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good afternoon today's a chn webinar overview of the new provider profiler reports will now begin before we start we would like to remind everyone to please mute your phone and computer microphone for the entirety of the webinar also as a reminder use the chat box function to type in any questions and all questions will be answered at the end of the webinar I will now turn the presentation over to dr. moon for some introductory remarks I'm Robert moon I'm Deputy Commissioner for health systems without any Medicaid and I appreciate your being on the webinar today we look forward to providing some hopefully useful information to you regarding the provider profiler reports these reports have actually been posted to the web portal or will be posted to the web portal today and you'll be able to access your reports to review as you know we are in the fourth month of the new system called ACH in or Alabama coordinated health network the system replaces the patient first program on the physician side and several separate care coordination programs also physicians have just received your second bonus payment in the new system the first one was in November and the second one was paid about a week ago during the first year of the program you are receiving a bonus simply based on the number of individuals attributed to your practice in the past you were assigned at panel of patients to take care of going forward attribution is what is being used now an attribution is fundamentally different attribution looks back over the past two years to let you know where the patient has gotten most of their care we think this gives the primary care physician a better look at where their patients are actually going for care versus where they thought they were going your list of attributed patients may be smaller or larger than the panels you have in the pan those of you that have been seeing your patients regularly will likely see more attributions those of you who have not seen your patients much will likely see fewer attributions so clearly the incentive is to see the patient many studies have indicated that more primary care results in better health outcomes that we all desire at the present your bonus is solely determined by your attributed patient list and the size of that list this is to only be for the first year to allow for a transition to your bonus in the future being determined about how many patients you serve and your actual achievement of higher quality more cost effectiveness of our providing patient-centered medical homes you have the opportunity right now to do things to improve your quality and cost effectiveness scores and there are reports that we will be reviewing today will help you in targeting your activities in the second year of the program your bonus will be affected by the activities that you're doing right now now I would like to highlight two things as I just said your activities right now will affect your scoring and thereby and your bonus in the second year of the program number two the reports you're about to see are very different from your current profile now why change the profiler we wanted to give you specific actionable information that you can use to improve your score this reason this uh stated a change in the profile now we've already had a couple of calls with a representative group of primary care physicians to get their input on the information included in this scorecard we took that input and used it to develop the to develop the improved reports that you'll be seeing today with that I'm now going to turn the present - Barry Cameron the director of our analytics division thank you dr. moon the purpose of the webinar is mentioned is to provide ACH and participating primary care groups an overview of the new provider profile reports these reports will provide information on quarterly bonus payments attribution and dashboards that illustrate progress toward quality measure and cost-effectiveness performance targets participating providers will receive both summary level report dashboard information as well as recipient level summary models specifically today we will quickly review the PCP payment structure and timelines associated with that a review of attribution quality measure and cost effectiveness scoring and before moving to the actual four new reports we'll provide a quick overview of how to access the provider profiler dashboard reports through your provider portal specifically the four reports that we'll cover today or the provider profiler quality measure scorecard the provider profile are supplemental member summary file for quality measures the cost-effectiveness scorecard and the supplemental member member or summary level file for cost effectiveness as a reminder that effective last october 1 our new bonus incentive payment system went into effect the bonus payments for the first two quarters have already been processed and as dr. moon mentioned these bonus payments reflected attribution and attribution alone that will remain the case for the next two quarters beginning next fiscal year the bonus payment pool will be allocated as follows fifty percent for quality measure performance forty five percent for cost-effectiveness performance in five percent for PCMH recognition these will continue to be infected by attribution again as mentioned bonus payments have already been processed for the first two quarters as seen in this following calendar the first payment was processed a November of last fall and most recently the second quarter bonus payment was processed in January we'd like to remind everyone that again beginning in October of 2020 the first calculated payment will be made for PCMH recognition in January of 2021 the first calculated payment will be made for cost-effectiveness and finally in July of 2021 the first calculated payment for quality measures will be made it's important to note that you are all determining right now how you'll be paid in future periods in these reports were designed to assist you in this determination process let's review attribution starting with the guiding principles of why we developed a methodology first consistency with ACH ends principles