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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. These transformation targets include ACH project pay for reporting (P4R) and pay for performance (P4P) metrics, ACH high performance metrics, and DSRIP statewide accountability quality metrics. More information can be found in the DSRIP Measurement Guide on the Medicaid Transformation Resources page.
DSRIP quality and outcome metrics
Metrics listed in the state's DSRIP planning protocol, funding and mechanics protocol, and Project Toolkit were approved by the Centers for Medicare and Medicaid Services (CMS). These metrics use national and/or state standard specifications. Each technical specification sheet notes the utility of each metric and some metrics have multiple utilities within the DSRIP program (e.g., ACH project pay for performance, ACH high performance, statewide accountability). Calculation of metrics performance for year 1 of Medicaid Transformation (calendar year 2017) will use the specifications below. Variations from these standards are noted in the specification sheets.
- Acute hospital utilization
- All cause emergency department visits per 1,000 member months
- Antidepressant medication management
- Childhood immunization status combo
- 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)
- Dental sealants for children at elevated caries risk
- 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
ACH project P4R is designed to incentivize the collection of valuable and actionable information that the ACH and partnering providers are in the best position to collect. This information will support the Independent Assessor, the Independent External Evaluator, and the state in monitoring and evaluation of transformation activities.
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