A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS

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1 A COMPARISON OF MEDI-CAL MANAGED CARE P4P MEASURE SETS The matrix below provides a comparison of all measures included in Medi-Cal P4P programs and the measures includes in DHCS s External Accountability Set and Auto- program. It is arranged in alphabetical order by the name of the managed care plan and includes all measures included in the plans primary care P4P programs. The measures are broken down by domain including access, clinical quality, encounter submission, patient experience, utilization and all other measures. Set & Net Joaquin Mateo ACCESS Children and Adolescents Access to PCPs X Cycle time Extended hours X X X X 4 Improvement in access as measured by CG-CAHPS Member reassignments Patient auto assignment PCP office visits per member per year Practice open to new members Third next available appointment Depression screen Annual monitoring for patients on persistent medications: ACE or ARB, Digoxin, Diuretics, Anticonvulsants Controlling high blood pressure Comprehensive chronic pain management Diabetes blood pressure control X X

2 Set & Net Joaquin Mateo Diabetes eye exam X X X X X X X X X X X 1 Diabetes HbA1c control Diabetes HbA1c testing X X X X X X X X X 8 X X X X X X X X X X X Diabetes LDL control Diabetes LDL testing X X X X X X 6 Diabetes nephropathy X X X X X X X X X X 9 Postpartum care X X X X X X X 6 Same day pregnancy testing and referrals Timeliness of prenatal care Overuse of imaging studies for low back pain Adolescent comprehensive well-care visits years Adolescent immunizations Adult preventive medicine evaluation X X X X X X X X 6 X X BMI percentile-adult BMI percentilepediatric Breast cancer screening Cervical cancer screening Childhood immunizations X X X X X X X X X X X 0 X X X X X X X X X X 8 Chlamydia screening Colorectal cancer screen

3 Set & Net Joaquin Mateo Counseling for nutrition 3-17 years Counseling for physical activity 3-17 years y weight for life form Smoking status & intervention Well child visit with PCP 3-6 years Well infant care 0-15 months X X X X X X X X X X X Women s Exam (Pap, pelvic, breast) Appropriate testing for children with pharyngitis Appropriate treatment for children with URI Asthma health assessment/action plan Avoidance of antibiotic treatment for adults with acute bronchitis X Use of appropriate medications for people with asthma PATIENT EXPERIENCE Appointment with specialist Implement survey (such as CAHPS) Implement training Meet PCMH criteria

4 Set & Net Joaquin Mateo PATIENT EXPERIENCE Rating of all healthcare Rating of PCP Staff satisfaction improvement strategies Team based care Timely patient visits Overall rating of health network Overall satisfaction with UM process RESOURCE USE All-cause readmissions following acute inpatient stays Ambulatory care sensitive admissions Avoidable emergency department visits Emergency department visits per 1,000 member years Generic prescription and formulary compliance rates Inpatient bed days per 1,000 member years Physician and outpatient expenses not covered by capitation Potentially preventable admissions X X X X X X 4 ENCOUNTER AREA Timeliness, completeness, acceptance rate of data submitted

5 Set & Net Joaquin Mateo ENCOUNTER AREA Data accuracy between encounter and medical record data Encounter data submission OTHER Call abandonment Provider continuity Show rate/no show rate Initial health assessment Meaningful use of health IT Medicare DualChoice Annual Visit Outreach to patients recently discharged from hospital PCMH recognition Peer led self management support groups POLST/advanced care planning form Utilization of CAIR TOTAL NUMBER OF MEASURES

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