of payment for activities as well as outcomes continued emphasis on care coordination and health outcomes with a focus on preventative care acknowledgment that some recipients do require specialist care and finally evaluation of activities and determination of bonuses at the group level again as a reminder the definition of attribution it is the process that is used to associate a Medicaid recipient to the pcp group that provides primary care to that recipient as a reminder groups must sign two agreements one with Medicaid and one with the ACH and entities in order to participate under the ACH a program was are attributed to PCP groups and it's based on historic claims Univ utilization therefore P CPS are encouraged to continue seeing patients as medically necessary on a consistent basis to increase the likelihood of attribution attribution is a critical factor in determining the distribution of bonus payments and is the sole determinant in year one as we previously mentioned finally attribution replaced panel assignments beginning in October under ACH and the patient first program ceased to exist as of September 30th 2019 we would note that a smaller number of attributed members compared to members and previous panels do not necessarily equate to reduce payment levels as dr. moon previously mentioned now a review on our guiding principles for quality metrics they are based on CMS s collection of quality measure data from all 50 states internet effort to strengthen quality of care and health outcomes all measures are net are naturally validated and have specific standard specifications ACH ACH in benchmarks are based on quality measure performance scores as reported by the various states and will be adjusted as necessary benchmarks are now posted at wwm a decade alabama gov and these will be updated on an annual basis the primary focus of quality measures is to measure attainable improvement and healthcare outcomes and to qualify for quality bonus payments PCP groups must achieve this quality score a 50% of or higher that is they must meet the targets for at least half of their applicable quality measures in any given quarter there are total of eight provider quality measures divided into childhood quality measures and adult quality measures the four child measures are as follows W 34 CH which is well child visits in the third through six years of life adolescent well care visits childhood immunization status combination three an immunization for adolescents combination to the adult quality measures are as follows antidepressant medication management continuation phase comprehensive diabetes care does a EULA a one C testing follow-up after emergency department visit for alcohol and other drug abuse or dependence and finally chlamydia screening and women ages 21 to 24 it's important to note that practices will be scored only for the measures for which they have recipients in the denominator guiding principles for cost-effectiveness scoring also these principles are consistent with the overall ACH in principle paying for activity with a focus on outcomes with an acknowledgement that risk levels will vary across practices and as a result our scoring and results are risk adjusted using validated methodologies again evaluation of activities activities will be made at the group level and to qualify for the cost effectiveness bonus payments PCP groups must be at or below the statewide median cost effectiveness for cost effectiveness will be scored as follows it will start with the comparison of the group's actual 12 months per member per month and it will be compared to a risk adjusted expected per member per month the resulting score is the cost-effectiveness score and every group will be raped on the score that is derived from their actual PMPM versus the expected PMPM every group in the state will be ranked and again as mentioned previously bonus payments will be awarded to the groups that are at or below the median cost effectiveness score we would also note that this expected PMPM calculation is based upon the statewide ACH n population and it is risk adjusted we also exclude certain cost that is for the purposes of accounting for the certain cost or beyond the control of certain of most PCP groups this would include drug rebates as an example as well as certain waiver costs now we'll move on to the section of the webinar where we're going to go through some of the provider dashboard reports again there will be four reports so we will review today the first is titled mg ds3 6 2 Q report this is otherwise known as the provider profiler quality measure scorecard as you will see this is a summary level report that illustrates your current scoring the second is named mg d m 316 q otherwise known as the provider profiler supplemental memory summary member summary file for quality measures this is a report the rule there were bills tell me how much each individual recipient affects your scoring the next we'll go through the provider profiler cost-effectiveness scorecard this is mg ds3 6 4q report this again will be a summary level report that illustrates the illustrates your current scoring relative to cost-effectiveness and finally a recipient level cost-effectiveness report known as mg d m36 4q this is a report that reveals again how each individual recipient have your score relative to cost-effectiveness scoring before we review some of these reports we would like to quickly go through how to access these reports through the provider pro to the provider web portal first you'll go to the web portal link which is seen here WW medicaid Alabama Services org slash al portal to access the login panel click on account and then click secure site where you will enter your login credentials as always next you will have the ability to click on the trade files tab and download options this is where you will see a variety of different reports available to you highlighted in the red below are the four new provider profiler reports related to quality and cost effectiveness next we'll select the quality measure scorecard report as our example here you'll see the provider to provider portal showing mg ds3 six to - Q in the drop down list as seen and the highlighted red box below this