Our team at OPEN MINDS is always challenging executive teams of specialty provider organizations to ‘prove their value.’ It’s key for getting preferred contracts with health plans, for succeeding with value-based reimbursement, and for remaining relevant.
There are certainly hundreds of performance measures (Quality Measurement In Addiction Treatment: Advancing Adoption Of Best Practices, How Do You Measure Access?, and What Gets Measured Is What Gets Done: Keys To Selecting Measures For Performance Management). Whether clinical executives think these are good measures, they are the measures that, right now, payers, health plans, and rating agencies are using.
But for executive teams that have put performance measurement programs in place, one of the challenges is benchmarking. Whatever their performance on particular measures, how does it compare with their competition? Will health plan managers think that level of performance is good?
One place to start with benchmarking is the Medicaid Core Measure Sets for adults and children. The Medicaid Core Measure Sets are quality measures that states voluntarily report to the Centers for Medicare & Medicaid Services (CMS) in categories such as primary care access and preventive care; maternal and perinatal care; care of acute and chronic conditions; behavioral health care; and experience of care. While reporting on the measures is currently voluntary, reporting will be mandatory in 2024.
Our team has pulled together the behavioral health performance measures, by state, in the Medicaid Adult Core Measure Sets in our new report, State Performance On Adult Medicaid Core Measures: An OPEN MINDS Reference Guide. Provider organizations can use these measures to compare how they are doing relative to other provider organizations in their state.
So how do executive teams use this data? Let’s take seven-day follow-up after hospitalization for mental illness. Provider organizations in Massachusetts are doing the best job in the country – 75.9% of Medicaid discharges have a follow-up visit after discharge within seven days. If you’re a provider organization in Massachusetts how does your performance compare with the state as a whole?
What was interesting to our team is the variance between states. No one state reported the highest performance on all measures. New Hampshire had the highest performing system on adherence to antipsychotics for individuals with schizophrenia and follow-up after an emergency department (ED) visit within 30 days. Arizona was the highest performing system on four of the sub-measures related to initiation and engagement of alcohol and other drug abuse or dependence treatment. Arkansas was the lowest performing system on measures related to antidepressant medication management and antipsychotic adherence. West Virginia had the lowest rate on follow-up after an ED visit for mental illness, and follow-up after hospitalization for mental illness within seven days.
To see how your organization compares with your state and across the country, check out our latest report: State Performance On Adult Medicaid Core Measures: An OPEN MINDS Reference Guide. It includes charts on national medians, and quartiles for each measure. It also provides a state-by-state chart with performance on each measure for states with available data.
And for even more, join us at The 2020 OPEN MINDS Performance Management Institute in Clearwater, Florida on February 13 for “The Payer Perspective: An OPEN MINDS Forum On The Performance Management Metrics Health Plans Are Looking For From Providers” featuring Cathy Lipton, M.D., CMD, Regional Medical Director – East and Northeast Complex Care Management, Optum.