1PROPRIETARY & CONFIDENTIAL® Marks of the Blue Cross and Blue Shield Association. U10404, 2/16

Joy Simmons, Sr. Program Manager

Casey Lynn White, Strategic Advisor

BQPP 2018 PROGRAM UPDATE

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+ PCMH/PCSP Accreditation: threshold for BQPP worth one third of total points

+ Stronger focus on improving quality outcomes, access, and reducing cost:

worth two thirds of total points

� Quality outcome based scoring (national benchmarks percentiles)

� Added Addressing Social determinants of Health

� Weights of each Section = 100%

Quality- 35%

Cost- 25%

Access- 20%

Patient Experience - 20%

+ Data sharing to move towards population health management

� Actionable reports (Provider Quality Report- PQR)

+ Tracks specific to specialty criteria

+ Best Practice Sharing Forum to support practice transformation

BQPP EVOLUTION: EFFECTIVE JANUARY 2018

PCMH/PCSP(1/3 points) + BQPP Elements(2/3 points) = 100% of points

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THE BQPP WEBSITE- WWW.BCBSNC.COM/BQPP

All practices applying or renewing will follow the 2018 criteria and applicable points: All information will be on the BQPP website by second week of

January

Practices that email or call with questions that can be found on the website will be sent the link to the website criteria.

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ALL TRACKS

Recognitions *Mandatory

+ Adult and Pediatrics:

� NCQA PCMH

� URAC PCMH

� JCAHO PCMH

+ OBGYN

� NCQA PCSP

� URAC PCMH

� JCAHO PCMH

� ACOG Scope

+ Accreditations MUST be current before applying. All practices with expired

accreditations will be removed from BQPP.

+ Practices will be required to give expiration date on application

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PROVIDER QUALITY REPORTS

+ Mandatory Element: Pulling and reviewing the Provider Quality Report (PQR) monthly - no points for mandatory elements

+ This element will be closely tracked and audited at time of application

AND throughout the entire year. Practices must pull PQR each month

before and after BQPP renewal

+ PQR will be first element to be used for scoring quality. Practices that

have a denominator of 20+ will only be scored using the PQR results

� Scorecards will still need to be completely filled out.

� Practices that have lower than 20 denominator on the PQR, the

scorecard will be used.

� We will look at the scorecard first for hybrid (BMI peds only, CBP, Childhood Immunizations and Diabetes HbA1c < 8%) measures to

score.

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PRACTICE QUALITY SCORECARD(S) & PQR

+ Scorecard Categories

� Adult scorecard: FM, IM and GP - practices with Blue Cross of NC patient

populations that are less than 50% Pediatrics

� Pediatrics scorecard: Pediatrics

� OBGYN scorecard: OBGYN

� GYN scorecard: GYN only

� Multispecialty scorecard: only for practices with Blue Cross of NC patient

populations consisting of at least 50% Pediatrics

+ Data comes from practice EHR (all payer population-not only BCBSNC)

+ Fill in a value for numerator and denominator for all measures (if your EHR can

not pull a measure put 0s on the scorecard)

+ 1-year look back or if your EHR can only pull calendar year

+ Denominator has to be at least 20 to score

SCORECARDS MUST BE FULLY COMPLETE AND WILL BE UPLOADED TO THE APPLICATION. INCOMPLETE SCORECARD WILL CAUSE A DELAY IN THE SCORING OF YOUR PRACTICE.

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ADULT TRACK

Quality: Aligned HEDIS/Medicare measures

Points will be only be awarded on the 75th and 90th percentile of HEDIS National Benchmarks

PDSAs will be required for all measures at or below 50th percentile- no points

• Diabetes HbA1c Control < 8%

• Nephropathy TestDiabetes

• Breast cancer

• Colorectal

• Cervical

Cancer Screening

• Controlling High Blood pressure

• Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

• NEW: Med Management Asthma - MMA-rate 75% no points- reporting only

Other

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PEDIATRIC TRACK

Quality: Aligned HEDIS/Medicaid measures

Points will be awarded on percentile of HEDIS National Benchmarks

PQR and Practice Quality Scorecards will be utilized for consistency

Appropriate Testing for Children with Pharyngitis

ADHD 1 & 2

Appropriate Treatment for Children with URI

Childhood Immunizations Combo 10 & 7

WCC_BMI Percentile

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ADDITIONAL PEDIATRIC MEASURES

Quality: Aligned HEDIS/Medicaid measures

Reporting measures only (no points)

Setting baseline and education for 2018- enter value on scorecard for each measure. High probability these will be held accountable in 2019

Well Child Visits in years 3,4,5,6- W34

Well Child Visits in the first 15 months of life- W15

Adolescent Well Visits- AWC

Immunizations for Adolescents- combo 2- IMA includes HPV

Med Management Asthma - MMA- rate 75%.

