Crosswalk

Revisions to Medicare Advantage Quality Bonus Payment Demonstration:
Survey of Health Plan Contract Holders

Issue #

Page #

Section

Action to be performed

Changes to the Application

Reason for the Change

i

Overview of the Survey

Revise as follows:

Replace: Section A, the first section of this survey, asks about the contract’s QI activities.

With: Section A, the first section of this survey, asks about the contract’s QI activities. By QI activities, we mean any activities implemented to improve patient outcomes, improve system performance, or improve professional development.

Revised for clarification purposes based on results from pre-test and public comments.

i

Important instructions

Revise as follows:

Replace: (1) Please answer the questions only about the Medicare Advantage (MA) contract administered by your organization specified on the cover this document.

(2) If your organization has more than one MA contract, please answer questions about only the MA contract specified on the cover of this document.

With: (1) Please answer the questions only about the Medicare Advantage (MA) contract administered by your organization specified on the cover this document.

(2) If your organization has more than one MA contract, please answer questions about only the MA contract specified on the cover of this document.

(1) You have received this questionnaire because you are the contact person for the Medicare Advantage (MA) contract specified on the cover of this document. Please answer the questions only about this contract and its associated plans.

Revised for clarification purposes.

i

Important instructions

Revise as follows:

Replace: Most questions can be answered by simply placing a check mark in the appropriate box. For a few questions you will be asked to write in a response. Feel free to elaborate on any responses in the questionnaire margins or to provide additional thoughts or documentation about your contract at the end of the questionnaire.

With: Most questions can be answered by simply placing a check mark in checking the appropriate box. For a few questions you will be asked to write in a response. Feel free to elaborate on any responses in the questionnaire margins or to provide additional thoughts or documentation about your contract at the end of the questionnaire.

Revised for clarification purposes.

i

Important instructions

Revise as follows:

Added item 6:

If you do not know the answer to a question, feel free to consult with others at your organization who may have the information requested.

Revised for clarification purposes.

ii

Important instructions

Revise as follows:

Replace:  Please return the completed questionnaire within the next two weeks in the enclosed return mail envelope to Mathematica Policy Research, P.O. Box 2393, Princeton, New Jersey 08543-2393, ATTN: Martha Kovac, or fax it to (609) 799‑0005. If you have any questions, please call Martha Kovac at (609) 275‑2331.

With: If completing a mailed questionnaire, please remove the inner adhesive label on the cover page of the questionnaire that contains your health plan and MAO contract identifying information and leave the outer label that contains only a tracking identification number. Please return the completed questionnaire within the next two weeks in the enclosed return mail envelope to Mathematica Policy Research, P.O. Box 2393, Princeton, New Jersey 08543-2393, ATTN: Martha Kovac QBP Survey, or fax it to (609) 799‑0005. To return an electronic questionnaire, or if you have any questions, please call Martha Kovac at (609) 275‑2331 email [email protected].

Revised to update contact information and clarify instructions for paper submission. Added instructions for electronic submission, per requests received in public comments.

1

Section A

Revise as follows:

Added: Throughout the questionnaire, “QI activities” refers to any activities implemented to improve patient outcomes, improve system performance, or improve professional development.

Revised for clarification purposes based on results from pre-test and public comments.

1

Section A, Question A1

Revise as follows:

Replace:

1 □ Provider reminder systems (e.g., computer-based reminders for providers)

2 □ Provider portal systems

3 □ Member reminder systems (e.g., postcard reminders)

4 □ Patient portal systems

With:

1 □ Provider and/or patient portal systems (any online applications for appointment and/or follow-up reminders, communication between providers, patients and/or hospitals, and/or access to clinical information)

Revised based on results from pre-test.

1

Section A, Question A1

Revise as follows

Replace:

□ Incentivizing members to get needed services

With:

□ Incentivizing members to get needed services (if permitted)

Revised based on results from pre-test.

1

Section A, Question A1

Revise as follows

Added response categories:

10 □ Other methods of member engagement

11 □ Benefit modifications

12 □ Formulary modifications

13 □ Provider incentive programs

14 □ Compliance with NCQA accreditation standards

15 □ Compliance with state and federal regulations for various QI programs

16 □ Physician credentialing and medical affairs, supporting evidence based practices

17 □ Overall utilization management (including for pharmacy and therapeutics and behavioral health)

18 □ Service QI improvement activities (member complaints and grievances, etc.)

