Thirty-four individual measures of quality performance are used to determine if an ACO qualifies for shared savings. These 34 measures span four quality domains: Patient Experience of Care, Care Coordination/Patient Safety, Preventive Health, and At-Risk Population.
CHADIS can assist with these Medicare requirements:
ACOs - Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan
ACO-18 (PREV-12) Depression Screening: CHADIS provides access to many depression screens: PRIME MD PHQ (adult depression), Mood Disorder Questionnaire (MDQ).
ACO – 40 Depression Remission at Twelve Months: PRIME MD PHQ (adult depression), Mood Disorder Questionnaire
Medicaid:
There is considerable variety in state Medicaid ACO measurement approaches, related to each state’s access, quality, clinical, and cost goals.
Common measurement areas include (1) chronic condition (e.g., asthma, diabetes) processes and outcomes; (2) emergency department use; (3) inpatient admission and readmission; (4) well‐child visits; (5) patient experience; and (6) behavioral health.
Medicaid ACO Pediatric Quality Measures and Innovative Payment Models (2015)
Alabama: Metrics related to children include: 1) medication management for people with asthma; 2) timeliness of prenatal care; 3) timeliness of postpartum care; 4) percentage of live births weighing less than 2,500 grams; 5) follow‐up after hospitalization; 6) well‐child visits; 7) adolescent well‐care visits; 8) ambulatory care‐sensitive condition admission; 9) transition record transmitted to health care professional; and 10) diabetes care.
Arkansas: The Arkansas Medicaid program reports on 13 of the 24 core Medicaid/Children’s Health Insurance Program (CHIP) Children’s Health Care Quality Measures.
Colorado: The Colorado Medical Homes for Children program offers primary care practices pay-for-performance payment for well-baby and well-child visits for children enrolled in Medicaid. The state is working to move the Medical Homes for Children Program into the ACC/RCCO Program. Metrics: RCCOs track 4 metrics, 1 of which is well-child visits.
Massachusetts: Metrics: A recent report indicates that there are 18 quality measures for both the adult and pediatric populations. In terms of pediatric quality measures, a preliminary list focused on National Quality Forum (NQF) metrics, including 1) asthma medication management; 2) body mass index (BMI) assessment and counseling; 3) adolescent immunization; 4) developmental screening in the first five years; 5) well-child visits for <15 months, 3-6 years, and adolescents; 6) childhood immunizations; and 7) ADHD medication management for children.
North Carolina:
Ohio: Quality measures are derived from the Agency for Healthcare Research and Quality’s (AHRQ) Pediatric Quality Indicators. Four additional measures PFK targets include neonatal intensive care days, emergency department (ED) visits for asthma, diabetes care management, and 3- to 6-year-old well-child visits.
Oregon: Pediatric-specific incentive metrics for the CCOs include: 1) adolescent well-care visits; 2) developmental screening in the first 36 months of life; 3) follow-up care for children prescribed ADHD medication; and 4) mental and physical health assessment within 60 days for children in the custody of the Department of Human Services. Pediatric-specific performance metrics include 1) appropriate testing for children with pharyngitis; 2) child and adolescent access to primary care practitioners; 3) childhood immunization status; 4) immunization for adolescents; and 5) well-child visits in the first 15 months of life.
Vermont: Pediatric-specific quality metrics included in the program are: 1) adolescent well-care visits; 2) developmental screening in first 3 years of life; 3) depression screening by 18 years of age; 4) appropriate testing for children with pharyngitis; 5) childhood immunization status; and 6) pediatric weight assessment and counseling.