medicaid only (N = 10,477)
Cost breakdown by provider for ODD episodes (clients aged 6 – 17, no comorbid conditions)
Total cost, ($ millions)
$19M
$0.4M
$18.5M
$0.1M
Total
Episode count
% total episodes
Average cost / episode
Other1
Physician
(PCP or
Psychiatrist)
190
Behavioral health
provider
organization
10,225
1.8%
98%
0.5%
$1,311
$1,782
$731
62
1 Other includes FQHC providers, non-behavioral health provider school-based providers, and non-standard providers of care
SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services SFY2011 Claims data (includes pharmacy)
A third of clients (32%) are receiving care above and beyond what
is recommended in guidelines and evidence-based treatments
PRELIMINARY
Episodes ending in SFY 2010 – SFY 2011 (i.e., two years of data), Medicaid only
Episode count
Episode cost distribution for episodes (clients aged 6 – 17, no comorbid conditions)
Average cost / episode ($)
2,000
These clients represent
63% of spend
1,500
Estimated cost of effective
evidence based programs1
1,000
500
0
0
1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 11,000 12,000 13,000 14,000
Mor
e
Average cost / episode
Dollars
1 Evidence Based programs suggest 1-2 treatments per week for 12-14 weeks = ~30 treatments; Medicaid data shows median cost/treatment
= $72; 30 treatments x $72/treatment = $2160 per episode.
SOURCE: Evidence Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior; Journal of Clinical Child and
Adolescent Psychology and Clinical Guidelines for treatment of ODD, American Academy of Child and Adolescent Psychiatry;
Arkansas Department of Human Services (DHS), Division of Medical Services; Arkansas Department of Human Services (DHS),
Division of Medical Services SFY2010-SFY2011 Claims data (includes pharmacy)
Contents
▪ Dr. Bill Golden, DMS Medical Director - Overview of the
Healthcare Payment Improvement Initiative
▪ Shelley Tounzen, Medicaid Health Innovation Unit Public
Information Coordinator – Initiative Update
▪ Sheena Olson, Assistant Director, Medicaid Programs and
Provider Management – Patient Centered Medical Home
Update
▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH
and ValueOptions Medical Director - Oppositional Defiant Disorder

Paula Miller, HP Enterprises Analyst - PAP Report Update
Medicaid
Little Rock Clinic
123456789
April 2013
Arkansas Health Care Payment Improvement Initiative
Provider Report
Medicaid
Report date: April 2013
Historical performance: April 1, 2012 – March 31, 2013
DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program.
The data in the reports is neither intended nor suitable for other uses, including the selection of a health care provider. For more
information, please visit www.paymentinitiative.org
Division of Medical Services
P.O. Box 1437, Slot S-415 · Little Rock, AR 72203-1437
501-683-4120 · Fax: 501-683-4124
Dear Medicaid provider,
This is an update on the Arkansas Health Care Payment Improvement Initiative – a payment system developed with input from hundreds of health care providers,
patients and family members. Our goal is to support and reward providers who consistently deliver high-quality, coordinated, and cost-effective care.
As a reminder, a core component of this multi-payer initiative is episodes of care. An episode is the collection of care provided to treat a particular condition over
a given length of time. Since July, Arkansas Medicaid introduced five episodes: Upper Respiratory Infection (URI), Perinatal, Attention Deficit/Hyperactivity
Disorder (ADHD), Total Joint Replacement (TJR), and Congestive Heart Failure (CHF), with many more episodes to be added over time.
For each episode, the provider that holds the main responsibility for ensuring that care is delivered at appropriate cost and quality will be designated as the
Principal Accountable Provider (PAPs). For some episodes in the period covered in the attached report (Jul 2011 to Jun 2012), you were identified as the PAP.
After appropriate risk-adjustments and exclusions, your average quality and cost was compared with previously announced thresholds. This determines any
potential sharing of savings or excess cost indicated in the report. Note that all information described throughout your report is based on retrospective claims and
all providers should continue to submit and receive reimbursement for claims as they do today.