19 □ Optimizing medical loss ratio – working to ensure safe, efficient and effective care delivery (to include risk management)

Revised based on results from pre-test.

1

Section A, Question A2

Revise as follows

Replace:

A2. Do the QI efforts focus on particular beneficiary populations?

With:

A2. Do the QI efforts focus on particular vary for different beneficiary populations?

Revised based on results from pre-test.

2

Section A, Question A2a.

Revise as follows

Added response categories:

10 □ Institutionalized (an MA eligible individual who continuously resides, or who is expected to continuously reside, for 90 days or longer in a long-term care facility which is a skilled nursing facility [SNF] nursing facility [NF]; SNF/NF; an intermediate care facility for the mentally retarded [ICF/MR]; or an inpatient psychiatric facility)

13 □ Persons of a particular racial or ethnic group (Specify)

14 □ Persons with English as a second language (Specify)

Revised based public comments.

Added question A2b:

A2b. How do you tailor your QI efforts to different populations?

__________________________________________________________________________________________

Revised based on public comments.

2

Section A, Question A3

Revise as follows:

Add questions A3 and A3a:

A3. Have you worked to contract with providers that have cultural and linguistic competencies for the particular beneficiary populations you are targeting?

1 □ Yes

0 □ No  GO TO A4

A3a. Please describe how you work with these providers.

Revised based on public comments.

2

Section A, Question A4

Revise as follows:

Add response category:

2 □ Plan does not have multiple contracts

Revised based on results from pre-test.

3

Section A, Question A4a

Revise as follows

Replace:

1 □ Focus on plans/product types where we are more likely to succeed in changing provider behavior via better collaboration, information, and contracts

2 □ Focus on maintaining existing QI efforts unless we are close to reaching the next highest star rating

3 □ Target more intensive efforts on products/plans with lower ratings

4 □ Target plans where we expect to get the highest return on our investment

5 □ Target plans with lower ratings for domains and/or measures considered more actionable, starting with those domains and/or measures that have more actionability

6 □ Target plans with lower ratings for domains and/or measures considered to have greater weight, starting with those domains and/or measures that have greater weight

With:

1 □ Focus on Variation for plans/product types where we are more likely to succeed in changing provider behavior via better collaboration, information, and contracts

2 □ Focus on maintaining Variation in maintenance of existing QI efforts unless we are close to reaching the next highest star rating

3 □ Target more intensive Variation in efforts on for products/plans with lower ratings

4 □ Target Variation for plans where we expect to get the highest return on our investment (including non-monetary factors such as member retention, stability in benefits, competition, etc.)

5 □ Target Variation for plans with lower ratings for domains and/or measures considered

more actionable, starting with those domains and/or measures that have more actionability

6 □ Target Variation for plans with lower ratings for domains and/or measures considered to have greater weight, starting with those domains and/or measures that have greater weight

7 □ Other (Specify)

Revised based on results from pre-test.

3

Section A, Question A5a

Revise as follows:

Add response category:

2 □ Moderate extent

Revised based on results from pre-test.

4

Section A, Question A7

Revise as follows:

Replace:

A6. Still thinking about this contract, do your QI efforts focus on any particular domains or measures that are part of the star rating system?

With:

A7. Still thinking about this contract, do your QI efforts focus on vary for any particular domains or measures that are part of the star rating system?

Revised based on results from pre-test.

4

Section A, Question A7a

Revise as follows:

Update list of measures to include new measures added for 2013 plan ratings.

The survey should include a comprehensive list of measures used for 2012 and/or 2013 plan ratings. When the survey was developed, the 2013 measures were not yet known.

4-5

Section A, Question A7a

Revise as follows:

Update domain names to use labels for the 2013 plan ratings.

When the survey was developed the 2013 labels were not yet known.

6

Section A, Question A8

Revise as follows:

Replace:

A7. What are the top three domains that your QI efforts focus on for the contract named on the cover page of this questionnaire?

With:

A8. What are the top three domains that for which your QI efforts focus on vary for the contract named on the cover page of this questionnaire? Please check up to two domains in Part C, and two domains in Part D.

Revised based on results from pre-test.

6

Section A, Question A8

Revise as follows:

Update domain names to use labels for the 2013 plan ratings.

