NQF

Agenda Synopsis

Full Agenda

Measure Index

• NQF #2967: CAHPS at Home and Community-Based Services Experience Measures

• Concurrent Use of Opioids and Benzodiazepines

Full Measure Information

Measure Specifications

• NQF Number (if applicable): 2967
  
  
• Description: The CAHPS Home- and Community-Based Services measures are created using top-box scoring. This refers to the percentage of respondents that give the most positive response. Details regarding the definition of the most positiveresponse are noted below. HCBS service experience is measured in the following areas.
  
  
• Numerator: The denominator for all measures is the number of survey respondents. Individuals eligible for theCAHPS Home- and Community-Based Services survey include Medicaid beneficiaries who are at least 18 years of age in the sampleperiod, and have received HCBS services for 3 months or longer and their proxies. Eligibility is further determined using threecognitive screening items, administered during the interview:Q1. Does someone come into your home to help you? (Yes, No)Q2. How do they help you?Q3. What do you call them?Individuals who are unable to answer these cognitive screening items are excluded. Some measures also have topic-specificscreening items as well.
  
  
• Denominator: Individuals less than 18 years of age and individuals that have not received HCBS services for at least3 months should be excluded. During survey administration, additional exclusions include individuals that failed any of the cognitivescreening items mentioned in the denominator statement below. There were 227 beneficiaries excluded due to not passing thecognitive screener (53 Aged/Disabled, 59 ID/DD, 25 TBI, and 90 SMI). Allowing proxy respondents in future administrations has thepotential to further reduce these numbers.
  
  
• Exclusions: Individuals less than 18 years of age and individuals that have not received HCBS services for at least 3 months should be excluded. During survey administration, additional exclusions include individuals that failed any of the cognitive screening items mentioned in the denominator statement below. There were 227 beneficiaries excluded due to not passing the cognitive screener (53 Aged/Disabled, 59 ID/DD, 25 TBI, and 90 SMI). Allowing proxy respondents in future administrations has the potential to further reduce these numbers.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Outcome: PRO
  
  
• Data Source: Patient Reported Data
  
  
• Level of analysis: Other
  
  
• Care Setting: Other; Home and Community-Based Services Program
  
  
• Use in Federal Programs: Voluntary in 8 state Medicaid programs
  
  
• Steward: AHRQ & CMS; CAHPS trademarked
  
  
• NQF Staff Notes: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: www.qualityforum.org
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure focuses on people who are elderly with disabilities, individuals with physical disabilities, persons withintellectual/developmental disability, individuals with brain injury, and those with serious mental illness who receive Medicaid funded home and community-based services. This new PRO-PM is a package of 19 different measures calculated from data from a newly developed experience-of-care survey focusing on HCBS programs.The unit of analysis is the Medicaid HCBS program, and the accountable entity is the operating entity responsible for managing and overseeing a specific HCBS program within a given state. The measures consist of seven scale measures, 6 global rating and recommendation measures and 6 individual measures
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; This measure is an Outcome: PRO. The survey may be administered in-person and over the phone, and is available in english and spanish. Survey implementers will need to be thoroughly trained on skip patterns, etc. Could pose reporting burden: The developer estimates 30 minutes is needed to complete the survey, as compared to 20 minutes for Nursing Home CAHPS. They noted that the average response includes 51 out of 96 items (due to skip patterns) which would indicate an expected response time of around 13 minutes. This measure is not used in federal reporting programs
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; Long-term supports and services - Home and community-based services
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; When evaluated for endorsement, the measure passed the use and usability criterion. This measure is not currently in use. It is expected that state Medicaid programs (HCBS programs) will voluntarily begin using the survey within the next few years. The survey was developed with CAHPS principles and was recently approved by AHRQ and the CAHPS Consortium for a CAHPS trademark.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; This measure passed the NQF Feasibility criterion when being evaluated against the NQF endorsement criteria. The data source for this measure is patient reported data. The measures are scored at the state program level (Medicaid programs including both fee-for-service and Managed Long Term Services and Supports programs), and the developer noted there are 3-11 programs per state. Multiple versions of the measure do not exist.Level of Analysis: HCBS Program Setting of Care: Other: Home and Community-Based Services Program Data Source: Patient Reported Data/SurveyAdjustment/Stratification: Statistical risk model The developer did not identify unintended consequences.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: NQF #2967
  
  
• Duals sensitive?: Yes; CAHPS Home- and Community-Based Services measures are derived from a cross disability survey. It addresses a broad population as it seeks to elicit feedback from adult Medicaid beneficiaries receiving home and community based services (HCBS) about the quality of the long-term services and supports they receive in the community and delivered to them under the auspices of a state Medicaid HCBS program.
  
