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Solutions to New Challenges
Facing ACOs and ACO Participants
in the 2021 QPP Final Rule
January 27, 2021
© 2020
Health
Catalyst
ACOs and ACO participants
2
CMS
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
ACO
© 2020
Health
Catalyst
ACOs and ACO participants
3
CMS
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
MlPS APM
Participants
ACO
Four Changes
1. Discontinuation of the CMS Web Interface
2. Introduction of the APM Performance Pathway (APP)
3. Discontinuation of the MIPS APM scoring standard
4. Addition of the APM entity as a MIPS submitter type
Eight Challenges
1. Submission method change
2. Care delivery changes
3. Data collection changes
4. Scoring changes
5. Decreased quality performance for ACOs
6. Decreased MIPS scores for ACO participants
7. Additional MIPS submissions for ACO participants
8. MIPS submissions for ACOs
Health Catalyst Solutions
Agenda
© 2020
Health
Catalyst
Four Changes
5
Change #1 - Discontinuation of the CMS Web Interface
Claims EHR Registry
CMS
Web
Interface
CMS
© 2020
Health
Catalyst
Four Changes
6
Quality
CAHPS for MIPS (counted as one measure)
Two administrative claims measures:
• (New) Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups
• (New) Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs
Three self-reported measures:
• Diabetes: Hemoglobin A1c (HbA1c) Poor Control
• Preventive Care and Screening: Screening for Depression and Follow-up Plan
• Controlling High Blood Pressure
The APP for ACOs using eCQMs and CQMs
Change #2 – Introduction of the APM Performance Pathway (APP)
© 2020
Health
Catalyst
Four Changes
7
Quality
CAHPS for MIPS (counted as one measure)
Two administrative claims measures:
• (New) Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups
• (New) Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs
Ten self-reported measures:
• Diabetes: Hemoglobin A1c (HbA1c) Poor Control
• Preventive Care and Screening: Screening for Depression and Follow-up Plan
• Controlling High Blood Pressure
• Falls: Screening for Future Fall Risk
• Preventive Care and Screening: Influenza Immunization
• Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
• Colorectal Cancer Screening
• Breast Cancer Screening
• Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
• Depression Remission at Twelve Months
The APP for ACOs using the CMS Web Interface
Change #2 – Introduction of the APM Performance Pathway (APP)
© 2020
Health
Catalyst
Four Changes
8
Quality
Promoting
Interoperability
Improvement
Activities
Cost
CAHPS for MIPS (counted as one measure)
Two administrative claims measures:
• (New) Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for
MIPS Eligible Clinician Groups
• (New) Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic
Conditions for ACOs
Three self-reported measures:
• Diabetes: Hemoglobin A1c (HbA1c) Poor Control
• Preventive Care and Screening: Screening for Depression and Follow-up Plan
• Controlling High Blood Pressure
All standard
measures in the PI
category
Automatic score
of 100% in 2021
PY
None
The APP for MIPS APM participants using eCQMs or CQMs
Change #2 – Introduction of the APM Performance Pathway (APP)
© 2020
Health
Catalyst
Four Changes
9
Quality
Promoting
Interoperability
Improvement
Activities
Cost
CAHPS for MIPS (counted as one measure)
Two administrative claims measures:
• (New) Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for
MIPS Eligible Clinician Groups
• (New) Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic
Conditions for ACOs
Ten self-reported measures:
• Diabetes: Hemoglobin A1c (HbA1c) Poor Control
• Preventive Care and Screening: Screening for Depression and Follow-up Plan
• Controlling High Blood Pressure
• Falls: Screening for Future Fall Risk
• Preventive Care and Screening: Influenza Immunization
• Preventive Care and Screening: Tobacco Use: Screening and Cessation
Intervention
• Colorectal Cancer Screening
• Breast Cancer Screening
• Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
• Depression Remission at Twelve Months
All standard
measures in the PI
category
Automatic score
of 100% in 2021
PY
None
The APP for MIPS APM participants using the CMS Web Interface
Change #2 – Introduction of the APM Performance Pathway (APP)
© 2020
Health
Catalyst
Four Changes
10
CMS
Change #3 – Discontinuation of APM scoring standard
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
MIPS
MSSP
ACO
© 2020
Health
Catalyst
Four Changes
11
Change #3 – Discontinuation of the APM scoring standard
Scenario
Final Score Used to Determine
Payment Adjustments
TIN/NPI has more than one APM Entity final score The highest of the APM Entity final scores
TIN/NPI has an APM Entity final score and also has an individual score APM Entity final score
TIN/NPI has an APM Entity final score that is not a virtual group score
and also has a group final score
APM Entity final score
TIN/NPI has an APM Entity final score and also has a virtual group score APM Entity final score
TIN/NPI has a virtual group score and an individual final score Virtual group score
TIN/NPI has a group final score and an individual final score, but no APM
Entity final score and is not in a virtual group
The highest of the group or individual final
score
Former MIPS Scoring Hierarchy
© 2020
Health
Catalyst
Four Changes
12
Change #3 – Discontinuation of the APM scoring standard
New MIPS Scoring Hierarchy
Scenario
Final Score Used to Determine
Payment Adjustments
TIN/NPI has a virtual group final score, an APM Entity final score, an APP
final score, a group final score, and/or an individual final score.