report will now be available for download from the weber portal from the web portal the report will be available this particular report will be available in a PDF format I would note that the recipient level reports are also available in PDF formats but will also be available to download as a as an excel file before we go through examples of these four reports we would like to provide information for more detailed resources that are available to you through our website the first web I met at Medicaid Alabama gov this link will specifically take you to three webinars that were recorded in September that are all related to attribution quality measures and cost-effectiveness these webinars and presentations go into detail around the methodologies used in the steps used to calculate the bonuses we will not go into those detailed steps today but those are available for you at any time there's also direct link to frequently asked questions around a station and finally we have an email address a chn at Medicaid Alabama gov for you to submit your questions for official agency responses now we'll review the first the first report MGD f 362 - Q which is the quality measures for corn again the principles for the design of these is trying to give X animal information for all groups as they strive to attain their quality and cost effectiveness measures this report is essentially divided into three sections the first section is the summary which has the group's total number of attributed ACH end members and in our example here for ABC providers this provides the total number of attributed ACH end members for this reporting period which is January 2023 March 2003 March 2020 again we are in the summary level portion of this report starting with the total number of attributed ACH end members again this is the statewide number of attributed ACH end members for quarter - that would be the January 2020 through march 2020 reporting period next we move on to the attributed members in the groups meeting the quality score minimum what this is is that members attributed to groups and practices that actually met the qualitative 50 percent next is the members attributed to ccp purport this will be the specific ear practice and next is the estimated bonus payment for quality again quality payments bonus payments for quality measures will not be made until june july 2021 but this provides guidance quarter tainment of that goal the next section there is the actual scorecard section for every quality measure report that the following eight rows which are again the pediatric and the adult measures that we reviewed earlier for this will move left to right on your screen starting with the numerator in the denominator what these numbers mean is the denominator is the number of recipients in this in this respective practice that qualify for inclusion in the specifications for this quality measure and in this example we'll use W 34 - CH which is well child visits in the third fourth fifth and six years of life the numerator is the number of recipients in this practice who met the criterion suspects so we simply take the numerator divided by the denominator and that gives this group a quality score of over 78% moving left or right we see the baselines in the benchmark the baseline is the statewide average for this quality measure the benchmark otherwise known as the target is that is the metric that the groups will need to attain in order to meet the in order to meet the target for this quality measure so in this example this quality score of 78 percent exceeded the benchmark a 67 percent or 66.7% thus no improvement is needed during this quarter in the group met the target for this particular quality measure because this is in this hypothetical example this is a pediatric practice they only have received in the denominato for four of these measures and it will accordingly be scored only for four quality measures in this example they met the quality they met the target in three of four quality measures thus qualifying them for quality measure bonus in the final portion of this report going down starts with quality bonus payment calculation methodology steps again we will not go into the detail of the methodology today you can refer to previous webinars for that but these reports will provide a step-by-step instruction and description of health and bonus payments would be calculated for quality next we will move to report MGD m36 - - - this is the provider profiler supplemental member summary file for quality measures again we will use a different practice in this scenario and we'd like to mention that we recognize the fact that this is a very detailed in busy report but this is again designed to be actionable so the guiding principle behind this design is if there is a specific measure that needs to be worked on for improvement for any given quarter or any given reporting period the provider the provider group will be able to identify the specific recipients that are affecting that particular metric in that particular score so in this example with XYZ Medical Associates will focus on the Medicaid ID these are obviously fake Medicaid IDs but if you go about halfway down the list of ID's here for recipient any and one - or a city and ID 12 you will see that for if you see if you scroll over five columns you'll see the measure 8 WC - si again this is the adolescent well care visit and you'll see that for this particular recipient they qualified for in the denominator as well as the numerator so in this case that recipient had a score of had a numerator value of 1 and a denominator value of 1 if you scroll down to recipient 20 you'll see where this recipient qualified in the denominator for this measure but did not in the numerator and therefore the sum for the recipients for this practice for this measure added up to 1 for the numerator and added up to 2 the denominator giving them 50% for this particular metric so again this this example has a relatively small number of recipients but again the the concept behind this report is to provide that practices the ability to go to any recipient for any quality measure and see whether or not they qualify for inclusion in the denominator or the numerator I