what are cms display measures

(J) A confidence interval estimate for the true error rate for the contract is calculated using a Score Interval (Wilson Score Interval) at a confidence level of 95 percent and an associated z of 1.959964 for a contract that is subject to a possible reduction. (f) Improvement measure. First examine your performance within your own contract(s) by calculating the differences between your SRF Group (e.g., LIS/DE members) vs non-SRF Group measure performance. lock (2) In advance of the measurement period, CMS will announce potential new measures and solicit feedback through the process described for changes in and adoption of payment and risk adjustment policies in section 1853(b) of the Act and then subsequently will propose and finalize new measures through rulemaking.

The. Health plans may choose to prioritize specific measures for health equity initiatives based on the level of disparity identified from these measure level differences. The following state regulations pages link to this page. (3) Special rules for calculation of the improvement score.

means youve safely connected to the .gov website. Prioritize Health Equity projects based on measures that rate a lower status in combination of both LIS/DE and Disability scoring. is responsible for overseeing the development and delivery of clinical services for all Mosaic members, RxAntes high-touch pharmacy service.

%%EOF (1) Non-substantive updates. As promised, the Centers for Medicare & Medicaid Services (CMS) released stratified results for Star Ratings measures in an effort to encourage Medicare Advantage (MA) plans to address potential health disparities for enrollees with social risk factors (SRF). CMS identifies measures to be used in the improvement measure if the measures meet all the following: (i) CMS will include only measures available for the current and previous year in the improvement measures and that have numeric value scores in both the current and prior year. Health plans can quickly identify potential disparities by comparing the differences in measure performance for members identified with a SRF (e.g., members with a disability) versus those members who do not have that SRF. (1) A Part D plan sponsor may request that CMS or the IRE review its' contract's appeals data provided that the request is received by the annual deadline set by CMS for the applicable Star Ratings year. (iii) The net improvement per measure category (outcome, access, patient experience, process) would be calculated by finding the difference between the weighted number of significantly improved measures and significantly declined measures, using the measure weights associated with each measure category. Drawing attention to this issue can present an opportunity for more prescriber communication from health plans and patient education to reduce the frequency of polypharmacy among these medications.

(2) CMS will announce in advance of the measurement period the removal of a measure based upon its application of this paragraph (e) through the process described for changes in and adoption of payment and risk adjustment policies in section 1853(b) of the Act in advance of the measurement period. [1]Chartbook on Long-term Trends in Health, [2]Concurrent Use of Opioids with Other Central Nervous System-Active Medications Among Older Adults, by CMS tests updates to PQA-endorsed measure specifications and drug-code lists and implements them as appropriate. CMS would like to make any performance gaps between stratified groups within individual MA contracts publicly reportable. (2) A Part D plan sponsor may request that CMS review its' contract's Complaints Tracking Module (CTM) data provided that the request is received by the annual deadline set by CMS for the applicable Star Ratings year. .gov HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

These measures are available on www.cms.gov., MA-PD contracts are rated on a total of 9 topic areas (domains) that cover both health and drug issues, MA-only contracts are measured on 5 topic areas, and Part D contracts are rated on 4 topic areas.

423.184 Adding, updating, and removing measures. The addition of these measures is meant to address concerns around patient safety. In the, , the regulatory body proposed including this stratified reporting as part of the display measures on. These specific polypharmacy measures seek to minimize use of the targeted medicationsspecifically by looking to keep overlap of medications under a thirty day period and avoid members qualifying for any of these measures. hb```">.B website belongs to an official government organization in the United States.

Although the methodology is still in development by CMS, this new index will likely compare a contracts performance on each measure by each SRF to national performance. ) By closing this message, clicking below or continuing to use this site, you consent to our use of cookies.