Virtual group final score.
TIN/NPI has an APM Entity final score, an APP final score, a group final
score, and/or an individual final score, but is not in a virtual group.
The highest of the available final scores.
© 2020
Health
Catalyst
Four Changes
13
Change #4 – Addition of the APM entity as a MIPS submitter type
APM participation Participation status Framework MIPS participation level
Yes MIPS APM participant
Traditional
Virtual group
APM entity
Group
Individual
APP
Virtual group
APM entity
Group
Individual
© 2020
Health
Catalyst
Four Changes
14
Change #4 – Addition of the APM entity as a MIPS submitter type
APP
CMS
Traditional
MIPS
APM Entity
“…individual clinicians submitting for
themselves, or someone authorized to
submit data on behalf of a clinician or
practice.” (CMS, QPP Website).
© 2020
Health
Catalyst
Four Changes
15
CMS
Change #4 – Addition of APM entity as a MIPS submitter type
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
(APP) MIPS (Traditional)
MSSP (APP)
ACO
© 2020
Health
Catalyst
Four Changes
16
Change #4 – Addition of the APM entity as a MIPS submitter type
APM participation Participation status Framework MIPS participation level
Yes MIPS APM participant
Traditional
Virtual group
APM entity
Group
Individual
APP
Virtual group
APM entity
Group
Individual
Four Changes
1. Discontinuation of the CMS Web Interface
2. Introduction of the APM Performance Pathway (APP)
3. Discontinuation of the MIPS APM scoring standard
4. Addition of the APM entity as a MIPS submitter type
Eight Challenges
1. Submission method changes
2. Care delivery changes
3. Data collection changes
4. Scoring changes
5. Decreased quality performance for ACOs
6. Decreased MIPS scores for ACO participants
7. Additional MIPS submissions for ACO participants
8. MIPS submissions for ACOs
Health Catalyst Solutions
Agenda
© 2020
Health
Catalyst
Eight Challenges
18
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
© 2020
Health
Catalyst
Eight Challenges
19
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
185
47
0 20 40 60 80 100 120 140 160 180 200
QCDRs
CQMs
eCQMs
Count of Quality Measures Available in each Submission Method
Varies by QCDR
© 2020
Health
Catalyst
Eight Challenges
20
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
1. New patient populations
2. New/different measures
© 2020
Health
Catalyst
Eight Challenges
21
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
1. New patient populations
2. New/different measures
All Patients
Medicare
Patients
Sample of Medicare
Patients
© 2020
Health
Catalyst
185
47
0 20 40 60 80 100 120 140 160 180 200
QCDRs
CQMs
eCQMs
Count of Quality Measures Available in each Submission Method
Eight Challenges
22
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
1. New patient populations
2. New/different measures
Varies by QCDR
© 2020
Health
Catalyst
Eight Challenges
23
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
1. New patient populations
2. New value sets
© 2020
Health
Catalyst
Eight Challenges
24
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
1. New patient populations
2. New value sets
All Patients
Sample of Medicare
Patients
Medicare
Patients
© 2020
Health
Catalyst
Eight Challenges
25
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
1. New patient populations
2. New value sets
Data
source
Data
type Unstructured data
Structured
data
Mapped
data
Source #1 Clinical 135 Systolic pressure: 135
Source #2 Clinical
Free text: “Counseled patient on the
need to diet in response to BMI of 38”
Drop-down selection: lifestyle education
regarding diet (drop-down option)
443288003
(SNOMED-CT)
Source #3 Clinical
Free text: “Reconciled patient meds after
discharge”
Drop-down selection: Medication
Reconciliation Post-Discharge
430193006
(SNOMED-CT)
Source #4 Clinical
Free text: “Prescribed Sulfazine for
patient’s rheumatoid arthritis ”
eRx: Sulfazine 1147790 (RxNorm)
© 2020
Health
Catalyst
Eight Challenges
26
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
4. Scoring changes
Collection
Type
Submission
Method
Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10
CMS Web
Interface
CMS Web
Interface
n/a
70.00-
60.01
60.00-
50.01
50.00-
40.01
40.00-
30.01
30.00-
20.01
20.00-
10.01
<=10
eCQM EHR / Registry
79.99-
70.01
70.00-
60.01
60.00-
50.01
50.00-
40.01
40.00-
30.01
30.00-
20.01
20.00-
10.01
<=10
CQM Registry
>=
99.46
99.45-
92.62
92.61-
74.48
74.47-
57.09
59.08-
46.85
46.84-
37.89
37.88-
31.41
<=
31.40
Diabetes: Hemoglobin A1c (HbA1c) Poor Control >9%
© 2020
Health
Catalyst
Eight Challenges
27
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
4. Scoring changes
Preventive Care and Screening: Influenza Immunization
Collection
Type
Submission
Method
Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10
CMS Web
Interface
CMS Web
Interface
n/a
30.00-
39.99
40.00-
49.99
50.00-
59.99
60.00-
69.99
70.00-
79.99
80.00-
89.99
90.00-
100
eCQM EHR / Registry
00.11-
03.34
03.35-
16.95
16.96-
36.49
36.50-
58.40
58.41-
81.09
81.10-
92.41
92.42-
99.99
100
CQM Registry
00.21-
11.43
11.44-
32.82
32.83-
61.63
61.64-
88.07
88.08-
99.43
99.44-
99.99
-- 100
© 2020
Health
Catalyst
Poll Question #1
28
Which challenge related to the
discontinuation of the CMS Web
Interface is the greatest?