When the survey was developed the 2013 labels were not yet known.

6

Section A, Question A8

Revise as follows:

Add response category:

0 □ Our organization does not focus QI efforts at the domain level→GO TO A9

Revised based on results from pre-test.

6

Section A, Question A8a

Revise as follows:

Replace:

A7a. Why do your QI efforts focus on those domains over others?

With:

A8a. Why do your QI efforts focus on vary for these domains over others?

Revised based on results from pre-test.

6

Section A, Question A9

Revise as follows:

Replace:

A8. How many full-time equivalent (FTE) staff in total work on quality improvement within your organization for this contract? For example, if your organization has four staff who each devote a quarter time to quality improvement, then the number of full-time equivalent staff at the organization is one. Your best estimate is fine.

| | | | TOTAL FTE STAFF WHO WORK ON QI

A8a. How many full-time staff members do these FTEs represent? For example, if your organization has one FTE but four staff who each devote a quarter time to quality improvement, then the number of full-time equivalent staff at the organization is four.

| | | | FULL-TIME QI STAFF

With:

A9. Which areas/departments within your organization have staff currently working on quality improvement for this contract?

_____________________________________

______________________________________

Revised based on results from pre-test.

7

Section A, Question A10a

Revise as follows:

Add response category:

2 □ Moderate extent

Revised based on results from pre-test.

7

Section A, Question A11a

Revise as follows:

Replace:

1 □ Provider reminder systems (e.g., computer-based reminders for providers)

2 □ Provider portal systems

3 □ Member reminder systems (e.g., postcard reminders)

4 □ Patient portal systems

With:

1 □ Provider and/or patient portal systems (any online applications for appointment and/or follow-up reminders, communication between providers, patients and/or hospitals, and/or access to clinical information)

Revised based on results from pre-test.

7

Section A, Question A11a

Revise as follows

Replace:

□ Incentivizing members to get needed services

With:

□ Incentivizing members to get needed services (if permitted)

Revised based on results from pre-test.

7

Section A, Question A11a

Revise as follows

Added response categories:

10 □ Other methods of member engagement

11 □ Benefit modifications

12 □ Formulary modifications

13 □ Provider incentive programs

14 □ Compliance with NCQA accreditation standards

15 □ Compliance with state and federal regulations for various QI programs

16 □ Physician credentialing and medical affairs, supporting evidence based practices

17 □ Overall utilization management (including for pharmacy and therapeutics and behavioral health)

18 □ Service QI improvement activities (member complaints and grievances, etc.)

19 □ Optimizing medical loss ratio – working to ensure safe, efficient and effective care delivery (to include risk management)

Revised based on results from pre-test.

8

Section A, Question A12a

Revise as follows

Replace:

1 □ Yes

0 □ No

With:

1 □ Yes, all measures

2 □ Yes, some measures (specify:___________________________________________________________)

0 □ No

Revised for provide more flexibility to respondents.

8

Section A, Question A16, A17, and A18

Revise as follows:

Add response category:

2 □ Moderate extent

Revised based on results from pre-test.

9

Section A, Question A19 and A19a

Revise as follows:

Add question A19 and A19a:

A19. To what extent does the publicity of star ratings incentivize you to improve your star ratings?

MARK ONE ONLY

1 □ Large extent

2 □ Moderate extent

3 □ Small extent

0 □ Not at all

A1a. Is the current publicity/advertising of the star ratings sufficient?

1 □ Yes

0 □ No, more should be done to advertise what they mean and/or how to read them

Revised based on results from pre-test.

10

Section B, Question B1, B2, and B3

Change “estimate” to “record” and add a “don’t know” response. (Example for Question B1 provided.)

Replace:

B1. Please estimate the percentage of enrollees in your MA contract who are of Hispanic, Latino or Spanish origin.

| | | | %

With:

B1. Please estimate record the percentage of enrollees in your MA contract who are of Hispanic, Latino or Spanish origin.

| | | | %

0 □ Don’t know

Revised based on results from pre-test.

10

Section B, Question B3

Revise as follows

Add response category:

b. | | | | % Institutionalized (an MA eligible individual who continuously resides, or who is expected to continuously reside, for 90 days or longer in a long-term care facility which is a skilled nursing facility [SNF] nursing facility (NF); SNF/NF; an intermediate care facility for the mentally retarded [ICF/MR]; or an inpatient psychiatric facility)

Revised based on results from pre-test.

