impact of payer mix on performance on specific quality ... - apha (final).pdfhannah sevcik, mph the...
TRANSCRIPT
![Page 1: Impact of Payer Mix on Performance on Specific Quality ... - APHA (FINAL).pdfHannah Sevcik, MPH The following personal financial relationships with commercial interests relevant to](https://reader033.vdocuments.us/reader033/viewer/2022042003/5e6e92518891022319573534/html5/thumbnails/1.jpg)
Population Health
Impact of Payer Mix on Performance on Specific Quality Measures in an
Advanced Primary Care Setting
Hannah Sevcik, MPH, PCMH CCE
Transformation Manager
Maimonides Medical Center, Population Health
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APHA 2019 Annual Meeting & Expo· Philadelphia, PA· November 5, 2019
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Population Health
Presenter Disclosures
Hannah Sevcik, MPH
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose
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Population Health
Problem/Gap Analysis
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Inefficient Healthcare System
• Delivery of care
• Payment system
Triple Aim
• Improve population health outcomes
• Lower healthcare costs
• Improve quality of care
Previous Research
• Limited high-quality research on success of payment and delivery system reform
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Population Health 4
• New York State initiatives to improve health of Medicaid population • Maimonides Medical Center’s participation in the Delivery System
Reform Incentive Payment (DSRIP) program as Community Care of Brooklyn
• Changing physician behavior in the primary care setting through monetary incentives
• Advanced Primary Care / New York State PCMH program
Background
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Population Health
Research Question
Are primary care practices with a higher proportion of Medicaid patients achieving
better performance on process measures?
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Population Health
• Data source: NYS PCMH practice scorecard• n = 17
• Dependent variable: clinical quality measures• 16 process measures (HEDIS)
• Independent variable: payer mix• High vs. low Medicaid volume
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Project Description
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Population Health 7
Prevention
Breast Cancer Screen
Cervical Cancer Screen
Chlamydia Screening in Women (16-20)
Chlamydia Screening in Women (21-24)
Chlamydia Screening in Women (16-24)
Childhood Immunization
Chronic Disease
Comprehensive Diabetes Care –
Eye Exam
Comprehensive Diabetes Care –
HgA1c Test
Comprehensive Diabetes Care –
Nephropathy
Asthma Medication Management 50%
Asthma Medication Management 75%
Behavioral Health/Substance
Use
Antidepressant Medication Management – Effective Acute Phase
Treatment
Antidepressant Medication Management
– Continuation Phase Treatment
Engagement of Alcohol & Other Drug Treatment
Initiation of Alcohol and Other Drug Treatment
Appropriate Use
Use of Imaging Studies for
Low Back Pain
Methods: Dependent Variable(s)
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Population Health 8
Practice characteristics by payer type
50th percentile for Medicaid
patient volume
Practice characteristics by Medicaid
category
Methods: Sample Practice Characteristics
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Population Health 9
HEDIS definition
Comparing mean HEDIS
rates between practices
with low vs. high
Medicaidvolume
Comparison to payer
statewide benchmark for HEDIS
Methods: HEDIS Measures
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Population Health 10
Mann-Whitney U Test (SPSS, Version 25)
Mean rate differences between high and low volume Medicaid practices
Statistical significance,
p < 0.05
Methods: Mann-Whitney U
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Population Health
Results: Sample Practice Characteristics
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Payer Category Scorecard (#) Patients (#)
Medicaid 17 53,131
Medicare 12 5,670
Commercial 17 7,312
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Population Health
Results: Medicaid Category Practice Characteristics
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Medicaid Category Scorecard (#) Patients (#)
High Medicaid 8 43,846
Low Medicaid 9 22,267
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Population Health 14
HEDIS Prevention Measure Mean Rate Comparisons
Results: HEDIS Prevention Measures
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Population Health 15
Results: HEDIS Chronic Disease Measures
HEDIS Chronic Disease Measure Mean Rate Comparisons
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Population Health 16
Results: HEDIS Behavioral Health/Substance Use Measures
HEDIS Behavioral Health/Substance Use Measure Mean Rate Comparisons
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Population Health 17
HEDIS Appropriate Use Measure Mean Rate Comparisons
Results: HEDIS Appropriate Use Measure
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Population Health 18
Results: Mann-Whitney U
Significant Results
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Population Health 20
Selection biasConfounding
factorsPayer data
Practice size Generalizability
Discussion/Limitations
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Population Health 21
Policy Change
• Information sharing & transparency
• Coordination and communication incentives
Future Research
• Differences in payer policy and effects on physician behavior/success in VBP
• Inform policy changes
Public Health Implications
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Population Health
• Additional data is needed to fully address research question
• Primary care practice process measure performance varies across payer categories
• Policy-level differences for value-based payment contracts exist across payer categories and may impact physician behavior
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Conclusion
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Population Health
Contact Information
Hannah Sevcik, MPH, PCMH CCE
Transformation Manager
Maimonides Medical Center, Population Health
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