© 2020
Health
Catalyst
Eight Challenges
29
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
6. The APP decreases APM entity MIPS scores for MIPS APM participants
© 2020
Health
Catalyst
Eight Challenges
30
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
“…The proposed methodological changes
in ACO quality scoring will reduce the mean
ACO quality score by roughly 10 to 15
percentage points relative to recent
historical performance years where ACO
quality performance scores have averaged
90 percent or more” (CMS, 2021 QPP
Proposed Rule, p. 913)
© 2020
Health
Catalyst
APM Entity
(93)
TIN
NPI (93)
NPI (93)
NPI (93)
NPI (93)
TIN
NPI (93)
NPI (93)
NPI (93)
TIN
NPI (93)
NPI (93)
NPI (93)
NPI (93)
TIN
NPI (93)
NPI (93)
TIN
NPI (93)
NPI (93)
NPI (93)
NPI (93)
Eight Challenges
31
APM entity reporting
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
6. The APP decreases APM entity MIPS scores for MIPS APM participants
© 2020
Health
Catalyst
Eight Challenges
32
APM entity reporting
APM Entity
(90)
TIN
NPI (90)
NPI (90)
NPI (90)
NPI (90)
TIN
NPI (90)
NPI (90)
NPI (90)
TIN
NPI (90)
NPI (90)
NPI (90)
NPI (90)
TIN
NPI (90)
NPI (90)
TIN
NPI (90)
NPI (90)
NPI (90)
NPI (90)
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
6. The APP decreases APM entity MIPS scores for MIPS APM participants
© 2020
Health
Catalyst
Eight Challenges
33
Change #3 – Discontinuation of the APM Scoring Standard
Clinicians classified as MIPS APM participants could have up to eight final MIPS scores
when a participant is included in multiple MIPS submissions.
APM participation Participation status Framework MIPS participation level
Yes MIPS APM participant
Traditional
Virtual group
APM entity
Group
Individual
APP
Virtual group
APM entity
Group
Individual
© 2020
Health
Catalyst
Eight Challenges
34
CMS
Change #4 – Addition of APM entity as a MIPS submitter type
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
(APP) MIPS (Traditional)
MSSP (APP)
© 2020
Health
Catalyst
Eight Challenges
35
Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
4. Scoring changes
Introduction of the APM Performance Pathway (APP)
5. Decreased quality performance for ACOs
6. Decreased MIPS scores for ACO participants
Discontinuation of the APM scoring standard
7. Additional MIPS submissions for ACO participants
Addition of an APM entity as a MIPS submitter type
8. MIPS submissions for ACOs
© 2020
Health
Catalyst
Poll Question #2
36
Which of the changes creates the
greatest challenge(s)?
Four Changes
1. Discontinuation of the CMS Web Interface
2. Introduction of the APM Performance Pathway (APP)
3. Discontinuation of the MIPS APM scoring standard
4. Addition of the APM entity as a MIPS submitter type
Eight Challenges
1. Submission method changes
2. Care delivery changes
3. Data collection changes
4. Scoring changes
5. Decreased quality performance for ACOs
6. Decreased MIPS scores for ACO participants
7. Additional MIPS submissions for ACO participants
8. MIPS submissions for ACOs
Health Catalyst Solutions
Agenda
© 2020
Health
Catalyst
38
Health Catalyst’s Quality Measures Solution
Creates a complete picture by combining complete data from a complete list of data sources,
complete measures from a complete list of programs, and complete performance visualizations.
© 2020
Health
Catalyst
39
Health Catalyst’s Quality Measures Solution
Creates a complete workflow by combining the processes for monitoring, improving, and
submitting performance to payers.
