Pt 2: Updates to Quality Measures FFY 2019 Reporting

Pt 2: Updates to Quality Measures FFY 2019 Reporting


My name is Kristie Liao and I’m an analyst at
Mathematica. We’ll walk through updates to the
three core sets for FFY 2019 in these slides. First, for FFY 2019, no measures were added to
the 2019 Child, Adult, or Health Home core sets. In addition, no measures were retired from the
2019 Child and Health Home core sets. One measure on the Adult core set, Antenatal
Steroids (PC03-AD) was retired for FFY 2019. We’d also like to highlight changes to existing
measures on the three core sets. The changes reflect updates by the measure
stewards to measure specification. On the adult
core set, the FUA/FUM-AD measure, Follow-Up After Emergency Department Visit for
Mental Illness or Alcohol and Other Drug Abuse
or Dependence, was separated into two measures for 2019. These two separate
measures are Follow-Up After Emergency
Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA-AD) and Follow-Up
After Emergency Department Visit for Mental
Illness (FUM-AD). Additionally, on the Health Home core set, the
Nursing Facility Utilization measure has been
renamed to Admission to an Institution from the Community to reflect measure specification
changes. We’d now like to highlight and describe
measures with significant updates across the
three core sets. These changes again reflect updates by measure stewards. Please note, we
held two technical assistance webinars in May
that reviewed these updates in detail, and more information including links to the webinars,
resource manuals, and summary of updates are
available in Appendix A of the slides which will be shared after the webinar. And for those
familiar with the Child and Adult core set
webpages on the Medicaid.gov site, you may notice that the pages have been updated. On
the webpage, you can navigate to these
reporting resources through the State Reporting Resources and Technical Assistance link. And
turning now to the updates, the first update is for
the Screening for Depression and Follow-Up Plan measure on the Child, Adult, and Health
Home core sets. The administrative method was
added as a method for reporting so the measure may be calculated using administrative data
only. Validation via the medical record is not
required to calculate and report this measure. In addition, in the guidance for reporting, the
measure exclusions and exceptions were
clarified. Next, for the measure Controlling High Blood
Pressure on the Adult and Health Home core
sets, the administrative method was added as a method of reporting in addition to the hybrid
method. Further, the different thresholds by age
and diagnosis were removed for the numerator calculation. Next, for the Follow-Up After
Hospitalization for Mental Illness measure, age
ranges were updated for the Child and Adult core set measures. The FUH-CH measure age
range was updated from beneficiaries ages 6 to
20 to beneficiaries ages 6 to 17, and the FUH-AD measure age range was updated from
beneficiaries age 21 and older to beneficiaries
age 18 and older. For the HIV Viral Load Suppression measure on
the Adult core set, eMeasure specifications
were added and are available at the link in the resource manual. Several updates were also
made for the Use of Opioids at High Dosage in
Persons Without Cancer measure on the Adult core set. The measure is now expressed as a
percentage, while in previous years it was
reported as a rate per 1,000 beneficiaries. In addition, the numerator was changed to
reflect beneficiaries in the eligible population
with an average daily dosage greater than or equal to 90 Morphine Milligram Equivalents over
a period of 90 days or more, where previously it
reflected beneficiaries with a daily dosage of 120 Morphine Milligram Equivalents for 90
consecutive days or longer. Next, for the Plan All-Cause Readmissions
measure on the Adult and Health Home core
sets, several changes were made. States report the Count of Expected 30-Day
Readmissions rather than the Expected
Readmission Rate. The Expected Readmission Rate is calculated
by MACPro based on data elements states
report. We also recently developed a fact sheet on the
Plan All-Cause Readmissions measure, and
we’ll send a communication soon on where to access this fact sheet on Medicaid.gov. Finally,
as we noted earlier for the 2019 Health Home
core set, the Nursing Facility Utilization measure was renamed to Admission to an
Institution from the Community. This measure
had a number of other changes for FFY 2019 Health Home Core Set reporting. Three rates –
short, medium, and long term admissions – are
now reported instead of two rates. In addition, rates are reported for four age groups
instead of two age groups. These age groups
are ages 18-64, ages 65-74, ages 75-84, and age 85 and older. In addition, the definition of
institutional facility now includes Medicaid
certified intermediate care facilities for individuals with intellectual disabilities in addition
to nursing facilities. Last, the definition of the
numerator was revised and now only reflects those enrollee months during which the enrollee
resided in the community for at least one day. For FFY 2019 reporting, we’d also like to note
that exclusions for frailty and advanced illness were added to the following measures on the
Adult and Health Home core sets: Breast Cancer Screening, the two measures of
Comprehensive Diabetes Care (Hemoglobin A1c
Poor Control Greater Than 9 percent and Hemoglobin A1c Testing), and the Controlling
High Blood Pressure measure. Please note these exclusions were noted as
optional in an earlier version of the FFY 2019
Resource Manual and Technical Specifications but they should be treated as required
