1. Medicaid Prime – Year 4
Shared Savings Criteria
November, 2017

2. State Quality Targets for RMHP

3. Plan Quality Measure Targets
NQF 0418
Depression Screening and Follow-Up = %
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

4. 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

5. RMHP Shared Savings Criteria

6. 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 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Questions?