Spring 2021 Newsletter

We are delighted to share the results of Blue Shield’s PPO ACO performance for Measurement Year 2 (7/1/19-6/30/20).

We received a shared savings bonus payout of approximately $20 million combined between the hospitals and providers of both the North and South panels.

This is, by far, the largest shared savings we have received for any of our value-based arrangements.

The analytics team is finalizing calculations for funds distribution, and the specific amounts will be shared as soon as possible. In the meantime, here are the aggregate totals for the North and South panels:

Finally, although we want to celebrate this success, we do recognize the impact COVID-19 has had on health care utilization and spending as a driver of this year’s performance. At this time, it is difficult to predict performance for Year 3, due to the uncertainty about costs, utilization and the effects of care deferral. For these reasons, we should anticipate that Year 3 performance may not be as positive.

In early 2021, the Dignity Health ACO entities (CVQCN, NSQCN, SCICN, SCQCN, SJQCN and VIPN) and UnitedHealthcare agreed to move forward to a new quality program. The revised program is designed to better address concerns related to measure-reporting burdens and better focus on improving patient health care outcomes and cost efficiency.

The new program consists of 18 HEDIS quality performance measures. It does not include any facility measures. The data source for all measures will be either claims or encounter data. Membership attribution will lock with the third quarter of the measurement period.

The new program will eliminate the use of the point system in the evaluation of ACO performance. Instead, calculation of ACO Performance Score will be based on overall performance of the new quality gate.

Performance Score = (Σ Closed Opportunities / Σ Opportunities) * 100

The target score will need to be met or surpassed in each measurement period (MP) to achieve the shared opportunity payment.

Target Score
MP 2 (10/1/2020 – 9/30/2021) = 68% or higher
MP 3 (10/1/2021 – 9/30/2022) = 70% or higher

Here is the list of new United quality measures and their descriptions.

In addition, here is a complete quality overview of all our ACO PPO quality measures.

It is important to remind our patients about the importance of immunizations to protect from potentially harmful diseases. CIS-Combo 10 and IMA Combo 2 are birth date-dependent measures. It defines gaps in these measures that are needed to close by a specified age.

Quality Measures and Specifications

1. Childhood Immunization (CIS) Combo 10.

Description: Children who had the following vaccinations by their second birthday:
Combination 10

• Four diphtheria, tetanus and acellular pertussis (DTaP)
• Three polio (IPV)
• One measles, mumps, rubella (MMR)
• Three haemophilus type B (HiB)
• Three hepatitis B (Hep B)
• One chickenpox (VZV)
• Four pneumococcal conjugate (PCV)
• One hepatitis A (HepA)
• Two or three rotavirus (RV)
• At least two influenza vaccinations

2. Immunizations for Adolescents (IMA) Combo 2

Description: Adolescents 13 years of age who had one dose of meningococcal vaccine, one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday.

Components:

• At least one meningococcal serogroups A,C,W,Y vaccine with a date of service on or between member’s 11th and 13th birthdays
• At least one Tdap with a date of service on or between the member’s 11th and 13th birthdays
• At least two HPV vaccines with dates of service at least 146 days apart on or between the member’s 9th and 13th birthdays or at least three HPV vaccines with different dates of service on or between the member’s 9th and 13th birthdays

Exclusion (for both measures): Anaphylactic reaction to the vaccine or its components
Additional Resources:
https://www.immunize.org/
https://www.cdc.gov/vaccines/schedules/index.html

Dignity Health Care Network (DHCN) successfully completed the Group Physician Reporting Option (GPRO) process for measurement year 2020. This was the ACO’s first year of participation in the Medicare Shared Savings Program (MSSP) as a single entity that included providers in California and Nevada. Submitted data satisfied both MSSP and Merit-based Incentive Payment System (MIPS) quality category requirements, and CMS likely will announce final results in August 2021.

Overall performance on quality and cost metrics within these programs may result in shared savings and/or positive payment adjustment in 2022.

How the Process Worked

CMS assessed DHCN’s attributed beneficiary pool and randomly sampled 616 patients for inclusion in each of the applicable 10 Web Interface-reported quality measures. Over the course of approximately 12 weeks, quality teams from across DHCN manually abstracted and validated quality data from medical record clinical documentation. Teams were required to confirm each patient’s eligibility, verify satisfaction of measure criteria and submit data for a minimum of 248 consecutively sequenced beneficiaries. The athenahealth platform was used to document quality results for submission via the CMS Web Interface. Additional metrics required within the MSSP and MIPS programs were reported through utilization and claims data and other sources.

CMS-GPRO reporting is the culmination of efforts made throughout the year by various clinical and quality teams to provide evidence-based preventive and condition-specific care. DHCN will continue to submit 2021 quality data through the Web Interface but anticipates a significant shift in methodology in 2022 with use of electronic clinical quality measures (eCQMs).

In early March, you should have received an e-blast regarding CIN Compliance Education. The U.S. Department of Health and Human Services Office of Inspector General (OIG) mandates that entities have a compliance program that includes a compliance plan, compliance education, auditing and monitoring as well as a standard of conduct.

Our CIN compliance plan requires annual compliance education and distribution of the standards of conduct to CIN providers. Enclosed is the CIN compliance education as well as the CommonSpirit Health Standards of Conduct: Our Values in Action (SOC) for distribution to each CIN provider for review. As new providers are on-boarded in the CIN practice, please ensure that each provider receives the CIN compliance education and SOC for review.

