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 Improvement over Self Compare ACH baseline (2017) to an No benchmark. ACHs must improve absolute benchmark (usually national ~2% over their baseline Medicaid 90 th percentile). ACHs must performance (2017). reduce gap by 10%.
2019 Measures Improvement over Self Gap to Goal • Emergency department visits • • Antidepressant and asthma Mental health and SUD treatment medication management penetration • • Child and adolescent access to Chronic and high-dose opioid primary care prescriptions • • Diabetes care Homelessness • Hospital readmissions (30 day)
Example Each measure has a How to read the following slides baseline (2017) and a target (2019) Not all measures relate to all SWACH 51.0% 2017 BASELINE project areas Measure 1 2019 TARGET 67.6% Integration 36.0% 2017 BASELINE Measure 2 Care Coordination 2019 TARGET 54.3% Opioids Chronic Disease Data Source:
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 2017 BASELINE 42.77% ← Lower is better Age 65+ 41.96% 2019 TARGET 53.73% Age 18-64 52.71% Integration Care Coordination 28.56% Age 0-17 Opioids 28.01% 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
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) BASE TARGET 2017 BASELINE 54.43% Higher is better Acute 55.35% 2019 TARGET Integration 39.98% Continuation Care Coordination 40.89% 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
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) 2019 Target: 55% 56% Higher is better 54% 52% Clark County Skamania County Klickitat County 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
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) 2017 BASELINE 44% 2019 TARGET 2019 Target: 41% 42% Higher is better 40% Clark County Skamania County Klickitat County 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
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 94.28% Higher is better 2017 BASELINE Age 12 - 24 months 94.64% 2019 TARGET 82.25% Age 2 - 6 years 84.25% 87.48% Age 7 - 11 years Integration 88.34% Care Coordination 87.23% Opioids Age 12 - 19 years 88.11% 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
Comprehensive Diabetes Care The percent of adults with diabetes who received recommended preventive services in the measurement period Higher is better 2017 BASELINE 86.79% Medical Attention for Nephropathy 2019 TARGET 87.61% 82.12% Integration HbA1c Testing Care Coordination 83.45% Opioids Chronic Disease 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% Data Source: DSRIP Pay-for-Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority
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). 36.77% Higher is better 2017 BASELINE Compliance 75% 38.09% 2019 TARGET 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
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). 12.90% Higher is better Ages 65+ 13.15% 47.1% 2017 BASELINE Ages 18-64 48.0% 2019 TARGET Integration Care Coordination 65.7% Ages 6-17 Opioids 66.9% 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
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). 2019 Target: 67% 70% Higher is better 66% Ages 6-17 62% Clark County Skamania County Klickitat County 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
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). 2019 Target: 48% Higher is better 47% 47% Ages 18-64 45% Clark County Skamania County Klickitat County 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. 14.17% 2017 BASELINE ← Lower is better >90 mg MED in a quarter 13.90% 2019 TARGET 27.28% Integration >50 mg MED in a quarter 26.76% 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
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. 34% 2019 Target: 27% 27% Lower is better 26% >50 mg MED Clark County Skamania County Klickitat County 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, 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. 2019 Target: 14% 16% 15% Lower is better 10% >90 mg MED Clark County Skamania County Klickitat County 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
Concurrent Opioids & Sedatives The percent of Medicaid members age 18-64 prescribed opioids and a concurrent sedative prescription, among beneficiaries prescribed chronic opioids. 21.46% 2017 BASELINE ← Lower is better Concurrent Opioid and Sedative Prescriptions 21.05% 2019 TARGET 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
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. 2019 Target: 21% 22% 22% Lower is better 14% Clark County Skamania County Klickitat County 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
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