The TJR and CHF episodes are currently in the preparatory phase and this current report is historical only, covering episodes completed between Jul 2011 and
Jun 2012. The ‘performance period’ for these episodes will start February 1, 2013, and reports reflecting episodes eligible for risk and gain sharing will follow
beginning in July 2013, due to time needed for appropriate claims to be received.
To aid you in your role as a PAP for future episodes, we have been working hard with providers and other payers to design a set of reports that give you detailed
data about the quality and cost of your care as well as how this compares with the range of performance of other providers. As each payer will send a report
covering their patients, you may receive similar reports from Arkansas Blue Cross Blue Shield or QualChoice.
We encourage you to log onto the provider portal at www.paymentinitiative.org to access your current and previous ‘preparatory period’ reports. As a PAP for
either the CHF or TJR episodes, you should begin using this portal to enter selected quality metrics for each patient with an episode of care starting after
February 1, 2013.
We have been working diligently to solicit feedback from the provider community and will continue in our efforts to respond to all questions, comments and
concerns raised in a timely and consistent manner. For answers to frequently asked questions regarding the initiative and episodes, please refer to the payment
initiative website (www.paymentinitiaitve.org). You can also call us at 1-866-322-4696 or locally at 501-301-8311 with questions or email [email protected].
Additionally, be sure to check the website regularly for updates on upcoming informational WebEx sessions, other resources, or to sign up for alerts.
Sincerely,
Andy Allison, PhD
Medicaid Director
DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program. The data in the reports is
neither intended nor suitable for other uses, including the selection of a health care provider. For more information, please visit www.paymentinitiative.org
Medicaid
Little Rock Clinic
123456789
Table of contents
Performance summary
Attention Deficit/Hyperactivity Disorder (ADHD) – Level I
Attention Deficit/Hyperactivity Disorder (ADHD) – Level II
Cholecystectomy
Colonoscopy
Congestive Heart Failure
Oppositional Defiant Disorder
Perinatal
Tonsillectomy
Total Joint Replacement
Upper Respiratory Infection – Non-specific URI
Upper Respiratory Infection – Pharyngitis
Upper Respiratory Infection – Sinusitis
Glossary
Appendix: Episode level detail
April 2013
Medicaid
Little Rock Clinic
123456789
April 2013
Performance summary
1
Quality of services and cost summary
Quality
of Service
Average
Episode Cost
Your Gain/Risk Share
Share
Amount
Attention Deficit / Hyperactivity Disorder
(ADHD) – Level I
Met
Acceptable
Not eligible for gain sharing
$0.00
Attention Deficit / Hyperactivity Disorder
(ADHD) – Level II
Met
Acceptable
Not eligible for gain sharing
$0.00
Cholecystectomy
Met
Acceptable
Not eligible for gain sharing
$0.00
Colonoscopy
Met
Acceptable
Not eligible for gain sharing
$0.00
Congestive Heart Failure
Not met
Acceptable
Not eligible for gain sharing
$0.00
Oppositional Defiant Disorder
Met
Acceptable
Not eligible for gain sharing
$0.00
Perinatal
Met
Acceptable
Not eligible for gain sharing
$0.00
Tonsillectomy
Met
Acceptable
Not eligible for gain sharing
$0.00
Total Joint Replacement
N/A
Acceptable
Not eligible for gain sharing
$0.00
N/A
Not acceptable
Subject to risk sharing
-$3,844.50
Not met
Acceptable
Not eligible for gain sharing
$0.00
N/A
Commendable
Will receive gain sharing
$349.50
Episode of Care