10

Section B, Question B4a

Revise as follows

Add question B4a:

B4a. To what extent do you use star ratings as a marketing tool to attract beneficiaries?

MARK ONE ONLY

1 □ Large extent

2 □ Moderate extent

3 □ Small extent

IF YOU ANSWERED B4a, please go to B6

Revised based on results from pre-test.

11

Section B, Question B6a

Revise as follows

Replace:

5 □ Five-star plans have continuous enrollment

With:

5 □ (If yours is a 5-star plan) Five-star plans have continuous enrollment

Revised for clarification purposes.

12

Section B, Question B6c

Revise as follows:

Update domain names to use labels for the 2013 plan ratings.

When the survey was developed the 2013 labels were not yet known.

12

Section B, Question B6c

Revise as follows

Add instruction:

IF YOU ANSWERED B6c, PLEASE GO TO C1

Instruction needed because of the addition of question B6d.

12

Section B, Question B6d

Add question

Add question B6d:

B6d. Why will there be no domains in particular that will lead to increases in beneficiary enrollment if the star ratings improve?

__________________________________________________________________________________________

IF YOU ANSWERED B6d, PLEASE GO TO C1

Revised based on results from pre-test.

13

Section C, Question C1

Allow respondents to specify if frequency varies by measure for all rows

Replace:

C1. How often is feedback on quality performance for your contract shared with the following types of individuals or organizations?

a. Primary care providers in our network

With:

How often is feedback on quality performance for your contract shared with the following types of individuals or organizations? If the frequency for different providers or staff varies by measure or different subsets of providers, please specify.

a. Primary care providers in our network (specify:______________________________)

(Include “specify” for all response categories)

Revised based on results from pre-test.

13

Section C, Question C1

Revise as follows

Add “N/A” column for all rows.

Revised based on results from pre-test.

13

Section C, Question C1

Revise as follows

Add:

g. Pharmacists

(specify:________________________________)

Revised based on results from pre-test.

14

Section C

Delete the following questions

Delete the following questions:

C2. How is feedback shared with MAO staff?

MARK ALL THAT APPLY

1 □ Written materials provided (such as reports, emails, and bulletins)

2 □ Presented orally in meetings or individually

3 □ Training sessions or webinars

4 □ Other (Specify)

C3. How is feedback shared with providers and contractor organizations?

MARK ALL THAT APPLY

1 □ Written materials provided (such as reports, emails, and bulletins)

2 □ Provider portals

3 □ Presented orally in meetings or individually

4 □ Training sessions or webinars

5 □ Other (Specify)

Revised based on results from pre-test.

14

Section C

Delete the following question

Delete the following question:

C4a. Which of the following methods does your organization use to distribute its education materials, tools, or information about star ratings to this contract’s providers?

MARK ALL THAT APPLY

1 □ Written materials provided (such as reports, emails, and bulletins)

2 □ Provider portals

3 □ Presented orally in meetings or individually

4 □ Training sessions or webinars

5 □ Other (Specify)

Revised based on results from pre-test.

15

Section D, Question D1

Revise as follows

Replace:

D1. What do you think are the main challenges to improving star ratings for your contract?

With:

D1. What do you think are the main challenges to improving star ratings for your contract? (COLUMN D1 BELOW) If the challenges vary across measures, please identify the main challenges across all the measures.

Revised for clarification purposes.

15

Section D, Question D1

Revise as follows

Replace:

c. Lack of plan interest or involvement

With:

c. Lack of plan interest or involvement member engagement

Revised based on results from pre-test.

15

Section D, Question D1

Revise as follows

Add response categories:

p. Population demographics

q. Socioeconomic status indicators

r. Health status of plan enrollees

Revised based on public comments.

15

Section D, Question D1

Revise as follows

Replace:

s. Other barrier (Specify)

With:

s. Other barrier challenge (Specify)

Revised for clarification purposes.

16

Section D, Question D3

Revise as follows

Add response category:

2 □ Too soon to tell →GO TO D5

Revised based on results from pre-test.

16

Section D, Question D4

Revise as follows

Add response category:

4 □ These QI initiatives were already in place before the QBP demonstration

Revised based on results from pre-test.