© 2020
Health
Catalyst
40
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
Health Catalyst’s Quality Measures Solution
© 2020
Health
Catalyst
41
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
Health Catalyst’s Quality Measures Solution
© 2020
Health
Catalyst
42
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
Health Catalyst’s Quality Measures Solution
© 2020
Health
Catalyst
43
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
Health Catalyst’s Quality Measures Solution
© 2020
Health
Catalyst
44
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
Health Catalyst’s Quality Measures Solution
© 2020
Health
Catalyst
45
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
Health Catalyst’s Quality Measures Solution
© 2020
Health
Catalyst
46
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
4. Scoring changes
Health Catalyst’s Quality Measures Solution
Floor: 100.0%
Decile 3: 68.31%
Decile 4: 50.62%
Decile 5: 37.5%
Decile 6: 28.69%
Decile 7: 20.0%
Decile 8: 13.59%
Decile 9: 9.02%
Decile 10: 2.7%
© 2020
Health
Catalyst
47
Health Catalyst’s Quality Measures Solution
Change #1 – Discontinuation of the CMS Web Interface
1. Submission method change
2. Care delivery changes
3. Data collection changes
4. Scoring changes
© 2020
Health
Catalyst
48
Health Catalyst’s Quality Measures Solution
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
6. The APP decreases APM entity MIPS scores for MIPS APM participants
© 2020
Health
Catalyst
49
Health Catalyst’s Quality Measures Solution
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
6. The APP decreases APM entity MIPS scores for MIPS APM participants
© 2020
Health
Catalyst
50
Health Catalyst’s Quality Measures Solution
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
6. The APP decreases APM entity MIPS scores for MIPS APM participants
© 2020
Health
Catalyst
51
Health Catalyst’s Quality Measures Solution
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
6. The APP decreases APM entity MIPS scores for MIPS APM participants
© 2020
Health
Catalyst
52
Health Catalyst’s Quality Measures Solution
Change #2 – Introduction of the APM Performance Pathway (APP)
5. The APP decreases quality performance scores for MSSP ACOs
6. The APP decreases APM entity MIPS scores for MIPS APM participants
© 2020
Health
Catalyst
Health Catalyst’s Quality Measures Solution
53
Change #3 – Discontinuation of the APM scoring standard
APM participation Participation status Framework MIPS participation level
Yes MIPS APM participant
Traditional
Virtual group
APM entity
Group
Individual
APP
Virtual group
APM entity
Group
Individual
© 2020
Health
Catalyst
Health Catalyst’s Quality Measures Solution
54
CMS
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
(APP) MIPS (Traditional)
MSSP (APP)
Change #3 – Discontinuation of the APM scoring standard
© 2020
Health
Catalyst
Health Catalyst’s Quality Measures Solution
55
CMS
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
(APP) MIPS (Traditional)
MSSP (APP)
Change #3 – Discontinuation of the APM scoring standard
© 2020
Health
Catalyst
Health Catalyst’s Quality Measures Solution
56
CMS
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
(APP) MIPS (Traditional)
MSSP (APP)
Change #3 – Discontinuation of the APM scoring standard
© 2020
Health
Catalyst
Health Catalyst’s Quality Measures Solution
57
CMS
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
(APP) MIPS (Traditional)
MSSP (APP)
Change #3 – Discontinuation of the APM scoring standard
Virtual
Group
© 2020
Health
Catalyst
Health Catalyst’s Quality Measures Solution
58
CMS
APM
Entity
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
NPI
TIN
NPI
NPI
NPI
TIN
NPI
NPI
TIN
NPI
NPI
NPI
NPI
(APP) MIPS (Traditional)
MSSP (APP)
Change #4 – Addition of the APM entity as a MIPS submitter type
© 2020
Health
Catalyst
59
Change #4 – Addition of the APM entity as a MIPS submitter type
Health Catalyst’s Quality Measures Solution
© 2020
Health
Catalyst
Poll Question #3
60
Which product in the Health Catalyst
quality measures solution would be
most helpful to ACOs or MIPS APM
participants?
