AdvancingDialysis.org CMS Kidney Care Choices (KCC) Voluntary Payment Model
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This document discusses the Centers for Medicare & Medicaid Services' Kidney Care Choices model, which includes four voluntary payment models - Kidney Care First, Comprehensive Kidney Care Contracting, and three CKCC options. The goals are to delay end-stage renal disease progression, encourage optimal dialysis transitions, support transplant processes, and keep transplant recipients healthy. Participating providers take on financial accountability and risk through these models.
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AdvancingDialysis.org CMS Kidney Care Choices (KCC) Voluntary Payment Model
- 1. AdvancingDialysis.org Kidney Care Choices Voluntary Payment Model Centers for Medicare & Medicaid Services Voluntary Specialty Care Models
- 2. AdvancingDialysis.org Kidney Care Choices (KCC) Voluntary Model Goals1 • Delay the progression to ESRD • Encourage optimal transitions to dialysis • Support through the transplant process • Keep transplant beneficiaries healthy, post-transplant • Offer financial risk options so providers take on financial accountability 1Centers for Medicare and Medicaid Services Innovation Center, “Kidney Care Choices (KCC) Model,” (Fact Sheet) accessed 1/2021, available at https://www.cms.gov/newsroom/fact-sheets/kidney-care-choices-kcc-model
- 3. AdvancingDialysis.org Services related mostly to the care of ESKD patients ‒ ESRD Treatment Choices Model (Mandatory) Up to 45% of practice revenue at risk of bonus or penalty 1Nephrologixx sample of 160 practices, 1,192 provider full-time employees, 12 months ending 06/30/2020 ETC Physician Proportion of Practice Revenue at Risk1
- 4. AdvancingDialysis.org Services related mostly to the care of ESKD patients ‒ ESRD Treatment Choices Model (Mandatory) 1Nephrologixx sample of 160 practices, 1,192 provider full-time employees, 12 months ending 06/30/2020 KCC Physician Proportion of Practice Revenue at Risk1 Services related to the care of CKD and ESKD patients ‒ Kidney Care Choices Model (Voluntary) Up to 94% of practice revenue at risk to bonus or penalty
- 5. AdvancingDialysis.org CMS Kidney Care Choices (KCC): 4 Voluntary Models1 Kidney Care First (KCF) • Nephrologists are the only participants Comprehensive Kidney Care Contracting (CKCC) • Nephrologists and transplant provider are required participants ‒ Dialysis providers are optional • 3 CKCC models ‒ Graduated Option ‒ Professional Option ‒ Global Option 6 Common Features: 1. Timeline 2. Required minimum patient counts 3. Transplant bonus 4. Patient eligibility and alignment / inclusion 5. CKD 4-5 advanced quarterly capitation payment 6. Annual home dialysis “true-up” payment 1Centers for Medicare and Medicaid Services Innovation Center, “Kidney Care Choices (KCC) Model,” (Fact Sheet) accessed 1/2021, available at https://www.cms.gov/newsroom/fact-sheets/kidney-care-choices-kcc-model
- 6. AdvancingDialysis.org Executive Order Request for application issued Request for application due date Implementation period Performance period Jul 10, 2019 Oct 24, 2019 Jan 22, 2020 Oct 15, 2020 Jan 1, 2022 Dec 31, 2026 Application acceptance notification 1. Timeline1 1Centers for Medicare and Medicaid Services Innovation Center, “Kidney Care Choices (KCC) Model,” (Fact Sheet) accessed 1/2021, available at https://www.cms.gov/newsroom/fact-sheets/kidney-care-choices-kcc-model
- 7. AdvancingDialysis.org KCF Practice / CKCC Kidney Care Entity must meet minimum patient counts for both CKD and ESRD by the end of 2022 $2,500 $5,000 $7,500 PY 2022 PY 2023 PY 2024 Voluntary Models KCF CKCC CKD 400 750 ESRD 200 350 Paid to KCF Practice / CKCC Kidney Care Entity for each performance year (PY) 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. 2. Transplant bonus (up to $15,000 total)1 3. Required CKD 4-5 & ESRD patient counts1
- 8. AdvancingDialysis.org CKD beneficiaries ESRD beneficiaries Kidney transplant beneficiaries Aligning Participant Nephrologist & Advanced Practitioners Nephrologist & Advanced Practitioners N/A – Must have been previously aligned by virtue of CKD or ESRD Criteria for Alignment 2 Evaluation & Management (E&M) visits within a 12-month period with a KCC nephrologist and with a diagnosis of CKD 4 or 5 2 MCP visits within a 90-day period with a KCC nephrologist Being previously first aligned to the KCC practice as a CKD or ESRD beneficiary and receiving a kidney transplant Criteria for De-Alignment Meets 1 or more of the exclusion criteria* or received the majority of E&M visits for kidney care outside the KCC practice’s market Meets 1 or more of the exclusion criteria* or received the majority of MCP visits from a non-KCC nephrologist Kidney transplant failure (likely the beneficiary then aligns as a CKD or ESRD beneficiary) 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. *See notes for detailed exclusion criteria 4. Inclusion and Exclusion Adjusted for Leakage Quarterly1
- 9. AdvancingDialysis.org CKD 4-5 Billing Categories Include (not limited to) • Office evaluation and management visits (E/M) • Established patient home visits • Advanced care planning Advanced Payment Model Requirements and Payees • 1 quarterly bundled payment in lieu of fee for service ‒ Still need to submit billing claims ‒ Paid to KCF Practice / CKCC Kidney Care Entity * See slide notes for full list of Nephrology services included in the CKD QCP 5. CKD 4 – 5 Quarterly Capitation Payment (CKD QCP)1 • Rate is ~$240 per quarter - 30% withholding starts 2022; 20% for alignment and 10% for leakage - Alignment withhold may change for future performance years 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021.
