RAE KPI Performance S FY 18-19 Matthew Lanphier Department of - - PowerPoint PPT Presentation

RAE KPI Performance

S FY 18-19

Matthew Lanphier Department of Health Care Policy and Financing

Improving health care access and

• utcomes for the people we serve

while demonstrating sound stewardship of financial resources

Our Mission

KPI Payment Summary

ACC Incentive Payment FY 18-19 Quarter 1 RAE ED HN pt. 2 HN pt. 1 BH Engagement Dental Prenatal Engagement Well Visits Incentive PMPM Amount Payment Amount RAE 1

• 0.26%
• 4.24%

36.60% 6.88% 0.39%

• 1.16%

0.31% $0 $321,275.01 RAE 2

• 1.23%

0.47% 5.77% 9.72% 0.84% 2.54%

• 1.84%

$1.712 $382,941.15 RAE 3 0.67%

• 3.73%

14.38% 13.03% 0.80% 1.09%

• 0.74%

$0.856 $819,865.32 RAE 4

• 1.58%
• 0.65%

0.88% 4.31% 1.21% 8.30% 1.11% $3.710 $895,769.30 RAE 5 0.82%

• 8.34%

7.87% 10.88% 2.40% 4.92%

• 3.12%

$1.712 $543,821.13 RAE 6 0.48%

• 6.14%

21.21% 10.03%

• 0.54%

2.49%

• 0.68%

$0.856 $445,291.27 RAE 7 1.09%

• 7.27%

19.23% 11.10%

• 1.62%

11.73%

• 2.54%

$1.142 $602,868.66 Tier 1 Tier 2 Grand Total $4,011,831.84

Baseline SFY 2018 July August September October November December RAE 1 597.43 591.31 593.20 595.86 594.21 590.40 595.29 RAE 2 620.43 612.92 611.34 612.82 613.12 610.58 610.89 RAE 3 661.55 665.75 666.78 665.95 663.80 662.43 662.38 RAE 4 571.57 564.49 565.83 562.55 557.60 550.65 552.52 RAE 5 647.52 655.12 655.35 652.85 649.67 642.44 647.82 RAE 6 585.72 588.10 590.35 588.52 584.51 583.63 577.10 RAE 7 700.34 702.76 707.01 707.96 708.50 700.45 701.31 Statewide 632.01 630.78 632.26 631.77 629.68 625.56 626.69 500.00 550.00 600.00 650.00 700.00 750.00 Actual ED Visits PKPY/ Average ED RAE Risk Weight

Emergency Department Visits PKPY (Risk Adjusted)

RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

• 0.26
• 1.24

0.66

• 1.60

0.82 0.48 1.08

• 0.04

0.49 0.03

• 0.29
• 1.23
• 0.84
• 0.61

0.81

• 0.17
• 2.00
• 1.50
• 1.00
• 0.50

0.00 0.50 1.00 1.50 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide Percent Difference

Risk Adjusted ED Visits % Difference from Baseline SFY 2019 Q1, 2

Q1: September 2018 Q2: December 2018

36.60% 5.77% 14.38% 0.88% 7.87% 21.21% 19.23% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% RAE1 RAE2 RAE3 RAE4 RAE5 RAE6 RAE7

Health Neighborhood pt. 1 - SFY 2019 Q1 - Rate

Baseline SFY 2018 July August September October November RAE 1 2.10 2.09 2.05 2.01 1.96 1.95 RAE 2 2.55 2.52 2.50 2.56 2.84 2.85 RAE 3 1.72 1.73 1.71 1.65 1.67 1.69 RAE 4 3.52 3.48 3.48 3.50 3.49 3.45 RAE 5 2.29 2.21 2.13 2.10 2.14 2.16 RAE 6 1.94 1.85 1.83 1.82 1.76 1.73 RAE 7 1.86 1.82 1.78 1.72 1.67 1.60 Statewide 2.18 2.16 2.12 2.09 2.09 2.08 1.00 1.50 2.00 2.50 3.00 3.50 4.00

Health Neighborhood pt. 2

RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

Percentage of Outpatient Specialist Visits with a PCMP visit within 60 days prior to the Specialist Visit AND a referral from the PCMP to the specialist

• 0.09

0.01

• 0.06
• 0.02
• 0.19
• 0.12
• 0.14
• 0.09
• 0.22

0.35

• 0.08
• 0.11
• 0.12
• 0.18
• 0.28
• 0.12
• 0.40
• 0.30
• 0.20
• 0.10

0.00 0.10 0.20 0.30 0.40 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide Percent Difference From Baseline

