2010-156 Health - AccessCare effective

Browse Search

Section 6 -Evaluation ORHCC will submit the following reports quarterly (items 1, 2, 3 below) and annually (item 4 below) to the Office of the Secretary. 1. Potentially Preventable Readmissions within 30 days as a Percent of Total Hospital Admissions, aniong enrolled non-duals, any diagnosis • Same-day transfers, long terns care admissions, rehabilitation, state mental hospital, hospice admissions, and observation stays are not considered hospital admissions • Admissions are excluded from both the numerator and denominator if either the initial or readmission DRGs indicates: malignancy, trauma, obstetrical. burn, or newborn. All other admissions are included. Target: • 5% reduction from network's baseline rate (SFY 08) by end of year 1 (SFY 10) • ] 0% reduction from baseline rate by end of year 2 (SFY 11) • I S% reduction from baseline rate by end of year 3 (SFY 12) 2. ED rate, enrolled ABD (dual +nondual) Target: • 5% reduction from network's baseline rate (SFY 08) by end of year 1 (SFY 10) • 10% reduction from baseline rate by end of year 2 (SFY 11) • 15% reduction from baseline rate by end of year 3 (SFY 12) 3. Generic Medications as Percent of All Fills, all Medicaid non-duals Target: • 2.5 percentage point increase from network's base]ine rate (SFY O8) by end of year ] (SFY 10), or 80%. whichever is lower • 5 percentage point increase from baseline rate by end of year 2 (SFY 11), or 80%. whichever is lower • 7.5 percentage point increase from baseline rate by end of year 3 (SFY 12). or 80%, whichever is lower 4. Quality of Care Measures, enrolled dual + non-dual • per QMAF methodology (chart review measures only). pertaining to: asthma, diabetes. hypertension. heart failure, ischemic vascular disease Target: • Improvement over network baseline (CY 2009) demonstrated in 50% of chart review measures in CY 2010 and 75% of chart review measures in CY 20] 1 17