Four Changes
1. Discontinuation of the CMS Web Interface
2. Introduction of the APM Performance Pathway (APP)
3. Discontinuation of the MIPS APM scoring standard
4. Addition of the APM entity as a MIPS submitter type
Eight Challenges
1. Submission method changes
2. Care delivery changes
3. Data collection changes
4. Scoring changes
5. Decreased quality performance for ACOs
6. Decreased MIPS scores for ACO participants
7. Additional MIPS submissions for ACO participants
8. MIPS submissions for ACOs
Health Catalyst Solutions
Agenda
Four Changes
1. Discontinuation of the CMS Web Interface
2. Introduction of the APM Performance Pathway (APP)
3. Discontinuation of the MIPS APM scoring standard
4. Addition of the APM entity as a MIPS submitter type
Eight Challenges
1. Submission method change
2. Care delivery changes
3. Data collection changes
4. Scoring changes
5. Decreased quality performance for ACOs
6. Decreased MIPS scores for ACO participants
7. Additional MIPS submissions for ACO participants
8. MIPS submissions for ACOs
Health Catalyst Solutions
Agenda
Questions & Answers

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Solutions to the New Challenges Facing ACOs and ACO Participants from the 2021 QPP Final Rule

  • 1. Solutions to New Challenges Facing ACOs and ACO Participants in the 2021 QPP Final Rule January 27, 2021
  • 2. © 2020 Health Catalyst ACOs and ACO participants 2 CMS APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI ACO
  • 3. © 2020 Health Catalyst ACOs and ACO participants 3 CMS APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI MlPS APM Participants ACO
  • 4. Four Changes 1. Discontinuation of the CMS Web Interface 2. Introduction of the APM Performance Pathway (APP) 3. Discontinuation of the MIPS APM scoring standard 4. Addition of the APM entity as a MIPS submitter type Eight Challenges 1. Submission method change 2. Care delivery changes 3. Data collection changes 4. Scoring changes 5. Decreased quality performance for ACOs 6. Decreased MIPS scores for ACO participants 7. Additional MIPS submissions for ACO participants 8. MIPS submissions for ACOs Health Catalyst Solutions Agenda
  • 5. © 2020 Health Catalyst Four Changes 5 Change #1 - Discontinuation of the CMS Web Interface Claims EHR Registry CMS Web Interface CMS
  • 6. © 2020 Health Catalyst Four Changes 6 Quality CAHPS for MIPS (counted as one measure) Two administrative claims measures: • (New) Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups • (New) Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs Three self-reported measures: • Diabetes: Hemoglobin A1c (HbA1c) Poor Control • Preventive Care and Screening: Screening for Depression and Follow-up Plan • Controlling High Blood Pressure The APP for ACOs using eCQMs and CQMs Change #2 – Introduction of the APM Performance Pathway (APP)
  • 7. © 2020 Health Catalyst Four Changes 7 Quality CAHPS for MIPS (counted as one measure) Two administrative claims measures: • (New) Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups • (New) Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs Ten self-reported measures: • Diabetes: Hemoglobin A1c (HbA1c) Poor Control • Preventive Care and Screening: Screening for Depression and Follow-up Plan • Controlling High Blood Pressure • Falls: Screening for Future Fall Risk • Preventive Care and Screening: Influenza Immunization • Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention • Colorectal Cancer Screening • Breast Cancer Screening • Statin Therapy for the Prevention and Treatment of Cardiovascular Disease • Depression Remission at Twelve Months The APP for ACOs using the CMS Web Interface Change #2 – Introduction of the APM Performance Pathway (APP)
  • 8. © 2020 Health Catalyst Four Changes 8 Quality Promoting Interoperability Improvement Activities Cost CAHPS for MIPS (counted as one measure) Two administrative claims measures: • (New) Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups • (New) Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs Three self-reported measures: • Diabetes: Hemoglobin A1c (HbA1c) Poor Control • Preventive Care and Screening: Screening for Depression and Follow-up Plan • Controlling High Blood Pressure All standard measures in the PI category Automatic score of 100% in 2021 PY None The APP for MIPS APM participants using eCQMs or CQMs Change #2 – Introduction of the APM Performance Pathway (APP)
  • 9. © 2020 Health Catalyst Four Changes 9 Quality Promoting Interoperability Improvement Activities Cost CAHPS for MIPS (counted as one measure) Two administrative claims measures: • (New) Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups • (New) Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs Ten self-reported measures: • Diabetes: Hemoglobin A1c (HbA1c) Poor Control • Preventive Care and Screening: Screening for Depression and Follow-up Plan • Controlling High Blood Pressure • Falls: Screening for Future Fall Risk • Preventive Care and Screening: Influenza Immunization • Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention • Colorectal Cancer Screening • Breast Cancer Screening • Statin Therapy for the Prevention and Treatment of Cardiovascular Disease • Depression Remission at Twelve Months All standard measures in the PI category Automatic score of 100% in 2021 PY None The APP for MIPS APM participants using the CMS Web Interface Change #2 – Introduction of the APM Performance Pathway (APP)
  • 10. © 2020 Health Catalyst Four Changes 10 CMS Change #3 – Discontinuation of APM scoring standard APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI MIPS MSSP ACO
  • 11. © 2020 Health Catalyst Four Changes 11 Change #3 – Discontinuation of the APM scoring standard Scenario Final Score Used to Determine Payment Adjustments TIN/NPI has more than one APM Entity final score The highest of the APM Entity final scores TIN/NPI has an APM Entity final score and also has an individual score APM Entity final score TIN/NPI has an APM Entity final score that is not a virtual group score and also has a group final score APM Entity final score TIN/NPI has an APM Entity final score and also has a virtual group score APM Entity final score TIN/NPI has a virtual group score and an individual final score Virtual group score TIN/NPI has a group final score and an individual final score, but no APM Entity final score and is not in a virtual group The highest of the group or individual final score Former MIPS Scoring Hierarchy
  • 12. © 2020 Health Catalyst Four Changes 12 Change #3 – Discontinuation of the APM scoring standard New MIPS Scoring Hierarchy Scenario Final Score Used to Determine Payment Adjustments TIN/NPI has a virtual group final score, an APM Entity final score, an APP final score, a group final score, and/or an individual final score. Virtual group final score. TIN/NPI has an APM Entity final score, an APP final score, a group final score, and/or an individual final score, but is not in a virtual group. The highest of the available final scores.