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MULTISPECIALTY FAMILY MEDICINE/PEDS TRACK

Quality: Aligned HEDIS/Medicaid and Medicare measures

Points will be only be awarded on the 75th and 90th percentile of HEDIS National Benchmarks

PDSAs will be required for all measures at or below 50th percentile- no points

• Diabetes HbA1c Control < 8%

• Nephropathy TestDiabetes

• Breast cancer

• Colorectal

• Cervical

Cancer Screening

• ADHD 1 & 2

• Childhood Immunizations Combo 10 & 7Pediatrics

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OB/GYN TRACK

Quality: Aligned HEDIS/MACRA measures

Points will be only be awarded on the 75th and 90th percentile of HEDIS National Benchmarks

PDSAs will be required for all measures at or below 50th percentile

• Breast

• Colorectal

• Cervical

Cancer Screening

• Chlamydia screening

• Prenatal and Postpartum*OB/GYN only

• New: C-section: measuring for 2018 giving the practices what percentile they are at compared to their peers and region with a 2 year lookback (quarterly report- no points)

Other

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GYN TRACK

Quality: Aligned HEDIS/MACRA measures

Points will be only be awarded on the 75th and 90th percentile of HEDIS National Benchmarks

PDSAs will be required for all measures at or below 50th percentile-no points

• Breast

• Colorectal

• Cervical

Cancer Screening

• Chlamydia screening

• Controlling High Blood PressureOther

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ONLINE APPLICATION

Expected changes to automate components of scoring

+ Quality Scorecard: Will be uploaded to application – practices cannot make

changes to excel sheet and must fully complete all metrics or application will

be delayed

+ Website Verification for the following BQPP elements will require practices to

submit URLs of where detailed information can be found within the practice

website – not just the practice homepage URL

Wrong: www.bcbsnc.com/BQPP

Correct:http://www.bcbsnc.com/content/providers/bqpp/bqpp/index.htm#requirem

ents

+ Advanced Care Team: Name and title of team member, direct URL

+ Addressing Social Determinants of Health: direct URL

+ Co- Management Agreements: Name of practice where C/M agreement exists

– audits for updated copy of agreement will occur, direct URL

+ Access: Number of hours for weekdays, Saturday, Sunday will need to be entered, direct URL for direct provider access, after hours, telehealth etc.

+ Patient Experience: direct URL to functional patient portal, survey etc.

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PATIENT EXPERIENCE

Improving the Patient Experience: Advanced Care Team providers

must see BCBSNC members

Types below must be listed on practice website to receive points with explanation of an Advanced Care Team, individual job function, and

name of each provider:

+ Health Coaching (RN, LPN, MA)

+ PharmD or Pharm Tech

+ LCSW or LPC

+ Psychologist/Psychiatrist

+ Nutritionist/Dietician

+ RN- Triage

+ Case manager/ Care coordinator (MA/RN/LPN)

+ Co-management agreement with Behavioral Health provider – name of

practice required

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* Mandatory: Functioning free Patient Portal for all patients (no points)

• Must be on practice website

Optional points: easily identifiable links to survey or explanation of survey

process (if sent through EMR) must be on practice website

+ Electronic patient satisfaction survey

� Link to Survey Monkey

� Online survey on practice website

� Survey link through EHR

PATIENT EXPERIENCE

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ADDRESSING SOCIAL DETERMINANTS OF HEALTH

Optional points: All items below must be on practice website with detailed information about classes/activities outlined for patients

+ Chronic Disease management program (class or counseling)

+ Prenatal education classes

+ Exercise related activities:

� Track RX program (Family Medicine and Pediatric)

+ Weight-management nutrition for parents - class or counseling

+ Prenatal Education, breast feeding, parenting classes

+ Dental Health: at Well Child visits (Pediatrics and Family Medicine)

� Primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is

deficient in fluoride

� Primary care clinicians apply fluoride varnish to the primary teeth of

all infants and children starting at the age of primary tooth eruption

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ACCESS: PREVENTS UNNECESSARY ED VISITS

After Hours Care

+ Weekdays (Hours after 5 pm and/or before 8 am) – must be posted on website and available for all patients

� Total 4 hours Weekday (lunch hour does not count)

� 7 hours on Weekday

+ Weekend – must be posted on website and available for all patients

� 2 hours Saturday

� 2 hours Sunday

� 4+ hours Saturday

� 4+ hours Sunday

ALL ITEMS BELOW MUST BE ON WEBSITE WITH EXPLANATION

+ Co-Management Agreement with Urgent Care (only for practices with 3 providers or less only)

+ Telehealth: following BCBSNC medical policy

+ Direct Provider Access after hours in real time (not nurse triage or hospital line) OR

+ Direct Messaging through Patient Portal (providers and patients send a secure messages - provider responds directly after hours within 30 minutes )

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HCC CODING EDUCATION

Improving Quality

+ Pulse8 webinars- * Mandatory for any new practices and new providers (including mid-levels) of renewing practices and new practices.

� Optional points for renewing practices with no new providers

� View or read (pdf) two new webinars per provider for before application

submission (1 hour per webinar)

- Live or Recorded- schedule and recorded webinars listed on pdf off BQPP website

- Access through Blue e

- Webinars are updated annually

- The appropriate webinars for your specialty will be highlighted in the

link on the BQPP website under ACA Risk Adjustment Education

- Multiple providers can view the webinars together

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ALL TRACKS

Practice Cost Report- Evaluation of the cost efficiency & utilization metrics of a practice in comparison to peer groups within the same specialty and region

ED visits Specialists ImagingInpatient Admits