payment reform tracking

Scorecard on Payment Reform 2.0

Introducing Scorecard 2.0

With the support of the Laura and John Arnold Foundation and the Robert Wood Johnson Foundation, CPR went on a mission to answer the question:  Are new payment reform models having their desired impact on health care costs and outcomes?

Curious to hear more? Watch the recording from the free Virtual Summit: Scorecard on Payment Reform 2.0- Results from Colorado, New Jersey, and Virginia Pilots.

The goal of Scorecard 2.0 is to help purchasers and other stakeholders in both the private and public sector track the nation’s progress on payment reform, as well as identify any high-level indicators of its impact on the cost and quality of health care. Scorecard 2.0 will track:

  • How much and what types of payment reforms were occurring in 2016, and
  • Whether these payment reforms are having their intended impact on the quality, efficiency, and cost of health care for both the commercial and Medicaid sectors.

Advisory Committee

CPR thanks the group of experts on our 2.0 Advisory Committee, whom have provided their expertise throughout the development of the new metrics, along with Discern Health for its significant contribution to this project.

Michael Belman, Anthem
Robert Berenson, The Urban Institute
John Bertko, Covered California
Mollyann Brodie, Kaiser Family Foundation
David Cowling, CalPERS
Pam Curtis, Oregon Health Sciences University
Andrea Ducas, The Robert Wood Johnson Foundation
Steven Farmer, Centers for Medicare & Medicaid Services
Debbie Freund, Claremont Graduate University
Scott Hewitt, UnitedHealthcare
Heather Howard, Princeton University
Frederick Isasi, Families USA
Doris Peter, Consumers Union
Kelli Rhee, The Laura and John Arnold Foundation
Jim Rickards, Oregon Health Authority
Jeff Rideout, Integrated Healthcare Association
Meredith Rosenthal, Harvard University
Scott Sarran, Healthcare Services Corporation
Lisa Woods, Wal-Mart Stores, Inc.

*CPR selected the final list of measures. 

Piloting Scorecard 2.0 at the State Level

CPR is piloting Scorecard 2.0 in three different states: Colorado, New Jersey, and Virginia. The states were selected via a Request for Proposals (RFP) process where organizations self-identified to sponsor Scorecard 2.0 at the state level in order to understand payment reform progress in their state’s unique context. CPR is thrilled to partner with three highly regarded organizations to carry out the pilots. Those organizations are:

The Center for Improving Value in Health Care (Colorado)

The New Jersey Health Care Quality Institute

The Virginia Center for Health Innovation & The Virginia Association of Health Plans

To learn more about the pilots, check out the related blogs and podcasts here.

Have questions? Review the Frequently Asked Questions or contact CPR’s Program Director, Andréa Caballero at [email protected]

What’s new to 2.0?

Here are the metrics that CPR added to our original Scorecard on Payment Reform. These metrics were selected as the leading indicators of payment reform’s impact on the quality and affordability of payment reform at a macro-level.

Health Plan Metrics- System Transformation Domain, developed by Catalyst for Payment Reform in 2017 for Scorecard on Payment Reform 2.0
METRIC NUMERATOR DENOMINATOR
Transparency Metrics:  The number of health plans that offered price, quality, and/or treatment decision information within their online member support tools in CY 2017 or most recent 12 months. Only applicable to commercial Scorecard. Total number of health plans that offered each of the following in CY 2017 or most recent 12 months:  member support tool with customized price information; member support tool with customized quality information; member support tool featuring treatment option decision support. One numerator for each. Total number of health plans that provided member support tools in CY 2017 or most recent 12 months and that responded to commercial survey in New Jersey.
Shared Risk Contracts: Number of shared risk contracts paired with total dollars flowing through shared risk with quality programs. Number of shared risk with quality contracts that health plans had in effect in CY2017 or most recent 12 months in New Jersey paired with the total dollars paid to providers through shared risk programs with quality in CY 2017 or most recent 12 months.

 

Limited Networks: Percent or number of plans that offered a limited network product, and the percent of members who enrolled in those products. For the purposes of this survey, limited network is defined as a product, within a health plan’s portfolio of offerings, that contains a network of providers with fewer providers (hospitals, specialists and/or PCPs) than the health plan’s broadest network. Only applicable to commercial Scorecard.

 

Plans that respond Yes, they offered at least one limited network product in New Jersey in CY 2017 or most recent 12 months. Total number of plans that responded to commercial survey in New Jersey.
Number of members enrolled in those products. Total commercial members in the participating health plans that offered limited network products.
Total commercial health plan members represented in data overall.

 

Other Metrics- included in both System Transformation & Outcomes domain, sourced from various sources for Scorecard on Payment Reform 2.0

All-Cause Readmissions (State-level risk adjusted readmission rate derived from the Plan All-Cause Readmissions: Observed-to-Expected Ratio) [NQF 1768]The state-level risk adjusted readmission rate, derived from the Observed-to-Expected Ratio of hospital admissions that are readmissions for any diagnosis within 30 days of discharge for commercially-insured (combined results of HMO & PPO plans) members 18- 64 years of age, captures the percent of hospitalizations that are followed by another hospitalization within 30 days based on New Jersey’s case mix. Depending on reporting period, this metric may not applicable to Medicaid. NCQA, 2017 HEDISâ

