Data Workgroup September 6, 2018
Welcome & Introductions
Agenda • Agenda Review / Action Items • SWACH Updates • Workgroup Updates • Revised Measurement Guide • Monitoring Data Products 3
Action Items from Last Meeting Sarah / David H Revise draft charter to incorporate discussed changes Sarah Update meeting appointments to reflect frequency changes Daniel Ask Beacon about a behavioral health representative for group DLT members Send additional thoughts about assessment findings to staff David D / Corey Ask internally about any MCO initiatives to increase / encourage MAT Staff Distribute notes / slides 4
SWACH Updates - New staff / leadership - Non-clinical partner RFI - Clinical Transformation Plan updates - Pathways environmental scan (Klickitat, Skamania)
Workgroup Updates Workgroup members share any data related updates from their organizations: new or updated data sources, data projects, new analyses, exciting news, etc
Revised Measurement Guide
Background • Revised measurement guide released Aug 2018 • Guide describes measures, timelines, and payment mechanisms for ACHs. https://www.hca.wa.gov/assets/program/mtp-measurement-guide.pdf 8
Pay for Performance
Pay for Performance (P4P) Measures • ACHs will earn a portion of their funding based on their performance (aggregate performance for the region) on the P4P measures beginning in Year 3 (2019). • HCA is responsible for calculating ACH performance on P4P measures; the state will not require any additional reporting from partners for these measures. • HCA will calculate these measures at the ACH level, not at the provider / practice level. 10
What’s branding? ACH Pay for Performance (P4P) Measures Care Chronic Measure Integration Opioids State MCO Coordination Disease All-Cause Emergency Department (ED) Visits X X X X X Acute Hospital Utilization X X X X Follow up after ED visit for mental health X X Follow up after hospitalization for mental illness X X Follow-up after ED visit for alcohol or drug dependence X X Mental health treatment penetration (broad) X X X X X Plan All-Cause Readmissions X X X Substance use disorder treatment penetration X X X X Child and Adolescents’ Access to Primary Care Practitioners X X
What’s branding? ACH Pay for Performance (P4P) Measures Care Chronic Measure Integration Opioids State MCO Coordination Disease Comprehensive Diabetes Care: Eye Exam performed X X Comprehensive Diabetes Care: HbA1c testing X X Comprehensive Diabetes Care: Medical Attention for Nephropathy X X Medication Management for People with Asthma (5-64 years) X X X X Antidepressant Medication Management X X X Patients on high-dose chronic opioid therapy X Patients with concurrent opioids/sedatives prescriptions X Substance use disorder treatment penetration (opioids) X Statin Therapy for Patients with Cardiovascular Disease X Percent homeless (narrow) X
Measure Production ACH P4P measures will have multiple criteria applied. This means that ACH P4P measure results will likely be different from other measure production (i.e. MCOs, APCD, Community Checkup, etc). 13
Measure Production: Chlamydia Screening 1) All Washington State Medicaid beneficiaries . 2) Apply metric specific criteria : women, ages 16-24, who are sexually active and who are not receiving hospice care. 3) Apply general eligible population criteria : include Medicaid beneficiaries with comprehensive medical benefits or family planning only benefits. Exclude duals and those with primary insurance other than Medicaid. 4) Metric population : total possible metric population after criteria applied. 5) Regional attribution : attribute a beneficiary to a single ACH region based on their address during the measurement period (11 of 12 months, or 7 of 12 14 months)
ACH Improvement Targets • To earn incentive dollars for P4P measures, ACHs must meet annual improvement targets. • Improvement targets are calculated in two ways: – Gap to Goal – Improvement Over Self 15
Gap to Goal Calculated based on the difference between ACH baseline performance and an absolute benchmark (national 90 th percentile for Medicaid). ACHs must close the gap by 10%. 16
Improvement Over Self Calculated based on 1.9% improvement over ACH baseline performance. 17
Official Baseline and Targets HCA will release ACH official baseline performance and improvement targets for 2019 in October. The first baseline performance period is CY 2017. Baseline performance and improvement targets will be reset for each of the three P4P years (2019, 2020, 2021). 18