would also note that again this is a PDF that we're viewing now these recipient level reports will also be available to download in an Excel format now we'll move on to the next report which is mg d - F 3 6 4 - q this is otherwise known as the provider profiler cost-effectiveness scorecard in this example we'll go back to another group ABC ABC Medical Associates that had an attributed number of recipients of 769 and again much like the quality measure score scorecard report this report has 3 primary section sections the first is the summary level starting with a total number of attributed attributed a CH n members statewide and in this example that's a little 497 thousand next is the attributed members in groups that are at or below the median threshold in other words this is the number of recipients attributed to the PCP groups that have met the cost-effectiveness score that is that the statewide median again we then take the members attributed to the PCP CP group in this quarter 769 and finally see the projected cost effectiveness bonus based on the cost-effectiveness scoring the section below PCP cost-effectiveness bonus payment scorecard provides again a scorecard that shows how each group is scored from a cost-effectiveness standpoint every practice will receive report or report that shows by service type in this case you can see where we have grouped the service types into inpatient outpatient mental health pharmacy physician services and other groupings every practice will receive a report that shows their overall PMPM in what service sites contributed to this PMPM it will also compare these PM PMS to the statewide PMPM again that would be the statewide ACH n per-member per-month going left or right you'll see in this example not comparing the practice PMPM of 166 dollars to the statewide PMPM that gives us a cost-effectiveness score going left to right of 0.3 7 this is taken by taking the expected PM PM taking the actual PM PM divided by the expected PM PM of 448 dollars which is derived from the statewide PM PM and applied to this practices risk or in this case of 1.56 as you can see in this example this cost effective effectiveness for 0.37 would be below the median threshold of 0.5 babe and therefore below the statewide median this example this group would qualify for cost-effectiveness bonus and in the final section of this report you can also again see the bonus payment calculation methodology steps and again every practice will receive this on a quarterly basis the final report that we will review is report MGD m36 4 - q this is the provider profiler member summary cost-effectiveness report again this is that the recipient level this is designed again much like quality the quality measure supplemental file this is designed to provide practices the ability to see any given recipient and how they are impacting and affected affecting their cost-effectiveness scoring so in this particular example again we'll we'll go back to XYZ associates who have a total of 23 recipients you can see the total at the bottom the total cost for this particular group is 215 thousand dollars for the period which is a 12-month period based on dates of service applied to their total number of months of 274 you will see at the bottom this gives through this particular group of PMPM of seven hundred eighty five dollars to see what recipients drove the cost and the subsequent PMPM let's direct our attention back to the second member that is the member ID ending in zero two you can see in this particular case this individual recipient incurred costs for this period of sixty two hundred dollars they had twelve member months and a subsequent PMPM of five hundred and eighteen dollars and in this case you can see that the inpatient costs for this particularly in' is what drove the majority of these costs so in this example one thing I would point out that just because the this particular PMT and for this group is seven hundred eighty five dollars it does not mean that they would not qualify or cost-effectiveness what you don't see here but this group this particular group had a risk score of over 4.4 giving them a high high expected PMPM of almost $1,300 that would make them cost-effective with a score of 0.61 which would be below the statewide median so again this that's an example of hell although the p and p m might be higher relative to other groups because the acuity in the risk level of the recipients in this group is high that does not necessarily disqualify them from cost-effectiveness bonus considerations so with that we will provide the link back to ACH and resources and dr. moon will have a few closing comments and then we'll open it up for questions sure there's a doctor running back I just want to make a few more comments and they will start going through the questions that you all have submitted first of all just some points to sort of reinforce that various pointed out already again your activities right now that you're doing now will affect your scoring and then the size of your bonus in that second year obviously even now the number of attributed patients you have affect your bonus with the actual scoring on these different methodologies will affect the size of your bonus in year two the second point I'd like to re-emphasize is that these reports obviously provide actionable information at the individual recipient level and you can actually look up and see which particular given patient is helping your score or not helping your score and then to whatever level you can intervene you can intervene I also like to re-emphasize that if you don't have patients in your panel that fit a given quality measure that's not held against you very demonstrating that in this presentation but I think that's an important point to stress if you're a pediatrician and you don't have adult patient adult scoring is not healthy the next thing to stress is risk adjustment as you saw risk adjustment can have a very significant impact to help you in the sense of meeting the cost-effectiveness part so there's no reason to avoid more complex patients that will be taken into account and there will be a risk adjustment of the cost-effectiveness such that you could still be possibly in the bonus pool