  • 13. © 2020 Health Catalyst Four Changes 13 Change #4 – Addition of the APM entity as a MIPS submitter type APM participation Participation status Framework MIPS participation level Yes MIPS APM participant Traditional Virtual group APM entity Group Individual APP Virtual group APM entity Group Individual
  • 14. © 2020 Health Catalyst Four Changes 14 Change #4 – Addition of the APM entity as a MIPS submitter type APP CMS Traditional MIPS APM Entity “…individual clinicians submitting for themselves, or someone authorized to submit data on behalf of a clinician or practice.” (CMS, QPP Website).
  • 15. © 2020 Health Catalyst Four Changes 15 CMS Change #4 – Addition of APM entity as a MIPS submitter type APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI (APP) MIPS (Traditional) MSSP (APP) ACO
  • 16. © 2020 Health Catalyst Four Changes 16 Change #4 – Addition of the APM entity as a MIPS submitter type APM participation Participation status Framework MIPS participation level Yes MIPS APM participant Traditional Virtual group APM entity Group Individual APP Virtual group APM entity Group Individual
  • 17. Four Changes 1. Discontinuation of the CMS Web Interface 2. Introduction of the APM Performance Pathway (APP) 3. Discontinuation of the MIPS APM scoring standard 4. Addition of the APM entity as a MIPS submitter type Eight Challenges 1. Submission method changes 2. Care delivery changes 3. Data collection changes 4. Scoring changes 5. Decreased quality performance for ACOs 6. Decreased MIPS scores for ACO participants 7. Additional MIPS submissions for ACO participants 8. MIPS submissions for ACOs Health Catalyst Solutions Agenda
  • 18. © 2020 Health Catalyst Eight Challenges 18 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change
  • 19. © 2020 Health Catalyst Eight Challenges 19 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 185 47 0 20 40 60 80 100 120 140 160 180 200 QCDRs CQMs eCQMs Count of Quality Measures Available in each Submission Method Varies by QCDR
  • 20. © 2020 Health Catalyst Eight Challenges 20 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 1. New patient populations 2. New/different measures
  • 21. © 2020 Health Catalyst Eight Challenges 21 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 1. New patient populations 2. New/different measures All Patients Medicare Patients Sample of Medicare Patients
  • 22. © 2020 Health Catalyst 185 47 0 20 40 60 80 100 120 140 160 180 200 QCDRs CQMs eCQMs Count of Quality Measures Available in each Submission Method Eight Challenges 22 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 1. New patient populations 2. New/different measures Varies by QCDR
  • 23. © 2020 Health Catalyst Eight Challenges 23 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes 1. New patient populations 2. New value sets
  • 24. © 2020 Health Catalyst Eight Challenges 24 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes 1. New patient populations 2. New value sets All Patients Sample of Medicare Patients Medicare Patients
  • 25. © 2020 Health Catalyst Eight Challenges 25 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes 1. New patient populations 2. New value sets Data source Data type Unstructured data Structured data Mapped data Source #1 Clinical 135 Systolic pressure: 135 Source #2 Clinical Free text: “Counseled patient on the need to diet in response to BMI of 38” Drop-down selection: lifestyle education regarding diet (drop-down option) 443288003 (SNOMED-CT) Source #3 Clinical Free text: “Reconciled patient meds after discharge” Drop-down selection: Medication Reconciliation Post-Discharge 430193006 (SNOMED-CT) Source #4 Clinical Free text: “Prescribed Sulfazine for patient’s rheumatoid arthritis ” eRx: Sulfazine 1147790 (RxNorm)
  • 26. © 2020 Health Catalyst Eight Challenges 26 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes 4. Scoring changes Collection Type Submission Method Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10 CMS Web Interface CMS Web Interface n/a 70.00- 60.01 60.00- 50.01 50.00- 40.01 40.00- 30.01 30.00- 20.01 20.00- 10.01 <=10 eCQM EHR / Registry 79.99- 70.01 70.00- 60.01 60.00- 50.01 50.00- 40.01 40.00- 30.01 30.00- 20.01 20.00- 10.01 <=10 CQM Registry >= 99.46 99.45- 92.62 92.61- 74.48 74.47- 57.09 59.08- 46.85 46.84- 37.89 37.88- 31.41 <= 31.40 Diabetes: Hemoglobin A1c (HbA1c) Poor Control >9%
  • 27. © 2020 Health Catalyst Eight Challenges 27 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes 4. Scoring changes Preventive Care and Screening: Influenza Immunization Collection Type Submission Method Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10 CMS Web Interface CMS Web Interface n/a 30.00- 39.99 40.00- 49.99 50.00- 59.99 60.00- 69.99 70.00- 79.99 80.00- 89.99 90.00- 100 eCQM EHR / Registry 00.11- 03.34 03.35- 16.95 16.96- 36.49 36.50- 58.40 58.41- 81.09 81.10- 92.41 92.42- 99.99 100 CQM Registry 00.21- 11.43 11.44- 32.82 32.83- 61.63 61.64- 88.07 88.08- 99.43 99.44- 99.99 -- 100
  • 28. © 2020 Health Catalyst Poll Question #1 28 Which challenge related to the discontinuation of the CMS Web Interface is the greatest?
