1. 1 SNP Educational Session – January 13, 2014 Model of Care Scoring Guidelines SNP Educational Session - January 13, 2014 Brett Kay, AVP, SNP Assessment, NCQA

2. 2 SNP Educational Session – January 13, 2014 2 Objectives of SNP MOC Scoring Guidelines Raise the bar and strengthen the guidelines Modeled after S&P measures format – Familiar to the SNPs – SNPs have publicly requested such a change – Supports consistent scoring of MOCs

3. 3 SNP Educational Session – January 13, 2014 3 Used revised Appendix 1 of the MA application Model of Care Matrix Upload Document—kept requirements intact, but revised formatting MOC Scoring Guidelines

4. 4 SNP Educational Session – January 13, 2014 4 Scoring will be similar to previous years MOC elements worth 0-4 points, based on # of factors met Total of 60 points (15 elements) Converted to percentage scores – E.g., 50 points = 83.33% (2-year approval) How will NCQA Score the MOC?

5. 5 SNP Educational Session – January 13, 2014 5 Scoring Previous MOC Scoring Guidelines ElementMaximum Score MOC 1: SNP-specific Population4 MOC 2: Measurable Goals12 MOC 3: Staff Structure/roles12 MOC 4: ICT12 MOC 5: Provider Network20 MOC 6: MOC Training16 MOC 7: HRA16 MOC 8: ICP20 MOC 9: Communication Network16 MOC 10: Vulnerable Populations8 MOC 11: Outcome Measurement24 Total160 New MOC Scoring Guidelines ElementMaximum Score MOC 1: SNP Population8 MOC 2: Care Coordination20 MOC 3: Provider Network12 MOC 4: Quality Measurement20 Total60

6. 6 SNP Educational Session – January 13, 2014 6 NCQA held a two week public comment period to solicit comments on the draft scoring guidelines Received input from stakeholders – 222 comments – Health plans, trade associations, provider groups, others Used feedback to revise guidelines and clarify expectations Public Comment Process

7. 7 SNP Educational Session – January 13, 2014 7 MOC Audit Issues—requests for clarification/interpretation of requirements; reaction to CMS’ review of MOC during the audit cycle Requests for better harmonization & coordination of MOC and S&P measures assessments Redundancy with existing MA requirements Public Comment-Major Themes

8. 8 SNP Educational Session – January 13, 2014 8 Network Model vs. Staff Model—some requirements not feasible/heavy burden for network model SNPs Plan level vs. member-level data and information High risk/stratification for ICP/ICT-focus on high need members Requests for examples, expectations of intent Public Comment-Major Themes

9. 9 SNP Educational Session – January 13, 2014 9 Element A: Overall SNP Population- – Intent: Identify and describe the target population, including health and social factors, and unique characteristics of each SNP type – Response to public comments: Factor 1: Clarify that emphasis is on process, not care coordination Factors 2 & 3: Separated social and medical/health factors MOC 1: Description of SNP Population

10. 10 SNP Educational Session – January 13, 2014 10 Element B: Most Vulnerable Beneficiaries – Intent: Describe the most vulnerable beneficiaries and how their medical and social factors affect health outcomes and what services and resources the SNP provides to address these – Response to public comments: Clarify that focus is on population-level, not individual members MOC 1: Description of SNP Population

11. 11 SNP Educational Session – January 13, 2014 11 Element A: Staff Structure – Intent: Describe administrative and clinical staff roles and responsibilities – Response to public comments: Factor 2: Oversight functions related to license and competency verification relates to specific population being served Factor 4: Contingency plans are developed for plan-level operations Factors 5&6: Clarify that contracted staff do not include contracted network providers MOC 2: Care Coordination

12. 12 SNP Educational Session – January 13, 2014 12 Element B: Health Risk Assessment Tool – Intent: Describe process for using HRAT to inform development of the ICP; communicate HRAT info to ICT; identify and stratify needs of beneficiaries – Response to public comments: Factor 3: Establish that all SNP beneficiaries must receive an HRA Factor 3: SNPs should describe how they address beneficiaries that cannot or will not undergo an HRA MOC 2: Care Coordination