even though you had sicker patients obviously it would be to your advantage to work with the ACH in to get needed case management services for those individuals are going to be affecting your store that you feel I could be impacted and that could help quite a bit and then the last thing I would say before I turn it back over to Barry and his team would be oh we recognize it takes several reviews of this to kind of get the hang of it and what you're looking at sort of what your need to interpret on you will be able to review this webinar as many times as you would like it will be ultimately posted to our website there are already many other webinars with great detailed webinar presentations about various parts of this that you can review today they're already posted and this one will be posted very soon so again we recognize it takes a few times looking at this because the hang of it and we would encourage you to do that but you should pretty easily be able to see that clearly there's actionable information here in terms of individuals that are helping or hurting your store one way or the other so with that I'm going to turn it back over to Barry and his team answering you the questions that have been submitted thank you dr. Boone we we didn't want to answer some questions that have been asked earlier and we did review a few of these during this presentation one a couple of questions when will the actual calculated bonus for cost-effectiveness start again the actual bonus payment for cost effectiveness will begin January of 2021 and again that would be based on attribution for that period but it would be based on claims data from October 2009 to September of 2000 that with this report you were able to see what it would be if in fact cost effectiveness and quality measure calculations were part of your bonus again attribution is what drives your bonus for this year for this first year in the program that these reports are designed to show you what we would have expected your bonus to be based on cost effectiveness in quality scoring again this is meant to serve as guidance and to be actionable for you and your practice all right so we have a couple questions coming in how do you add more diagnoses in the four attached to one CPT code and other insurances we can add blood pressure include more diagnoses how should we add for Medicaid claims if you file electronically more that form can be submitted and if you need assistance when you're Japan then unique content dancing provider reps to help you what defines a group practice practice site or a tax ID laguardia measures B claims driven how will this affect the clinics that are rural I'll say the first part yeah what defines a group practice is how you register with Medicaid it could be practicing or be tax IDs however you enroll as a group provider the same that you did with your PCP agreement and your participation agreements it's however you decided to register move the appointment be plain trippin the majority of our quality measures are claims driven we do incorporate data from other state agencies as applicable such as immunization registry data how will this affect clinics like rule rural health clinics are if they are if they have signed agreements with both the agency and with an ACH n they are eligible for a bonus on those recipients are attributed to them when horsie available to provider groups do we have to obtain reports from our ACH in no reports will not come from the ACH n this is that a stations do not receive attribution list and do not receive a copy of these reports if you would like to work with the Ahn needs the assistance of the Ahn to help improve your measures and work with patients who might not be as compliant you would need to share these reports with them that's why we allows you to download them as Excel version and work with the DA actually I think most of the patients would agree that they prefer the Excel version so they can work and sort those patients and the reports will actually be available within this afternoon the first round report will be in your file cabinet this afternoon how do you dismiss the patient so they're no longer attributed to you well attribution and your assignments are two different things attribution is based off of his story care provided by provider so as long as the patient continues to come to your office and you see them and you get billed and paid for them then they will always be attributed to you sound a process it was a prospective and we've gotten rid of that sense as past October is the patient lock-in still in effect yes or all ACN's accepting referrals at this time yes as far as I know we have no issues but they teach end I don't know if you're meaning referrals for care coordination or if you're needing a referral to or as a specialist or a provider but yet all the institutions are often running how is the AMM AD aim depressant medication management now has your calculated is it based on pharmacy claims so for the measure the pharmacy claim is certainly the for the AMM maker is a pharmacy claims risen major all right if you do not use PS football through a practice management system will claim the accepted using CPT nine nine zero eight zero to add additional diagnosis that would be a question I would ask I would refer you to your practice rep through DX e how do you determine who is how risk some patients go to the ER even if it you advise them not to and demand specialists and referrals et cetera our risk levels are based on as mentioned earlier a nationally validated methodology based on what we call Mora risk wearing which is Milliman advanced risk scoring and so the risk score for each practice is what we what we call a concurrent risk score that is we take into account every recipients claims history and other factors diagnosis history and we use that to project to project what their actual cost should have been so every every recipients claims history is taken in an account in risk scoring and and this would include er claims among others if that claims if that is a claims drip and how are they attached in get quality measures from rural health claims several years ago even as we started developing those that old project the RCO we didn't