Cesarean Sections (Perinatal Care- Cesarean Birth) (NQF 0471): percent of nulliparous women [women who have not borne offspring] with a term [37 completed weeks or more], singleton baby [one fetus] in a vertex [head first] position [NTSV] who deliver via cesarean section. A lower rate indicates better performance with the Leapfrog Group’s target rate being 23.9% or lower. The Leapfrog Group, Leapfrog Hospital Survey results. For more information, see: http://www.leapfroggroup.org/sites/default/files/Files/leapfrog_castlight_maternity_care_FINAL.pdf

Childhood Immunizations: Children ages 19-35 months who received all recommended doses of seven vaccines: 4 doses of diphtheria, tetanus, and accellular pertussis (DTaP/DT/DTP) vaccine; at least 3 doses of poliovirus vaccine; at least 1 dose of measles-containing vaccine (including mumps-rubella (MMR) vaccine); the full series of Haemophilus influenza type b (Hib) vaccine (3 or 4 doses depending on product type); at least 3 doses of hepatitis B vaccine (HepB); at least 1 dose of varicella vaccine, and at least 4 doses of pneumococcal conjugate vaccine (PCV). A metric from the National Immunization Surveys (NIS). Radley et al. analysis of data from the 2016 NIS-PUF (CDC, NCIRD). A higher rate indicates better performance with the United States average being 71% in 2016 and performance ranging from 58%-85% across all states. Published in Commonwealth Fund Scorecard on State Health Performance, May 2018. Available at https://interactives.commonwealthfund.org/2018/state-scorecard/

Controlling High Blood Pressure (NQF 18): The percentage of commercially-insured (combined results of HMO & PPO plans) patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) for members 18-59 years of age and whose BP was <140/90 mm Hg for members 60-85 years of age with a diagnosis of diabetes or whose BP was <150/90 mm Hg for members 60-85 years of age without a diagnosis of diabetes. A higher rate indicates better performance with the United States average being 52.4% across HMO plans and 54.5% across PPO plans in 2016. NCQA, 2017 HEDISâ

HbA1c Poor Control (Diabetes – Hemoglobin A1c Poor Control) (NQF 59): Percent of commercially-insured (combined results of HMO & PPO plans) members 18-75 years of age with diabetes (type 1 and type 2) whose most recent HbA1c level during the measurement year was greater than 9.0% (poor control) or was missing a result, or if an HbA1c test was not done during the measurement year. A lower rate indicates better performance with the United States average being 33% across HMOs plans and 42.5% across PPO plans in 2016. NCQA, 2017 HEDISâ

HbA1c Testing (Comprehensive Diabetes Care- HbA1c Testing) (NQF 057): Percent of commercially-insured (combined results of HMO & PPO plans) members 18 to 75 years of age with diabetes (type 1 and type 2) who had a hemoglobin A1c (HbA1c) test performed during the measurement year. A higher rate indicates better performance with the United States average being 90.6% across HMO plans and 89.3% across PPO plans in 2016. NCQA, 2017 HEDISâ

Health-Related Quality of Life: Adults ages 18-64 who report fair/poor health. Radley et al. analysis of data from the 2016 Behavioral Risk Factor Surveillance System -BRFSS (CDC, NCCDPHP). A lower rate indicates better performance with the United States average being 16% in 2016 and performance ranging from 10%-24% across all states. Published in Commonwealth Fund Scorecard on State Health Performance, May 2018. Available at https://interactives.commonwealthfund.org/2018/state-scorecard

Home Recovery Instructions (Information About Recovery at Home): Proportion of adult patients who responded to the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) post-hospitalization that yes, they were given information about what to do during their recovery at home.  Radley et al. analysis of 2013 and 2016 HCAHPS as administered to adults discharged from acute care hospitals; data retrieved from 4th Quarter 2017 and 4th Quarter 2014 Hospital Compare (CMS). A higher rate indicates better performance with the United States average being 87% in 2016 and performance ranging from 82%-91% across all states. Published in Commonwealth Fund Scorecard on State Health Performance, May 2018. Available at https://interactives.commonwealthfund.org/2018/state-scorecard/

Hospital-Acquired Pressure Ulcers (Hospital-Acquired Stage III & IV Pressure Ulcers): Rate of hospital-acquired stage III & IV pressure ulcers per 1,000 adult, inpatient discharges. A lower rate indicates better performance with the Leapfrog Group’s standard being 0 per 1,000 inpatient discharges. The Leapfrog Group, Leapfrog Hospital Survey. For more information, see: www.leapfroggroup.org/sites/default/files/Files/Castlight-Hospital-Acquired_Conditions_Report%202017_round4%5B3%5D.pdf

Preventable Admissions (Prevention Quality Overall Composite, Prevention Quality Indicator (PQI) 90): PQI overall composite per 100,000 population, ages 18 years and older. Includes admissions for one of the following conditions: diabetes with short-term complications, diabetes with long-term complications, uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic obstructive pulmonary disease, asthma, hypertension, heart failure, dehydration, bacterial pneumonia, or urinary tract infection. A lower rate indicates better performance, with the national rate being 1,457.5 in 2012, as cited by the New Jersey Department of Health- Office of Health Care Quality Assessment December 2016. Available at https://www.nj.gov/health/healthcarequality/documents/qi/pqi2014.pdf. Accessed August 2018.

Unmet Care Due To Cost: Percent of adults age 18 and older who reported a time in the past 12 months when they needed to see a doctor but could not because of cost. Radley et al. analysis of 2016 BRFSS [CDC, NCCDPHP]. Published in Commonwealth Fund Scorecard on State Health Performance, May 2018. A lower rate indicates better performance with the United States average being 13% in 2016 and performance ranging from 7%-19% across all states. Available at interactives.commonwealthfund.org/2018/state-scorecard/

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