  
• Both Medicaid Adult and Child sensitive?: No; Individuals eligible for the CAHPS Home- and Community-Based Services survey include Medicaid beneficiaries who are at least 18 years of age in the sample period
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2015 annual meeting.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: When being evaluated by the PFCC SC, Committee members noted that the quality of these services is tremendously important to the disability community, and that the measures in this survey could be very useful for states as they assess whether their programs are meeting goals and are effective.
  
  
• Lead Discussant: Clarke Ross
  
  

Measure Specifications

• NQF Number (if applicable): N/A
  
  
• Description: The number of individuals from the denominator with:- 2 or more prescription claims for any benzodiazepine (Table COB-B:Benzodiazepines) filled on 2 or more separate days, AND- Concurrent use of opioids and benzodiazepines for 30 or more cumulative days.Concurrent use is identified using the dates of service and days supply of an individual’s opioid and benzodiazepine prescription drug claims. The days of concurrent use is the sum of the number of days during the treatment period with overlapping days supply for an opioid and a benzodiazepine.
  
  
• Numerator: The number of individuals from the eligible population with 2 or more prescription claims for any opioid (see Table COB-A: Opioids) filled on 2 or more separate days, for which the sum of the days supply is 15 or more days during the measurement period.
  
  
• Denominator: Hospice: Any patient with a hospice indicator from the enrollment database during the measurement year is excluded from the denominator.Cancer diagnosis: Any patient with a cancer diagnosis during the measurement year is excluded from the denominator.Commercial, Medicaid, or Medicare data (if available):? ICD-9 or ICD-10 codes, based on the American Medical Association-convenedPhysician Consortium for Performance Improvement Cancer value set (OID: 2.16.840.1.113883.3.526.3.1010).Available at: https://vsac.nlm.nih.gov/See ICD-9 and/or ICD-10 diagnosis codes in the excel file, ICD Codes Measure Manual, tab COB- Table Cancer Exclusion? A cancer diagnosis is defined as having at least one claim with any of the listed cancer diagnoses, including primary diagnosis or any other diagnosis fields during the measurement year.Medicare Data (if ICD codes not available)? RxHCCs 8, 9, 10, 11 for Payment Year 2015; orRxHCCs 15, 16, 17, 18, 19 for Payment Year 2016 Available at: https://www.cms.gov/Medicare/Health- Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html)
  
  
• Exclusions: Information not provided
  
  
• Endorsement Status: Not Endorsed
  
  
• Endorsement Status Notes: N/A
  
  
• Measure Type: Intermediate Outcome
  
  
• Data Source: Administrative claims
  
  
• Level of analysis: Health Plan
  
  
• Care Setting: Pharmacy
  
  
• Use in Federal Programs: N/A
  
  
• Steward: Pharmacy Quality Alliance (PQA)
  
  
• NQF Staff Notes: N/A
  
  

Summary of NQF Endorsement Review

• QPS Link: N/A
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; This measure examines the percentage of individuals 18 years and older with concurrent use of prescription opioids and benzodiazepines. There is evidence that concurrent use of opioids and benzodiazepines has an unfavorable balance of benefit versus harm for most individuals. The measure one-pager cites several studies and the CDC Guideline for Prescribing Opioids for Chronic Pain.
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No; This is a new measure, just finalized by PQAMeasure Type: Intermediate Outcome
  
  
• Does the measure address a quality challenge and or a specific gap area?: Yes; New chronic opiate use (45 days); Polypharmacy
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: No additional resources are required to implement this measure. Currently, this measure is not used in any programs.
  