16

Section D, Question D5a

Delete response categories

Delete response categories:

1 □ Compliance with CMS and other payer QI requirements

7 □ Building competency in performance and process improvement

8 □ Service improvement activities (member complaints and grievances, etc.)

Revised based on results from pre-test.

17

Section D, Question D6

Delete response categories

Delete response categories:

a. High-performer icon on the Plan Finder Web site

c. Low-performer icon on the Plan Finder Web site

Revised based on results from pre-test.

17

Section D, Question D7a

Revise as follows

Replace:

D7a. How did you spend the bonus payment? Please estimate the percentage of the bonus payments that you spent for each item below. Your best estimate is fine.

a. | | | | % Toward lowering premiums

b. | | | | % Toward enriching benefits for Part A/B covered services

c. | | | | % Toward adding/enriching benefits for services not covered under Part A/B

d. | | | | % Toward augmenting or implementing QI efforts [IF “0%”  GO TO D11]

e. | | | | % Other (Specify)

With:

D7a. How did you primarily spend the bonus payment?

MARK ALL THAT APPLY

1 □ Toward lowering premiums

2 □ Toward enriching benefits for Part A/B covered services

3 □ Toward adding/enriching benefits for services not covered under Part A/B

4 □ Toward augmenting or implementing QI efforts

5 □ Other (Specify)

Revised based on results from pre-test.

17

Section D, Question D7c

Revise as follows:

Update domain names to use labels for the 2013 plan ratings.

When the survey was developed the 2013 labels were not yet known.

18

Section D, Question D7d

Add question

Add question D7d:

D7d. Why will you apply the payment to these specific domains?

MARK ALL THAT APPLY

1 □ Include measures with the most room for improvement

2 □ Include measures that are most easily impacted by our organization

3 □ Include measures that have the largest impact on the contract’s overall star rating

4 □ Include measures that require fewer resources to improve

5 □ Include measures that require the least time to improve

6 □ Include measures that are most important for member health and wellness

7 □ Include measures that are unlikely to be retired or to change significantly from year to year

8 □ Include measures that are most important for accreditation

9 □ Other (Specify)

Revised based on results from pre-test.

18

Section D, Question D9

Revise as follows

Replace:

D9. What do you think are the reasons that your contract was unable to attain a star rating that would qualify for a bonus payment?

D10. What are the top three reasons for your contract?

	D9.	D10.
	MARK ALL THAT APPLY	MARK UP TO THREE ROWS BELOW
a. Lack of staff trained in QI	1 □	1 □
b. Resource constraints, other than staffing	2 □	2 □
c. Lack of plan interest or involvement	3 □	3 □
d. Lack of parent organization interest or involvement	4 □	4 □
e. Disagreement with selection of domains or measure(s)	5 □	5 □
f. Our organization has other priorities	6 □	6 □
g. Our organization is unsure about how to improve performance	7 □	7 □
h. Our organization has no incentive to improve	8 □	8 □
i. Insufficient senior management leadership and support	9 □	9 □
j. Ability to influence measure(s) is out of our control	10 □	10 □
k. MAO or providers lack sufficient data systems	11 □	11 □
l. Lack of provider engagement	12 □	12 □
m. Inaccurate reporting of measures	13 □	13 □
n. Our geographic region faces different and more challenging circumstances	14 □	14 □
o. Measures are not appropriate for specialized populations that we serve (e.g., SNPs)	15 □	15 □
p. Measures are often changing or are “moving targets”	16 □	16 □
q. Our organization is not able to take “actionable steps” toward improvement	17 □	17 □
r. No room for improvement	18 □	18 □
s. We focused on becoming compliant with state and federal regulations first	19 □	19 □
t. Other barrier (Specify)	20 □	20 □

With:

D9. What do you think is the main reason that your contract was unable to attain a star rating that would qualify for a bonus payment?

_______________________________________________________________________

Revised based on public comments.

18

Section D, Question D10

Add a response category

Add response category:

0 □ Unsure  GO TO D12

Revised based on results from pre-test.

19

Section D, Question D11

Add question

Add question D11:

D11. Why do you think the changes will remain in place once the demonstration ends?

20

Section D, Question D12

Add question

Add question D12:

D12. What is this plan’s perspective on how the plan will proceed once the QBP demonstration ends (e.g. if the plan does not become a 4-star plan)?

Revised based on results from pre-test.

18