work with the Rural Health Association as well as the primary health care Association and work with all providers to try and urge them to bill and submit claims as appropriate to let everything that they do not just build straight under the encounter plan you still get being outraged but as long as you add all the CPT codes the diagnosis codes that you actually are from your patients you would get we would get a copy of those in the claims processing system and we would be able to calculate your measures again if you have specific claim specific questions I would refer you to DX these provider reps because that's where they'll be able to help you how do you access the file cabinet you mentioned if you want to go back on Sox tickets struggling with slide 13 okay looking at slide 13 in the presentation today again you would go to your provider web portal go to the following link WW medicaid Alabama Services org slash al portal you would then log in you have to access the login panel you would enter in your login credentials with your username and password and these would be the same credentials that you use for left world so if your staff does eligibility checks and things like that it reads the same factor now I will give you a heads up we will be posting this webinar a copy of these slots as well as a couple other documents that you'll be going through to he p provide additional resources including some of these sample reports will all be on the Medicaid provider website under the ACH inside so we will send out and listen to everybody that this has been posted and we'll also be these patients will be able to work with you and kind of going through everything also you have any issues getting onto the portal that's also another resource where the exe provided us will be able to help you out is there a list of impressive medications that are included and Barry says all of these measures that we use our CMS core measures so all of the specifications can be found on the website on CMS's website but also we have provided all the information and the a stage in also have all the specifications for the measures so this is a good opportunity for you to partner with the ACH in not only one working with a different recipient but this is where they can come in and work with you to improve your quality measures and for you to understand these measures so how they encourage you to reach out to your eight-day chen's almond report mg ds3 64 Q there is a cost effective score can you review how we get the cost effective bonus yes so the specific cost effectiveness methodology the detailed step-by-step methodology I would reference the webinars and presentations that were done in September but specifically for any groups cost effectiveness score it is it starts with taking the actual cost incurred based on a data service basis on a rolling for a rolling 12 months we allow for three months and claims run out we then apply that groups particularly for which we described earlier x' is describing the Maura risk scoring we applied that groups risk score to a statewide peer group which is the statewide ACH ed and cost-effectiveness excuse me cost effectiveness score that gives them each group an expected PMPM based on their risk level it compares that to the actual PM PM and we then take the ratio to come up with a cost-effectiveness score every practice is scored in the state has been ranked and we have chosen the median as the cutoff every group that is at or below that median would then qualify for a cost-effectiveness bonus the what about obg went ob/gyn are we eligible for the bonus yes and there are a set two separate bonuses if you're a delivering health care provider on DHCP those bonuses are if you see a patient for a prenatal visit within the first trimester or if you are if you see a patient for a postpartum business between days 21 and 56 after delivery now if you're an OBGYN and you are also acting as a primary care provider and have signed a PCP agreement with the agency and a participation agreement with your ACH in then yes you would be level for these bonuses but you must meet both requirements so you would have to do you have to be the primary care but bonus requires to get these balances do we only calculate the medications that we prescribe and the answer would be no it is only those that are actually still because we run off of claims that correct yes but it would be all paid medications that are prescribed and filled by a patient which goes to our next question what if one of our treated patients go to a specialist to receive other medication yes they have those medications we get being filled and yes same thing with ER but again this is an opportunity to work with the ACH in because the ACH in actually get daily pharmacy feeds so they know exactly what all patients are taking and so I would reach out to either their pharmacy staff or to the their care coordinator if you happen to have one in your office or who your contact is because they would have access to everything that has been paid for prescription wise for a patient see how do we find out who is our sign Ahn rep that would you would have to contact the ACH in within your region again if you go to the Medicaid website under ACH ins tab go to providers and there's a rider list there is a contact information and provider number for every ACH in it the assignment is based off of where the county resides so you might be on a board going so you might actually have reps from different ACH ends depending upon where your patients come from a couple couple more questions and this actually came in from a previous webinar if I take care of critically ill patients well the cost of my patients be higher and is there any way that I'll be eligible for the bonus yes again that is why we're calculating your expected PMPM with risk adjustments in other words if your patients are sicker the average risk of your tributed group will be higher so it for example if the average risk score of your attributed group is two that essentially reflects that your patients are sicker because it estimates that your tributed group is two times higher than the average attributed group and so again this risk score is applied to the statewide