Upper Respiratory Infection – Nonspecific URI
Upper Respiratory Infection –
Pharyngitis
Upper Respiratory Infection – Sinusitis
Across these Episodes of Care You are Subject to Risk Sharing:
Stop-loss was applied
-$3,000.00
Medicaid
Little Rock Clinic
123456789
April 2013
Summary – ADHD: Level I closed episodes
1
Overview
Total episodes: 262
2
Total episodes included: 233
Cost of care compared to other providers
Commendable
Acceptable
< $1,547
3
Total episodes excluded: 29
Gain/Risk share
Not acceptable
$1,547 to $2,223
Quality summary
50%
Standard
for gain
sharing
Completed certification
100%
Cost summary
Your total cost overview, $
512,000
466,000
% episodes with medication
100%
You (nonadjusted)
50%
Average cost overview, $
2,000
1,750
You
(adjusted)
You
Avg
% Level I episodes
100%
100
50
<$700
50%
0%
$700$1547
$1547$1772
$1772$1998
$1998-$2223
$2223$10157
Cost,
$
7500
10
5000
2500
0
You
You
Avg
Commendable
Acceptable
Percentile
Not acceptable
Key utilization metrics
Average number of visits per episode
4.1
3.9
>$10157
Distribution of provider average episode cost
You
Avg
Avg. physician visits/episode
20
5
All providers
Your episode cost distribution
# episodes
You
Avg
You are not eligible for gain sharing
 Selected quality metrics: Met
 Average episode cost: Acceptable
Your average cost is acceptable
0%
0%
You
All providers
4
You achieved selected quality metrics
Linked to gain sharing
$0
You
>>$2,223
$4000
Average number of psychosocial visits per episode
62
38
You
All providers
Medicaid
Little Rock Clinic
123456789
Quality and utilization detail – ADHD: Level I closed
You
1
Metric linked to gain sharing
April 2013
Minimum standard for gain sharing
Quality metrics: Performance compared to provider distribution
Metric
You
25th
Percentile
50th
75th
% with completed certification
92%
50%
75%
85%
% of episodes with medication
48%
40%
52%
67%
% of episodes that are Level I
25%
20%
30%
40%
4.1
2.3
3.9
4.3
% non-guideline concordant
28%
10%
30%
50%
% non-guideline no rationale
15%
5%
15%
25%
Avg. physician visits per episode
0
25
Percentile
50
75
100
-
-
You achieved selected quality metrics
2
Utilization metrics: Performance compared to provider distribution
Metric
You
25th
Percentile
50th
75th
Average number of visits per episode
4.1
2.3
3.9
4.3
Average number of psychosocial visits per
episode
62
15
38
74
0
25
Percentile
50
75
100
Medicaid
Little Rock Clinic
123456789
April 2013
Cost detail – ADHD: Level I closed
Total episode included = 233
Care category
Inpatient – PAP
Outpatient – PAP
# and % of episodes with claims
in care category
233
100%
100%
230
99%
99%
Ancillary
professional
221
Inpatient
readmission or
transfer
184
Primary inpatient
admission
Outpatient
facility
Pharmacy
Emergency
department
Other
You
95%
97%
Average cost per episode
when care category
utilized, $
All providers
Total vs. expected cost
in care category, $
550
500
128,150
116,500
2,415
2,400
555,450
552,000
76
76
16,796
16,796
79%
77%
81
81
14,904
14,904
21
75%
80%
117
95
2,457
1,995
16
78%
75%
70
75
1,120
1,200
12
5%
3%
69
62
828
744
1
<1%
<1%
97
84
97
84
7
3%
4%
25
27
175
189
Medicaid
Little Rock Clinic
123456789
April 2013
Summary – ADHD: Level II closed episodes
1
Overview
Total episodes: 262
2
Total episodes included: 233
Cost of care compared to other providers
Commendable
Acceptable
< $5,403
3
Total episodes excluded: 29
Gain/Risk share
Not acceptable
$5,403 to $7,112
Quality summary
50%
Standard
for gain
sharing
Completed certification
100%
Cost summary
Your total cost overview, $
512,000
466,000
% episodes with medication
100%
You (nonadjusted)
50%
Average cost overview, $
2,000
1,750
You
