Vice President Business Development & Strategic Alliances
The California Value Based Pay for Performance (VBP4P) program is the largest alternative payment model in the United States. It predates healthcare reform by almost a decade. The program was launched in 2001 as a statewide initiative managed by the Integrated Healthcare Association (IHA) on behalf of 10 health plans. The VBP4P has been deploying quality measure sets and reporting results and the program is the longest running example of the power of the transition to value-based care.
IHA has worked in partnership with the National Committee for Quality Assurance (NCQA) since the program’s inception. The VBP4P program was refined in 2018 when the program name was changed to “Align. Measure. Perform.” (AMP). The overall objectives of the AMP program are to drive improvements in clinical quality and patient experience while also controlling healthcare costs and utilization rates.
When the revised AMP program was launched, it included new compliance requirements intended to make progress on the path towards the AMP objectives by demonstrating performance through reporting specific and uniform quality metric calculations. Organizations participating in the California AMP program receive annual incentive payments for controlling costs and utilization rates measured against benchmarks and that payment is increased or decreased based on the quality metrics scores.
In 2020, IHA adopted a set of requirements requiring specific reporting methods of all the metrics used in the AMP program. The required reporting for the 2020 plan year must be filed by May 7, 2021. Those requirements provide, among other things, three possible options for measurement year 2020:
Health plans and physician organizations that run their own measure results (without a vendor) may undergo manual source code review by a certified auditor.
Health plans and physician organizations that run their own measure results (without a vendor) may certify their measure logic using NCQA’s automated source code review (ASCR).
Contract with an NCQA certified vendor to support the periodic reporting and avoid source code review and measure logic certification. There are currently only 13 software vendors that have earned this certification. They are listed on the NCQA website.
Option 1 will get the job done but will not add much value to the program or process. Option 2 would require the physician organization or plan sponsor to build, test and implement appropriate software and then undergo an annual, time-consuming, rigorous and expensive certification process. With the proper platform, Option 3 will remove all the heavy lifting involved in options 1 and 2 and will add further value by providing actionable information that will result in continuous operational improvement. Properly utilized, a platform that combines an NCQA certified quality system with a risk management system will help improve all value-based operations of the provider organization while compliantly maximizing the organization’s revenue.
The reporting deadline for the MY 2020 is May 7, 2021 and each of the above options requires a comprehensive execution plan. Progressive organizations are satisfying the AMP requirements through proactively implementing an NCQA certified AMP software platform that accomplishes all of the program objectives while delivering an extremely attractive ROI.
A pioneer in healthcare analytics, qrcAnalytics leverages their extensive experience with CMS programs to streamlines using the power of big data to compliantly optimize incentive and capitation payments and minimize penalties. The qrcAnalytics platform arms healthcare organizations with high impact analytics harnessing the strategic power embedded in clinical data.
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