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SOONERCARE PCMH REDESIGN
STAKEHOLDER MEETINGS
January 17 – 18, 2017
BEFORE WE GET STARTED…
What will the PCMH redesign do? (we hope)

Build on the existing “value-based” reimbursement system
by strengthening the relationship between payment and
quality/outcomes

Simplify the “recognition” criteria for PCMH participation
and process for earning incentive payments
What will the PCMH redesign not do? (we
promise)

It will not reduce the amount of funding for PCMH
providers from what would be paid under the current
system
PCMH Redesign Stakeholder Meeting
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AGENDA
Topic
Approximate Time
1. Introduction and background
15 minutes
2. PCMH redesign overview
15 minutes
3. Redesign discussion
45 minutes
4. Transformation & transition from current to new
15 minutes
5. Measuring & rewarding quality/improved outcomes
25 minutes
6. Next steps
5 minutes
PCMH Redesign Stakeholder Meeting
3
INTRODUCTION & BACKGROUND

SoonerCare is undergoing significant change, with
enrollment of ABD members into SoonerHealth+
managed care organizations

However, most members will remain in SoonerCare
Choice

These members will continue to have patient-centered
medical home (PCMH) providers as their most
important source for care

515,000 children and adolescents (Nov 2016)

88,000 adults (Nov 2016)
PCMH Redesign Stakeholder Meeting
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INTRODUCTION & BACKGROUND
cont’d

The current PCMH design was introduced in 2009 and
has been updated over time

The current design has three tiers for which providers
can seek “recognition” (certification), as shown on the
next slide

The design includes three payment components:

Case management fee paid on a per member per month basis

Fee-for-service payments for patient visits

SoonerExcel incentive payments for meeting/exceeding
program targets
PCMH Redesign Stakeholder Meeting
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INTRODUCTION & BACKGROUND
Tier 1
Entry Level
•
•
•
13 Required Activities
20 hours/week
CM Fee $3.36-$4.70 PMPM
•
•
•
Primary/preventive care
VFC participant
Clinical data in paper or
electronic format
Maintains medication list
Tracks lab/diagnostic tests
Tracks referrals
Care Coordination
Patient and Family
Education
Medical Home Agreement
Maintains open schedule
E-Comm. from OHCA
Phone coverage 24/7
BH screening annually
•
•
•
•
•
•
•
•
•
•
Tier 2
Advanced
•
•
•
17 Required Activities + 3 of
5 Optional Activities
30 Hours/Week
CM $4.36-$6.13 PMPM
Required
• Tier 1 plus
• Minimum 30 hours/week
• Track panel members
inside/outside of practice
• Transitional Care
• Multi-modal communication
Optional (3 of 5 required)
• Healthcare team led by PCP
• Post-visit outreach
• Evidence based guidelines
• Medication Management
• Minimum 4 hours after hours
PCMH Redesign Stakeholder Meeting
cont’d
Tier 3
Optimal
•
•
•
23 Required Activities + 3
Optional Activities
30 Hours/Week
CM $5.81-$8.15 PMPM
Required
• Tier 2 plus
• Healthcare team led by PCP
• Post-visit outreach
• Evidenced based guidelines
• Medication Management
• Minimum 4 hours after hours
• Health Assessment Tools
Optional (3)
• Secure interactive web site
• Integrated care plans
• Performance improvement
6
INTRODUCTION & BACKGROUND
cont’d
SoonerExcel - SFY 2016
SoonerExcel
Quality Measure
Benchmark
Incentive (subject to
available funds)
SFY 2016
Payments
4th Diphtheria-TetanusPertussis Vaccine Dose
Immunization prior to age 2
$3.00 per child
Early & Periodic
Screening, Diagnosis &
Treatment Services
(EPSDT)
Meet or exceed appropriate
compliance rate
Up to 25 percent bonus on standard
Fee-for-Service (FFS) rate for
procedure
Breast/ Cervical Cancer
Screens
Payment made for each
screen
Amount based on comparison to
peers and available funds
$342,000
Emergency Room
Utilization
Expected ER/office visit rate
(risk adjusted)
Additional PMPM payment for
outperforming benchmark
$489,000
Physician Hospital Visits
Making inpatient visits
25 percent bonus per procedure +
additional $20 per visit if above
average of participating providers
$831,000
Behavioral Health
Performing annual BH
screen on members age 5+
$5.00 per assessment
$209,000
$50,000
Total
PCMH Redesign Stakeholder Meeting
$1,000,000
$2,921,000
7
INTRODUCTION & BACKGROUND

