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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.
On this page
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 October 2020)
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.
- Acute hospital utilization per 1,000 members
- Adult access to preventive/ambulatory health services
- All-cause emergency department visits per 1,000 member months
- Antidepressant medication management
- Asthma medication ratio
- Childhood immunization status (combo 10)
- Children's and adolescent's access to primary care practitioners
- Chlamydia screening in women
- Comprehensive diabetes care: blood pressure control
- Comprehensive diabetes care: eye exam (retinal) performed
- Comprehensive diabetes care: hemoglobin A1c poor control
- Comprehensive diabetes care: hemoglobin A1c testing
- Comprehensive diabetes care: medical attention for nephropathy
- Contraceptive care - most and moderately effective methods
- Contraceptive care - most and moderately effective methods (LARC)
- Contraceptive care - postpartum
- Contraceptive care - postpartum (LARC)
- Follow-up after emergency department visit for alcohol and other drug abuse or dependence
- Follow-up after emergency department visit for mental illness
- Follow-up after hospitalization for mental illness
- Medication management for people with asthma: medication compliance 75%
- Mental health treatment penetration (broad version)
- Patients prescribed chronic concurrent opioids and sedatives
- Patients prescribed high-dose chronic opioid therapy
- Percent arrested
- Percent homeless (narrow definition)
- Periodontal evaluation in adults with chronic periodontitis
- Plan all-cause readmissions (30 days)
- Preventive services for children at elevated caries risk, dental, or oral health services
- Primary caries prevention intervention as offered by medical provider: topical fluoride application delivered by nondental health professional
- Statin therapy for patient with cardiovascular disease (prescribed)
- Substance use disorder treatment penetration
- Substance use disorder treatment penetration (opioid)
- Timeliness of prenatal care
- Utilization of dental services
- Well-child visits in the first 15 months of life
- Well-child visits in the third, fourth, fifth, and sixth years of life
- Acute hospital utilization
- All cause emergency department visits per 1,000 member months
- Antidepressant medication management
- Asthma medication ratio
- Childhood immunization status (combo 10)
- Children's and adolescents' access to primary care practitioners
- Chlamydia screening in women
- Comprehensive diabetes care
- Blood pressure control (statewide accountability only)
- Eye exam performed
- Hemoglobin A1c poor control (statewide accountability only)
- Hemoglobin A1c testing
- Medical attention for nephropathy
- Contraceptive care
- Controlling high blood pressure (statewide accountability only)
- Follow-up after emergency department visit for alcohol and other drug abuse or dependence
- Follow-up after emergency department visit for mental illness
- Follow-up after hospitalization for mental illness
- Medication management for people with asthma
- Mental health treatment penetration
- Patients prescribed chronic concurrent opioids and sedatives
- Patients prescribed high-dose chronic opioid therapy
- Percent arrested
- Percent homeless (narrow definition)
- Periodontal evaluation in adults with chronic periodontitis
- Plan all-cause readmissions (30 days)
- Primary caries prevention intervention as offered by medical provider
- Statin therapy for patients with cardiovascular disease
- Substance use disorder treatment penetration (opioid)
- Substance use disorder treatment penetration
- Timeliness of prenatal care
- Utilization of dental services
- Well-child visits in the first 15 months of life
- Well-child visits age three to six
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.
Project 2A
Project 3A
- CBO site is an access point in which persons can be referred for MAT
- CBO site provides services aimed at reducing transmission of infectious diseases to persons who use injection drugs
- ED protocols to initiate MAT or offer to take home naloxone
- Key clinical decision support features for opioid prescribing guidelines
- Linkage to behavioral care and MAT for people with opioid use disorders
- Provider use of guidelines for prescribing opioids for pain