MSSP ACO Attestation Requirements

In addition, if you are part of the DHCN MSSP ACO, we require an additional attestation. That information was sent to you on March 1. Please work with Christi Knox (916-545-4965 ([email protected]) to complete this attestation by May 29, 2021 if you have not done so already.

If you have any questions or concerns, please feel free to contact our Compliance Officer at [email protected].

Control of hypertension is a clinical goal across CommonSpirit for 2021, designed to improve the quality of life for our patients and improve the health of our communities. Unfortunately, when comparing encounters from 2019 to 2020, we see a 45% decrease in patients with hypertension seeking care (in-clinic or virtually).

Providers are essential in reversing this trend. Through a comprehensive communications campaign, the Physician Enterprise is encouraging providers to help address the danger of untreated hypertension among their patients by:

1. Leveraging provided tools. View the communications toolkit, which includes various patient education materials.
2. Encouraging in-clinic visits. In-clinic visits should be scheduled for hypertension patients who do not have access to a home digital monitor.
3. Promoting virtual visits. Virtual visits (i.e., video, telephonic) are appropriate for patients with access to home digital monitors, as CMS now accepts patient-reported blood pressure readings.
4. Sharing their successes. Providers who successfully increase HTN visits should share their strategies and tactics with their market quality leader.

Research shows that a disproportionate number of vulnerable populations and people of color are expressing hesitancy toward COVID-19 vaccination. Simultaneously, people of color also have been disproportionately impacted by the virus, making equitable vaccine access a priority.

CommonSpirit Population Health is committed to providing proactive and culturally competent education to our staff and providers, as well as the patients and communities we serve to promote health equity and COVID-19 vaccination.

Population Health leaders have collaborated with marketing and communications to create a document to guide providers in their COVID-19 communications. The document also provides markets and practices with a menu of collateral to assist in broader communications efforts.

More information about this campaign will be shared in an upcoming special edition of the Population Health newsletter.

As California experienced a surge in COVID-19 cases in January, our Western Division Ambulatory Care Coordination pivoted to COVID-19 surge support, concentrating on patients being discharged from hospitals while also supporting COVID-19-positive patients in the clinic.

Getting Patients the Care They Need

Every discharged COVID-19 patient receives a call from a Registered Nurse Care Manager. To ensure patients were getting the care they needed, Western Division team members utilized a payer-agnostic approach, focused on identifying those patient needs and then looked to the local markets for assistance, says Liz Spinella-Jones, System Director, Clinical Care Coordination.

The team was given the freedom to develop workflows together as the situation developed — and to remain fluid and flexible until they settled on a system that worked. Weekly huddles became daily so team members could share their concerns, raise any issues and solve them together.

“It’s really helped all the teams get to know each other across the Western Division, which has been a beautiful thing,” Spinella-Jones says.

Measuring Success

The resulting patient success stories demonstrate the needs the team has been able to help address. Here are a few brief examples:

• Food insecurity: A 23-year-old male with disabilities was recuperating well but mentioned to his case manager that he had little to no food (he had not disclosed this during hospitalization). The case manager connected him to both a disability agency and a food hotline, following up with the patient to confirm food was being delivered to him via the hotline.
• Missing medications: A 30-year-old female received nebulizer meds but couldn’t figure out how to take them. The care team member discovered she had not received the actual nebulizer and reached out to the hospitalist, who put in orders for treatment. By the next day, she had received the nebulizer and was able to use it properly.
• DME disconnect: A 73-year-old male had been waiting for months for a CPAP machine but had not received it. The case manager called his physician’s office and determined that the DME supplier had the wrong number for the patient. The case manager helped the patient get the DME he required, and the patient was grateful for the follow-up care.
• COVID-19 education: A surprising number of patients are receiving misinformation from family members, news sources and even medical sources regarding COVID-19. For example, many are surprised to learn that they are not immune after being diagnosed with COVID-19, so this effort has provided an opportunity for the teams to offer patient education from a trusted source on which they already rely.

The team has received excellent feedback on the COVID-19-positive follow-up calls, with patients expressing their gratitude and relief that someone is watching out for them.

While multiple teams contributed to the overall success of this effort, special recognition goes out to the following team members for their dedication:

• Susan Bartkowski and Robbie Grant for taking on the daily discharge lists and devising a system to make those lists actionable.
• The Frontline Triage RN team — Dominique Fairbank, Kathy Holton and Aida Munoz De Ortiz — for taking on the triage for payer-agnostic hospital discharges for COVID-19-positive patients and helping to develop the process.
• Local Market RNs — Charisse Sayson (VIPN), Pinder Maheru (CVQCN, NSQCN and SJQCN), Sarah Wilson (NSQCN), Cheryl Demonner PA (SCQCN), Bev Cruz and Aida Munoz (IE) — for working across the markets with the Triage team and each other to help the members and our team.

Spinella-Jones and the team also are aiming to ensure that this work will live on.

“We’re hoping to take some of the things we’ve learned from this and embed them into our everyday care coordination,” she says. “Now that we’ve developed this workflow and these processes, we can use them to address other needs as well.”

To learn more about the Care Coordination program, please call 661-716-7100 ext. 6159 or email [email protected].