- 10. AdvancingDialysis.org • $334 – 4 in-center visits/month • $278 – 2-3 in-center visits/month • $202 – 1 in-center visit/month • $278 – 1 home clinic visit/month • KCC annual home dialysis “true-up” payment 2 - Additional $35 per home clinic visit / claim • Optional 1-time payment - $500 – home modality training payment per patient Medicare Allowable ESRD Capitated Payment rates (MCP)1 1Centers for Medicare & Medicaid Services, “Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021,” (Fact Sheet) accessed 1/2021, available at https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare- physician-fee-schedule-calendar-year-1/. 2RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. + 6. Annual home dialysis “true-up” payment
- 11. AdvancingDialysis.org Comprehensive Kidney Care Contracting (CKCC) Aggregation, Assessment, and Adjustment
- 12. AdvancingDialysis.org CKCC Quality Measures1 Patient Activation Depression Remission Optimal ESRD Starts 1Centers for Medicare and Medicaid Services Innovation Center, “Kidney Care Choices (KCC) Model,” (Fact Sheet) accessed 1/2021, available at https://www.cms.gov/newsroom/fact-sheets/kidney-care-choices-kcc-model
- 13. AdvancingDialysis.org Graduated Level 1 Graduated Level 2* Professional* Global* Quality Impact Withhold 0% 2.5% 5% 5% Shared Savings 40% 50% 50% 100% Shared Losses 0% 30% 50% 100% *Advanced Payment Models 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. CKCC Model Options and Medicare Total Cost of Care (TCOC) Exposure1
- 14. AdvancingDialysis.org Measures Weighting Optimal ESKD starts; NQF #2594 50% Gains in patient activation (PAM) scores at 12 months; NQF #2483 25% Depression remission at 12 months — progress toward remission; NQF #1885* 25% * Pay-for-Reporting in Performance Year 1 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. CKCC Quality Withhold Performance Measures1
- 15. AdvancingDialysis.org Performance Year 2022 Total Quality Score Benchmarks Quality Measures Measure-Specific Benchmark Optimal ESKD starts • Compared to performance of all nephrology practices nationwide Gains in patient activation scores • Record with Insignia Health both a baseline PAM® survey and a follow-up PAM® survey for 50% of aligned beneficiaries • Follow-up survey conducted at least six months after baseline and before performance year end • Average change of at least 3 points in PAM® score Depression response at twelve months – Progress towards remission • Record an index Patient Health Questionnaire-9 (PHQ-9) score for 50% of aligned beneficiaries • Record, for 100% of beneficiaries with a PHQ-9 score greater than 9, and whether: • Patient was diagnosed with major depression and/or dysthymia • Patient met any of the exclusion criteria during the index period Achievement only 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021.
