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As a part of the Value Based Care system, physicians are incentivized based on performance across a set of quality metrics, as opposed to payments from a straight free-for-service system. GBUACO providers were evaluated on quality metrics for two contracts based on three different populations: YourCare Medicaid, YourCare Health and Recovery Plan (HARP), and Fidelis Medicaid. These quality metrics are based on NCQA Healthcare Effectiveness Data and Information Set (HEDIS) standards, and fall into a range of quality categories such as Prevention and Screening, Behavioral Health, Access to Care, and other chronic health conditions such as Diabetes and Cardiovascular Conditions.

YourCare
Among the YourCare population, GBUACO physicians were evaluated on a point system based on quality metrics. In the Medicaid contract, there were 24 agreed-upon quality metrics. Half of these metrics were worth 1-point, while the other half were worth ½-point. For the HARP component, there were 21 agreed-upon metrics; 12 metrics worth 1-point, and 9 metrics worth ¼-point. The point breakdown to receive shared savings was as follows:

By the end of the year in the YourCare Medicaid population, GBUACO…

  • Met 11 of the 24 metrics at the target thresholds for a total of 7.5 points.
  • Increased performance rates from 2018 to 2019 on 16 of the 24 metrics.
  • Outperformed NYS averages on 9 of the 23 metrics for which state data was available.
  • Outperformed National averages on 15 of the 19 metrics for which national data was available.

For the YourCare HARP population, GBUACO…
  • Met 14 of the 21 metrics at the target thresholds for a total of 8.75 points
  • Increased performance from 2018 to 2019 on 16 of the 21 metrics
  • Outperformed NYS averages on 13 of the 20 metrics for which state data was available

Fidelis
In the Fidelis Medicaid population, quality metrics were based on a 100-point system: 64 points available for HEDIS quality metrics, and 36 points for Potentially Preventable Events (PPE) (calculated using the 3MTM proprietary tool). GBUACO earned 8 points per metric if the end-of-year rate was at or above the NYS 75th percentile, and 4 points if the rate was from the 50th-74th percentile. The HEDIS metrics included:
  • Adolescent Immunization (Combo 2)
  • Annual Dental Visit (Ages 2-20)
  • Antidepressant Medication Management – Effective Acute Phase
  • Breast Cancer Screening
  • Childhood Immunization (Combo 3)
  • Comprehensive Diabetes Care – HbA1c Test
  • Asthma Medication Management – 75% Compliant
  • Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life

Potentially Preventable Events are metrics that look at utilization of hospital services that could have been prevented through more optimized health care coordination and delivery of services. If GBUACO met the 75th percentile, full points were earned. If the rate fell at the 50th-74th percentile, half of the points were earned. This category is broken down into three metrics:
  • Potentially Preventable Admissions (PPA) – 16 points
  • Potentially Preventable Readmissions (PPR) – 10 points
  • Potentially Preventable Emergency Department Visits (PPV) – 10 points

At the end of 2019, GBUACO…
  • Met 2 of the 8 HEDIS measures at the 75th percentile, for a total of 16 points
  • Met 1 of the 3 PPE measures at the 75th percentile, and 2 of the 3 PPE measures at the 50th percentile, for a total of 21 points
  • Increased performance rates on 7 of the 8 HEDIS measures when compared to 2018
  • Outperformed NYS averages on 3 of the 8 HEDIS measures
  • Outperformed National averages on 6 of the 7 HEDIS measures for which data was available

The graphs below depict a summary of our performance results.





Measures from: https://www.ncqa.org/hedis