(adjusted)
You
Avg
100
50
<$2223
50%
0%
$2223$5403
$5403$5973
$5973$6543
$6543$7112
$7112$12601
Cost,
$
7500
10
5000
2500
0
You
You
Avg
Commendable
Acceptable
Percentile
Not acceptable
Key utilization metrics
Average number of visits per episode
4.1
3.9
>$12601
Distribution of provider average episode cost
You
Avg
Avg. physician visits/episode
20
5
All providers
Your episode cost distribution
# episodes
You
% Level II episodes
100%
Avg
You are not eligible for gain sharing
 Selected quality metrics: Met
 Average episode cost: Acceptable
Your average cost is acceptable
0%
0%
You
All providers
4
You achieved selected quality metrics
Linked to gain sharing
$0
You
>>$7,112
$4000
Average number of psychosocial visits per episode
62
38
You
All providers
Medicaid
Little Rock Clinic
123456789
April 2013
Summary – Perinatal
1
Overview
Total episodes: 262
2
Total episodes included: 233
Cost of care compared to other providers
Commendable
Acceptable
< $3,394
3
Gain/Risk share
Not acceptable
$3,394 to $3,906
Quality summary
Your average cost is acceptable
Your total cost overview, $
850,000
815,500
50%
You (nonadjusted)
0%
You
Avg
Group B Strep screening
100%
0%
You
<$2000
50%
0%
Avg
You
All providers
$2000$3394
$3394–
$3565
$3565–
$3735
$3735$3906
$3906$5399
12000
50%
8000
4000
0%
You
You
Avg
Commendable
Acceptable
Percentile
Not acceptable
Key utilization metrics
C-section rate
17%
Avg. number of ED visits per episode
30%
>$5399
Distribution of provider average episode cost
You
Avg
Hepatitis B screening
100%
Standard
for gain
sharing
50%
You
(adjusted)
100
50
Cost,
$
You
Avg
Chlamydia screening
100%
Average cost overview, $
3500
3400
Your episode cost distribution
You
Avg
Bacteriuria screening
100%
Standard
for gain
sharing
0%
You are not eligible for gain sharing
 Selected quality metrics: Met
 Average episode cost: Acceptable
Cost summary
# episodes
0%
50%
All providers
4
Standard
for gain
sharing
50%
$0
You
>>$3,906
$4000
You achieved selected quality metrics
Linked to gain sharing
HIV screening
Gestational DM screening
100%
100%
5
Total episodes excluded: 29
1.3
2.1
You
All providers
Medicaid
Little Rock Clinic
123456789
April 2013
Quality and utilization detail – Perinatal
You
1
Metric linked to gain sharing
Minimum standard for gain sharing
Quality metrics: Performance compared to provider distribution
Metric
You
25th
Percentile
50th
75th
HIV screening rate
97%
50%
66%
99%
Group B strep screening rate
87%
60%
83%
93%
Chlamydia screening rate
90%
63%
84%
87%
Gestational diabetes screening rate
56%
42%
50%
65%
Asymptomatic bacteriuria screening rate
90%
43%
62%
73%
Hepatitis B screening rate
58%
41%
55%
69%
0
25
Percentile
50
75
100
25
Percentile
50
75
100
-
You achieved selected quality metrics
2
Utilization metrics: Performance compared to provider distribution
Metric
You
25th
Percentile
50th
75th
C-section rate
17%
23%
30%
40%
% episodes with an ultrasound
78%
71%
75%
81%
Avg number of ED visits per episode
1.3
1.7
2.1
5.1
0
Questions
For more information talk with provider support representatives…
▪ More information on the Payment Improvement Initiative
Online
can be found at www.paymentinitiative.org
– Further detail on the initiative, PAP and portal
– Printable flyers for bulletin boards, staff offices, etc.
– Specific details on all episodes
– Contact information for each payer’s support staff
– All previous workgroup materials
Phone/ email
▪ Medicaid: 1-866-322-4696 (in-state) or 1-501-301-8311 (local
and out-of state) or [email protected]
▪ Blue Cross Blue Shield: Providers 1-800-827- 4814, direct to EBI 1-888-800-3283,
[email protected]
▪ QualChoice: 1-501-228-7111, [email protected]