ACHs can earn partial credit Even if an ACH does not meet its improvement target, it can earn a portion of the incentive dollars. Partial improvement will be translated into “Achievement Values” (AV) to determine incentives earned. 19
High Performance Incentives High Performance Metrics If ACHs do not earn all of their P4P incentives based on meeting improvement All-cause ED visits targets, the remaining dollars can still be Antidepressant medication management earned based on performance on 9 metrics. Medication management for people w/asthma Mental health treatment penetration Available funds are adjusted based on # of Percent arrested Medicaid lives. Percent homeless Plan all-cause readmission The high performance metrics include duals. Substance use disorder treatment penetration Well-child visits in 3-6 years of life 20
Current Performance on P4P Measures Not official baseline
Pay for Performance (P4P) Measure Dashboard Aug 2018 Measurement Period: Oct 2016 – Sept 2017 SWACH Statewide Relative to Measure Date Legend Performance Performance State All-cause Emergency Department Utilization (per 1,000 member months) * Q3 2017 39.4 48.0 SWACH performance is Antidepressant Medication Management – Acute Q3 2017 51% 50% at or above statewide Antidepressant Medicaid Management – Continuation Q3 2017 36% 34% SWACH performance is below statewide Child and Adolescent Access to Primary Care (12-24 months) Q3 2017 89% 93% Child and Adolescent Access to Primary Care (2-6 years) Q3 2017 SWACH is the lowest 81% 85% performing ACH region Child and Adolescent Access to Primary Care (7-11 years) Q3 2017 87% 90% Child and Adolescent Access to Primary Care (12-19 years) Q3 2017 86% 90% Comprehensive Diabetes Care: Eye Exam Improvement over Self Q3 2017 39% 33% Comprehensive Diabetes Care: HbA1c Testing Q3 2017 Gap to Goal 83% 84% Comprehensive Diabetes Care: Medical Attention for Nephropathy Q3 2017 86% 86% Follow up after Discharge from ED for Alcohol or Other Drug Dependence (7 day) Q3 2017 34% 24% Data Sources Follow up after Discharge from ED for Alcohol or Other Drug Dependence (30 day) Q3 2017 43% 32% Follow up after Discharge from ED for Mental Health (7 day) Q3 2017 62% 61% Data sources used include: Follow up after Discharge from ED for Mental Health (30 day) Q3 2017 75% 72% Healthier Washington Data Follow up after Hospitalization for Mental Health (7 day) Dashboard + RDA Measure Q3 2017 86% 87% Decomposition Reports Follow up after Hospitalization for Mental Health (30 day) Q3 2017 91% 91% Inpatient Hospital Utilization (per 1,000 member months) * Q3 2017 65.3 67.1 *lower rate indicates better performance 1
Pay for Performance (P4P) Measure Dashboard Aug 2018 Measurement Period: Oct 2016 – Sept 2017 SWACH Statewide Relative to Measure Date Legend Performance Performance State Medication Management for People with Asthma Q3 2017 32% 31% SWACH performance is Mental Health Treatment Penetration Q3 2017 47% 46% at or above statewide Percent Homeless (ages 18-64) * Q3 2017 4% 5% SWACH performance is below statewide Plan All-Cause Readmission* Q3 2017 11% 14% Substance Use Disorder Treatment Penetration (ages 18-64) Q3 2017 31% 29% SWACH is the lowest performing ACH region Patients on High Dose Chronic Opioid Therapy Data for these measures not yet available Patients with Concurrent Opioid and Sedative Prescriptions Statin Therapy for Patients with Cardiovascular Disease Q3 2017 80% 78% Improvement over Self Substance Use Disorder Treatment Penetration (Opioids) Q3 2017 36% 46% Gap to Goal *lower rate indicates better performance About P4P Measures The first year ACHs will be held accountable for P4P measures is CY 2019. Performance in CY 2019 will be compared to baseline (CY 2017). Official ACH baseline performance will be calculated for CY 2017; the state intends to release baseline results in October 2018. Official improvement targets and benchmarks for measures will also be released in October 2018. SWACH performance reported here is preliminary. Benchmarks for gap to goal measures will likely be the national Medicaid 90 th percentile; ACHs must close the gap between baseline and benchmarks by 10%. Targets for improvement over self measures will be based on 1.9% improvement from baseline. Future updates of the P4P Measure Dashboard will include official baseline and benchmarks / improvement targets. The P4P Measure Dashboard will be updated quarterly where possible; however, some measures are only available annually or semi-annually. 2
Pay for Reporting
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