1. Supplemental Payments
Steps Towards Managing Population Health and Risk
No Risk
Full Risk
Payment: FFS Architecture
HIE: Use of Certified EHRs and Basic Exchange
Care Coordination: Basic
Financial Reserves
Quality Measurement: Reporting Required
HIE: Population Health Management
Care Coordination: More Integrated Care
Fee-for-Service
Supplemental Payments
Pay-for-Performance
Quality Measurement: Payment Tied to Performance
HIE: Real-Time Clinical Data
Bundled Payments
Care Coordination: Integrated Across Care Continuum
Shared Savings
Care Coordination: Fully Integrated
Payment: Risk Adjusted Total Cost of Care
Global Payments
LAN Category 1
LAN Category 2
LAN Category 3
LAN Category 4
* Alternative Payment Model (APM) categories are based on the 2017 Update to the Health Care Payment Learning and Action Network Framework. (LAN). In essence, category 1 is fee for service (FFS) with no link to quality; category 2 is FFS with a link to quality such as pay for reporting or a bonus payment for quality outcomes; category 3 is an an APM built on a fee for service architecture (e.g. shared savings, or shared savings with downside risk; and category 4 is population-based payment for populations or conditions.
Source: Edmunds, Hass, Holve (eds.),Consumer Informatics and Digital Health

2. Measure Set Development Is An Evolving (Multi-Year) Process
Step 6: Implement program
Step 5:
Develop
policy & incentive structure
Step 4:
Identify selection criteria
Providers
Step 3:
Align priorities, goals, and outcomes
Step 2:
Identify current
activities/
initiatives
Step 1:
Determine who should participate in the process

3. What We Measure and Pay for Defines Quality Strategy and Goals (DRAFT)
Improve Patient-Centered Care
Follow up after hospitalization: 21 and older (MNCM)
Controlling High Blood Pressure (NQF #0018)
Nursing Home CAHPS Long-Stay Resident Instrument (NQF #0692)
Prenatal and Postpartum care (HEDIS)
Getting Care Quickly Composite (HEDIS)
Getting Needed Care Composite (HEDIS)
Adolescent Well-Care Visit (HEDIS)
Reduce Preventable Utilization
LANE Visit (DHCF)
Plan All Cause Readmission (NQF #1768)
Potentially preventable hospitalizations (DHCF)
Diabetes short-term complications admission rate (HEDIS)
Ambulatory Care - ED Visits (NCQA)
Ensure Population Health
Immunizations for Adolescents (HEDIS)
Adult BMI Assessment (NCQA)
Adults Access to Preventive/Ambulatory Health Services (NCQA)
Pct. High-Risk Long-Stay Residents with Pressure Ulcers (NQF #0679)
Pct. Of Long_Stay Residents with a UTI (NQF #0684)
Pct. Of Long-Stay Residents Who Lose Control of Bowels or Bladder (CMS)
PCT of Long-Stay Residents Experiencing One or More Falls with Major Injury (NQF #0674)
Pct of Eligible Benes Receiving preventive dental services (HEDIS)
Well-Visits in the first 15 months of life (HEDIS)
Well-Visits in the first fourth, fifth, and sixth years of life (HEDIS)
Integrate
Behavioral Health
Screening for Clinical Depression (NQF #0418)
F/U after Hospitalization for Mental Illness
(NQF #0576)
Initiation and Engagement of Alcohol and Drug Dep. Tx (NQF #0004)
Use of multiple concurrent antipsychotics in children and adolescents (HEDIS)
Pct of Long-Stay Residents Receiving Antipsychotic Medication (CMS)
Build Infrastructure to Support High Performance
Quality Improvement Plan (DHCF)
24/7 Coverage Documentation (DHCF)
Extended Hours Documentation (DHCF)
Staff Education in MDS Training (DHCF)
Staff Turnover (DHCF)
RN Hours (DHCF)
End of Life Program (DHCF)
Measurement Strategy Defines DHCF Quality Strategy
Red = DHCF core measure used for all VBP programs

4. Backup Slides

5. My Ideal Measure(s)? Those that Accurately Reflect the Complexities of Care Delivery & Care Transitions
Hospitals
Currently, 9 acute care hospitals and 6 non-acute care hospitals are located within the District. However, many of these facilities are concentrated in Ward 2 and Ward 5. District residents also seek care at hospitals in neighboring counties in Virginia and Maryland.
Physicians
As of 2016, there are 8,934 physicians (MD, DO) licensed in the District, of which 2,810 are actively practicing medicine – providing at least 20 hours of clinical care per week in the District. There are 780 actively practicing primary care physicians in the District, 45% of whom work in an office/clinic setting and indicated that their primary practice setting was located in Wards 1, 2, 3, and 5.
Federally Qualified Health Centers
In 2016, the District’s network of 8 Federally Qualified Health Center (FQHC) grantees collectively served 178,324 patients at 39 clinical sites. Nearly 54% of patients seen in District FQHCs billed Medicaid or the Children’s Health Insurance Program (CHIP). FQHC providers included approximately: 115 physicians; 77 nurse practitioners; 21 physician assistants; 15 certified nurse midwives; 30 dentists; 96 licensed mental health providers; and 140 case managers.
Behavioral Health
As of 2016, 46 District Mental Health Rehabilitation Services and 57 Substance Use Disorder (SUD) community-based sites provide services for District residents. The Department of Behavioral Health (DBH) manages mental health services for Medicaid beneficiaries and coordinates programs with 32 Core Service Agencies.
Long-term Services and Supports (LTSS)
LTSS are provided in the home, community, nursing home, or other facilities. As of 2017, there are 18 skilled nursing facilities (SNFs) that operate in the District. There are 38 home health agencies distributed throughout the District. District residents are often transferred to SNFs or home health agencies for care upon discharge from District acute care hospitals.
Community Service Providers (CSPs)
As of 2016, CSPs offered a wide range of services across the District, including medication management support, counseling, and community support to address issues such as health, housing, transportation, food insecurity, education, and employment. CSPs include health and social services non-profits (such as food banks), faith-based organizations, and other community organizations.
In July 2018, Providence Hospital announced a plan to close its inpatient services by the end of the year and to open ambulatory services in the current hospital’s location.
Doctors of medicine (MD) and doctors of osteopathic medicine (DO).
DC Board of Medicine. (2015, September). Physician and Physician Assistant Workforce Capacity Report 3.0. Retrieved from
Health Services and Resources Agency, Uniform Data System. (2017). District of Columbia Aggregated Health Center Data. Retrieved from:
DC Health. District of Columbia Health Systems Plan. (2017, July). Retrieved from
Ibid.
DC Health Matters. Funding and Resources. Retrieved from:
Source: Improving Care Through Innovation: the District’s State Medicaid Health IT Plan.