cont’d
Tier 1 accounts for slightly over half of PCMH providers
PCMH Providers by Tier - June 2016*
*Total provider count is 889. Clinics count as a single provider
PCMH Redesign Stakeholder Meeting
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INTRODUCTION & BACKGROUND

cont’d
Tier 2 and 3 providers account for most of the membership
TANF Members by Tier – SFY 2016
PCMH Redesign Stakeholder Meeting
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INTRODUCTION & BACKGROUND
cont’d

Providers with the greatest concentration of
members have strived to meet the higher tier
requirements

The current PCMH design has contributed to
improvements in primary care among
SoonerCare members

On one critical measure – access to a PCP –
SoonerCare outperforms other Medicaid
programs nationally
PCMH Redesign Stakeholder Meeting
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INTRODUCTION & BACKGROUND
cont’d
Children & Adolescents’ Access to PCP*
100.0%
96.2%
96.1%
96.2%
95.50%
89.6%
89.0%
90.0%
90.9%
89.8%
91.8%
92.1%
92.7%
92.9%
92.8%
91%
89.30%
87.80%
80.0%
70.0%
60.0%
50.0%
12 - 24 mos.
25 mos. - 6 yrs.
2014 (CY 2013)
2015 (CY 2014)
7 - 11 years
2016 (CY 2015)
12 - 19 years
Nat'l Benchmark
*The percentage of members 12 months–19 years of age who had a visit with a PCP. Note: scale is not 0 - 100
PCMH Redesign Stakeholder Meeting
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INTRODUCTION & BACKGROUND
cont’d
Adult Access to Preventive/Ambulatory Care*
100.0%
89.9%
90.0%
90.1%
90.0%
84.7%
82.4%
81.0%
84.1%
83.6%
80.3%
80.0%
78.2%
77.4%
77.5%
70.0%
60.0%
50.0%
20 - 44
45 - 64
2014 (CY 2013)
2015 (CY 2014)
65+
2016 (CY 2015)
Total
Nat'l Benchmark
*The percentage of members 20 years and older who had an ambulatory or preventive care visit.
Notes: scale is not 0 – 100; no national benchmark was available for this measure.
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – OVERVIEW

Building on the progress made since 2009, the time is appropriate for a
broader redesign of the SoonerCare PCMH model

Nationally, there is ever greater emphasis on value-based purchasing that:


Establishes uniform standards

Recognizes and rewards higher quality and improved outcomes

Promotes integration of primary care with the broader “medical neighborhood” and
with behavioral health

Acknowledges the importance of social determinants of health to improving outcomes
The current PCMH model:

Has three tiers, even though Tier 1 incorporates over one-half of the Tier 3 recognition
requirements and Tiers 2/3 account for most of the membership

Pays incentives for some “process” (e.g., performing assessments) that more logically
belong as recognition requirements
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – OVERVIEW
cont’d

Reimbursement - The redesign will not reduce payments to PCMH
providers in aggregate but will be budget neutral versus what is
projected to be spent under the current model (approximately $500
million per year for claims + PCMH/HAN case management +
SoonerExcel)

Administration – The system will not add to provider or OHCA
administrative burdens

Quality – The metrics selected for measuring quality/performance
will:

Reflect Oklahoma priorities (more on that shortly)

Be related to PCMH activities

Be measurable through claims data or medical records without increasing
administrative burden

Be “quantifiable” in terms of estimating the financial impact to the program
associated with improved outcomes (wherever possible)
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – OVERVIEW cont’d
Base
Add-on Payments
Requirements
•
Base case management fee
•
•
Onsite inspection
Outcomes-based QI
•
•
Health risk assessment
Social determinants of health
assessment
Mental health substance use screening
Minimum of 30 office hours per week
Open scheduling
Preventive service
EPSDT outreach and education, as
applicable
Certified EMR
Post-visit follow-up
Care coordination across the medical
neighborhood
•
•
•
•
•
•
•
•
PCMH Redesign Stakeholder Meeting
•
Payments per additional activity (upon
meeting criteria)
•
•
•
•
Patient portal
Accreditation
HIE
Extended hours outside of core
business hours
o 4 – 8 or
o 9 or more
Integrated behavioral health and
substance use
Population health management
o Disease registry
o Risk stratification
o Standards of care
o Outreach/follow-up
Care coordination across the medical
neighborhood: Integrated care plans
•
•
•
15















