RAE KPI Performance S FY 18-19 Matthew Lanphier Department of - PowerPoint PPT Presentation

RAE KPI Performance S FY 18-19 Matthew Lanphier Department of Health Care Policy and Financing

Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

KPI Payment Summary ACC Incentive Payment FY 18-19 Quarter 1 Incentive BH Prenatal Well Payment RAE ED HN pt. 2 HN pt. 1 Dental PMPM Engagement Engagement Visits Amount Amount -0.26% -4.24% 0.39% -1.16% 0.31% $0 36.60% 6.88% $321,275.01 RAE 1 RAE 2 -1.23% 0.47% 5.77% 9.72% 0.84% 2.54% -1.84% $1.712 $382,941.15 0.67% -3.73% 0.80% 1.09% -0.74% $0.856 14.38% 13.03% $819,865.32 RAE 3 -1.58% -0.65% 0.88% 4.31% 1.21% 8.30% 1.11% $3.710 $895,769.30 RAE 4 0.82% -8.34% 7.87% 10.88% 2.40% 4.92% -3.12% $1.712 $543,821.13 RAE 5 0.48% -6.14% 21.21% 10.03% -0.54% 2.49% -0.68% $0.856 $445,291.27 RAE 6 1.09% -7.27% -1.62% 11.73% -2.54% $1.142 19.23% 11.10% $602,868.66 RAE 7 Grand Tier 1 Tier 2 Total $4,011,831.84

Emergency Department Visits PKPY (Risk Adjusted) RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide 750.00 Actual ED Visits PKPY/ Average ED RAE Risk Weight 700.00 650.00 600.00 550.00 500.00 Baseline SFY July August September October November December 2018 RAE 1 597.43 591.31 593.20 595.86 594.21 590.40 595.29 RAE 2 620.43 612.92 611.34 612.82 613.12 610.58 610.89 RAE 3 661.55 665.75 666.78 665.95 663.80 662.43 662.38 RAE 4 571.57 564.49 565.83 562.55 557.60 550.65 552.52 RAE 5 647.52 655.12 655.35 652.85 649.67 642.44 647.82 RAE 6 585.72 588.10 590.35 588.52 584.51 583.63 577.10 RAE 7 700.34 702.76 707.01 707.96 708.50 700.45 701.31 Statewide 632.01 630.78 632.26 631.77 629.68 625.56 626.69

Risk Adjusted ED Visits % Difference from Baseline SFY 2019 Q1, 2 1.50 1.08 1.00 0.82 0.81 0.66 0.49 0.48 0.50 0.03 Percent Difference 0.00 -0.04 Q1: September 2018 -0.17 Q2: December 2018 -0.26 -0.29 -0.50 -0.61 -0.84 -1.00 -1.23 -1.24 -1.50 -1.60 -2.00 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

Health Neighborhood pt. 1 - SFY 2019 Q1 - Rate 40.00% 36.60% 35.00% 30.00% 25.00% 21.21% 19.23% 20.00% 14.38% 15.00% 10.00% 7.87% 5.77% 5.00% 0.88% 0.00% RAE1 RAE2 RAE3 RAE4 RAE5 RAE6 RAE7

Health Neighborhood pt. 2 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide 4.00 3.50 Percentage of Outpatient Specialist Visits with a PCMP visit within 60 days 3.00 prior to the Specialist Visit AND a referral from the PCMP to the specialist 2.50 2.00 1.50 1.00 Baseline SFY July August September October November 2018 RAE 1 2.10 2.09 2.05 2.01 1.96 1.95 RAE 2 2.55 2.52 2.50 2.56 2.84 2.85 RAE 3 1.72 1.73 1.71 1.65 1.67 1.69 RAE 4 3.52 3.48 3.48 3.50 3.49 3.45 RAE 5 2.29 2.21 2.13 2.10 2.14 2.16 RAE 6 1.94 1.85 1.83 1.82 1.76 1.73 RAE 7 1.86 1.82 1.78 1.72 1.67 1.60 Statewide 2.18 2.16 2.12 2.09 2.09 2.08

Health Neighborhood pt. 2 % Difference from Baseline SFY 2019 Q1, 2 0.40 0.35 0.30 0.20 Percent Difference From Baseline 0.10 0.01 Q1: September 2018 0.00 Q2: December 2018 -0.02 -0.06 -0.08 -0.10 -0.09 -0.09 -0.11 -0.12 -0.12 -0.12 -0.14 -0.18 -0.20 -0.19 -0.22 -0.28 -0.30 -0.40 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

