VBP update: Information on 2022 VBP measures selection
HCA has selected the quality performance measures for the value-based purchasing (VBP) strategy within 2022 Medicaid managed care contracts. HCA acknowledges that quality improvement takes time and requires stability for successful outcomes to be achieved. As this has been a unique and challenging year, our agency’s intent is to avoid unnecessary change where possible.
HCA partnered with the contracted External Quality Review Organization (EQRO) Comagine Health to conduct a review of the current performance results. After reviewing the current results, our agency determined that no significant changes will be made to the current set of VBP measures for the 2022 contract year.
Contact carey.wallace@hca.wa.gov with questions.
2022 integrated managed care measures
- Child and Adolescent Well-Care Visit (WCV), 3-11 years
- Follow-Up Care for Children Prescribed ADHD Medication (ADD), Initiation phase
- 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 will continue unchanged in MCO contracts to incentivize performance outside the VBP strategy:
- Chlamydia Screening
- Childhood Immunizations, Combo 10
2022 integrated foster care measures
- Child and Adolescent Well-Care Visit (WCV), 12-17 & 18-21 years
- 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)
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. The measures are selected each year to drive meaningful improvements in quality objectives.
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, including the following:
- Measure managed care performance in four common measures across each managed care organization, including:
- At least one common measure must be weighted towards having the potential to impact managed care costs; and
- At least one common measure must be weighted towards population health management, as defined by the measure; and
- Measure managed care performance in an additional three quality focus performance measures specific to a managed care organization. Quality focus performance measures chosen by the authority must:
- Be chosen from the statewide common measure set;
- Reflect specific measures where a managed care organization has poor performance; and
- Be substantive and clinically meaningful in promoting health status.
It should be noted that the 2022 set of integrated managed care VBP measures continue to allow for the same seven measures across all five MCOs. However, when you consider the results and analyses presented by our contracted EQRO the final list of measures aligns well with the required criteria above. In addition to the required criteria, the measures were also selected using the following considerations, established by the HCA Quality Measurement and Monitoring Improvement (QMMI) program:
- Replace VBP measures less frequently to allow time for improvement and stability in measure performance
- VBP measures have been validated and tested as reported metrics in contract previously
- Increase alignment across state contracts
- Decrease the administrative burden of measurement
- Decrease/avoid unintended consequences
- Health plans/carriers/providers may provide feedback before new measures are put in contact
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