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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.

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.