1.
2.
Critical lab
Medication changes
Nurse visit, phone call etc.
Care coordination across the medical
neighborhood

Criteria

Health risk assessment
Social determinants of health assessment
for new patients
Mental health substance use screening
Minimum hours of 30 office hours per
week
Open scheduling
Preventive service
EPSDT outreach and education as
applicable
Certified electronic medical record (EMR)
Post-visit follow-up
Questions
PCMH REDESIGN – BASE REQUIREMENTS DISCUSSION
Referral tracking/documentation
After-hours access to care (voice-to-voice,
telehealth etc.)
Transitional care
Oral health (screening)
PCMH Redesign Stakeholder Meeting
As a group, are these appropriate
recognition criteria for promoting:

Access to preventive and acute care

PCMH integration with the
member’s “medical neighborhood”

PCMH integration with behavioral
health & substance use treatment

Inclusion of social determinants of
health in a patient’s care planning
Which criteria appear most
challenging?

Performing

Documenting
3.
What should be the OHCA’s role
in supporting providers?
4.
Other criteria?
16
Patient portal

Accreditation

HIE

Extended hours





Criteria

Questions
PCMH REDESIGN – ADD-ON PAYMENTS DISCUSSION
1.
As a group, are these appropriate
“add-on” criteria for promoting
enhanced:


4 – 8 hours available outside of core business
hours

9 or more hours available outside of core
business hours

Integrated behavioral health & substance
use
2.
Population health management
Which criteria appear most
challenging?

Disease registry


Risk stratification


Standards of care

Outreach/follow-up
Care coordination across the medical
neighborhood – integrated care plans
PCMH Redesign Stakeholder Meeting
3.
4.
Access to preventive and acute care
PCMH integration with the
member’s “medical neighborhood”
PCMH integration with behavioral
health & substance use treatment
Inclusion of social determinants of
health in a patient’s care planning
Performing
Documenting
What should be the OHCA’s role
in supporting providers?
Other criteria?
17
PCMH REDESIGN - TRANSFORMATION


Existing SoonerCare PCMH providers

The OHCA is developing a plan for transitioning providers from
current to new model

To the extent possible, providers will be certified prior to the
effective date of new agreements (January 1, 2018)
Providers new to SoonerCare

Providers who are entirely new to SoonerCare will be given a
period of time to achieve certification (e.g., six months) and will be
permitted to enroll members in their panels, following an onsite
visit by the OHCA

Providers who previously were in SoonerCare, left and returned
will likely be given a shorter time frame for certification (e.g., three
months)
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – REWARDING QUALITY

Potential areas of focus – defining OK priorities

Metrics with relationship to base requirements (e.g., preventive and
chronic care)

Metrics aligned with Comprehensive Primary Care+ (CPC+)
measures (those relevant to TANF)

Metrics aligned with Healthy Oklahoma 2020/OHIP areas of focus


Obesity

Tobacco cessation

Maternal-Child health (MCH), including child preventive and oral health

Behavioral Health
Measures within all of the above areas for which Oklahoma lags
national benchmarks
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – REWARDING QUALITY

cont’d
Potential areas of focus – defining OK priorities cont’d

Possible measures for inclusion in the PCMH redesign are presented
starting on the next slide (along with data for a few examples)*

The OHCA is interested in stakeholder recommendations regarding
which measures should be part of the quality data set

The list is not exhaustive – stakeholders are welcome to
recommend other measures

The final selected measures will be a much smaller subset of the
potential universe