13. 13 SNP Educational Session – January 13, 2014 13 Element C: Individualized Care Plan (ICP) – Intent: Describe essential elements of the ICP, how the SNP develops and updates the ICP – Response to public comments: Clarify that CMS expects an ICP for all SNP beneficiaries but allows flexibility for SNP to determine level of detail for ICPs—may stratify by risk and place priority on high risk/high need beneficiaries MOC 2: Care Coordination

14. 14 SNP Educational Session – January 13, 2014 14 Element D: Interdisciplinary Care Team (ICT) – Intent: Describe the ICT, including key members, roles and responsibilities and how they contribute to improving beneficiary health status. – Response to public comments: Clarify that the ICT may meet “virtually” using various forms of communication and technology (face-to-face is not required) Element E: Care Transition Protocols – Intent: Describe the SNP’s processes to coordinate care transitions and facilitate timely communications across settings and providers – Response to public comments: Factor 2: Delete requirement about providing staff credentials Factor 5: Revise to match AHRQ language on self management MOC 2: Care Coordination

15. 15 SNP Educational Session – January 13, 2014 15 Element A: Specialized Expertise – Intent: Demonstrate how the network is designed to address the needs of the SNP’s target population – Response to public comments: Focus is on plan-level information for the provider network Factor 3: Remove language on credentialing Element B: Use of clinical practice guidelines (CPGs) and Care Transitions Protocols – Intent: Describe how the SNP ensures that beneficiaries receive appropriate, evidence-based care and services – Response to public comments: Population level decision making, not individual clinician level Identify challenges to using CPGs and protocols MOC 3: Provider Network

16. 16 SNP Educational Session – January 13, 2014 16 Element C: Provider Network Training – Intent: Describe how the SNP provides training for its provider network – Response to public comments: SNPs should show how they make training available to all network providers Make providers aware of trainings Offer various training modalities to suit the needs of network providers MOC 3: Provider Network

17. 17 SNP Educational Session – January 13, 2014 17 Element A: Quality Performance Improvement Plan – Intent: Describe how the SNP conducts quality improvement related to its overall MOC – Response to public comments: Plan-level information focusing on goals that measure overall plan performance related to all aspects of the MOC MOC 4: MOC Quality Measurement & Performance Improvement

18. 18 SNP Educational Session – January 13, 2014 18 Element B: Measureable Goals – Intent: Identify and define the measureable goals and health outcomes for the target population, and how the SNP determines if goals are being met – Response to public comments: Plan-level measures and goals for the target population Focus is on health and clinical goals (e.g., controlling diabetes, mental health screening) MOC 4: MOC Quality Measurement & Performance Improvement

19. 19 SNP Educational Session – January 13, 2014 19 Element C: Measuring Patient Experience – Intent: Describe how the SNP measures beneficiary satisfaction and responds to results – Response to public comments: Plans may use wide variety of patient experience/satisfaction surveys—CAHPS and HOS are acceptable, as are other alternatives Provide details of surveys and methodology for data collection MOC 4: MOC Quality Measurement & Performance Improvement

20. 20 SNP Educational Session – January 13, 2014 20 Element D: Ongoing Performance Improvement Evaluation – Intent: Describe how the SNP uses the results from its performance indicators and measures to support its ongoing quality improvement plan – Response to public comments: Include lessons learned and challenges in obtaining timely data MOC 4: MOC Quality Measurement & Performance Improvement

21. 21 SNP Educational Session – January 13, 2014 21 Element E: Dissemination of SNP Quality Performance – Intent: Describe how the SNP communicates its quality improvement plan and performance to stakeholders – Response to public comments: Detail who receives the information, how often they receive it, and what communication methods are used MOC 4: MOC Quality Measurement & Performance Improvement

22. 22 SNP Educational Session – January 13, 2014 22 QUESTIONS