Medicaid Transformation metrics

Under the Delivery System Reform Incentive Payment (DSRIP) program, Washington State, Accountable Communities of Health, and Medicaid managed care organizations are all accountable for demonstrating improvement toward and attainment of transformation targets. Earning the maximum funding available requires that performance expectations, including reporting activities, are met.

DSRIP Measurement Guide

The measurement guide describes how performance is measured for all accountable entities participating in the Medicaid Transformation effort through DSRIP.

View the full DSRIP Measurement Guide (updated August 2019).

Measurement guide by chapters

In this guide, you will find:

Change log
Chapter 1: DSRIP program requirements and accountability
Chapter 2: statewide accountability
Chapter 3: managed care organization accountability
Chapter 4: ACH incentives for value-based care
Chapter 5: ACH project incentives overall
Chapter 6: ACH project incentives - pay-for-reporting
Chapter 7: ACH project incentives - pay-for-performance
Chapter 8: ACH high-performance incentives
Appendix A: glossary of terms
Appendix B: resources for monitoring DSRIP progress
Appendix C: DSRIP measurement and payment timing
Appendix D: ACH VBP incentive calculation examples
Appendix E: sample calculation of ACH high-performance incentives
Appendix F: DSRIP metric selection and alignment
Appendix G: DSRIP quality and outcome metrics
Appendix H: ACH project P4P improvement target and AV methodology
Appendix I: ACH project P4P metrics - sample AV calculations
Appendix J: technical specifications (DSRIP quality and outcome metrics)
Appendix K: technical specifications (ACH project P4R metrics)

Measurement updates and resources

DSRIP metrics update (2017 to 2018) (August 2019)
Measurement of dual eligible beneficiaries (September 2018)
Statewide accountability approach (August 2018)
Notification of change to Medicaid Transformation project metrics (December 2017)

DSRIP quality and outcome metrics

Metrics listed in the state's Medicaid Transformation protocols were approved by the Centers for Medicare and Medicaid Services (CMS). These metrics use standard national and/or state specifications. Each technical specification sheet notes the utility of each metric within the DSRIP program.

Guidance documents

How to read metric specification sheets

Technical specifications for year 2 (calendar year 2018)

ACH improvement targets

ACH pay for reporting metrics

P4R metrics can help ACHs, partnering providers and the state gain greater insight of how Project 2A and Project 3A are progressing through a short list of site-level indicators.