  • 29. © 2020 Health Catalyst Eight Challenges 29 Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs 6. The APP decreases APM entity MIPS scores for MIPS APM participants
  • 30. © 2020 Health Catalyst Eight Challenges 30 Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs “…The proposed methodological changes in ACO quality scoring will reduce the mean ACO quality score by roughly 10 to 15 percentage points relative to recent historical performance years where ACO quality performance scores have averaged 90 percent or more” (CMS, 2021 QPP Proposed Rule, p. 913)
  • 31. © 2020 Health Catalyst APM Entity (93) TIN NPI (93) NPI (93) NPI (93) NPI (93) TIN NPI (93) NPI (93) NPI (93) TIN NPI (93) NPI (93) NPI (93) NPI (93) TIN NPI (93) NPI (93) TIN NPI (93) NPI (93) NPI (93) NPI (93) Eight Challenges 31 APM entity reporting Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs 6. The APP decreases APM entity MIPS scores for MIPS APM participants
  • 32. © 2020 Health Catalyst Eight Challenges 32 APM entity reporting APM Entity (90) TIN NPI (90) NPI (90) NPI (90) NPI (90) TIN NPI (90) NPI (90) NPI (90) TIN NPI (90) NPI (90) NPI (90) NPI (90) TIN NPI (90) NPI (90) TIN NPI (90) NPI (90) NPI (90) NPI (90) Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs 6. The APP decreases APM entity MIPS scores for MIPS APM participants
  • 33. © 2020 Health Catalyst Eight Challenges 33 Change #3 – Discontinuation of the APM Scoring Standard Clinicians classified as MIPS APM participants could have up to eight final MIPS scores when a participant is included in multiple MIPS submissions. APM participation Participation status Framework MIPS participation level Yes MIPS APM participant Traditional Virtual group APM entity Group Individual APP Virtual group APM entity Group Individual
  • 34. © 2020 Health Catalyst Eight Challenges 34 CMS Change #4 – Addition of APM entity as a MIPS submitter type APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI (APP) MIPS (Traditional) MSSP (APP)
  • 35. © 2020 Health Catalyst Eight Challenges 35 Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes 4. Scoring changes Introduction of the APM Performance Pathway (APP) 5. Decreased quality performance for ACOs 6. Decreased MIPS scores for ACO participants Discontinuation of the APM scoring standard 7. Additional MIPS submissions for ACO participants Addition of an APM entity as a MIPS submitter type 8. MIPS submissions for ACOs
  • 36. © 2020 Health Catalyst Poll Question #2 36 Which of the changes creates the greatest challenge(s)?
  • 37. Four Changes 1. Discontinuation of the CMS Web Interface 2. Introduction of the APM Performance Pathway (APP) 3. Discontinuation of the MIPS APM scoring standard 4. Addition of the APM entity as a MIPS submitter type Eight Challenges 1. Submission method changes 2. Care delivery changes 3. Data collection changes 4. Scoring changes 5. Decreased quality performance for ACOs 6. Decreased MIPS scores for ACO participants 7. Additional MIPS submissions for ACO participants 8. MIPS submissions for ACOs Health Catalyst Solutions Agenda
  • 38. © 2020 Health Catalyst 38 Health Catalyst’s Quality Measures Solution Creates a complete picture by combining complete data from a complete list of data sources, complete measures from a complete list of programs, and complete performance visualizations.
  • 39. © 2020 Health Catalyst 39 Health Catalyst’s Quality Measures Solution Creates a complete workflow by combining the processes for monitoring, improving, and submitting performance to payers.