exclusions. The Adult and Health Home manual
posted on Medicaid.gov have been updated to reflect this, and the date on the manuals is
August 2019. These are available in Appendix A
of the slides. Now, I will pass it over to Emily to walk through
the data quality. My name is Emily Hoe. I also work at
Mathematica, and I’m going to continue our
discussion on the Adult, Child, and Health Home core set measures. So first, we would like to
provide a recap of the state data quality
outreach process for FFY 2018. As many of you know, we conducted systematic
data quality outreach using the Seek More
Information, or SMI, function in MACPro. We would like to thank all the states that
responded to our questions or provided
important clarification and feedback. There are many reasons that we reach out to
states during the data quality review process. On this slide, you’ll see some of the more
common topics raised in state outreach for
2018. For example, we typically ask states to clarify
their data if we see something that looks like a
potential data entry or calculation error. We may also ask for additional clarification
about data entered into key data fields or notes
that may be unexpected. We also often request more information about
delivery systems or populations included in
specific measures. Finally, we typically ask a question if we notice
large changes in the state’s rates or
denominator from what the state reported the previous year, or if the state uses a different
methodology to report the measures. Please note, if you receive any questions from
us during the SMI process, it does not mean
that your state did anything wrong. We typically ask clarifying questions to every
state about some aspect of their core set
reporting. The SMI process helps us to gain a more comprehensive understanding of the
nuances in each states data. This process can
also help to increase the number of measures reported, as some states are able to report more
measures with additional time or technical
assistance. Once again, we’d like to thank all states for the timely and informative feedback
that they provide during this process. For FFY 2019, CMCS will have a similar focus
on data quality. This slide contains some of the
high-level things we look for, but if you would like any more detail about these issues please
refer to the appendix at the end of the slide
deck. You should be able to refer to this once the slides are sent out after the training. Here
are some ways we can address the most
common data quality issues in MACPro. As you enter data into MACPro, you may notice
that the system contains built in data quality checks to help ensure the data are complete
and accurate. States can refer to the Data Quality Checklist,
which is linked in the appendix of this
presentation, to see the list of checks that are implemented in MACPro. These error flags
will often show up in red when you try to save a
message or when you try to validate the measure. They may not appear right away, but if
you notice you are having trouble saving or
validating a measure, you may need to scroll up to look for these flags, and they’ll often show up
as a red box around the data entered. Reviewing the flags during data entry will help
improve the quality of data, and also help
facilitate the process of certifying the report in MACPro. As in previous years, CMCS plans to
conduct outreach using the SMI function in
MACPro. On this slide, we listed some of the areas CMCS will be focusing on during the data
quality process for this year. These include
looking for consistency of reporting on measures calculated using the hybrid method, meaning
ensuring there is complete information on the
sample size, denominator, and measure eligible population. We will also focus on calculation
and reporting of state level rates when data are
combined from multiple reporting units, such as health plans or programs. We will look for
documentation of populations excluded from the
data, for example if certain state delivery systems, programs, special populations, or
certain health care settings are excluded. The
more information you can provide when reporting, the more helpful that will be when we
review the data. We look for documentation of any deviations
from core set specifications, including use of
different age groups, data sources or methods, knowing whether measures were audited or
validated, and finally, ensuring alignment
between Core sets when measures are reported for multiple core sets. Next, we’re going to review some of the
technical assistance resources developed for
FFY 2019 Child and Adult core set reporting, and the slide after this will talk about Health
Home core set reporting. The first resources are the Measure Lists. These
list all the measures included in the specified
core set, as well as their NQF number if applicable, measure steward, full measure
name, data collection method, and contextual
notes. Next, the Resource Manual and Technical
Specifications begin with an introduction to the
core set and general guidance on some crosscutting topics related to data collection
and reporting. The remainder of this document
includes step-by-step measure specifications for each of the measures included in that core set,
as well as some specific guidance for each
measure. The next document is the Summary of Updates
to the Resource Manual and Technical
Specifications, which includes a summary of all changes to the specifications, including any new
guidance to reporting that was added. The next document is the Data Quality
Checklist which includes data checks aimed to
improve the accuracy, consistency, and documentation of the data reported in MACPro.