BH Engagement -SFY 2019 Q1 - Improvement over Baseline 14.00% 13.03% 12.00% 11.10% 10.88% 10.03% 9.72% 10.00% 8.00% 6.88% 6.00% 4.31% 4.00% 2.00% 0.00% RAE1 RAE2 RAE3 RAE4 RAE5 RAE6 RAE7

Dental Visits % of Members with at Least One Dental Visit RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide 42.00 40.00 38.00 36.00 34.00 32.00 30.00 Baseline SFY July August September October November December 2018 RAE 1 33.38 32.76 32.99 33.52 34.27 34.79 35.09 RAE 2 32.47 32.40 32.49 32.74 33.73 34.38 34.55 RAE 3 37.61 37.84 37.85 37.91 38.50 39.76 40.41 RAE 4 32.26 31.93 32.08 32.65 33.20 32.98 32.30 RAE 5 33.62 34.93 34.64 34.42 34.72 35.60 36.10 RAE 6 34.56 34.84 34.52 34.38 35.07 35.65 35.18 RAE 7 32.94 33.15 32.89 32.41 32.59 32.46 32.66 Statewide 34.34 34.45 34.42 34.50 35.05 35.56 35.72

Dental Visits Percent Difference from Baseline SFY 2019 Q1, 2 3.00 2.80 2.48 2.50 2.08 2.00 1.71 Percent Difference 1.50 1.38 Q1: September 2018 Q2: December 2018 1.00 0.81 0.62 0.50 0.39 0.30 0.27 0.16 0.13 0.04 0.00 -0.19 -0.28 -0.50 -0.53 -1.00 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

Prenatal Engagement RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide 70.00 % of Deliveries with At least One Prenatal Visit 65.00 60.00 55.00 50.00 45.00 40.00 35.00 30.00 Baseline SFY July August September October November December 2018 RAE 1 60.19 60.38 59.07 59.50 58.89 59.01 58.07 RAE 2 42.96 44.56 44.43 44.05 43.98 44.09 44.32 RAE 3 57.58 58.00 57.65 58.21 58.65 59.06 58.99 RAE 4 41.82 42.96 43.35 45.30 45.51 45.53 46.14 RAE 5 38.15 38.33 38.19 40.03 43.30 46.47 49.45 RAE 6 55.64 56.10 57.17 57.02 57.27 58.38 59.32 RAE 7 54.26 57.33 59.62 60.63 61.99 62.82 64.88 Statewide 51.28 52.19 52.51 53.39 54.05 55.01 55.79

Prenatal Engagement % Difference from Baseline SFY 2019 Q1, 2 12.00 11.30 10.62 10.00 8.00 6.37 6.00 Percent Difference 4.51 4.32 3.69 Q1: September 2018 4.00 3.47 Q2: December 2018 2.10 1.88 2.00 1.41 1.39 1.36 1.09 0.63 0.00 -0.70 -2.00 -2.12 -4.00 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

Well Visits RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide 38.00 % of Members with At least One Well Visit 36.00 34.00 32.00 30.00 28.00 26.00 24.00 22.00 20.00 Baseline SFY July August September October November December 2018 RAE 1 31.33 30.75 30.99 31.43 32.04 32.32 32.59 RAE 2 25.38 25.60 25.41 24.91 24.81 24.99 25.04 RAE 3 34.36 34.48 34.31 34.11 34.28 33.77 35.71 RAE 4 23.08 23.31 23.40 23.34 23.95 23.81 23.38 RAE 5 29.83 31.07 29.74 28.90 28.58 28.81 29.05 RAE 6 29.22 29.33 28.98 29.03 29.75 28.83 29.89 RAE 7 27.20 27.69 27.28 26.50 26.48 26.19 26.42 Statewide 29.50 29.67 29.50 29.22 29.45 29.14 29.80

Well Visits % Difference from Baseline SFY 2019 Q1, 2 1.50 1.35 1.26 1.00 0.67 0.50 0.30 0.30 0.26 Percent Difference 0.10 Q1: September 2018 0.00 Q2: December 2018 -0.20 -0.25 -0.28 -0.34 -0.50 -0.47 -0.69 -0.78 -0.78 -1.00 -0.93 -1.50 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

Thank You Matthew Lanphier Program Operations Analyst Department of Health Care Policy & Financing Matthew.Lanphier@ state.co.us