Regional Health Improvement Plan Council March 17, 2020 1
Meeting Objectives • SWACH updates • Learn about clinical transformation work and P4P measures and advise for improvement
Review Meeting Minutes and Action Items • Vote on Co-Chair • Approve Minutes from January meeting
SWACH Updates • Key Updates • Board and RHIP Ad Hoc Committee • Legislative Luncheon and Session Recap
Partner Reporting
Overview • Partner reporting • Successes & barriers • Examples Organization Type # • Discussion Clinical 18 Community Serving 7 Total 25
Partner Reporting Project Type # 2A – Integration Whole Person Care (WPC) 20 2B – Care Coordination 3A – Opioid Community-Clinical Linkages (CCL) 22 3D – Chronic Disease Other 8 Quarterly Reports • Milestone progress based on scope of work • Success, barriers, technical assistance
Whole Person Care: Successes Partnerships Creating opportunities for collaboration • Finalizing MOUs, policies and procedures • Capacity building Hiring of staff • Training • Physical space • Leadership and staff engagement Buy-in, enthusiasm, collaboration towards common goal •
Whole Person Care: Successes Systems change & patient/client impact • Increased access to services for clients • Expanding types of services available • Implementation or increased use of assessment and screening tools • Increased communication and coordination between organizations
Community-Clinical Linkages: Successes • Identifying new & strengthening relationships with community partners • Program piloting and implementation • Expanding resources to community • Increasing community engagement • Aligning priorities
Other: Successes • Increased buy-in and engagement of staff • Increased capacity • Implementing PreManage (CMT) • Training • Program implementation
Partner-Identified Barriers by Project in Q4 14 12 10 8 6 4 2 0 Workforce Financial Policy Partnership Technology WPC CCL Other
Examples • Brief overview of project area(s) • How has the work moved forward? • What impact have you seen? (systems / outcomes) • Key successes • Challenges
Discussion • How would RHIP like to see partner successes captured and/or disseminated? • What gaps and challenges can be addressed by RHIP? • Other questions?
Thank you! Kim.lepin@ southwestach.org
P4P Measures
Pay-for-Performance (P4P) Measure Dashboard Feb 2020 Measurement Period: Apr 1, 2018 – Mar 31, 2019 SWACH Statewide 2019 2020 Legend Measure Rate Rate Target Target Acute Hospital Utilization per 1000 Members 66.3 70.8 69.8 -- Lower rate indicates better performance All Cause ED Visits per 1000 MM: Ages 0-17 Years 25.9 34.2 28.2 26.1 Current SWACH All Cause ED Visits per 1000 MM: Ages 18-64 Years 52.9 53.4 66.4 51.8 performance is worse than 2019 target All Cause ED Visits per 1000 MM: Ages 65+ Years 39.9 40.2 49.9 37.1 55.9% 50.7% 55.5% 56.2% Antidepressant Medication Management: Acute 41.1% 39.8% 36.2% 40.9% Antidepressant Medication Management: Continuation Data Sources 59.1% 52.9% -- 59.4% Asthma Medication Ration: 5-64 Years Measures are calculated 95.6% 96.8% 95.0% 96.0% Child and Adolescents’ Access to Primary Care Practitioners: 12-24 Months using ProviderOne claims and enrollment data and Child and Adolescents’ Access to Primary Care Practitioners: 25 Months-6 85.0% 84.0% 87.9% 85.4% other administrative and Years public health data sources. 88.5% 88.3% 92.3% 88.9% Measure performance and Child and Adolescents’ Access to Primary Care Practitioners: 7-11 Years targets are provided by the 88.4% 92.2% 88.4% 88.7% Child and Adolescents’ Access to Primary Care Practitioners: 12-19 Years Washington Health Care Authority via the Healthier 47.2% 44.1% -- 50.0% Comprehensive Diabetes Care: Eye Exam (Retinal) Performed Washington Measures Report. 83.8% 83.7% 83.5% 84.0% Comprehensive Diabetes Care: Hemoglobin A1c Testing 87.7% 86.6% 85.9% 86.3% Comprehensive Diabetes Care: Medical Attention for Nephropathy 17
