Medicaid Prime – Year 4 Shared Savings Criteria November, 2017

State Quality Targets for RMHP

Plan Quality Measure Targets NQF 0418 Depression Screening and Follow-Up = 55.63% HEDIS - CDC HgbA1c Poor Control > 9.0 = 29.23% HEDIS - ABA Adult Body Mass Index = 93.5% Patient Activation Measure Levels 1 & 2 Re-assessment = 30% Patient Activation Measure Roadmap Report Section - Title

What has changed? CQM Depression Screening and Follow-Up measure replacing HEDIS AMM measure (Medication Management of Depression) Performance focus on Prime practices participating in SIM, and Advancing the number of Prime practices screening for depression and reporting Step toward moving to CQMs as opposed to HEDIS Step towards measure alignment across programs Performance Targets BMI – increase of about 2.5% PAM –change to focus on re-assessment

RMHP Shared Savings Criteria

Practice Shared Savings Criteria NQF 0418 Report 2018 Practice Level Performance on Screening for Clinical Depression and Follow-Up via EMR by 2/1/2019 NQF 0059 Report 2018 Practice Level Performance on HgbA1c Poor Control > 9.0 via EMR by 2/1/2019 (Peds excempt) NQF 0421(Adult Practices) Report 2018 Practice Level Performance on BMI Screening and Follow-up via EMR by 2/1/2019 NQF 0024 (Peds Practices) Report 2018 Practice Level Performance on Childhood BMI/Nutrition/Physical Activity via EMR by 2/1/2019 Patient Activation Measure Perform a Reassessment (2nd PAM) on all Previously assessed Levels 1 and 2 by 12/31/2018 Section - Title

Practice Reported CQMs Required reporting - Calendar Year 2018, reported by 2/1/19 Quarterly reporting highly encouraged Ongoing assessment of practice performance Quarterly feedback reports allowing meaningful comparison Opportunity to trouble shoot reporting issues Opportunity to trouble shoot performance issues

Patient Activation Measure Required – all Patients previously assessed at Level 1 or Level 2 are re-assessed by 12/31/2018 Ongoing Growth of Utilization of both PAM and CFA encouraged

What has changed? CQM Reporting – Required PAM - Required Reporting only – but all 3 measures (except Peds) No performance target setting or achievement PAM - Required change to focus on re-assessment Encouraged focus areas Continued CQM performance improvement Continued growth in PAM / CFA use ED Utilization Improved attribution

Recommended Focus Area - ED ED Utilization – ongoing area for improvement Practice has information to help begin to manage excessive utilization via the monthly attribution reports Improved performance here may contribute to the likelihood of improved financial performance of Prime

Recommended Focus Area – Attribution Attribution – ongoing area for improvement Practice has information to help begin growing their attribution via the monthly attribution reports (assigned but not attributed tab) Larger attribution equates to more payment to practice

Questions?