- 16. AdvancingDialysis.org Performance Years 2023 – 2026 Total Quality Score Variables and Scoring1 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. Achievement • KCE participants outperforms measure-specific benchmarks • Performance is evaluated and assessed by achievement percentile scale Improvement • KCE participants outperform their own past performance • Earning points through improvement alone does not produce the highest score Benchmark Percentile Possible Points ≥ 90th percentile 2.0 ≥ 75th percentile 1.5 ≥ 50th percentile 1.0 ≥ 30th percentile 0.5 <30th percentile 0 Improvement Percentage Possible Points ≥ 10% 1.5 ≥ 5 - <10% 1.0 >0% - <5% 0.5 <0% - 0% 0
- 17. AdvancingDialysis.org Financial benchmark blend and timing* 2021 2022 PY 1 2023 PY 2 2024 PY 3 2025 PY 4 2026 PY 5 Traditional Medicare Local MA Rate Book Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 65% 35% 65% 35% 60% 40% 55% 45% 50% 50% CKD 4-5 advanced payment Advanced, quarterly, bundled, CKD 4-5 payments, adjusted for geographic factors, is calculated and paid with 30% withheld; 20% for alignment and 10% for leakage. Kidney transplant bonus An incremental, quarterly reimbursement beyond current fee for service claims of up to $15,000 per aligned beneficiary who receives a kidney transplant and remains alive with a functioning transplant. Reconciliation of CKD QCP, shared savings / losses and home dialysis true-up CKD QCP, shared savings/losses and home dialysis true-up payments will be calculated for each KCE. Savings/Losses will compare the benchmark expenditure and the actual expenditure for a given KCE’s aligned population. 1Centers for Medicare and Medicaid Services Innovation Center, “Direct Contracting Model Financial Methodology -Reconciliation Global and Professional,” (PPT) accessed 1/2021, available at https://innovation.cms.gov/media/document/dc-model-options-fnclmethrecon-slides 00 KCE Shared Payments, Bonuses, Savings and Losses Reconciliation Schedule1
- 18. AdvancingDialysis.org • $334 – 4 in-center visits/month • $278 – 2-3 in-center visits/month • $202 – 1 in-center visit/month • $278 – 1 home clinic visit/month • KCC annual home dialysis “true-up” payment 2 - Additional $35 per home clinic visit / claim • Optional 1-time payment - $500 – home modality training payment per patient No Impact to Physician Professional Fees1 1Centers for Medicare & Medicaid Services, “Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021,” (Fact Sheet) accessed 1/2021, available at https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare- physician-fee-schedule-calendar-year-1/. 2RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. + 2022 CKCC Estimated ESKD Payments
- 19. AdvancingDialysis.org CKCC High Performers Pool Quality Bonus1 KCEs can qualify for a High Performers Pool (HPP) bonus which rewards KCEs for high performance on the PAM® and Optimal Starts measures • HPP funded by 50% of remaining funds after earned back quality withholds are dispersed • Eligibility is limited to advanced payment model KCEs that meet reporting requirements • The top third performing and eligible KCEs receives HPP bonus • Bonus amounts based on HPP KCE proportion of aligned beneficiaries to the total number of aligned beneficiaries of all HPP KCEs 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021.
- 20. AdvancingDialysis.org Kidney Care First (KCF) Aggregation, Assessment, and Adjustment
- 21. AdvancingDialysis.org KCF Quality Measures1 Patient Activation Depression Remission Optimal ESRD Starts Reduced Cost of Care 1Centers for Medicare and Medicaid Services Innovation Center, “Kidney Care Choices (KCC) Model,” (Fact Sheet) accessed 1/2021, available at https://www.cms.gov/newsroom/fact-sheets/kidney-care-choices-kcc-model
- 22. AdvancingDialysis.org • The PBA has two components: ‒ Relative Performance (RP) to other KCF practices ‒ Continuous Improvement (CI) to their past performance • In order to evaluate relative performance, they must pass ‒ “The Quality Gateway” ‒ Minimum quality threshold established by CMS 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. KCF Annual Performance Based Adjustment (PBA)1
- 23. AdvancingDialysis.org Performance Based Adjustment Metrics1 Quality Gateway Measures • Gains in patient activation measurement scores at 12-months • Depression remission, or progress toward remission, at 12-months Utilization Measures • Optimal ESRD starts ‒ Start on HHD or ICHD without a CVC ‒ Start on PD • Includes outpatient or inpatient urgent start PD ‒ Preemptive transplant • Cost of Care Composite Measure ‒ Calculated combined cost of CKD and ESRD care for each KCF practice • CKD cost of care measure will contribute more to the composite if the practice has a greater share of measure-eligible CKD patients 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021.