Health Neighborhood pt. 2 % Difference from Baseline SFY 2019 Q1, 2

Q1: September 2018 Q2: December 2018

6.88% 9.72% 13.03% 4.31% 10.88% 10.03% 11.10% 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% RAE1 RAE2 RAE3 RAE4 RAE5 RAE6 RAE7

BH Engagement -SFY 2019 Q1 - Improvement over Baseline

Baseline SFY 2018 July August September October November December RAE 1 33.38 32.76 32.99 33.52 34.27 34.79 35.09 RAE 2 32.47 32.40 32.49 32.74 33.73 34.38 34.55 RAE 3 37.61 37.84 37.85 37.91 38.50 39.76 40.41 RAE 4 32.26 31.93 32.08 32.65 33.20 32.98 32.30 RAE 5 33.62 34.93 34.64 34.42 34.72 35.60 36.10 RAE 6 34.56 34.84 34.52 34.38 35.07 35.65 35.18 RAE 7 32.94 33.15 32.89 32.41 32.59 32.46 32.66 Statewide 34.34 34.45 34.42 34.50 35.05 35.56 35.72 30.00 32.00 34.00 36.00 38.00 40.00 42.00 % of Members with at Least One Dental Visit

Dental Visits

RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

0.13 0.27 0.30 0.39 0.81

• 0.19
• 0.53

0.16 1.71 2.08 2.80 0.04 2.48 0.62

• 0.28

1.38

• 1.00
• 0.50

0.00 0.50 1.00 1.50 2.00 2.50 3.00 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide Percent Difference

Dental Visits Percent Difference from Baseline SFY 2019 Q1, 2

Q1: September 2018 Q2: December 2018

Baseline SFY 2018 July August September October November December RAE 1 60.19 60.38 59.07 59.50 58.89 59.01 58.07 RAE 2 42.96 44.56 44.43 44.05 43.98 44.09 44.32 RAE 3 57.58 58.00 57.65 58.21 58.65 59.06 58.99 RAE 4 41.82 42.96 43.35 45.30 45.51 45.53 46.14 RAE 5 38.15 38.33 38.19 40.03 43.30 46.47 49.45 RAE 6 55.64 56.10 57.17 57.02 57.27 58.38 59.32 RAE 7 54.26 57.33 59.62 60.63 61.99 62.82 64.88 Statewide 51.28 52.19 52.51 53.39 54.05 55.01 55.79 30.00 35.00 40.00 45.00 50.00 55.00 60.00 65.00 70.00 % of Deliveries with At least One Prenatal Visit

Prenatal Engagement

RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

• 0.70

1.09 0.63 3.47 1.88 1.39 6.37 2.10

• 2.12

1.36 1.41 4.32 11.30 3.69 10.62 4.51

• 4.00
• 2.00

0.00 2.00 4.00 6.00 8.00 10.00 12.00 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide Percent Difference

Prenatal Engagement % Difference from Baseline SFY 2019 Q1, 2

Q1: September 2018 Q2: December 2018

Baseline SFY 2018 July August September October November December RAE 1 31.33 30.75 30.99 31.43 32.04 32.32 32.59 RAE 2 25.38 25.60 25.41 24.91 24.81 24.99 25.04 RAE 3 34.36 34.48 34.31 34.11 34.28 33.77 35.71 RAE 4 23.08 23.31 23.40 23.34 23.95 23.81 23.38 RAE 5 29.83 31.07 29.74 28.90 28.58 28.81 29.05 RAE 6 29.22 29.33 28.98 29.03 29.75 28.83 29.89 RAE 7 27.20 27.69 27.28 26.50 26.48 26.19 26.42 Statewide 29.50 29.67 29.50 29.22 29.45 29.14 29.80 20.00 22.00 24.00 26.00 28.00 30.00 32.00 34.00 36.00 38.00 % of Members with At least One Well Visit

Well Visits

RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide

0.10

• 0.47
• 0.25

0.26

• 0.93
• 0.20
• 0.69
• 0.28

1.26

• 0.34

1.35 0.30

• 0.78

0.67

• 0.78

0.30

• 1.50
• 1.00
• 0.50

0.00 0.50 1.00 1.50 RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Statewide Percent Difference

Well Visits % Difference from Baseline SFY 2019 Q1, 2

Q1: September 2018 Q2: December 2018

Thank You

Matthew Lanphier Program Operations Analyst Department of Health Care Policy & Financing Matthew.Lanphier@ state.co.us