2022 Healthmine, Inc. All rights reserved. Read our last post on this topic here. https:// We will be making polypharmacy data available for all clients on the RxAnte Client Portal and we are adding a polypharmacy tile for those clients who have RxEffect. 1169 0 obj <> endobj 1200 0 obj <>/Filter/FlateDecode/ID[]/Index[1169 86]/Info 1168 0 R/Length 141/Prev 412016/Root 1170 0 R/Size 1255/Type/XRef/W[1 3 1]>>stream (3) New measures added to the Part D Star Ratings program will be on the display page on www.cms.gov for a minimum of 2 years prior to becoming a Star Ratings measure. ( There is a strong push among physicians to transition to care models that incentivize fewer, more effective treatments.

Sign up to get the latest information about your choice of CMS topics. CMS is still considering what other data are available and what other SRFs might be appropriate to include over time. A member that qualifies for any of these polypharmacy measures would have thirty or more days of overlap in the targeted medications, which is meant to be avoided due to their associated health risks. Secure .gov websites use HTTPSA You can decide how often to receive updates.

CMS will announce non-substantive updates to measures that occur (or are announced by the measure steward) during or in advance of the measurement period through the process described for changes in and adoption of payment and risk adjustment policies in section 1853(b) of the Act. Through this data, CMS has provided MA plans with the ability to identify within-contract differences in performance between subgroups for Star measures. (M) CMS reduces the measure rating to 1 star for the applicable appeals measure(s) if a contract fails to submit Timeliness Monitoring Project data for CMS's review to ensure the completeness of the contract's IRE data. CMS also assigns a Star Rating for each of the domains, a Part C and/or Part D summary rating, and an overall rating that summarizes performance on all measures for each contract.

CMS will calculate an improvement score only for contracts that have numeric measure scores for both years in at least half of the measures identified for use applying the standards in paragraphs (f)(1)(i) through (iii) of this section. 423.184 Adding, updating, and removing measures. An official website of the United States government

To learn how RxAnte and Mosaic can improve medication use within your member population, contact us today.

If you need help, please contact me at [emailprotected] for more information. With the increasing prevalence of this issue among medically complex seniorsas many as 4 in 10 seniors now take 5 or more prescriptions, a 300% increase since 2000[1]it is no surprise CMS is including three polypharmacy-related display measures for the 2022 quality measure performance year. Every member of our team has weathered seasons of significant change, and established strategies for 4+ star success even during the most tumultuous periods of industry change. (B) The determination of the Part C appeals measure IRE data reduction is done independently of the Part D appeals measure IRE data reduction. Prioritize those areas with the largest disparities. (I) Contracts are subject to a possible reduction due to lack of IRE data completeness if both of the following conditions are met: (1) The calculated error rate is 20 percent or more; and. b`sd0Q>@ v8I endstream endobj 1170 0 obj <>/Metadata 592 0 R/Pages 1167 0 R/StructTreeRoot 708 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1171 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/Shading<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1172 0 obj <>stream

endstream endobj 4921 0 obj <. (1) CMS will remove a measure from the Star Ratings program as follows: (i) When the clinical guidelines associated with the specifications of the measure change such that the specifications are no longer believed to align with positive health outcomes, or.

Each year, CMS conducts a comprehensive review of the measures that make up the Star Ratings, taking into consideration the reliability of the measures, clinical recommendations, feedback received from stakeholders, and data issues.