PM PM to calculate your expected and then compare it to your actual so call cost alone will not impact your cost-effectiveness score your the risk and acuity level of your attributed number of recipients as taken into consideration as well why did you choose median as a cutoff yes we mentioned that a couple of times about the median is a cut-off essentially it's because we find that both costs and risk scores are highly skewed towards the more expensive patients and as a result the average calculation of the cost efficient efficiency is highly skewed as well so choosing the median reduces the influence of some of these higher cost outliers what comes under combo two then combo three for the different vaccines so combo three that is the US cabal combo two as well as combo three combo two is the adolescent immunization measure ninja the meningococcal vaccine Tdap in HPV those three make up common or two for combo three again another childhood immunization measure but it includes the Tdap and it includes the IPV it includes MMR it includes your here hepatitis B and there so on in the PCV but again I would point you to the CMS website to look at this specifically so you can look at it in more detailed fashion this is off the top of our head we want you to be able to look at it in detail and look at the standard again also you can always work with the orientation because they'll be able to provide that these are the type of questions that the medical match means that where they can work with again if you have any questions please enter them in the chat box and we'll get to them what about the recipient has to be seeing me for a full year to be counted towards my bonus course no risk scores are calculated monthly actually but the risk score is much more accurate with the full year's worth of data but I would also remind you that recipients cannot be attributed to your practice until they've had at least three months of eligibility out of out of 24 and they chn again that that methodology is in previous presentations so so the risk scores and recipients attributed to your group will at least have three months of eligibility and claims if a patient is seen for prenatal care in one region by one physician and delivers in a different reason with a different position all same practice which region implies patients home region so this gets a little bit of a different issue we assign or sip into an ACH in based off of their county of residence but we allow our recipients to see whichever provider they choose to wherever they might be looking so for this example they might be seeing the patient is seen in a physician's office in their home region in the county where they're in the region where there have been a soccer of care coordination but maybe there's not a hospital deliberate close to them and they have to travel across to a different regions border to deliver for that case all of the care would still be provided by that home ACH in and so all of it is tied to that region to where the recipient is residing if the recipient moves between the initial prenatal care and then postpartum delivery it would be based off of the county of residence when the report is wrong but that recipient address has been updated and the recipient has been assigned to a new ACH in all of those that go into effect but again it is these measures and their quad reports and the bonuses are not tied to where a recipient look at is tied simply to whether that patient is attributed to you where do I find the requirements you were talking about that we reviewed in September to see what are the measures to meet for the cost effective score so all of for the cost-effectiveness score very clean answer that is second with the quality measures that we actually have in a target those are all on the ACH and website and medicate website beginning go to Medicaid go to a CH in and then go to quality measures and you will actually see because they file for the ACH in quality measures and their target as well as the provider measures and the targets for those and again we have to link up here for the previous webinars but the questions specifically around cost-effectiveness the the methodology itself the the risk scoring component of that is based on a proprietary algorithm that is from a from a company called Melman Melman adjusted Melman advanced risk adjustors so there are some proprietary components of that which we cannot disclose publicly but effectively every practice that has their actual cost applied to a risk score to come compared to a peer group that cut dead ultimately results in their cost efficiency score and again we use the median as the cutoff to determine whether or not that practice is qualifying for the bonus in Amara risk formula is a very uncommon risk adjustment model for design for Medicaid populations correct that is correct is designed for Medicaid populations and we we have applied our own algorithms to that to adjust for the nuances of Alabama Medicaid so we only have about another three minutes so we wanted second see if there's any additional questions if not we will end this webinar again like I said this reporting will be purchased to the website templates the sample reports that we've demonstrated will be posted to website as well as a digital other material that you can go back and walkthrough types of the measures how to calculate these step-by-step some nice posters got a really overview the concepts of attribution cost effectiveness and quality as well as links to the webinars previously done back in September in October about attribution about cost effectiveness and about quality so again thank you for everything we did get one last question here what date would your application happy approve to buy to get to November botnet to be get see November bonus necklace so the last one came out in January to be eligible for the January bonus payment you had to have your agreement in house by December 1st it has to be in a month prior to that be effective for the month prior to the calculation of the quality on it so the next one will be paid out April so you need to have all of your dreams both the pcpd agreement and the participation agreement by March 30 thank you for attending and