This checklist contains guidance on how to
complete some of the crosscutting fields in MACPro, as well as measure specific quality
checks. As we discussed previously, many of
these validation checks have been built into MACPro, so this document would be really
helpful to keep handy when you’re entering the
data. Next, the Measurement Period Table outlines
the appropriate measurement periods for each
measure specification. CMCS encourages states to enter the denominator start and end
date according to this document, as long as the
state follows the core set measure specification. Additionally, there are a few technical
assistance briefs that may be helpful. First, the
hybrid method brief provides an overview of the hybrid method and gives considerations for
using this method. Second, the state-level rates
brief is helpful for states that combine data from multiple programs or managed care
organizations. This brief also includes
information on how to combine data when programs use different methodologies for
collecting data– for example, one uses admin
and another uses hybrid. And as Kristie mentioned previously, we also
recently developed a fact sheet on the Plan All-
Cause Readmissions measure. We will send a communication soon on where you can access
this fact sheet on Medicaid.gov. Several core set measures also have sample
SAS code that has been developed. The SAS code can be obtained by emailing the Technical
Assistance mailbox. Finally, there are a couple of technical
assistance webinars that states may find helpful
in reporting the core set measures. First, the FFY 2019 Updates and Reporting
Resources Webinar discusses the major
updates to the FFY 2019 core set. Second, the Collecting and Using Stratified Data
for Quality Improvement in Medicaid and CHIP
Webinar provides information on how to collect and use stratified core set data for quality
improvement, highlights states experiences,
discusses how to report stratified data in MACPro, and presents technical assistance
resources. Hyperlinks to these resources are
included in Appendix A. Next, we are going to review some of the
technical assistance resources developed for
FFY 2019 Health Home core set reporting. As you’ll see, the Health Home core set also
has a 2019 Measure List, Resource Manual and
Technical Specifications, Summary of Updates document, Data Quality Checklist, and
Measurement Period Table. These resources
are very similar to those we discussed in the previous slide, so I won’t discuss them in detail
here. There are, however, a couple of resources
that are unique to the Health Home core set. First, the Health Home Expected Reporting
Table provides a list of states by SPA that are
required to report from FFY 2018-2020. Second, the Technical Assistance Webinar on
State Reporting of Health Home Core Set
Measures: Status of FFY 2015-2018 Reporting and Updates for FFY 2019 discusses
updates to measure specifications in more
detail. Hyperlinks to these resources are also included
in Appendix A. There are two important email addresses to
keep in mind when reporting your core set data. The first is the Technical Assistance mailbox,
[email protected] You can use this mailbox when you have
questions about calculating, reporting, or using
the core set measures. We are happy to answer any questions you
have or set up a telephone call to discuss your
questions. The second mailbox is
[email protected] This is the appropriate mailbox to contact when
you have questions about MACPro, its
functionality, or accessing the system.

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