The measure set likely will be updated over time as goals are met
and new priorities identified
* CPC+ measures largely overlap with other categories and so are not shown separately.
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – PREVENTIVE CARE
Measure
Brief Description
Primary Steward
Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to
screen for breast cancer.
National Committee for
Quality Assurance
Cervical Cancer
Screening
Percentage of women 21-64 years of age who were screened for
cervical cancer using either of the following criteria: * Women age 2164 who had cervical cytology performed every 3 years * Women age
30-64 who had cervical cytology/human papillomavirus (HPV) co-testing
performed every 5 years.
National Committee for
Quality Assurance
Colorectal Cancer
Screening
Percentage of adults 50-75 years of age who had appropriate screening
for colorectal cancer.
National Committee for
Quality Assurance
Adult Access to
Preventive/Ambulatory
Health Services
Percentage of members 20 years and older who had an ambulatory or
preventive care visit.
AHRQ
Emergency Room
Utilization
Emergency room visits per 1,000 member months
OHCA (claims data)
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – PREVENTIVE CARE
Breast Cancer Screening
70.0%
59%
60.0%
50.0%
40.0%
36.5%
38.5%
39.0%
2015 (CY 2014)
2016 (CY 2015)
30.0%
20.0%
10.0%
0.0%
2014 (CY 2013)
PCMH Redesign Stakeholder Meeting
Nat'l Benchmark
22
PCMH REDESIGN – PREVENTIVE CARE
Cervical Cancer Screening
70.0%
60%
60.0%
50.0%
47.5%
41.2%
37.7%
40.0%
30.0%
20.0%
10.0%
0.0%
2014 (CY 2013)
2015 (CY 2014)
PCMH Redesign Stakeholder Meeting
2016 (CY 2015)
Nat'l Benchmark
23
PCMH REDESIGN – QUALITY EXAMPLES
Emergency Room Visits*
* SoonerCare Choice visits per 1,000 member months. There were an estimated 98,567 potentially preventable ER visits
in SFY 2015, with associated expenditures of $14.9 million (Source: “Oklahoma Emergency Department Utilization – July
2012 through June 2015”, Mercer Government Human Services Consulting, August 24, 2016.
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – PREVENTIVE CARE
cont’d
Measure
Brief Description
Primary Steward
Children's and
Adolescents' Access to
Primary Care Practitioners
Percentage of members 12 months to 19 years of age who had a visit with a
primary care practitioner (PCP). The organization reports four separate
percentages for each product line: Children 12 to 24 months and 25 months
to 6 years who had a visit with a PCP during the measurement year, and
children 7 to 11 years and adolescents 12 to 19 years who had a visit with a
PCP during the measurement year or the year prior to the measurement year.
National Committee for
Quality Assurance
Lead Screening
Assesses children 2 years of age who had one or more blood tests for lead
poisoning by their second birthday.
National Committee for
Quality Assurance
Chlamydia Screening for
Women
Percentage of women 16-24 years of age who were identified as sexually
active and who had at least one test for chlamydia during the measurement
period
National Committee for
Quality Assurance
Chlamydia Screening and
Follow Up
The percentage of female adolescents 16 years of age who had a chlamydia
screening test with proper follow-up during the measurement period
National Committee for
Quality Assurance
Non-Recommended
Cervical Cancer Screening
in Adolescent Females
The percentage of adolescent females 16-20 years of age who were screened
unnecessarily for cervical cancer
National Committee for
Quality Assurance
Audiology Evaluation
Newborns with audiology evaluation no later than 3 months of age
Centers for Disease
Control & Prevention
Appropriate Treatment for
Children with Upper
Respiratory Infection (URI)
Percentage of children 3 months-18 years of age who were diagnosed with
upper respiratory infection (URI) and were not dispensed an antibiotic
prescription on or three days after the episode
National Committee for
Quality Assurance
Appropriate Testing for
Children with Pharyngitis
Percentage of children 3-18 years of age who were diagnosed with pharyngitis,
ordered an antibiotic and received a group A streptococcus (strep) test for
the episode
National Committee for
Quality Assurance
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – PREVENTIVE CARE
cont’d
Measure
Brief Description
Primary Steward
Well-Child Visits in the First
15 Months of Life
Percentage of members who turned 15 months old during the measurement
year and who had the following number of well-child visits with a PCP during
their first 15 months of life: 0-6 Visits
National Committee for
Quality Assurance
Well-Child Visits in the
3rd, 4th, 5th, 6th Years of
Life
Percentage of members 3–6 years of age who received one or more well-child
visits with a PCP during the measurement year.
National Committee for
