Partial federal government shutdown
HCA does not anticipate any immediate impacts to our services or disruption to provider payments at this time. We will continue to monitor the situation and share updates if anything changes.
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 Project (MTP) effort through DSRIP.
- View the entire DSRIP Measurement Guide (updated September 2021)
- Measurement guide by chapters
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In the DSRIP Measurement Guide, you will find:
- Change log
- Orientation to the DSRIP Measurement Guide
- Chapter 1: DSRIP program requirements and accountability
- Chapter 2: statewide accountability
- Chapter 3: MCO accountability
- Chapter 4: ACH incentives for value-based care
- Chapter 5: ACH project incentives overall
- Chapter 6: ACH project incentives - P4R
- Chapter 7: ACH project incentives - P4P
- 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 summary (2018 to 2021) (August 2021)
- Measurement of dual-eligible beneficiaries (July 2021)
- Statewide accountability approach (August 2018)
- Notification of change to MTP project metrics (December 2017)
DSRIP quality and outcome metrics
Metrics listed in the state's MTP protocols were approved by the Centers for Medicare & Medicaid Services. 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
- Technical specifications
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- Acute hospital utilization
- Adult access to preventive/ambulatory health services
- All-cause emergency department visits per 1,000 member months
- Antibiotic utilization for respiratory conditions
- Antidepressant medication management
- Asthma medication ratio
- Avoidance of antibiotic treatment for acute bronchitis bronchiolitis
- Breast cancer screening
- Cervical cancer screening
- Child and adolescent well care visits
- Childhood immunization status (combination 10)
- Chlamydia screening in women
- Colorectal cancer screening
- Comprehensive diabetes care: eye exam (retinal) performed
- Comprehensive diabetes care: hemoglobin A1c testing
- Contraceptive care - access to LARC
- Contraceptive care - most and moderately effective methods
- Contraceptive care - postpartum - access to LARC
- Contraceptive care - postpartum - most and moderately effective methods
- Follow-up after emergency department visit for mental illness
- Follow-up after emergency department visit for substance use
- Follow-up after hospitalization for mental illness
- Kidney health evaluation for patients with diabetes
- Mental health services rate
- Opioid use disorder treatment rate
- Patients prescribed chronic concurrent opioids and sedatives
- Patients prescribed high-dose chronic opioid therapy
- Percent arrested
- Percent homelessness (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)
- Statin therapy for patients with diabetes adherence
- Statin therapy for patients with diabetes received
- Substance use disorder treatment rate
- Timeliness of prenatal care
- Utilization of dental services
- Well-child visits in the first 30 months of life
- ACH improvement targets
ACH pay-for-reporting (P4R) metrics
P4R metrics can help ACHs, health care providers, and Washington State gain greater insight of how Project 2A and Project 3A are progressing through a short list of site-level indicators.
- Guidance documents
- Technical specifications
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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