Join us tomorrow, August 10, 2023, for an overview of the MY 2022 preliminary AMP results. We’ll dive into performance insights, how to review your results using Onpoint’s Performance Reporting Portal (PRP), and what to do if you have questions or appeals. If you aren’t able to attend, the session will be recorded and made available on our website.
We recommend that you complete Onpoint PRP account set-up prior to the preliminary results release on August 10. This will allow you more time to review your results during the questions and appeals period. Your organization’s admin has the ability to edit, remove, and add new users. View further instructions on how PRP admins can edit contacts on the portal.
For additional questions about PRP account set-up, please contact amp@iha.org.
Preliminary MY 2022 results will be released via the Onpoint Performance Reporting Portal (PRP) on August 10. The PRP will also include refreshed MY 2021 results. Historical AMP results will remain available in the AMP Analytics Portal.
MY 2022 questions and appeals
The MY 2022 questions and appeals period will begin on August 10 and end on September 1 for FinThrive-generated results and September 8 for Onpoint and PBGH-generated results. This allows provider organizations and health plans to review their MY 2022 preliminary results and check for possible errors. We encourage you to submit questions or appeals early to give IHA and partners enough time to thoroughly investigate your submission.
What can be appealed?
Health plans and provider organizations can submit questions or appeals for the following results:
MY 2022 FinThrive, PBGH, and Onpoint generated measures*
Clinical Quality (CQM)
Patient Experience
Appropriate Resource Use (ARU)
Total Cost of Care (TCOC)
Encounter Measures (ENFMT & ENLAG)
MY 2021 Onpoint-generated results if you are also submitting questions and appeals about your MY 2022 Onpoint-generated results
Note: Any changes to MY 2021 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.
*Since testing measures are not considered to be fully adopted into the AMP program, their measure results are not eligible for appeals. However, we highly encourage you to submit any questions about your testing measure results, as your questions may be reviewed when our technical committees vet these measures.
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.
Email the identified information using our Submission Form to appeals@iha.org by September 1, 2023, 5 p.m. PDT for any FinThrive-generated measures and September 8, 2023, 5 p.m. PDT for any PBGH and Onpoint-generated measures.
Important dates for MY 2022 results
August 10: Preliminary MY 2022 results released to participants.
August 10 – September 1: Questions and appeals submission period for FinThrive (formerly TransUnion) pipeline. Please note the shorter timeframe due to the complexities of the FinThrive pipeline.
August 10 – September 8: Questions and appeals submission period for Onpoint and PBGH pipelines.
September 8: If the questions and appeals period results in necessary resubmissions via the FinThrive pipeline, health plans must resubmit FinThrive results to their auditor by September 8. FinThrive must receive auditor-locked resubmissions by September 15.
September 14: If the questions and appeals period results in necessary resubmissions via the Onpoint pipeline, health plans must resubmit to Onpoint by September 14 and files must be in passing status by September 21.
September 15: Last day to finalize any communications and documentation related to questions and appeals.
September 20: Appeals hearing.
September 27: Appeals decisions communicated to participants.
End of October: Final MY 2022 results released to participants.
In other news
CDII Medical Group Report Card, 2022-23 Edition now available
The Center for Data Insights and Innovation’s Office of the Patient Advocate has released the latest edition of its Medical Group Report Cards. These report cards utilize AMP Commercial HMO and Medicare Advantage performance results from MY 2021 AMP data.
Did you know? Patients benefit from better care and lower out-of-pocket costs when plans and providers share in the financial risk.
Financial risk sharing is moving the needle on healthcare quality in California! New results from our California Healthcare Cost & Quality Atlas are now available. The 2021 results show that better care and lower out-of-pocket costs typically result when plans and providers share in the financial risk through capitation arrangements compared to fee-for-service models:
At least 6 percentage points higher on average clinical quality
Roughly $400 savings in out-of-pocket costs for patients
Covering 16 million Californians, the Atlas is a publicly available web tool that allows you to explore year-over-year trends, as well as performance across insurance type, regions, and provider risk sharing categories.
This newsletter is a part of our 2023 Stakeholders’ Series. Through this channel you’ll get industry, program, and IHA-wide insights, in a more tailored and timely way.
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