Pay-for-Performance (P4P) Measure Dashboard Jan 2020 Measurement Period: Apr 1, 2018 – Mar 31, 2019 SWACH Statewide 2019 2020 Measure Legend Rate Rate Target Target Follow-Up After ED for Alcohol and Other Drug Abuse or Dependence: 7 25.4% 15.6% -- 25.3% Lower rate indicates Days better performance Follow-Up After ED for Alcohol and Other Drug Abuse or Dependence: 30 33.0% 25.3% -- 34.8% Days Current SWACH performance is worse 53.4% 62.8% -- 57.9% Follow-Up After ED for Mental Illness: 7 Days than 2019 target 68.3% 73.6% -- 73.9% Follow-Up After ED for Mental Illness: 30 Days 63.7% 61.1% -- 70.0% Follow-up After Hospitalization for Mental Illness: 7 days 80.6% 79.2% -- 86.4% Follow-up After Hospitalization for Mental Illness: 30 days Data Sources 41.8% 34.5% 37.7% -- Medication Management for People with Asthma: 75%, 5-64 Years Measures are calculated 67.8% 67.0% 68.2% 68.1% Mental Health Treatment Penetration: 6-17 Years using ProviderOne claims and enrollment data and 48.0% 49.9% 47.7% 48.9% Mental Health Treatment Penetration: 18-64 Years other administrative and 20.0% 36.6% 14.6% 13.3% Mental Health Treatment Penetration: 65+ Years public health data sources. Measure performance and Patients Prescribed Chronic Concurrent Opioids and Sedatives 19.8% 19.7% 21.2% 19.7% targets are provided by the Patients Prescribed High- Dose Chronic Opioid Therapy: ≥50mg MED 27.1% Washington Health Care 31.9% 35.4% 30.1% Authority via the Healthier Patients Prescribed High- Dose Chronic Opioid Therapy: ≥90mg MED 14.1% 16.3% 17.1% 15.6% Washington Measures Report. 18
Pay-for-Performance (P4P) Measure Dashboard Jan 2020 Measurement Period: Apr 1, 2018 – Mar 31, 2019 SWACH Statewide 2019 2020 Measure Legend Rate Rate Target Target Percent Homeless: 0-17 Years 0.4% 0.7% 0.5% 0.4% Lower rate indicates better performance Percent Homeless: 18-64 Years 3.7% 4.3% 5.8% 4.1% Percent Homeless: 65+ Years Current SWACH 0.0% 1.3% 2.0% 0.9% performance is worse Plan All-Cause Hospital Readmission Rate (30 days) 11.1% 12.0% 11.5% 11.3% than 2019 target 83.1% 82.3% -- 86.6% Statin Therapy for Patients with Cardiovascular Disease (Prescribed) 39.7% 33.6% 37.2% 39.8% Substance Use Disorder Treatment Penetration: 12-17 Years 37.2% 35.8% 34.4% 37.9% Substance Use Disorder Treatment Penetration: 18-64 Years Data Sources 0.0% 6.7% 0.0% 0.0% Substance Use Disorder Treatment Penetration: 65+ Years Measures are calculated 52.3% 54.0% -- 51.2% Substance Use Disorder Treatment Penetration (Opioid): 18-64 Years using ProviderOne claims and enrollment data and 0.0% 20.0% -- 0.0% Substance Use Disorder Treatment Penetration (Opioid): 65+ Years other administrative and public health data sources. Measure performance and targets are provided by the Washington Health Care Authority via the Healthier Washington Measures Report. 19
What are Pay-for-Performance (P4P) measures? • ACH Pay-for-Performance (P4P) measures are a set of quality measures, for which ACHs must demonstrate improvement • HCA calculates ACH performance for P4P measures • P4P results are calculated for the entire region, based on Medicaid enrollee residence – they are not limited to Medicaid enrollees treated by partnering providers or participating in ACH projects • P4P performance is measured annually, though current performance data are shared quarterly
How are P4P measures tied to ACH funding? ACHs will earn a portion of their funding based on their performance on a set • of P4P measures The portion of ACH funding tied to P4P measures increases throughout • Medicaid Transformation 2017 2018 2019 2020 2021 Percent of ACH project incentives 0% 0% 25% 50% 75% tied to P4P
How are P4P measures tied to ACH funding? Performance is measured based on progress toward Improvement Targets • Improvement Targets are performance goals for each metric and associated sub-metrics, • and will change for each performance period or target year (TY) HCA determines Improvement Targets for each ACH • To earn 100% of incentive funds, ACHs must meet or exceed their Improvement • Targets for P4P measures ACHs can earn partial credit - and a smaller portion of incentive funds - for making progress • towards an Improvement Target, even if they do not meet it The amount of progress an ACH makes toward P4P targets determines their Achievement • Value (AV) AV = 0 AV = .25 AV = .5 AV = .75 AV = 1.0 0% 25% 50% 75% 100%
P4P timeline by target year (TY) TY 2019 TY 2020 TY 2021 Baseline Year 2017 2018 2019 Targets published Q4 2018 Q4 2019 Q4 2020 Performance measurement period 2019 2020 2021 Performance data published Q4 2020 Q4 2021 Q4 2022 Funds determined and dispersed Q1 2021 Q1 2022 Q1 2023
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