Official Pay for Performance (P4P) Measure Results Clinical - - PowerPoint PPT Presentation

Official Pay for Performance (P4P) Measure Results

Clinical Integration Committee February 28, 2019

What’s new?

HCA has now provided official ACH 2017 baseline and 2019 targets for ACH Pay for Performance measures

Pay for Performance Measures (P4P)

• Calculated automatically by Health Care Authority
• Measure the region’s progress toward Medicaid transformation

goals

• Determine whether ACHs earn payment for transformation work

(which affects available funds for partner organizations)

• ACHs can receive partial credit (and earn partial funds)

Two Types of P4P Measures

Gap to Goal

Compare ACH baseline (2017) to an absolute benchmark (usually national Medicaid 90th percentile). ACHs must reduce gap by 10%.

Improvement over Self

No benchmark. ACHs must improve ~2% over their baseline performance (2017).

2019 Measures

Gap to Goal

• Antidepressant and asthma

medication management

• Child and adolescent access to

primary care

• Diabetes care

Improvement over Self

• Emergency department visits
• Mental health and SUD treatment

penetration

• Chronic and high-dose opioid

prescriptions

• Homelessness
• Hospital readmissions (30 day)

Example

How to read the following slides

51.0% 36.0% 67.6% 54.3%

Measure 1 Measure 2

2017 BASELINE 2019 TARGET 2017 BASELINE 2019 TARGET

Integration Care Coordination Opioids Chronic Disease

Data Source:

Not all measures relate to all SWACH project areas Each measure has a baseline (2017) and a target (2019)

Emergency Department Utilization (“All Cause”)

The rate of Medicaid member visits to the Emergency Department (all ages), including visits related to mental health and chemical dependency, reported per 1,000 member months

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

← Lower is better

28.01% 52.71% 41.96% 28.56% 53.73% 42.77% Age 0-17 Age 18-64 Age 65+

2017 BASELINE 2019 TARGET

54.43% 39.98% 55.35% 40.89% Acute Continuation

BASE TARGET

Antidepressant Medication Management

The percent of Medicaid members ages 18+ with a diagnosis of major depression who were newly treated with antidepressant medication and remained on for 12 weeks (acute) and 6 months (continuation)

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

 Higher is better 2017 BASELINE 2019 TARGET

54% 52% 56%

Clark County Skamania County Klickitat County

Antidepressant Medication Management – Acute, By County

The percent of Medicaid members ages 18+ with a diagnosis of major depression who were newly treated with antidepressant medication and remained on for 12 weeks (acute)

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

2017 Baseline Higher is better

2019 Target: 55%

Antidepressant Medication Management – Continuation, By County

The percent of Medicaid members ages 18+ with a diagnosis of major depression who were newly treated with antidepressant medication and remained on for 6 months (continuation)

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

2017 BASELINE 2019 TARGET 2017 Baseline Higher is better

2019 Target: 41%

40% 42% 44%

Clark County Skamania County Klickitat County

Child and Adolescent Access to Primary Care

The percent of Medicaid children who had a visit with a primary care provider in the measurement period

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

94.28% 82.25% 87.48% 87.23% 94.64% 84.25% 88.34% 88.11% Age 12 - 24 months Age 2 - 6 years Age 7 - 11 years Age 12 - 19 years

2017 BASELINE 2019 TARGET  Higher is better

Comprehensive Diabetes Care

The percent of adults with diabetes who received recommended preventive services in the measurement period

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

83.45% 87.61% 82.12% 86.79%

0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

HbA1c Testing Medical Attention for Nephropathy

2017 BASELINE 2019 TARGET  Higher is better

Medication Management for People with Asthma

The percent of Medicaid members age 5-64 who were identified with persistent asthma and dispensed appropriate medications that they remained on during the measurement period (with 75% compliance).

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

38.09% 36.77% Compliance 75%

2017 BASELINE 2019 TARGET  Higher is better

Mental Health Treatment Penetration

The percent of Medicaid members with a mental health treatment need who received at least one qualifying service during the measurement period (broad).

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

12.90% 47.1% 65.7% 13.15% 48.0% 66.9% Ages 65+ Ages 18-64 Ages 6-17

2017 BASELINE 2019 TARGET  Higher is better

Mental Health Treatment Penetration – By County

66% 70% 62%

Clark County Skamania County Klickitat County Ages 6-17

The percent of Medicaid members age 6-17 with a mental health treatment need who received at least one qualifying service during the measurement period (broad).

Higher is better

2019 Target: 67%

2017 Baseline

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

47% 45% 47%

Clark County Skamania County Klickitat County Ages 18-64

Mental Health Treatment Penetration – By County

The percent of Medicaid members age 6-17 with a mental health treatment need who received at least one qualifying service during the measurement period (broad).

Higher is better

2019 Target: 48%

2017 Baseline

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

Chronic High-Dose Opioid Therapy

The percent of Medicaid members age 18-64 who were prescribed chronic opioid therapy in high Morphine Equivalent Dosage (MED) in a quarter.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

26.76% 13.90% 27.28% 14.17% >50 mg MED in a quarter >90 mg MED in a quarter

2017 BASELINE 2019 TARGET ← Lower is better

27% 34% 26%

Clark County Skamania County Klickitat County

>50 mg MED

Lower is better

2019 Target: 27%

2017 Baseline

Chronic High-Dose Opioid Therapy, By County

The percent of Medicaid members age 18-64 who were prescribed chronic opioid therapy in >50 mg Morphine Equivalent Dosage (MED) in a quarter.

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

15% 16% 10%

Clark County Skamania County Klickitat County

>90 mg MED

Lower is better

2019 Target: 14%

2017 Baseline

Chronic High-Dose Opioid Therapy, By County

The percent of Medicaid members age 18-64 who were prescribed chronic opioid therapy in >90 mg Morphine Equivalent Dosage (MED) in a quarter.

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

Concurrent Opioids & Sedatives

The percent of Medicaid members age 18-64 prescribed opioids and a concurrent sedative prescription, among beneficiaries prescribed chronic opioids.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

21.05% 21.46% Concurrent Opioid and Sedative Prescriptions

2017 BASELINE 2019 TARGET ← Lower is better

22% 14% 22% Clark County Skamania County Klickitat County

Lower is better

2019 Target: 21%

2017 Baseline

Concurrent Opioids & Sedatives, by County

The percent of Medicaid members age 18-64 prescribed opioids and a concurrent sedative prescription, among beneficiaries prescribed chronic opioids.

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

Percent Homeless

The percent of Medicaid members who were homeless in at least one month of the measurement period.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

0.46% 3.67% 1.96% 0.47% 3.74% 1.99% Ages 0-17 Ages 18-64 Ages 65+

2017 BASELINE 2019 TARGET ← Lower is better

Plan All-Cause Readmission

The percentage of acute inpatient stays for Medicaid members ages 18-64 that were followed by an unplanned acute readmission within 30 days.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

10.28% 10.47% Patients readmitted within 30 days

2017 BASELINE 2019 TARGET ← Lower is better

Substance Use Disorder Treatment Penetration

The percent of Medicaid members age 12+ with a substance use disorder treatment need who received substance use disorder treatment during the measurement period.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

34.4% 32.4% 35.0% 33.0% Ages 12-17 Ages 18-64

2017 BASELINE 2019 TARGET  Higher is better

33% 30% 24% Clark County Klickitat County Skamania County

Substance Use Disorder Treatment Penetration, by County

The percent of Medicaid members age 18-64 with a substance use disorder (SUD) treatment need who received SUD treatment during the measurement period.

Higher is better

2019 Target: 33%

2017 Baseline

Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority