This release includes reports for the following AMP product lines:
Preliminary Commercial HMO & Medicare Advantage: Appropriate resource use, total cost of care, behavioral health & substance abuse, encounter, and statin use measure results
Preliminary Commercial ACO & Medi-Cal Managed Care: Quality, patient experience, appropriate resource use, total cost of care, and encounter measure results
MY 2020 preliminary Onpoint-generated results webinar
Come learn more about the MY 2020 preliminary Onpoint-generated results release at our webinar! The session will be recorded and made available for those who can’t join live.
This release kicks off the beginning of a 15-business day participant Questions and Appeals Period. You can submit questions and/or appeals at any time until September 8, 2021 at 5:00 p.m., but we recommend you submit early to allow ample time for investigation and follow up.
Who can submit an appeal?
Health plan and provider organizations can submit questions or appeals for the following MY 2020 results:
Appropriate Resource Use (ARU)
Total Cost of Care (TCOC)
Behavioral Health & Substance Use (COB & HDO)
Encounter Measures (ENFMT & ENLAG)
Statin Use (SUPD for Medicare Advantage only)
Starting this year, you can also submit questions and appeals for:
Medi-Cal and Commercial ACO quality results, as well as Medi-Cal patient experience results
MY 2019 Onpoint-generated results if you are also submitting questions and appeals about your MY 2020 Onpoint-generated results
Note: Any changes to MY 2019 results because of questions and appeals will inform trending but will not impact previous year public recognition awards, public reporting, or health plan incentive payments.
Identify the organization name and ID, measure rates in question and applicable product lines and health plans, as well as any rationale and documentation to substantiate the claim
Easily find and share the latest IHA program information. Visit the News & Events section of the IHA website for past issues of our newsletter.
in other news
MY 2020 results available on Onpoint Member-Level Detail Portal Aug. 20
The Onpoint Member-Level Detail Portal will help you better understand your preliminary Onpoint-generated results by allowing you to see which patients fell into the numerator and denominator for each utilization measure for AMP Commercial HMO, Medicare Advantage, and Medi-Cal Managed Care Programs. Any questions and/or appeals for this data should be submitted during the Questions and Appeals Period that runs from now through September 8. Need access? Email amp@iha.org.
AMP Participant Spotlight
MemorialCare Medical Group
As MemorialCare Medical Group’s Medical Director for Performance Improvement, pediatrician Marnie Baker, M.D., MPH, oversees the organization’s quality improvement and incentive programs, including AMP. The organization prioritizes the quality measures that have the most overlap and impact across its various lines of business. “We try to have a good balance of screening and outcomes measures, including breast and colorectal cancer screening, childhood immunizations, and controlling high blood pressure,” says Dr. Baker. “IHA has done a good job of developing a measure set strategy that looks out five years and creates stability and alignment with standardized measures.”
When it comes to benchmarking and performance improvement, a culture of transparency runs deep at MemorialCare. Physicians receive transparent monthly AMP benchmarking reports to see how they’re performing on key measures. “AMP has created a sense of collaborative competition, where providers strive to improve because their peers are focused on improvement,” says Dr. Baker. “Looking at trending history and seeing year-over-year improvement in quality measures has been an enormous benefit.”
At the end of the day, Dr. Baker says the organization’s participation in AMP is helping to improve patient care. “AMP’s transparency and incentive design has made us look at things that maybe we weren’t considering before,” she says. For example, when AMP added the generic prescribing quality measure, MemorialCare built reports so physicians could see their performance on the measure. As a result, the organization saw rapid improvements in generic prescribing rates and utilization.
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