The value of the constant will be 1.0 for contracts that submitted 3 months of data; 1.5 for contracts that submitted 2 months of data; and 3.0 for contracts that submitted 1 month of data. We are exploring the feasibility of developing a health equity index that would summarize performance among those with SRFs across multiple measures into a single score. CMS is still considering what other data are available and what other SRFs might be appropriate to, CMS has provided this data so that it may be used by contracts to inform and target their quality improvement efforts. CMS is committed to continuing to improve the Parts C and D quality and performance measurement system to increase the focus on improving beneficiary outcomes, beneficiary experience, population health, and efficiency of health care delivery. (1) Identifying eligible measures. more updates to come soon when CMS next provides the stratified CAHPS measure data. %PDF-1.6 % Optimizing Health by Advancing the Quality of Medication Use, Copyright 2022 Pharmacy Quality Alliance |Terms |Privacy, 5911 Kingstowne Village Parkway Suite 130 Alexandria, VA, USA 22315 703.347.7963, Social Determinants of Health Resource Guide, Call Center - Foreign Language Interpreter and TTY Availability, Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension (RAS antagonists), Medication Adherence for Cholesterol (Statins), Antipsychotic Use in Persons with Dementia, Concurrent Use of Opioids and Benzodiazepines, Use of Opioids at High Dosage in Persons Without Cancer, Use of Opioids from Multiple Providers in Persons Without Cancer, Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults, Polypharmacy Use of Multiple Central Nervous System-Active Medications in Older Adults, Initial Opioid Prescribing for Long Duration, Use of Opioids at High Dosage in Persons without Cancer, Use of Opioids from Multiple Providers in Persons without Cancer, Polypharmacy Use of Multiple Anticholinergic (ACH) Medications in Older Adults, Polypharmacy Use of Multiple Central Nervous System (CNS)-Active Medications in Older Adults. This page contains performance data related to the Part C & D programs.

(ii) Each contract's improvement change score per measure will be categorized as a significant change or not a significant change by employing a two-tailed t-test with a level of significance of 0.05. 0

To learn more about the display measures and their significance to health plans and plan members, we turned to Tori Erxleben Rush, PharmD and Product Director at RxAnte, who manages clinical programs, user training, and RxAntes Client Portal. lock As a significant methodological change to Star Ratings, CMS is developing a single score Health Equity Index (HEI) to potentially replace the current reward factor as an incentive for health plans to address health care disparities for at-risk beneficiaries. 4920 0 obj <> endobj

Digital quality management is the new normal for health plans, and Dwight Pattison has broken down what that means for your current strategies and operations.

This same perspective should also be held in pharmacy. hbbd```b``akA$%Xd6dbe`X,,r, f_k0yDV[I vS _"A8^FO 0 E

CMS reviews the quality of the data on which performance, scoring and rating of a measure is based before using the data to score and rate performance or in calculating a Star Rating. For measures that are already used for Star Ratings, CMS will update measures so long as the changes in a measure are not substantive. (H) The projected number of cases not forwarded to the IRE in a 3-month period is calculated by multiplying the number of cases found not to be forwarded to the IRE based on the TMP or audit data by a constant determined by the data collection or data sample time period.

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based on the level of disparity identified from these measure level differences. (vi) The Part D improvement measure cut points for MA-PDs and PDPs will be determined using separate clustering algorithms in accordance with 422.166(a)(2)(iii) and 423.186(a)(2)(iii). :hhO Share sensitive information only on official, secure websites. Federal News Network: Why services contractors hav, CMS awards $500M Data Analytics Supporting Healthc, Centers for Medicare & Medicaid Services Xtra, Nextgov: Federal Agencies Invest More Each Year in Cloud as Benefits Outweigh Challenges, Nextgov: White House Advocates Cloud Investment as a Path to Artificial Intelligence, Analytica seeking Director Federal Health IT, Centers for Medicare & Medicaid News Xtra. lock

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(F) The scaled reduction is applied after the calculation for the appeals measure-level Star Ratings. https:// You can learn more about how we use cookies and how to change your cookies settings in our Privacy Policy. Addressing the New Polypharmacy Display Measures, Concurrent Use of Opioids with Other Central Nervous System-Active Medications Among Older Adults. For instance, concurrent use of benzodiazepines and opioids is associated with increased risks of falls and confusion[2].

National performance scores are provided for comparison in the stratified data tables. Learn how incentivized digital HRAs can help. (ii) For the appeals measures, CMS will use statistical criteria to estimate the percentage of missing data for each contract (using data from multiple sources such as a timeliness monitoring study or audit information) to scale the star reductions to determine whether the data at the independent review entity (IRE) are complete.

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