- 24. AdvancingDialysis.org • Driven by KCF practice performance vs. peers • Results in stepped assignment to 1 of 5 performance levels: Step 1: Achieve Quality Gateway threshold? • Yes Move to step 2 • No Assigned to level 5 Step 2: Utilization performance vs. KCF peers? • Top 25% Assigned to level 1 • Top 26% Assigned to level 2 • Bottom 50% Move to step 3 Step 3: Utilization performance vs. nation? • Top 50% Assigned to level 3 • Bottom 25 – 49% Assigned to level 4 • Bottom <25% Assigned to level 5 1 2 3 4 5 Range of +/- adjustments based on Relative Performance +10% -20% PBA Level +2% n/a -6% 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. PBA Relative Performance (RP)1
- 25. AdvancingDialysis.org …the higher the PBA improvement target is set The lower the PBA level… Incentive to Improve Underutilization Performance and Sustain High Performance 5.0% 4.5% 4.5% 4.0% 3.5% 5 4 3 2 1 PBA Improvement Target PBA Level 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. PBA Continuous Improvement (CI)1
- 26. AdvancingDialysis.org Performance year 2 and after PBA Components (% Adjustment to CKD QCP & AMCP) Total PBA Impact (% Adjustment to CKD QCP and AMCP) PBA Performance Level RP Component CI Component RP + CI (maximum upward adjustment) RP Only (did not meet CI target) Top 50% of performers vs. all KCF practices Level 1 (Top 25%) +10% +10% +20% +10% Level 2 (Top 26 – 50%) +2% +5% +7% +2% Bottom 50% of performers vs. all KCF practices (then compared to practices nationally) Level 3 (Performance vs. top 50%) 0% +4% +4% 0% Level 4 (Performance vs. 25 – 49%) -6% +4% -2% -6% Level 5 (Performance vs. <25%) -20% +10% -10% -20% 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. Combining PBA Relative Performance (RP) and Continuous Improvement (CI)1
- 27. AdvancingDialysis.org PBA Payment Applied 2022 PY 1 2023 PY 2 2024 PY 3 2025 PY 4 2026 PY 5 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1st PBA: PY2Q3 – PY3Q2 (RP only) Measure Calculate Adjust 2nd PBA: PY3Q3 – PY4Q2 (RP and CI) Measure Calculate Adjust 3rd PBA: PY4Q3 – PY5Q2 (RP and CI) Measure Calculate Adjust 4th PBA: PY5Q3 – PY6Q2 (RP and CI) Measure Calculate Adjust Measurement period Data collection on measurement performance concludes at the end of PBA performance period Calculation period PBA amount calculated during PBA calculation period based on performance during PBA performance period Adjustment period Performance based adjustment applied to CKD QCP and AMCP (excluding the home dialysis “true up”) during the PBA adjustment period 1RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. KCF Annual Performance Based Adjustment (PBA)1
- 28. AdvancingDialysis.org • $334 – 4 in-center visits/month • $278 – 2-3 in-center visits/month • $202 – 1 in-center visit/month • $278 – 1 home clinic visit/month Performance based adjustment applied to Physician’s professional fees starting Q3 - 2023 2 • KCC annual home dialysis “true-up” payment 2 - Additional $35 per home clinic visit / claim • Optional 1-time payment - $500 – home modality training payment per patient 2022 – No Impact to Physician’s professional fees1 1Centers for Medicare & Medicaid Services, “Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021,” (Fact Sheet) accessed 1/2021, available at https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes- medicare-physician-fee-schedule-calendar-year-1/. 2RTI International. Kidney Care Choices ( KCC ) Model Quality Operating Guide : Overview.; 2021. + 2022 KCF Estimated ESKD Payments
- 29. AdvancingDialysis.org Risk and Responsibility All forms of dialysis, including treatments performed in-center and at home, involve some risks. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks. In addition, there are certain risks unique to treatment in the home environment. Patients differ and not everyone will experience the reported benefits of more frequent hemodialysis. Certain risks associated with hemodialysis treatment are increased when performing solo home hemodialysis because no one is present to help the patient respond to health emergencies. Certain risks associated with hemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping.
- 30. AdvancingDialysis.org About AdvancingDialysis.org AdvancingDialysis.org is dedicated to providing clinicians and patients with better access to and more awareness of the reported clinical benefits and improved quality of life made possible with home dialysis, including solo and nocturnal therapy schedules. For more information, visit AdvancingDialysis.org AdvancingDialysis.org is a project of NxStage Medical, Inc.
- 31. AdvancingDialysis.org www.AdvancingDialysis.org © 2022 NxStage Medical, Inc.
