HCA selects 2021 quality performance measures for managed care contracts
The Washington State Health Care Authority (HCA) selected the quality performance measures for the value-based purchasing (VBP) strategy within 2021 Apple Health (Medicaid) managed care contracts. As we continue to move towards a system that recognizes and rewards quality care, your feedback has been critical during the measure selection process.
What are the 2021 integrated managed care measures?
- Child and Adolescent Well-Care Visit (WCV), 3-11 years
- Replacing retired measure Well-Child in the Third, Fourth, Fifth and Sixth Years of Life (W34). This age group is selected to continue the focus on younger childhood.
- Follow-Up Care for Children Prescribed ADHD Medication (ADD), Initiation phase
- Replacing Comprehensive Diabetes Care (CDC): Medical Care for Nephropathy and Hemoglobin A1c Poor Control (<9%)
- Requiring ADD measure for all MCOs due to an opportunity to focus efforts where performance has been consistently lower.
The following will continue unchanged:
- Antidepressant Medication Management (AMM), Acute & Continuation Phases
- Mental Health Treatment Penetration (MH-B)
- Prenatal and Postpartum Care (PPC), Timeliness of Prenatal Care & Postpartum Care
- Asthma Medication Ratio (AMR)
- Substance Use Disorder Treatment Penetration (SUD)
The following measures are selected within the MCO contract to incentivize performance outside the VBP strategy:
- Chlamydia Screening
- Replacing Comprehensive Diabetes Care - Eye Exam. Data shows that rates of chlamydia have been progressively increasing over time; performance on this measure is consistently low.
- Childhood Immunizations, Combo 10 (continued, unchanged)
What are the 2021 integrated foster care measures?
- Child and Adolescent Well-Care Visit (WCV), 12-17 & 18-21 years
- Replacing retiring measures Adolescent Well Care Visit (AWC) and Children's Access to Primary Care Practitioners (CAP). Selected these age groups to continue focus on adolescents/young adults.
The following will continue unchanged:
- Asthma Medication Ratio (AMR)
- Follow-Up Care for Children Prescribed ADHD Medication (ADD), Initiation
- Mental Health Treatment Penetration (MH-B)
- Substance Use Disorder Treatment Penetration (SUD)
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
What are VBP performance measures?
HCA's goal is to achieve a healthier Washington by containing costs while improving outcomes, patient and provider experience, and equity through innovative VBP strategies. One component of the strategy is to incentivize Medicaid managed care plans for performance on high priority quality measures. HCA does not mandate a specific approach by the MCOs in rewarding quality performance for providers. One of the MCO strategies for improvement is to contract with providers to improve performance on these measures.
What is considered in measure selection?
The selection of MCO quality measures is guided by Legislative mandate, which outlines specific criteria HCA must follow and evaluate performance against. The measures are selected each year to drive meaningful improvements in quality objectives.
We know quality measurement and current performance rates are concerning to many of you, especially in light of the challenges resulting from COVID-19. Although Legislative mandate limits our flexibility in adjusting MCO requirements, HCA will continue to look for opportunities to reduce unnecessary administrative burden and seek streamlined measurement collection practices for you and your practice.
For more information, contact HCAMCPrograms@hca.wa.gov.
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