Quality Assurance
Developmental Screening
in the First Three Years of
Life
Percentage of children screened for the risk of developmental, behavioral and
social delays using a standardized screening tool in the 12 months preceding
their 1st, 2nd and 3rd birthdays.
Oregon Health and Science
University
Childhood Immunization
Status
Percentage of children 2 years of age who had four diphtheria, tetanus and
acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella
(MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken
pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two
or three rotavirus (RV); and two flu vaccines by their second birthday.
National Committee for
Quality Assurance
Adolescent Well-Care
Visits
Percentage of enrolled members 12–21 years of age who had at least one
comprehensive well-care visit with a PCP or an OB/GYN practitioner during
the measurement year.
National Committee for
Quality Assurance
Immunizations for
Adolescents
The percentage of adolescents 13 years of age who had the recommended
immunizations by their 13th birthday. (Adding HPV in 2017; retired separate
HPV measure)
National Committee for
Quality Assurance
Preventive Care and
Screening: Influenza
Immunization
Percentage of patients aged 6 months and older seen for a visit between
October 1 and March 31 who received an influenza immunization OR who
reported previous receipt of an influenza immunization.
Physician Consortium for
Performance Improvement
PCMH Redesign Stakeholder Meeting
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PCMH REDESIGN – CHRONIC CARE
Measure
Brief Description
Diabetes: Comprehensive
Care
HbA1c testing (most recent date and result from 2015) − HbA1c < 8.0 % =
National Committee for
control − HbA1c > 9.0 % = poor control 2. Retinal eye exam (most recent date Quality Assurance
and result from 2014 or 2015) 3. Medical attention for nephropathy (one of the
following during 2015): − Nephropathy screening or monitoring test −
ACE/ARB therapy − Evidence of nephropathy (ESRD, CKD, kidney transplant)
4. Blood pressure (most recent date and result from 2015) − BP of < 140/90 =
control
Diabetes: Medical
Attention for Nephropathy
Percentage of patients 18-75 years of age with diabetes who had a
nephropathy screening test or evidence of nephropathy during the
measurement period.
National Committee for
Quality Assurance
Diabetes: Hemoglobin A1c
(HbA1c) Poor Control
(>9%)
Percentage of patients 18-75 years of age with diabetes who had hemoglobin
A1c > 9.0% during the measurement period
National Committee for
Quality Assurance
Diabetes: Foot Exam
Percentage of patients 18-75 years of age with diabetes (type 1 and type 2)
who received a foot exam (visual inspection and sensory exam with mono
filament and a pulse exam) during the measurement year
National Committee for
Quality Assurance
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or
dilated eye exam by an eye care professional during the measurement period
or a negative retinal exam (no evidence of retinopathy) in the 12 months prior
to the measurement period
National Committee for
Quality Assurance
Diabetes Care for People
with Serious Mental Illness
Hemoglobin (HbA1c) Poor
Control (>9.0%)
Percentage of patients 18-75 years of age with a serious mental illness and
diabetes (type 1 or type 2) whose most recent HbA1c level during the
measurement year is >9.0%.
National Committee for
Quality Assurance (New to
CMCS in 2017)
PCMH Redesign Stakeholder Meeting
Primary Steward
27
PCMH REDESIGN – CHRONIC CARE
cont’d
Measure
Brief Description
Primary Steward
Controlling High Blood
Pressure
Percentage of patients 18-85 years of age who had a diagnosis of hypertension and
whose blood pressure was adequately controlled (<140/90mmHg) during the
measurement period
National Committee for
Quality Assurance
Preventive Care and
Screening: Screening for
High Blood Pressure and
Follow-Up Documented
Percentage of patients aged 18 years and older seen during the reporting period who
were screened for high blood pressure AND a recommended follow-up plan is
documented based on the current blood pressure (BP) reading as indicated
Centers for Medicare &
Medicaid Services
Hypertension:
Improvement in Blood
Pressure
Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose
blood pressure improved during the measurement period.
Centers for Medicare &
Medicaid Services
Optimal Asthma Control
Composite measure of the percentage of pediatric and adult patients whose asthma is
well-controlled as demonstrated by one of three age appropriate patient reported
outcome tools and not at risk for exacerbation
Minnesota Community
Measurement
Medication Management
for People with Asthma
The percentage of patients 5-64 years of age during the measurement year who were
