Frequently Asked Questions:
AMP Commercial HMO Program Updated Results for Measurement Year 2018
Why is IHA updating the measurement year (MY) 2018 Commercial HMO Appropriate Resource Use & Total Cost of Care Results?
Health Net, Sharp and Western Health Advantage were not able to submit their data in time for the MY 2018 final results release on October 21, 2019. With guidance from our Governance Committee, we released the MY18 final results without data from these health plans. These MY18 results were used for awards, public reporting and health plan incentive payments in 2019.
Since then, IHA worked with the impacted health plans to collect MY18 data and have incorporated it into the MY18 final results. That way, health plans can use the results for trending and for MY19 incentive payments, which require 2 years of data.
Which results did IHA update?
We have updated MY 2018 HMO results for measures in the following domains:
- Appropriate Resource Use (ARU)
- ED Visits
- Frequency of Selected Procedures
- Generic Prescribing
- Inpatient Utilization
- Total Cost of Care (TCOC)
- Total Cost of Care including service categories
- Clinical Quality: Behavioral Health & Substance Use
- Concurrent Use of Opioids and Benzodiazepines
- Use of Opioids at High Dosage
How does the update impact physician organizations?
If you had a commercial HMO contract with Health Net, Sharp, and/or Western Health Advantage last year, you will get two sets of results:
- Your preliminary MY18 and updated all-plan aggregated results for specified measures
- Your preliminary MY19 clinical quality results
You will need to review BOTH SETS of results during the questions and appeals period.
All POs will see a small shift in risk-adjusted utilization and cost results. The change should be minimal and should not have any impact on your relative comparison to other physician organizations for MY 2018.
Will this update change my comparative PO ranking for MY18?
No. For risk adjusted measures, IHA normalizes the results to the AMP Commercial HMO population in order to create relative results for PO comparison. This data update will shift all physician organization results the same relative amount and will not change any ranking results.
Does this impact awards, public reporting, and incentive payments made to physician organizations in 2019?
No. There is NO CHANGE to 2019 incentive payments, awards, or public reporting made based on MY 2018 data (released on 10/21/19).
Questions & Appeals Period
Who can submit questions and appeals for updated MY 2018 Commercial HMO results?
Physician organizations with commercial HMO contracts Health Net, Sharp, and/or Western Health Advantage in MY 2018 will have a chance to submit questions and appeals for their MY 2018 Commercial HMO ARU, Cost, and Behavioral Health & Substance Use (COB & UOD) results during this Questions & Appeals period. All other participant results have been finalized as part of MY 2018 HMO Reports Release on October 21, 2019.