  • 40. © 2020 Health Catalyst 40 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change Health Catalyst’s Quality Measures Solution
  • 41. © 2020 Health Catalyst 41 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change Health Catalyst’s Quality Measures Solution
  • 42. © 2020 Health Catalyst 42 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes Health Catalyst’s Quality Measures Solution
  • 43. © 2020 Health Catalyst 43 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes Health Catalyst’s Quality Measures Solution
  • 44. © 2020 Health Catalyst 44 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes Health Catalyst’s Quality Measures Solution
  • 45. © 2020 Health Catalyst 45 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes Health Catalyst’s Quality Measures Solution
  • 46. © 2020 Health Catalyst 46 Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes 4. Scoring changes Health Catalyst’s Quality Measures Solution Floor: 100.0% Decile 3: 68.31% Decile 4: 50.62% Decile 5: 37.5% Decile 6: 28.69% Decile 7: 20.0% Decile 8: 13.59% Decile 9: 9.02% Decile 10: 2.7%
  • 47. © 2020 Health Catalyst 47 Health Catalyst’s Quality Measures Solution Change #1 – Discontinuation of the CMS Web Interface 1. Submission method change 2. Care delivery changes 3. Data collection changes 4. Scoring changes
  • 48. © 2020 Health Catalyst 48 Health Catalyst’s Quality Measures Solution Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs 6. The APP decreases APM entity MIPS scores for MIPS APM participants
  • 49. © 2020 Health Catalyst 49 Health Catalyst’s Quality Measures Solution Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs 6. The APP decreases APM entity MIPS scores for MIPS APM participants
  • 50. © 2020 Health Catalyst 50 Health Catalyst’s Quality Measures Solution Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs 6. The APP decreases APM entity MIPS scores for MIPS APM participants
  • 51. © 2020 Health Catalyst 51 Health Catalyst’s Quality Measures Solution Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs 6. The APP decreases APM entity MIPS scores for MIPS APM participants
  • 52. © 2020 Health Catalyst 52 Health Catalyst’s Quality Measures Solution Change #2 – Introduction of the APM Performance Pathway (APP) 5. The APP decreases quality performance scores for MSSP ACOs 6. The APP decreases APM entity MIPS scores for MIPS APM participants
  • 53. © 2020 Health Catalyst Health Catalyst’s Quality Measures Solution 53 Change #3 – Discontinuation of the APM scoring standard APM participation Participation status Framework MIPS participation level Yes MIPS APM participant Traditional Virtual group APM entity Group Individual APP Virtual group APM entity Group Individual
  • 54. © 2020 Health Catalyst Health Catalyst’s Quality Measures Solution 54 CMS APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI (APP) MIPS (Traditional) MSSP (APP) Change #3 – Discontinuation of the APM scoring standard
  • 55. © 2020 Health Catalyst Health Catalyst’s Quality Measures Solution 55 CMS APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI (APP) MIPS (Traditional) MSSP (APP) Change #3 – Discontinuation of the APM scoring standard
  • 56. © 2020 Health Catalyst Health Catalyst’s Quality Measures Solution 56 CMS APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI (APP) MIPS (Traditional) MSSP (APP) Change #3 – Discontinuation of the APM scoring standard
  • 57. © 2020 Health Catalyst Health Catalyst’s Quality Measures Solution 57 CMS APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI (APP) MIPS (Traditional) MSSP (APP) Change #3 – Discontinuation of the APM scoring standard Virtual Group
  • 58. © 2020 Health Catalyst Health Catalyst’s Quality Measures Solution 58 CMS APM Entity TIN NPI NPI NPI NPI TIN NPI NPI NPI NPI TIN NPI NPI NPI TIN NPI NPI TIN NPI NPI NPI NPI (APP) MIPS (Traditional) MSSP (APP) Change #4 – Addition of the APM entity as a MIPS submitter type
  • 59. © 2020 Health Catalyst 59 Change #4 – Addition of the APM entity as a MIPS submitter type Health Catalyst’s Quality Measures Solution
  • 60. © 2020 Health Catalyst Poll Question #3 60 Which product in the Health Catalyst quality measures solution would be most helpful to ACOs or MIPS APM participants?
  • 61. Four Changes 1. Discontinuation of the CMS Web Interface 2. Introduction of the APM Performance Pathway (APP) 3. Discontinuation of the MIPS APM scoring standard 4. Addition of the APM entity as a MIPS submitter type Eight Challenges 1. Submission method changes 2. Care delivery changes 3. Data collection changes 4. Scoring changes 5. Decreased quality performance for ACOs 6. Decreased MIPS scores for ACO participants 7. Additional MIPS submissions for ACO participants 8. MIPS submissions for ACOs Health Catalyst Solutions Agenda
  • 62. Four Changes 1. Discontinuation of the CMS Web Interface 2. Introduction of the APM Performance Pathway (APP) 3. Discontinuation of the MIPS APM scoring standard 4. Addition of the APM entity as a MIPS submitter type Eight Challenges 1. Submission method change 2. Care delivery changes 3. Data collection changes 4. Scoring changes 5. Decreased quality performance for ACOs 6. Decreased MIPS scores for ACO participants 7. Additional MIPS submissions for ACO participants 8. MIPS submissions for ACOs Health Catalyst Solutions Agenda