identified as having persistent asthma and were dispensed appropriate medications
that they remained on for at least 75% of their treatment period.
National Committee for
Quality Assurance
Asthma Medication Ratio
Percentage of members ages 5 to 64 who were identified as having persistent asthma
in 2015 and 2016 and had a ≥ 50% ratio of controller medications to total asthma
medications during the 2016 measurement year.
National Committee for
Quality Assurance
Annual Monitoring for
Patients on Persistent
Medications
Percentage of patients 18 years of age and older who received at least 180 treatment
days of ambulatory medication therapy for a select therapeutic agent during the
measurement year and at least one therapeutic monitoring event for the therapeutic
agent in the measurement year. (1) ACE inhibitors or ARBs, (2) Digoxin, (3)
Diuretics, (4) Total rate.
National Committee for
Quality Assurance
PCMH Redesign Stakeholder Meeting
28
PCMH REDESIGN – QUALITY EXAMPLES
CDC – HbA1c*
100.0%
90.0%
86.3%
86.3%
80.0%
71.9%
72.1%
72.2%
71.1%
86.3%
74.3%
70.7%
76.2%
76.3%
70.8%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
HbA1c
18 - 64
2014 (CY 2013)
2015 (CY 2014)
2016 (CY 2015)
65 - 75
Nat'l Benchmark
* The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following:
Hemoglobin A1c (HbA1c) testing, Eye exam (retinal) performed, LDL-C screening, and Medical attention for nephropathy.
PCMH Redesign Stakeholder Meeting
29
PCMH REDESIGN – QUALITY EXAMPLES
CDC – Eye Exam*
60.0%
54.4%
50.0%
40.0%
30.0%
26.3%
27.3%
27.6%
2014 (CY 2013)
2015 (CY 2014)
2016 (CY 2015)
20.0%
10.0%
0.0%
Nat'l Benchmark
* The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following:
Hemoglobin A1c (HbA1c) testing, Eye exam (retinal) performed, LDL-C screening, and Medical attention for nephropathy.
PCMH Redesign Stakeholder Meeting
30
PCMH REDESIGN – QUALITY EXAMPLES
CDC – Nephropathy*
90.0%
80.9%
80.0%
70.0%
60.0%
53.4%
52.4%
52.5%
2014 (CY 2013)
2015 (CY 2014)
2016 (CY 2015)
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Nat'l Benchmark
* The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following:
Hemoglobin A1c (HbA1c) testing, Eye exam (retinal) performed, LDL-C screening, and Medical attention for nephropathy.
PCMH Redesign Stakeholder Meeting
31
PCMH REDESIGN – OHIP FOCUS
Measure
Brief Description
Primary Steward
Child Overweight or
Obesity Status Based on
Parental Report of BodyMass-Index (BMI)
Age and gender specific calculation of BMI based on parent reported
height and weight of child (ages 10-17). The measure uses CDC BMI-forage guidelines in attributing overweight status (85th percentile up to
94th percentile) and obesity status (95th percentile and above).
The Child and Adolescent
Health Measurement
Initiative
Tobacco Use and Help
with Quitting Among
Adolescents
The percentage of adolescents 12 to 20 years of age with a primary care National Committee for
visit during the measurement year for whom tobacco use status was
Quality Assurance
documented and received help with quitting if identified as a tobacco
user
Preventive Care and
Screening: Screening for
Clinical Depression and
Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression
on the date of the encounter using an age appropriate standardized
depression screening tool AND if positive, a follow-up plan is
documented on the date of the positive screen.
PCMH Redesign Stakeholder Meeting
Centers for Medicare &
Medicaid Services
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PCMH REDESIGN – REWARDING QUALITY


Quality Measure Selection

As noted, the OHCA is seeking stakeholder recommendations on the final
measure set

Measures selected at the outset may later be retired, as improvement
occurs, and replaced with new measures focused on areas of greatest
concern
Payment of Incentives

Absolute performance, year-over-year improvement or both

Oklahoma benchmarks based on historical rates, national benchmarks or a
mix
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PCMH REDESIGN – NEXT STEPS
Activity/Milestone
Date(s)
Continue gathering stakeholder recommendations
(meetings and written)
January – February 2017
Finalize recommended recognition criteria and case
management payment rates
March 2017
Finalize quality measures, baseline values and thresholds
March 2017
for incentive payments
Prepare updated provider agreements and educational
materials
April 2017
Conduct provider outreach and education
May 2017 (ongoing)
Updated provider agreements take effect
January 1, 2018
PCMH Redesign Stakeholder Meeting
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WRITTEN COMMENTS & QUESTIONS

Written comments and questions are welcome

Comments/recommendations should be sent
before the end of February

Email to…
PCMH Redesign Stakeholder Meeting
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