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Part of our VBP work includes selecting the VBP quality performance measures within the Medicaid managed care contracts. Performance measures are a tool that managed care organizations use to monitor the health of their enrollees. HCA’s Quality Measurement and Monitoring Improvement program helps determine the measures that HCA selects for these contracts.
We partner with Comagine Health, an external quality review organization, to conduct annual reviews of the current performance measures and their results. Comagine provides recommendations for which quality measures we incentivize, in line with HCA’s priorities of stability and alignment.
In addition, the past legislative proviso language created a framework for VBP that is largely continuing this year, although the proviso itself is no longer in effect.
Beginning in 2024, HCA will move toward outcomes-based measures, rather than continuing to use process of care measures. Included in the final list of measures for 2024 is the Depression Remission and Response (DRR-E) measure. Electronic Clinical Data Systems (ECDS) measures like DRR-E have been included as required reporting for Medicaid in Washington State since 2020 and are being implemented in VBP contracts across health care plans for 2024.
Our transition to ECDS measures is an investment in measuring what really matters for individuals with depression: better health outcomes.
Washington State is a leader in adopting new and innovative ways to improve access to quality health care for our residents. We appreciate the many partnerships that together, help achieve a healthier Washington.
We acknowledge that for some providers, this transition may be challenging, and it will take time to fully implement and see results. Providers who need support can contact their MCO.
Here are the integrated managed care and integrated foster care contract measures for next year:
2024 integrated managed care measures:
- Antidepressant Medication Management (AMM) – Acute & Continuation Phases
- Breast Cancer Screening (BCS-E) Electronic Clinical Data Systems measure
- Child and Adolescent Well-Child Visits (WCV) – 3-11 years
- Depression Remission and Response for Adolescents and Adults (DRR-E) (Follow-up PHQ9, Total) Electronic Clinical Data Systems measure – Zero weight for MY2024, new
- Follow-Up Care for Children Prescribed ADHD Medication (ADD) – Initiation
- Follow-Up After Emergency Department Visit for Substance Use (FUA) (30 day, Total) new
- Follow-Up After Hospitalization for Mental Illness (FUH) (30 day, Total) new
- Prenatal and Postpartum Care (PPC) – Timeliness of Prenatal Care & Postpartum Care
We’ve selected these measures to incentivize performance outside of VBP:
- Childhood Immunizations, Combo 10 (CIS)
- Chlamydia Screening in Women (CHL) (Total) new
2024 integrated foster care measures:
- Asthma Medication Ratio (AMR) - 5-11 and 12-18 years
- Child and Adolescent Well-Child Visits (WCV)
- Depression Remission and Response for Adolescents and Adults (DRR-E) (Follow-up PHQ9, 12-17 years) Electronic Clinical Data Systems measure – Zero weight for MY2024 new
- Follow-Up Care for Children Prescribed ADHD Medication (ADD) – Initiation
- Follow-Up After Emergency Department Visit for Substance Use (FUA) (30 day, 13-17 years) new
- Follow-Up After Hospitalization for Mental Illness (FUH) (30 day, 6-17 years) new
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
Looking to 2025 and beyond, HCA will be evaluating our VBP strategy to ensure it supports population health priorities, health equity and community engagement, and the ability to achieve quality goals and sustain improvement.
For questions, please contact EQRO@hca.wa.gov.
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