  
• Can the measure can be feasibly reported? Are there multiple versions of the measure? Which format is being considered and why? : Yes; The data sources for this measure are administrative claims: Medical claims, Pharmacy claims, Prescription Drug Hierarchical Condition Categories (RxHCCs). The level of analysis is health plan. This measure has been stratified: Commercial, Medicaid, Medicare and Low-income subsidy (LIS) population (report rates for LIS population and non-LIS population separately. The care setting is pharmacy. Multiple versions of this measure do not exist.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: No
  
  
• Duals sensitive?: Yes; This measure reaches a broad population, uses pharmacy claims data, and addresses substance use/abuse (a growing issue in the duals population).
  
  
• Both Medicaid Adult and Child sensitive?: No; This measure is specified for individuals 18 years and older
  
  
• Summary: What is the potential value to the program measure set?: This measure addresses a critical gap area identified by TF members during the 2015 annual meeting.
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure could potentially limit/eliminate the harmful practice of prescribing opioids and benzodiazepines concurrently.
  
  
• Lead Discussant: Marissa Schlaifer
  
  

Gap Area Index

• Access to primary, specialty, and behavioral healthcare* 
  
  
• Behavioral health and integration with primary care* 
  
  
• Beneficiary-reported outcomes 
  
  
• Care coordination* 
  
  
• Efficiency* 
  
  
• Long-term supports and services* 
  
  
• Maternal/Reproductive health* 
  
  
• Promotion of wellness* 
  
  
• Treatment outcomes for behavioral health conditions and substance use disorders* 
  
  
• Workforce* 
  
  
• New chronic opiate use (45 days) 
  
  
• Polypharmacy* 
  
  
• Engagement and activation in healthcare* 
  
  
• Trauma-informed care* 
  
  

Web Meeting Comments

• Hi, this is (Sean Currigan) from ACOG. I would invite the MAP to discuss removing also postpartum care rates from adult. We agree with slide 573 on frequency of ongoing prenatal care from child, and also removing behavioral health with assessment from child. Some things that we would like you to consider adding are the use of opioid measures, 2940, 2951, 2950, the contraceptive care measures that were discussed last year, 2903, 2904, 0716, unexpected complications in term new born to the child set. And then, we wanted to make note of the screening for clinical depression and follow-up plans. CMS' specification for 2018 for MIPS includes postpartum or perinatal depression screening, the measure that went to the behavioral health panel a month ago or couple of weeks ago, did not include the expanded denominator to include pregnant women. So, we'd like you to kind of figure out how to consider the 2018 stratification of the eMeasure and the regular measure for screening for clinical depression and follow-up plan for the adult sets. Thanks. (Submitted by: Sean Currigan)
  
  

Navigating the Discussion Guide

• How do I get back to the section I was just looking at?
  The easiest way is to use the back button on your browser. Other options are using your backspace button (which works for many browsers on laptops), or using the permanent links at the upper right hand corner of the discussion guide. But the back button is the best choice in most situations.
  
  
• Can I print the discussion guide out?
  You can, but we don't recommend it. Besides using a lot of paper (probably a couple hundred pages at least), you'll lose all the links that allow you to move around the document. For instance, if you're scrolling through the agenda and want to see more information about a particular measure, the electronic format will allow you to click a link, read more, and then go back. If you're on paper, there will be a lot of flipping through paper.
  
  
• How do I know that I'm looking at the most recent version?
  At the top left corner of the discussion guide is a version number. At the beginning of the in person meeting, the NQF staff will ask everyone to load the most recent discussion guide version and will check that everyone has the same version loaded.
  
  
• What electronic devices can I use to view the discussion guide?
  We tried to make this as universal as possible, so it should work on your laptop (PC, Mac, Linux), your tablet (iPad, Android), or your phone (iPhone, Android). It should also work on many types of browsers (IE, Firefox, Chrome, Safari, Opera, Dolphin,....). Please let us know if you have any problems, and we'll troubleshoot with you (and improve the discussion guide for the next go around).
  
  
• Why do I see weird characters in some places?
  Because we're joining data from many different sources, we do find some technical challenges. This generally shows up as strange characters--extra question marks, accented characters, or otherwise unusual items. We've been able to fix many of these problems, but not all. We ask that you bear with us as we improve this over time!
  
  

Content