Notas del editor
- Leakage def: volume of care a beneficiary receives for their CKD outside of the KCC practice CKD Beneficiary Exclusion Criteria: not continuously enrolled in both Medicare Parts A and B. enrolled in Medicare Advantage (Part C). does not have Medicare as the primary payer. not at least 18 years of age. death date occurs during the quarter. resides outside of the United States. currently or prospectively aligned in other Medicare programs or models as determined by KCC Model policy. kidney transplant in the last 12 months. has received or is receiving hospice care. ESRD Beneficiary Exclusion Criteria: not continuously enrolled in both Medicare Parts A and B. enrolled in Medicare Advantage (Part C). does not have Medicare as the primary payer. not at least 18 years of age. death date occurs during the quarter. resides outside of the United States. currently or prospectively aligned in other Medicare programs or models as determined by KCC Model policy. has had a kidney transplant in the last 12 months. has received or is receiving hospice care. Prior to disbursing the KTB Installment, CMS will evaluate claims during a Lookback Period of up to 12 months post transplant, with 2 months claims run out CMS will review claims in the Lookback Period to determine that the transplant beneficiary met the following criteria: Their transplant did not fail The beneficiary did not receive a second transplant The beneficiary remained alive If these criteria are met during the Lookback Period, CMS will disburse the KTB Installment
- CKD Quarterly payments includes the following nephrology services: Office/Outpatient Visit Evaluation and Management (E/M) 99201-99205, 99211-99215 Prolonged E/M 99354-99355 Transitional Care Management Services 99495-99496 Advance Care Planning 99497-99498 Welcome to Medicare and Annual Wellness Visits G0402, G0438, G0439 Chronic Care Management Services (CCM) 99490 Complex Chronic Care Coordination Services 99487 Home Care / Domiciliary Care E/M 99348, 99349 Prolonged Non-Face-to-Face E/M Services 99358 Assessment/Care Planning for Patients Requiring CCM Services G0506 Online Digital E/M for an Established Patient; Phone E/M for an Established Patient 99421-99423, 99441-99443
- Each Performance Year, CMS withholds 5 percent of the Benchmark Expenditure from KCEs in both Professional and Global Risk Arrangements for quality. This quality withhold is held “at-risk,” meaning it can be earned back by the KCE by reporting and/or sufficiently performing on a set of pre-determined quality measures and Continuous Improvement/Relative Performance (CI/RP) metrics.
- Optimal ESRD Starts Preemptive transplant Start on HHD as an outpatient absent a CVC Start on ICHD as an outpatient absent a CVC Start on PD (as an outpatient or urgent start PD if as an inpatient) Patient Activation: “Refers to having the knowledge, skills and confidence needed to effectively manage one’s health” PAM® survey – 13 question proprietary survey tool developed and distributed by Insignia Health Survey to be administered at baseline and again within PY1 Insignia Health to provide support NQF endorsed patient reported outcomes measure which is designed to measure improvements in patient activation Depression Remission: Targets patients with a diagnosis of major depression or dysthymia AND a PHQ-9 score > 9 Must repeat the PHQ-9 twelve months later Success defined by a 50% reduction in the PHQ 9 score Pay-for-reporting in PY1
- Patient Activation: “Refers to having the knowledge, skills and confidence needed to effectively manage one’s health” PAM® survey – 13 question proprietary survey tool developed and distributed by Insignia Health Survey to be administered at baseline and again within PY1 Insignia Health to provide support NQF endorsed patient reported outcomes measure which is designed to measure improvements in patient activation Depression Remission: Targets patients with a diagnosis of major depression or dysthymia AND a PHQ-9 score > 9 Must repeat the PHQ-9 twelve months later Success defined by a 50% reduction in the PHQ 9 score Pay-for-reporting in PY1 Optimal ESRD Starts Preemptive transplant Start on HHD as an outpatient absent a CVC Start on ICHD as an outpatient absent a CVC Start on PD (as an outpatient or urgent start PD if as an inpatient) Reduced Cost of Care The measure is calculated by first determining the ratio of observed (actual) over expected costs for each beneficiary with ESRD who is aligned to a participating KCF Practice, and then by summing the beneficiary ratios across all beneficiaries for a KCF Practice. The resulting sum of ratios is then averaged across all beneficiaries with ESRD aligned to a participating KCF Practice. The ratio is multiplied by the national ESRD Cost of Care rate to present the number in dollar figures.
- Optimal ESRD Starts Preemptive transplant Start on HHD as an outpatient absent a CVC Start on ICHD as an outpatient absent a CVC Start on PD (as an outpatient or urgent start PD if as an inpatient) No more than 10% of ICHD new starts may use an AVG Patient Activation: “Refers to having the knowledge, skills and confidence needed to effectively manage one’s health” PAM® survey – 13 question proprietary survey tool developed and distributed by Insignia Health Survey to be administered at baseline and again within PY1 Insignia Health to provide support NQF endorsed patient reported outcomes measure which is designed to measure improvements in patient activation Depression Remission: Targets patients with a diagnosis of major depression or dysthymia AND a PHQ-9 score > 9 Must repeat the PHQ-9 twelve months later Success defined by a 50% reduction in the PHQ 9 score Pay-for-reporting in PY1
- PY: Performance Year